NFL Tackles Pain Without Widespread Opioid Use

The National Football League and NFL Players Association have implemented a prescription drug monitoring program (PDMP) to ensure that opioids are not overprescribed by league-affiliated doctors or misused by players. Despite the heightened risk for injury and pain faced by football players, PDMP data published in Current Sports Medicine Reports indicate that the prevalence of opioid prescriptions among NFL players is similar to that of the general U.S. population (Curr Sports Med Rep 2024 ;23[10]:348-351).

“Our medical staff and our players, working together, are doing a really good job in utilizing and appropriately resourcing nonopioid types of treatments that we think are really helpful for treating pain,” said study author Allen Sills, MD, FACS, the chief medical officer of the NFL in New York City.

Although the PDMP was established in 2019, standardized data from the program became available only for the 2021 and 2022 NFL seasons. From the start of training camp through one week after each team’s final game, all pain medications issued to NFL players by club physicians or external providers were recorded in the NFL’s electronic medical record (EMR).

In the 2021 season, out of 3,142 players, 14,903 prescriptions for pain medications were issued to 2,207 players (70.2%). In the 2022 season, across a population of 3,152 players, 14,880 prescriptions were issued to 2,189 (69.4%).

The majority of these prescriptions were for nonsteroidal anti-inflammatory drugs: 84.6% in 2021 and 85.5% in 2022. In 2021, 319 players (10.2%) received opioid prescriptions, a number that decreased to 300 (9.5%) in 2022. This report cites two studies suggesting that the opioid prescribing prevalence in the NFL for 2021-2022 is similar to or even lower than the 10% to 11% prevalence of opioid prescriptions to men aged 19 to 49 years in the early 2010s.

Furthermore, a 2020 CDC study, conducted between 2008 and 2018, found that 14.8% of men aged 25 to 34 (the age group most representative of the NFL population) received at least one opioid prescription annually (MMWR Morb Mortal Wkly Rep 2020;69:298-302).

The injuries treated, as well as the exact drugs and dosages prescribed for each injury, were collected in the EMR but not made publicly available in the report. However, Sills noted that “most of the opioid prescribing is associated with surgical procedures and major musculoskeletal trauma.”

All medical information collected in the PDMP is protected by a privacy firewall and not used to individually target potential cases of opioid misuse. Instead, the data are used on an aggregate basis to identify substantial variances in opioid use and prescribing, which informs targeted education to medical staff about appropriate opioid use.

Zachary Mannes, PhD, MPH, an assistant professor of epidemiology at Columbia University, in New York City, whose own research has focused on opioid use as a risk factor for poor mental health among retired NFL players, said the paper is an “important first step to estimate the prevalence of opioid prescribing and prescription opioid use among NFL players in 2021 and 2022.”

He explained that even with the inherent risk for injury and pain associated with football, the data indicate there is room to potentially make pain treatment in the NFL safer. Mannes pointed to the percentage of players prescribed muscle relaxants (626 prescriptions among 10.3% of players in 2021 and 523 among 10.6 of players in 2022) as an area of concern.

“The data from this study indicate that potentially approximately 20% of players were prescribed opioids or muscle relaxants, which remains relatively high considering these medications can have long-term mental health risks,” Mannes explained.

However, Mannes emphasized that reducing opioid and muscle relaxant use in the NFL must not come at the expense of properly monitoring pain medication use. “If we know players’ history and their individual risk of opioid misuse, we will be better able to mitigate the potential harms of these medications. Furthermore, players who could really benefit from prescription opioids to treat a serious acute pain episode will get the care they need.”

The PDMP is an ongoing project that will continue to collect data and publish reports detailing trends in the treatment of pain in the NFL. Sills noted that “we are continuing to use our platform, the NFL, to help educate and inform the broader sports medicine community that again, there are many alternatives to opioids. Opioids have their place in the medical armamentarium, but it’s a very defined and narrow place.”

—Myles Starr

Mannes and Sills reported no relevant financial disclosures.