Addiction to prescription narcotics often starts innocently for an athlete.
Following surgery for a damaged knee or shoulder, the doctor prescribes about 10 days worth of painkillers.
"Very few (injuries) require more than a couple of weeks worth of meds," says University of Utah team doctor Amy Powell. "Acute injuries calm down quickly."
But for whatever reason, after the bottle and perhaps a refill are gone, the pain persists. Pressure mounts from coaches, teammates and within to stay in the lineup. The athlete starts hitting up teammates and friends for extra pills to get through practice. As the season ends, the player might go doctor shopping or shop online. Soon, a dozen pills aren't enough and the habit gets expensive. Cheaper and more accessible illicit opiates, typically heroin, become attractive.
"It's almost a natural progression," said Sandra Knowles, a Provo psychiatric nurse practitioner who specializes in addiction. "I have seen that multiple times in athletes."
And that's what happened to former Brigham Young University linebacker Bryant Atkinson, who became addicted to painkillers after three knee surgeries. He was arrested this year for possessing and intending to sell heroin. Atkinson entered a plea in abeyance last month to the felony charges. He's trying to get his life back on track.
A question that arises is how much culpability rests with the university and how much rests with the individual.
Are coaches, doctors and trainers in any way to blame for a player who develops a prescription drug habit? Or does it fall strictly on the athlete?
"The bottom line is no one wants to take responsibility," said Marcus Amos, a former collegiate academic mentor who now makes presentations on preventing opiate addiction.
A school's responsibility
Brigham Young University considered itself at least partially responsible in 1987 when three players became addicted to Percodan in the wake of a scandal that resulted in the state of Utah reprimanding a former team doctor for improperly dispensing painkillers.
Paul Richards, BYU's public spokesman back then, almost excused the athletes, suggesting they might not have been aware of the drugs' addictive nature nor been knowledgeable about proper dosages.
Several players from that era who abused painkillers declined to be interviewed. One said he did not want to tarnish the BYU football program by bringing up the past.
BYU assistant coach Dick Felt wondered at the time, "Where does our responsibility begin and end, and where does the player's responsibility begin and end?"
Ten years later, linebacker Brad Martin, who became addicted to Lortab after suffering spinal injuries in a car accident on the way to practice, hired a lawyer to sort it out. BYU paid at least $34,000 for rehab through 2002. Martin continued to struggle and sued the university two years later.
His lawsuit contended that BYU "continually allowed me to play football despite my injuries" and "provided me with an abundance of painkillers ... to allow me to play through the pain in my last football season."
Martin and BYU settled out of court. He died last year of causes related to drug abuse.
BYU athletic director Tom Holmoe said the school has a "pretty good set of screens" to detect problems like prescription drug abuse. They include an ecclesiastical endorsement for each player, a religiously based Honor Code, and NCAA and in-house drug testing. But they are not foolproof.
"Even though we have those screens in place, if prescription narcotics are involved there's always a possibility" of abuse, Holmoe said.
Recently, Atkinson became hooked on Lortab after his third knee surgery. A projected starter, he quit the team during fall camp in 2004.
His father, Scott Atkinson, said he puts half the blame on BYU and half on his son. The university did not offer to pay for Bryant Atkinson's treatment, nor did the Atkinsons seek it.
"I wish it would be different, but I know the reality. They don't want to touch this with a 10-foot pole. I think in their eyes there's nothing productive that can come from it," Scott Atkinson said.
"I guess my expectations are zero, so I guess my expectations will be met."
Tom Holmoe, who became athletic director in March 2005, wasn't on the job while Atkinson was at BYU. He said any discussion of drug rehab costs would be handled case by case. But "if someone very irresponsibly went out to find other narcotics, it's hard to say you're (the university) responsible for that."
Ultimately, Amos said injured players need to communicate effectively with team trainers and doctors. Many athletes try to medicate themselves, but doctors need to keep tabs on prescriptions. A red flag should go up if it runs out too fast.
"At this point it's the doctors' responsibility to investigate the problem. But if the athlete can't get any more medication from the team doctors, he or she will resort to other alternatives. Either way, they will get them legally or illegally once they become addicted," Amos said.
Weber State University athletic director Jerry Graybeal said athletic programs assume some responsibility for players they recruit. Teams become surrogate families.
"We have to do our part, no doubt," he said, adding that includes education, knowing the injury, monitoring drug prescriptions and following up.
"I know it's something that coaches have to be educated on also," said Graybeal, formerly the Wildcats' head football coach. "It's something you can't take lightly."
Graybeal knows firsthand the power of prescription painkillers. Demorol hooked him 26 years ago after a bout with Guillain-Barre syndrome, a disease in which the body's immune system attacks part of the peripheral nervous system.
"I had to be weaned off it like heroin," he said.
Sports psychologist Keith Henschen said athletes are vulnerable to addiction.
"I think most athletes are addictive anyhow. Addicted to working out. Many of them have addictive personalities. They will keep doing things that most (people) will say, 'I won't do that. That's no fun for me."'
Athletes as a whole are driven, doing whatever it takes to compete on the field or court.
Injured players worry about losing their starting spots. They question their usefulness to the team. They perceive themselves as wimpy. They feel like they're being left behind, Henschen said.
And on the collegiate level, they literally are when the team travels to away games. Henschen, who has worked with the Utah Jazz for years, said that unlike pro teams, college teams usually don't take injured players on road trips.
"What message are they sending these kids?" he said. "You're not worth anything to us unless you're healthy."
Coaches, fans, boosters and teammates push athletes to perform when injured.
"There is pressure on some level from us," said Utah assistant gymnastics coach Megan Marsden. But they don't have the final say on whether a gymnast practices or competes.
"We as coaches at the college level are very removed from being able to decide much at all," she said.
The decision, Marsden said, falls to the doctor, trainer, the athlete's parents and the athlete.
Competitive athletes, however, may ignore medical advice; they may not be forthcoming about the injury, or medicate themselves.
"Some players figure it's OK to pop a pill here and there," said University of Utah senior safety Steve Tate. "I can definitely see why kids get caught up in it."
Tate has suffered several serious injuries in his collegiate career, including a painful dislocated shoulder. He described it as "on fire" during games last season and frequently popped it back into place between plays.
Doctors prescribed Lortab after off-season surgery to repair his damaged shoulder. He was given direction on how to use the pills but wasn't monitored closely.
"It all falls on the athlete," Tate said.
The Skyline High grad saw members of his family struggle with prescription drug abuse. He was determined that it would not happen to him. "I've learned to use it and not abuse it," he said.
Stories for years have circulated about schools having a doctor or trainer who freely dispenses painkillers the "candy man."
Two University of Arkansas athletic trainers were placed on probation in the 1990s for keeping poor records of federally controlled painkillers. The university could account for only 332 of 10,059 doses
in a 15-month period, according to the Drug Enforcement Administration.
Local team medical staffs, though, say drugs are tightly controlled.
"Our athletes have very little access to pain medications," Powell of the U. medical team said. Tate affirms that, saying players practically have to sign their lives away to get a Tylenol.
U. team doctor Liz Joy said prescription pain medication isn't indiscriminately dispensed. Athletes with non-surgical injuries don't get narcotics, she said. Dosages for those who go under the knife are carefully measured. She doesn't issue refills for OxyContin and Percocet but does allow them for Lortab and Tylenol with codeine.
The law prohibits athletic trainers from dispensing prescription drugs, though they can give players over-the-counter pain relievers. Only licensed doctors may prescribe narcotics.
"Of course, the stuff is locked up. You might have your part contained. I won't dispute that," Amos said of team medical staffs. But there are always other sources.
"With athletes, one of the biggest problems is people want to be around them. All they need to do is autograph a jersey, and they can go into the doctor's office and get what they want," he said.
Medical professionals aren't so easily bought, says longtime Utah State University trainer Dale Mildenberger.
Doctors and trainers, he said, aren't going to compromise personal and medical ethics to keep players on the field or the court.
"The athlete always wants to play. The coach always wants the athlete available. Do they want them at the expense of their health and welfare? No, they don't," he said.
"It's just awful easy to blame the doctor or trainer. Those are the things of movie scripts," Mildenberger said. "There's little basis to all the myths."
Not at the University of Washington.
Washington fired its women's softball coach in 2004 after an internal investigation found a volunteer team doctor freely dispensing painkillers and muscle relaxants to players.
University administrators determined coach Teresa Wilson should have known the doctor overused medications to treat players and that such conduct was dangerous and wrong.
One player reported receiving between 100 and 180 narcotic pills from 2000 to 2002. During three games she was high to the point that she was "giggly, loopy and was laughing on the dugout floor," according to the report."No matter what you do, there are people who will abuse those situations," Mildenberger said. "I don't think it's common for that choice to be aided and abetted in college athletics."