Opiates and the Bodybuilding Dead Pool

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Q: Are opioid painkillers a problem in bodybuilding circles?

A: Opiates are a class of drugs that includes prescription painkillers like oxycodone, hydrocodone, codeine, morphine and fentanyl as well as the illegal drug heroin. A doctor’s prescription for an opiate after an injury can reduce pain. But prescription opiates can be highly addictive, trapping some patients in a web of dependency. The drugs tend to lose their effect over time, leading to escalating dosages or, in some cases, a transition to heroin.

In sports where muscle tears or bone injuries are common, it’s not surprising that opiate usage rates would be higher than in the general public. A study from the University of Washington found that among retired NFL players, 52% used opiates during their playing days and, of those, 71% admitted to misusing them.[1] Opiate use among professional wrestlers was linked to many tragic consequences, including deaths,[2] leading to wellness policy changes to protect the talent.

While reports of anabolic steroid abuse have dominated media headlines, there was a time when the use of the opiate nalbuphine (“Nubain”) in bodybuilding accounted for widespread abuse and dependency (I dedicated a 2003 Muscular Development magazine column to the problem). Director Chris Bell followed up his anabolic steroid feature film documentary “Bigger, Stronger, Faster” with a startling exposé on the opioid painkiller epidemic called “Prescription Thugs” in which he revealed his own addiction to opiates. Some bodybuilders regularly pop Vicodins or Percocets to numb training injuries and facilitate sleep. And some have paid for it dearly. One pro bodybuilder known as “Quadzilla” for his massive quadriceps was reported to have been heavily addicted to opiates before his heroin overdose death in 2005, and a top amateur reportedly died in 2008 from an accidental overdose of fentanyl (the same extremely powerful opiate involved in the death of singer-songwriter Prince).

The number of opiate prescriptions in the U.S. has skyrocketed in the past 25 years, from around 76 million in 1991 to nearly 207 million in 2013.[3] One in every 5 doctor visits in the U.S. results in an opiate prescription. Americans consume 80% of the global opiate supply despite being only 5% of the global population. This increased availability has been accompanied by alarming consequences. Nearly half a million Americans died from drug overdoses between 2000 and 2014 and more than six of ten deaths involved opiates. The rate of opiate overdose deaths (prescription opiates and heroin) nearly quadrupled since 1999.[4] Physicians were advised by some drug makers that patients had a less than 1% chance of becoming addicted – a claim that was, at best, highly misleading.[5] In 2007, Purdue Pharma and its top executives paid $634.5 million in fines for deceptive marketing that downplayed the addictive properties of OxyContin.

Is there a solution? Some advocates suggest that a prescription for medical marijuana, instead of an opiate prescription, may alleviate pain in some patients.[6] A University of Pennsylvania study found 25% fewer opioid-related deaths in states allowing medical marijuana.[7] The extent to which medical marijuana is a solution to America’s opiate abuse epidemic is open to debate, but it seems like a no-brainer for Congress to move marijuana from Schedule I to Schedule II to give more physicians the marijuana option before writing an opiate prescription.

However, medical marijuana isn’t available in most states. Follow the money and you’ll see why. One of the biggest opponents of medical marijuana is the pharmaceutical drug industry. Big Pharma has huge political clout. Between 1998 and 2012, drug companies spent $2.3 billion on lobbying and $183 million on campaign contributions, according to the Center for Responsive Politics.[8] That’s a whopping four times the defense and aerospace industry. And opiates are a $24 billion market – more opiates mean more profits for Big Pharma.[9] The industry’s critics point out that pharmaceutical companies pay anti-marijuana researchers to help keep their customers on opiate painkillers over cannabis.[10]

Chris Bell, who’s used both steroids and opiates and researched eye-opening documentaries about each, sums it up like this: “My first movie was about those ‘super-dangerous’ steroids that doctors tell you NOT to take but are much less dangerous than the media claims – responsible for at best a handful of deaths. My second film was about opiate painkillers that doctors tell you to take, but kill one American from overdose every 19 minutes.” It makes no sense … unless you follow the money.

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[1] Cottler L, Abdallah AB, Cummings SM, Barr J, Banks R, Forchheimer R. Injury, Pain, and Prescription Opioid Use Among Former National Football League (NFL) Players. Drug Alcohol Depend. 2011 Jul 1; 116(1-3): 188-194.

[2] http://whatculture.com/wwe/wwe-10-wrestlers-whose-lives-ruined-substance-abuse

[3] http://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse

[4] http://www.cdc.gov/drugoverdose/epidemic/

[5] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/

[6] http://norml.org/library/item/chronic-pain

[7] http://www.uphs.upenn.edu/news/News_Releases/2014/08/bachhuber/

[8] http://www.opensecrets.org/industries/indus.php?ind=H04

[9] http://www.cnbc.com/2016/04/27/americans-consume-almost-all-of-the-global-opioid-supply.html

[10] http://www.usnews.com/opinion/articles/2014/12/08/pot-legalization-opponents-aim-to-protect-their-bottom-line; http://news.vice.com/article/leading-anti-marijuana-academics-are-paid-by-painkiller-drug-companies