Jun 14, 2017
A Slippery Slope
Julie Alexander

As athletic trainers, we are prepared to help our athletes with many different health issues. But one that we may not be prepared for is narcotic drug addiction following a major injury or surgery. I recently encountered this problem with “Alex,” a male athlete here at St. Cloud State University.

Alex had suffered a severe ankle injury that required a couple of weeks of rest and rehabilitation. During this time, he was prescribed a 10-day dose of Vicodin for pain relief and to help him sleep at night. I was aware that he was taking this painkiller, and he tolerated the medication well.

After returning to the playing field, Alex had a follow-up appointment with the doctor and asked for a refill of Vicodin, as his ankle was sore from resuming activity. He was given a second prescription for seven days to be used as needed.

Alex’s behavior continued to change. He became more withdrawn and secretive about what medications he was taking, and he started missing treatment and rehabilitation appointments.

It was around this time that I noted Alex seemed more withdrawn and irritable than normal, a conclusion the head coach agreed with. When talking with Alex, he denied being depressed but admitted that he was unhappy with his on-field performance and felt his ankle was holding him back.

Once Alex’s second prescription was finished, he asked the attending physician for more pain medication, but the physician denied him. Despite this refusal, Alex insisted on having something for the pain, which alarmed me. Instead of getting another Vicodin prescription, however, he was directed to take over-the-counter ibuprofen.

Alex’s behavior continued to change. He became more withdrawn and secretive about what medications he was taking, and he started missing treatment and rehabilitation appointments.

These red flags moved the head coach, assistant coach, and I to meet with Alex. We outlined a plan to voice our concerns for his welfare, allow him to talk about any issues, and detail the steps we wanted him to take to resolve the problem. Yet, the meeting didn’t go according to plan — Alex denied having any problems with drugs and was quite defensive.

Unsure of our next step, the coaches and I decided to talk to Alex’s teammates. They revealed that his alcohol consumption had increased after his injury — another red flag. This pushed us to have a second meeting with him where we again voiced our concerns about his behavior. Fortunately, he admitted that he was having some difficulty handling the injury and was willing to get help.

The coaches and I then outlined a series of expectations that would help get Alex back on track. The first step involved a referral to the campus drug-counseling center for an evaluation. This was a confidential assessment, and the only information we received from it was an acknowledgement that Alex had fulfilled his appointment. The second condition was he could no longer miss treatment and rehabilitation sessions.

Over the next two weeks, Alex’s attitude and behavior improved, and he did not skip any athletic training appointments. He continued to receive counseling and was referred to an attending physician to monitor his medication use, as he was still taking ibuprofen. Alex voluntarily communicated with me when he had appointments but did not talk about what they entailed.

Alex proceeded through the rest of the season without incident. In hindsight, I think the first meeting with him didn’t go as planned because athletes rarely like to admit they can’t handle a problem. Since we talked to his friends and they saw an issue with his behavior, as well, it may have led Alex to view our second meeting differently.

As a result of my experience with Alex, I now counsel all athletes who have been prescribed painkillers on the consequences of misusing them and the addictive properties they can have. Our team physicians also have a heightened awareness of the possible negative consequences of narcotic use and prescribe them sparingly. In the future, I will continue to be on the lookout for any red flags of addiction so that I can facilitate the appropriate referral to ensure the best care for my athletes.

This article first appeared in the March 2017 issue of Training & Conditioning.

Image by INeverCry

Julie Alexander, ATC, is Head Athletic Trainer at St. Cloud State University. She can be reached at: [email protected].

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