History of opioid use as a risk factor for current use and mental health consequences among retired National Football League athletes: A 9-year follow-up investigation

The association between exercise and prescription opioid misuse: A scoping review

Exercise prevents chronic diseases and modulates pain. People experiencing pain often use opioids for relief, increasing the risk of prescription opioid misuse. Nonetheless, exercise may influence prescription opioid misuse through the release of endorphins or induced injury-related pain. We aimed to summarize the existing literature on the association between exercise and prescription opioid misuse. We identified studies published through December 2021 in Cochrane, Embase, Medline, and Pubmed, using search terms like "opioid-related disorders," "opioid misuse," "exercise," and "sports." Observational and experimental studies with adult samples published in English were included. Exclusion criteria included participants < 18 years old, studies including heroin use as the outcome, and studies conducted among pregnant or institutionalized individuals. The risk of bias and quality assessment were conducted independently by two authors using the National Institutes of Health Study Quality Assessment Tools, and decisions were cross-checked with a third author. Our search yielded 10,796 records, of which eight studies were included. These studies were heterogeneous clinically and methodologically. Three were intervention trials, three were cross-sectional, and two were cohort studies. Three studies evaluated yoga, two evaluated exercise, and three evaluated sports. Significant findings showed lower prescription opioid misuse among people who exercise, except for one study that showed greater odds of prescription opioid misuse among college athletes. We conclude that the findings on the association between exercise and prescription opioid misuse vary, even within similar study types and samples. Future researchers should consider large samples, standardized questions, and common outcome measures in research on exercise and prescription opioid misuse. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Longitudinal Relationship Between Concussion History, Years of American Football Participation, and Alcohol Use Among Former National Football League Players: an NFL-LONG Study

OBJECTIVE

Investigate the relationships between concussion history and years of football participation (repetitive head impact proxy) with alcohol use across multiple decades in former professional football players.

METHODS

Participants (n = 348; mean age = 49.0 ± 9.4) completed health questionnaires in 2001 and 2019, which included self-reported concussion history and years of participation. Alcohol use frequency and amount per occasion were reported for three timepoints: during professional career, 2001, and 2019. Ordinal logistic regression models were fit to test associations of concussion history and years of participation with alcohol use at each timepoint.

RESULTS

There were no significant associations between either concussion history or years of football participation with alcohol use (frequency and amount per occasion) at any timepoint. Effect estimates for concussion history and years of football participation with alcohol use were generally comparable across timepoints.

CONCLUSIONS

Later life alcohol use by former American football players is not associated with concussion history or years of exposure to football.

Pain Acceptance Among Retired National Football League Athletes: Implications for Clinical Intervention

Over 80% of National Football League (NFL) retirees experience daily pain. Pain acceptance is an important psychological construct implicated in the intensity of chronic pain, though these findings have not been extended to NFL retirees. Therefore, the current study examined the association between pain acceptance and pain intensity among former NFL athletes. NFL retirees (N = 90) recruited from 2018 to 2019 completed questionnaires that assessed pain, substance use, and NFL career information. Multiple linear regression examined the association between current pain acceptance and pain intensity while adjusting for other risk factors of pain. NFL retirees reported average scores of 33.31 (SD = 10.00), and 2.18 (SD = 2.40) on measures of pain acceptance and pain intensity, respectively. After covariate adjustment, greater pain acceptance (β = -0.538, p < .001) was associated with lower pain intensity. These findings can further inform the behavioral and mental health care of retired NFL athletes.

Substance availability and use in ex-professional ice hockey enforcers

Some ex-professional ice hockey enforcers (players whose primary role was fighting) have experienced negative health outcomes following their careers including substance use. Some have suggested that negative post-career outcomes following a career in contact sport relate specifically to neurotrauma. The purpose of this study was to determine whether ex-professional ice hockey enforcers were negatively impacted by substance use during and/or following their careers. It was hypothesised that given their role in the sport, significant exposure to injury (including concussions) occurred, leading to challenges post-career including substance use. This study utilises a mixed methods quantitative and qualitative approach with one-on-one semi-structured interviews and questions related to substance use. This hypothesis for this study was not supported. Participants in this study reported low levels of substance use post-career. Patterns of substance use during career varied by era with a change in use from alcohol and over-the-counter stimulants to opioids, sleep aids, and anabolic androgenic steroids (AAS) estimated to occur near the mid to late 1990s. Four participants described patterns of excessive alcohol use during their careers. Stimulant use was prevalent in ice hockey pre-mid-1990s. The use of prescription opioids and sleep aids was reportedly rare before the mid to late 1990s, but eventually became easily attainable via team medical staff and prescription sharing. Two participants from the later era also reported use of AAS. This sample of ex-professional hockey enforcers experienced a significant number of concussions, continue to have challenges with chronic pain, and were exposed to several unique stressors during their careers, the effects of which may have varied based upon how the role was viewed. A combination of these factors may have resulted in substance use in some of these athletes during, but not following their careers.

Co-Use of Opioids and Sedatives Among Retired National Football League Athletes

OBJECTIVE

Among the general population, co-use of opioids and sedatives is associated with greater risk of overdose compared with opioid use alone. National Football League (NFL) retirees experience higher rates of opioid use than the general population, although little is known about their co-use with sedatives. The aim of this study was to examine the prevalence and risk factors of opioid and sedative co-use among NFL retirees.

DESIGN

Retrospective cohort study.

SETTING

Professional American football.

PARTICIPANTS

NFL retirees (N = 644).

INDEPENDENT VARIABLES

Self-reported concussions, pain intensity, heavy alcohol use, physical and mental health impairment, disability status.

MAIN OUTCOME MEASURE

Any past 30-day co-use of opioids and sedatives.

RESULTS

Approximately 4.9% of the sample reported past 30-day co-use of opioids and sedatives, although nearly 30% of retirees using opioids also used sedatives. Greater pain was associated with co-use of opioids and sedatives (adjusted odds ratios [aOR] = 1.58; 95% confidence interval [CI] = 1.23-1.98), although retirees with moderate/severe mental health impairment (vs none/mild; aOR = 2.47; 95% CI = 1.04-5.91) and disability (vs no disability; aOR = 1.35; 95% CI = 1.05-1.73) demonstrated greater odds of co-use compared with retirees not using either substance.

CONCLUSIONS

Given the high rate of sedative use among participants also using opioids, NFL retirees may be susceptible to the negative health consequences associated with co-use. Interventions focused on improving pain and mental health may be especially effective for reducing co-use of these substances among NFL retirees.

High School Football and Risk for Depression and Suicidality in Adulthood: Findings From a National Longitudinal Study

Background

There is growing public concern regarding the potential long-term effects of playing football on brain health, specifically that playing football before and during high school might cause damage to the brain that manifests years or decades later as depression or suicidality. This study examined if playing high school football was associated with increased lifetime risk for depression, suicidality over the past year, or depressed mood in the past week in men aged between their middle 30 s to early 40 s.

Methods

Publicly available data from the National Longitudinal Study of Adolescent to Adult Health were analyzed. This longitudinal, prospective cohort study sampled nationally representative U.S. youth starting in 1994–1995 (Wave I) and most recently in 2016–2018 (Wave V). A total of 3,147 boys participated in Wave I (median age = 15), of whom 1,805 were re-assessed during Wave V (median age = 38).

Results

Of the 1,762 men included in the study, 307 (17.4%) men reported being diagnosed with depression and 275 (15.6%) reported being diagnosed with an anxiety disorder or panic disorder at some point in their life. When comparing men who played high school football to those who did not, there were no differences in the proportions of the sample who had a lifetime diagnosis of depression, lifetime diagnosis of anxiety/panic disorders, suicidal ideation in the past year, psychological counseling in the past year, or current depressed mood. However, men who received psychological counseling and/or experienced suicidal ideation during adolescence were significantly more likely to report a lifetime history of depression, suicidal ideation in the past year, and current depressed mood.

Conclusion

Individuals who reported playing football during adolescence did not have an increased risk of depression or suicidal ideation when they were in their middle 30 s to early 40 s, but mental health problems during adolescence were associated with an increased risk for psychological health difficulties more than 20 years later.