Prescription Drug Abuse

We have heard it in the news, seen it in recent surveys, and some have even experienced the negative consequences of prescription drug abuse. Prescription drug abuse is the fastest growing drug problem among teens and young adults.  In 2009 an estimated 16 million people (or 6.4 % of the population 12 years and above) reported non-medical use of pain relievers, tranquillizers, stimulants and sedatives.  About 7 million were “current prescription drug users”.  The most commonly abused prescription drug of choice is pain relievers.  Many teens report the easy access to their parent’s medical cabinet or friends to be the source of their addiction.   The 2006 NCAA Study of Substance Use of College Student-Athletes found that 4.5% of student-athletes reported using Adderall without a prescription in the previous 12 months. With the recent deaths of young promising football players possibly being attributed to pain killers and athletes such as Erik Ainge admitting to abuse, it is important to discuss the problem of prescription drug abuse and ways we can all help eliminate this issue.

A common misconception that accompanies the abuse of prescription drugs is that they are safe unlike illicit street drugs because they are prescribed by a medical professional such as a family doctor. This however, is untrue. While prescription drugs have uses in medicine, they are not harmless. Substances like Adderall and Oxycodone are highly addictive.  Prescription drugs are designed to be used under the supervision of a physician, who knows drug interactions, your medical history, and the proper dosage for you. Taking drugs without a prescription is not only dangerous, but deadly. 

Who is at risk?

Anyone whom is prescribed a drug is at risk of addiction or other adverse reactions, however the risk is elevated anytime you ingest more than what is prescribed, with alcohol or take a drug that is not specifically prescribed for you.  Listed below are some additional examples of individuals or groups at risk:

·         Addictions to other drugs including alcohol

·         Teens or young adults

·         Exposure to an environment where there is drug use and peer pressure

·         Pressure to perform or succeed

·         Easy access to drugs

·         For student-athletes, the need for prescription pain medications may lead to the abuse of these drugs. Keep your eye on athletes you know have a prescription for signs they may be abusing the pills.

Most commonly abused drug categories

·         Opioids – Usually prescribed to treat pain (Codeine, Opium, Morphine, Oxycodone, Hydrocodone)

·         Centeral Nervous system depressants -  prescribed to treat anxiety and sleep disorders (Abmien, Lunesta, Xanax, Valium, Ativan)

·         Stimulants – prescribed to treat ADD/ADHD, and narcolepsy (Amphetamines (Adderall), Lisdexamfetamine - (dextroamphetamine with lysine) (Vyvanse) Methylphenidate (Ritalin, Concerta, Methylin), Methamphetamine (Desoxyn)

Warning signs of prescription drug abuse

                Dramatic changes in behavior
                Poor hygiene habits
                lack of energy
                Inability to concentrate
                Nausea
                Loss of coordination
                Hostility or aggression
                Increased anxiety

How do we reverse the trend? How can we, as coaches, athletic trainers, teacher, friends, and family help?

Education is key. Many drug and alcohol education programs don’t address the dangers of prescription drug abuse. Student-athletes, students, friends, coaches, parents, everyone needs to be educated. Adults, especially parents, should lock up prescription medications. Anyone with extra prescriptions should watch for a drug take back day and dispose of their medications. At the very least, monitor your prescriptions and know how many you should have and when your next refill should be needed. Educate teens and young adults on the dangers of sharing prescription medication, taking more than the recommended dosages.

Awareness is important.  Everyone should be aware of the warning signs/symptoms of prescription drug abuse. Please become more educated and turn to professionals such pharmacist, doctors, and other experts for more information.

Resources

http://www.whitehousedrugpolicy.gov/drugfact/prescr_drg_abuse.html

http://www.helpguide.org/mental/drug_substance_abuse_addiction_signs_effects_treatment.htm

http://www.nida.nih.gov/PDF/RRPrescription.pdf

http://timetoact.drugfree.org/

http://www.prescriptiondrugabuse.us/signs.html

http://www.theantidrug.com/drug-information/otc-prescription-drug-abuse/prescription-drug-rx-abuse/default.aspx

http://www.incb.org/incb/en/annual-report-2010.html

http://www.keepfriendshipalive.com/

I don’t have time to eat healthy!

Sound familiar?  I’m not a big fan of excuses so I thought I would provide some help or direction to make time for food.  While attempting to come up with a witty way to talk about time management and fitting nutrition into the schedule, I came across a great website from Dartmouth University’s Academic Skills Center, http://www.dartmouth.edu/~acskills/success/time.html. They have time management handouts, calendars, links to other time management websites and even videos.

Part of a student-athlete’s job is to fuel their body for optimal performance, so please remember to make eating for performance a high priority.  Your foods and their nutrients play a vital role in preparing you for competition, your immune health, and your recovery from workouts.  

Here are a few tips to remember:

Breakfast:  Start your day off right by breaking your fast.  Student-athletes who eat breakfast perform better in the classroom than those that skip breakfast.  Don’t be confined by tradition, if you want to eat leftovers or cheese and crackers for breakfast, then do it!  A banana dipped in peanut butter is another great option.

Lunch:  Plan, plan, plan!  It can be pretty cheap to take your lunch to class with you, sandwiches, yogurts, fruits, etc., but if  you forget or oversleep and are forced to eat fast food, do so with a plan!  Go for the lower fat options such as grilled chicken sandwiches (minus the mayo) or bean burritos.

Dinner:  End your day on a great note, by refueling your body and rewarding yourself for accomplishing all your day’s goals (or most of them anyway).  Enjoy your food and take some you time to relax because your mental health is just as important as your physical!

In between:  Internationally known sports nutritionist Nancy Clark, MS RD CSSD says, Research suggests that eating 15 minutes before you exercise is as effective for boosting your energy as eating an hour before. However, if you will be doing a sprint workout, you might want to eat an hour or two pre-exercise to allow food time to exit the stomach. One of the best ways to enhance recovery is to fuel before exercise with a carb/protein snack (recovery can actually start pre-exercise, so the "tools" to recover are already in your system) and then to refuel afterwards, again with some carbs & protein. The carbs provide fuel for working muscles and body processes and the protein heals and builds. (http://www.nancyclarkrd.com/about/index.html)

Tools to eat, work and play with:

·         Make a list of to-do’s (prioritize tasks)

·         Concentrate on one thing (avoid multi-tasking, texting, Facebook, and homework)

·         Avoid procrastination

·         Set personal deadlines

·         Avoid burnout and always save some time for relaxation, even if it is only 5-15 minutes, and remember to reward yourself for your accomplishments.

·         Foods to Promote Immune Function by SCAN registered dietitians

·         Performance Hydration by SCAN registered dietitians

·         Vegetarian eating for athletes by SCAN registered dietitians

·         Eating for recovery by SCAN registered dietitians

Need help with sports nutrition?  Start here:  http://www.scandpg.org/

NCAA Special -- Correcting the Record on NCAA Banned Drugs and Nutritional Supplements

The REC has recieved a number of emails in regards to the NCAA banned drug classes, dietary/nutritional supplements, and what is considered banned and how to effectively find this information.  The response is here:

As members of the institution’s sports medicine staff, athletic trainers and other health-care providers are called upon often to educate and advise student-athletes and athletics staff about NCAA policies related to banned drugs and nutritional/dietary supplements.  As members of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports, and having sat on dozens of drug test appeals, we felt it important provide a clear and accurate accounting of these issues to assure our colleagues are best prepared to provide reliable advice to student-athletes to protect their health and eligibility. 

The following three areas are of critical importance to protecting health and eligibility of student-athletes.

1.       NCAA Banned Drugs:  The NCAA lists banned drugs by class, and any substance that is chemically related to the class is banned (unless specifically exempted.)  When the NCAA originally developed the banned drug classes, many examples were listed under each class, though the list was never an exhaustive list of all banned drugs.  From the beginning, any stimulant and anabolic steroid was banned, even if it was not named as an example under the banned drug class.  THERE HAS NEVER  BEEN A COMPLETE LIST OF BANNED DRUGS. This concept is critically important to compliance with NCAA banned drug regulations.   In recent years, it has become clear that the list of examples, instead of providing some clarification,  have actually created a false sense of security to student-athletes and staff alike, who believe that if the ingredients on a product are not found on “the list” in the same manner the product manufacture names them, they are not banned.   And as we explain below, with the many new supplements and designer drugs appearing on the market annually, creating a complete list is impossible.

2.       Nutritional Dietary Supplements:  Since 1994, with the enactment of the Dietary Supplement Health and Education Act, DSHEA, the number of supplement products, and particularly products targeted to body building and athletic performance, has exploded.  The stated intent of DSHEA was to provide health products that consumer could easily access;  but the reality of  DSHEA is that many stimulants, anabolic steroids, diuretics and other non-essential nutrients are included in supplement products promoted to the public and our student-athletes as a quick route to enhanced performance –sexual, athletic and even cognitive.  DSHEA allows supplement products to go on the market without first proving effectiveness, safety and purity, creating a real drug problem for our student-athletes and for consumers in general.  Manufacturers add designer drugs and proprietary ingredients, and many of these products are spiked or contaminated with banned ingredients that are not listed on the labels.  And some supplement products change formulas without changing the name of the product.  This lack of premarket review and the ever-changing product formulas create real risks to eligibility, health and safety.  Student-athletes need to be aware of these real risks and understand that these products are NOT necessary for their health and performance and most are a waste of money.  Student-athletes should be advised that the most effective and safest way to enhance their performance is to avoid these questionable products and rely on a combination of a healthy diet, appropriate conditioning, rest and recovery, and avoiding substance abuse.

3.       Advising Student-Athletes who want to use supplements:  Even with the above stated concern, many of our student-athletes insist on using dietary supplements.  In most cases, members of the sports medicine staff are assigned the responsibility to educate student-athletes about banned drugs and to advise about and review supplement products that student-athletes intend to use.  The burden of this awesome responsibility can be dramatically reduced by establishing an athletics department policy that student-athletes bring all supplement products to the appropriate athletics staff before using, and then checking all supplements through the Resource Exchange Center, REC, staffed by the National Center for Drug Free Sport, the NCAA third party drug testing administrator.  The REC is the only authoritative resource for questions related to whether listed ingredients on nutritional supplement product labels or in medications contain NCAA banned substances.  Because of the changing nature of the dietary supplement industry and the manner in which manufacturers use proprietary names and rename products to suit their purposes, there is no way to create a reliable database of reviewed products.   Institutional staff should submit each time a student-athlete brings forth a dietary supplement product, as last year’s review may no longer apply to the this year’s newly formulated product by the same name.  To access the REC, call toll free or go to www.drugfreesport.com/rec.  Right on the home page you can select “Ask about Dietary Supplements” or go to the “Prescription/Over-the-Counter Drug Search”.  It’s as easy as 1,  2, or 3!

As sports medicine staff, we must fully understand these concepts, develop an appreciation for the real risks of supplement use, and create a comprehensive policy and educational program that provides clear advice to our student-athletes that promotes safe and healthy approaches to achieve their performance goals.

Debra Runkle

Medical Coordinator and Head Athletic Trainer

University of Dubuque

Doug Padron

Associate Director of Athletics and Head Athletic Trainer

Monmouth University

The all night cocktail – Adderall/Caffeine/Energy Drinks

There is no way around it, if you are in college you are probably going to do some  studying  to avoid failing a class, or to pass those dreaded finals to graduate.  Of course, the best method is a consistent nightly routine dedicated to specific classes and projects.  That would allow you to avoid cramming and make adequate time for rest (especially needed by collegiate athletes). From my personal experiences however, I know that “some” people may procrastinate and wait to study until the last minute before an exam.

What we know

College students cram for academic finals and student-athletes cram for academic and sport finals, but student-athletes have a great deal to lose when cramming.  Students and student-athletes alike are turning to caffeine (pill form), energy drinks (beverages that contain modest to relatively high levels and concentrations of caffeine; range: 50-505 mg caffeine/serving; 2.5-35.7 mg caffeine/oz) and Adderall to stay awake.  A scary trend is the combination of all three (more is not better…) to get the “best” effect.  It is estimated that 34% of students have used Adderall not prescribed to them to aid their studying.  A University of Kentucky study revealed that an estimated 75 % of students know someone who takes Adderall without a prescription.  All three include or are central nervous system stimulants and carry individual adverse reactions that increase in severity when combined.

Adderall (amphetamine and dextroamphetamine)

·         Can be habit-forming

·         If you are taking other drugs (prescribed or not) or supplements you should consult your doctor before taking Adderall.

·         Overusing Adderal may cause sudden death or serious heart problems such as heart attack or stroke.

·         Bottom line if you don’t have a prescription, don’t take the drug.

Energy drinks and caffeine

·         Caffeine has been clearly associated with adverse health effects in susceptible individuals.

·         Energy drinks frequently contain high and unregulated amounts of caffeine

·         Energy drinks have no therapeutic benefit and many ingredients are understudied and not regulated

Adverse reactions

Increased heart rate, increased blood pressure, insomnia and nervousness, headaches and tremors, and GI distress.

Easy Study Tools

Plan ahead and try to avoid cramming for your finals!!!  If that doesn’t work keep these tips handy for increased productivity.

·         Location - Avoid your couch, bed, dimly lit rooms, bean bags, etc...You want a good firm chair, strong lighting and a desk for all those books. 

·         Hydration - You are an athlete and this should be a staple in your daily routine.

·         Fuel – Just like you feed the body for on field/court workouts your mental workouts require that you fuel your body for success.  Avoid the junk food and try an apple or cereal to give you energy.

·         Breaks - Short 10-15 minutes, watch TV, text or talk on the phone, music, get creative.

·         Exercise - The last thing an athlete wants to hear I know…so try dancing, or take a short walk and after hop in the shower for some additional alertness!

If you can’t keep your eyes open no matter what you do, then it is time to go to bed.  Remember, your body recovers while you sleep and without sleep your muscles will not fully recover for your next workout or competition.

References

·         Mayo Clinic (accessed 5/5/2011) Energy Drinks Can Have a Variety of Adverse Effects on the Body http://www.mayoclinic.org/medical-edge-newspaper-2009/may-29b.html

·         Arria, A PhD; O’Brien, M, The “High” risk of Energy Drinks The Journal of the American Medical Association (JAMA). 2011; 305(6): 600-601(accessed online 5/5/2011)

·         Juliano, L, Griffiths, R, A critical review of caffeine withdrawal: empirical validation of symptoms and signs incidence, severity, and associated features. (2004) Psychopharmacology; 176: 1-29

·         Pubmed Health (accessed 5/5/2011) Dextroamphetamin and Amphetamine http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000166/