Prescription painkiller abuse is one of the dirty little secrets of college and professional sports.
It doesn't get the attention of muscle-building steroids, but tiny tablets like Lortab or Vicodin keep players in the game, especially those nursing chronic injuries. But pill popping can lead to dependency, crime, illicit drugs and death.
"It's a major problem," says Marcus Amos, who speaks at colleges and sports campuses about painkiller abuse through his Prevention Education for Athletes program. "But it's like this potential addiction wants to be hidden."
A string of local college athletes have become hooked on prescription pain medication dating back to the 1980s. Some moved to cheaper street drugs like heroin. They begged, borrowed and stole to feed their habits. They washed out of sports and school. They ruined relationships. They landed in jail. At least two died.
"There's no doubt it's a problem," said former Brigham Young University athletic director Val Hale. "It's something that people don't want to talk about, but it's certainly there."
Painkiller abuse is prevalent in pro sports. For some athletes, pain pills are as essential to getting through a season as working out.
Green Bay Packers quarterback Brett Favre, the NFL's all-time leading passer, is perhaps the best known sports figure to admit a problem. In 1996, he spent 45 days in rehab for addiction to Vicodin.
Administrators, team doctors, coaches and athletic trainers don't perceive prescription drug abuse as widespread in college athletics. But the issue hasn't received much study. University of Utah team doctor Liz Joy said she does not recall seeing prevalence figures for athletes' abuse of prescription narcotics.
"It is the dark side," said longtime U. sports psychologist Keith Henschen.
The NCAA does conduct a periodic survey of drug use among college athletes in a variety of sports, the last one in 2005. The extensive questionnaire asks about anabolic steroids, ephedrine, nutritional supplements, tobacco, alcohol, ecstacy, amphetamines, marijuana, hallucinogens and cocaine.
Everything but prescription narcotics.
"We don't have a targeted effort looking at that issue," said Mary Wilfert, NCAA associate director of education services. "We don't identify it as a category. We don't ban analgesic narcotics, so we haven't focused on that for student-athletes."
After being interviewed about pain pill use and abuse in collegiate sports, Wilfert said it would be good to consider adding questions about it to the drug survey.
'An absolute problem'
Prescription narcotics fall into the category of opioids, which include powerful drugs like morphine, codeine, fentanyl, methadone and heroin. Opioids attach to receptors in the central nervous system, preventing the brain from receiving pain messages. In addition to masking pain, they produce feelings of euphoria, invincibility and illusions of athletic prowess beyond athletic ability. Commonly prescribed pain pills include Lortab, Vicodin and OxyContin.
Pain medication abuse has skyrocketed in all aspects of society, across the nation and in Utah, the past few years, and fatal overdoses are alarmingly frequent. Athletes may be at higher risk for pain and therefore overdoses than other adults, according to Utah state epidemiologist Christy Porucznik.
As far back as 1991, a study found prescription painkillers the most commonly misused opioid among college athletes. Another study the same year showed 75 percent of college athletes used them for sports-related injuries.
"It's a problem. It's an absolute problem," said Sandra Knowles, a Provo psychiatric nurse practitioner who has treated athletes during her 10-year career.
Pain control is one of the biggest issues sports medicine doctors face when treating injured players. Still, overuse of pain pills draws little attention in college athletic programs.
Amos, who lives in Augusta, Ga., found it "mind-boggling" two years ago that no one was talking about the perils of painkillers. He combined master's degrees in sports management and drug rehab counseling to develop Prevention Education for Athletes. His specialty is opiate addiction.
He might be the only person in the college game talking about it now.
"I've seen a lot of deaths with this addiction. It's not a pretty sight. I can honestly say I've gotten numb to it," said Amos, a former academic mentor to the LSU men's basketball team.
Path to addiction
Locally, two BYU football players the past six years died of causes related to heavy, prolonged narcotics use after an injury.
Former offensive guard Craig Garrick died at age 41 after abdominal surgery six years ago last month. He underwent at least eight knee surgeries during and after his football career.
In May 2006, 30-year-old former linebacker Brad Martin was found dead in his Sugar House home. Martin's spiral began after injuring his neck in a car accident on the way to football practice.
Amos initially couldn't get anyone to listen to his presentation "Athletes and Painkillers: Opiate Addiction Prevention." Some college administrators told him they didn't want him talking to players about painkillers.
"It's not that they're resistant," Amos said. "It's like they do not know what is going on."
BYU athletic director Tom Holmoe said he would be surprised that any athletic program would not be aware of the potential for problems. While it would be irresponsible to ignore it, just because they're not bringing in speakers doesn't mean it's not being addressed, he said. BYU, he added, prefers to handle those presentations itself to save money and to manage the content.
Longtime Utah State University athletic trainer Dale Mildenberger doesn't see painkiller abuse as much of an issue.
"If your approach is athletes are different, you'd be incorrect. Prescription drug abuse is a societal problem," he said.
In 2003, approximately 15 million Americans reported using a prescription drug for non-medical reasons at least once during the year. Rates of abuse were highest in the 18-to-25 age group, according to the National Institute on Drug Abuse. Pain relievers were the most commonly misused drug.
In 33 years at USU, Mildenberger said, he recalls a half dozen players becoming addicted to pain pills. He concedes there are probably others he doesn't know about.
Former University of Utah defensive end Jason Kaufusi said it wasn't unusual for ailing teammates to seek pain medication beyond what was given.
"There was a constant trying to find more, take more than what was prescribed," he said.
Chronic shoulder injuries that required multiple surgeries cut Kaufusi's college career short. Many of his days were spent in a doctor's office, physical therapy or the training room.
Shots of Toradol before and during games kept him on the field. He tried to avoid painkillers between games, but sometimes his shoulders hurt too much.
"I didn't want to get addicted. At one point during my junior year, I was always constantly looking for something because you just want some relief, even a minute of relief," he said. "Once I noticed I was doing that I just kept telling myself to stay away from it."
Kaufusi didn't become addicted but said he can see how people who ache all the time could.
U. team physician Amy Powell said it's "pretty darn rare" for athletes to get hooked on pain pills.
Doctors say they closely monitor players' prescriptions. Very few injuries require more than about two weeks worth of narcotics. It's not impossible, she said, but it is difficult for a player to fall through the cracks.
"We are aware of who's on what meds," said University of Utah head athletic trainer Bill Bean.
But it's the drugs that athletes get from outside sources, such as roommates, friends or on the Internet, that fuel misuse.
"I'm sure that happens more than we realize," said Bean, a 31-year veteran at Utah.
U. sports medicine doctors studied pain medication use among collegiate club-level volleyball players in Salt Lake City for a tournament last year. Some of the results were eye-opening, said state epidemiologist Porucznik, who headed the study.
"The most surprising thing was among athletes who reported injuries that season. People taking prescription pain medications were less likely to have seen a doctor for that injury than people not taking prescription drugs," she said.
In fact, the study found 61 percent using prescription non-steroidal anti-inflammatory drugs without consulting a doctor.
That means those players were getting the pills somewhere other than from doctors, most likely from teammates or buying them on the street or online.
Not only are they risking further injury but the possibility of fatally overdosing.
"The big message is that athletes are self-medicating, and team physicians and athletic trainers need to keep in close contact with the athletes," Porucznik said.
Training staffs also should talk to athletes about the safe use of medications, the study concluded.
All college and university athletic programs hold annual drug education seminars. While athletes are warned about the evils of steroids and street drugs, prescription pain medication isn't discussed much.
"Pain pill addiction? No, they really don't touch it," Amos said. "That's part of making sure those guys perform. They don't see the potential risk for addiction."
The NCAA did add Amos to its health and safety speakers grant list, which provides money to schools for drug and alcohol education.
"I believe eventually this is gong to be part of everyone's program, but it takes knocking down a lot of doors," Amos said.
The U. holds a student-athlete conference at the beginning of each fall semester. Guest speakers the past two years addressed alcohol and drug abuse, but not painkillers specifically.