The high cost of painkiller abuse in professional hockey

[JR Ewing]

I came across this on youtube, recently produced by TSN, and aired on W5.

 

 

The players themselves talk about the culture surrounding pain in the NHL, and how it's dealt with.

 

[pilldoc]

16 hours ago, JR Ewing said:

I came across this on youtube, recently produced by TSN, and aired on W5.

 

 

The players themselves talk about the culture surrounding pain in the NHL, and how it's dealt with.

 

 

@JR Ewing

 

Wow is all I can say.  I have a mixed bag of feelings on this.  I appreciated the honest candor these former players shared with everyone.  It also pisses me off at the blatant misuse of some of these medications such at Ketorolac (Toradol).  As a Healthcare provider I am shocked at the callous nature some of these trainers and team doctors approach this medication with regards to the players on the team and their safety.

 

Don't get me wrong, Toradol is a wonderful post-op medication we use, when used appropriately and in short term use. (less than 5 days).  I am shocked at the number of doses some of these players have used. 

 

To me it seems like some of these team doctors ignore the Hippocratic Oath of doing no harm to the patient. It is often said that the exact phrase "First do no harm" (Latin: Primum non nocere) is a part of the original Hippocratic oath. Although the phrase does not appear in the AD 245 version of the oath, similar intentions are vowed by, "I will abstain from all intentional wrong-doing and harm". The phrase primum non nocere is believed to date from the 17th century. Another equivalent phrase is found in Epidemics, Book I, of the Hippocratic school: "Practice two things in your dealings with disease: either help or do not harm the patient". The exact phrase is believed to have originated with the 19th-century English surgeon Thomas Inman.  This upsets me greatly that a physician is willing to put a player in such harm's way.

 

Many of us look up to these athletes.  We ask for sticks, gloves, autographs, etc .... , however, many fail to realize that these are regular human beings who pay an awful price for a sport they love to play and we love to watch.  Many fans fail to understand the chronic pain many of these players face after they hang of their skates.  I truly feel sorry for the likes of Ryan Kessler. 

 

I am sick to my stomach that team doctors misuse these types of medications such as Toradol.  I too took an oath at my College of Pharmacy Graduation ...

 

"I promise to devote myself to a lifetime of service to others through the profession of pharmacy. In fulfilling this vow:

• I will consider the welfare of humanity and relief of suffering my primary concerns.
• I will apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for my patients.
• I will respect and protect all personal and health information entrusted to me.
• I will accept the lifelong obligation to improve my professional knowledge and competence.
• I will hold myself and my colleagues to the highest principles of our profession’s moral, ethical and legal conduct.
• I will embrace and advocate changes that improve patient care.
• I will utilize my knowledge, skills, experiences, and values to prepare the next generation of pharmacists.

I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.”

 

Finally I guess what irks me the most is that teams are willing to sacrifice a players long term health for the god awful dollar and win at all costs mentality.  Don't get me wrong, some of these players are just as equal in the blame game.  As Kessler state, "he will do anything to keep playing."  The lack of full disclosure of what long term effects are for chronic long term use of these medications is most disconcerting.

 

Thank You for sharing .... it really tugs at my heart especially since I understand what all these medications do since it is my job.

 

Edited December 19, 2020 by pilldoc

[fan4ever]

15 hours ago, JR Ewing said:

I came across this on youtube, recently produced by TSN, and aired on W5.

 

 

The players themselves talk about the culture surrounding pain in the NHL, and how it's dealt with.

 

 

Thanks for sharing.  This is so incredibly sad!

[yave1964]

Wow.

 

  Painkillers are so easy to abuse in all walks of life, not gonna lie i have had a run in or two with them over the years like most of us andthey scare the hell out of me. Of course, my situation is different than a pro athlete with a short shelf life to make as much money as they can before it comes to an end and truthfully i have a hard time blaming th athletes to me, the fault lies more with the prescribing physicians. Problem is, from Fleury, Probert and Boogard books i have been appalled that so many players find alternate ways of getting pills. Just a horrible situation.

[pilldoc]

3 minutes ago, yave1964 said:

the fault lies more with the prescribing physicians

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140023/

 

1) First, in all fairness, I will start with physicians. We over prescribe opioids, just as we over prescribe antibiotics.But it is generally well meaning; we don’t want our patients to experience pain. But then we prescribe 30 or 60 pills when 5 or 20 would have been adequate. ...It is the leftover pills that sit forgotten in the medicine cabinet which often lead to trouble, stolen by a relative or visitor and abused.

 

2) there are also what are known as “pill mill”doctors who set up shop, accept cash as the only payment  and are willing to prescribe to anyone for any ailment,real or feigned. One physician in my area was so bold as to meet his “patients” in a local coffee shop to exchange prescriptions for cash. Needless to say he is no longer licensed to practice medicine. Doctors such as these are criminals and need to be stopped.

 

3) After the minor role of physicians comes the real co-conspirators. First up is Purdue Pharmaceuticals, the manufacturer of Oxycontin. Oxycontin was approved by the Food and Drug Administration (FDA) in December,1995. Despite a lack of increased efficacy in treating pain compared to older medications, Purdue mounted an aggressive marketing campaign that included a warning from the FDA in 2003 over misleading advertisements.Physicians, including myself, believed Purdue and started using Oxycontin, thinking we were helping patients.

 

4) the American Pain Society, our third guilty party,introduced the “pain as the 5th vital sign” campaign. This declaration was not accompanied by the release of any device which could objectively measure pain, as was done with all previous vital signs, blood pressure, pulse, respirator rate and temperature, making it the first and only subjective vital sign.  Too date there is NO way adequately determine pain.  It is purely subjective.

 

5) The Joint Commission also bought into this, earning a place on the list. In 2001 they issued standards requiring the use of a pain scale and stressing the safety of opioids. According to an article in the Wall Street Journal, The Joint Commission went so far as to publish a guide sponsored by Purdue Pharma on pain management. This guide reportedly stated, “Some clinicians have inaccurate and exaggerated concerns about addiction, tolerance and risk of death. This attitude prevails despite the fact there is no evidence that addiction is a significant issue when persons are given opioids for pain control.”  Furthermore The Joint Commission also framed pain management as a patient’s rights issue, inferring that inadequate control of a subjective symptom would lead to sanctions.

 

6) Press Ganey, the next on the list, began in 1985 with the noble concept of surveying patients in an attempt to improve the patient experience. As is often said, without data you cannot improve, so collecting patient satisfaction data has value. But it is important to separate excellent patient satisfaction from excellent quality of care. Of course Press Ganey monetized their concept, selling not only patient satisfaction surveys but also consulting services to help hospitals improve their patient satisfaction.

 

7) Then comes the Centers for Medicare and Medicaid Services (CMS). CMS determined that pay for volume was leading the Medicare Trust Fund into bankruptcy and that they needed to shift to pay for performance. Because CMS was now attaching significant reimbursement to patient satisfaction, hospital administrators, the next on the list, were forced to develop initiatives to improve their scores and avoid a penalty.

 

In essence, healthcare providers have no one to blame but ourselves and in the end it is the patient who suffers.

 

 

[yave1964]

@pilldoc

 

The Derek Boogaard book is brilliantly written, the author with permission from family got copies of his medical records including his prescription history. From his rookie year he was receiving multiple prescriptions from multiple team doctors, often the same pills (usually Percocet) filed at different pharmacies. And his brother who had a bit of a pro career tells of Derek, when there was a bit of a crackdown from the league on those practices tells of Derek finding a source who would have massive packages sent to Boogaard at the Wild and then the Rangers facility Not through the team anymore but through a third party, in the mail, to the teams facility.

 

 I have tried to get my mind around all of this, and put myself in the players shoes. First if anyone thinks that it is/was just the fighters who get caught up in this with painkillers is wrong, i have no doubt that it is a high percentage of players taking opioids of all levels of skills. 

 

  And in the players shoes, if you are Probert, or the late Todd Ewen or the late Steve Montador or Theo Fleury or Mike Richards or one of many, many others with this problem, money and security for the family post career has to come into it. And of course a Ribiero, a Nate Schmidt with PEDs, a Tootoo always thinks it is helping them by dulling the pain or making them stronger or whatever excuse they use. And you live in fear because there are a finite amount of jobs at the highest, amazing pay level and every year you get more beat up, more bruises, a bit slower, doubt sets in, and you do what you have to do to block it out and maintain an edge. I am a voracious reader, i cannot tell you how many books i have read from player after player who ran into this trap.

 

 So you make a million and a half over your first two years in the league you are full of doubt in spite of your hubris, the team will load you up with pills for any and every reason and if the club is becoming suspicious their are pathetic creatures more than willing to take some of your hard earned money and at a premium will get you whatever you want no questions asked. They may get you another year, perhaps two at the end of a contract and of course, 'you can quit anytime you want' after your career is over.

 

 So most of the dumb Western Canadian farm boys, the ignorant and naïve Euros who are used to team doctors putting things in their arms, the Ontario kids suddenly in New York and every year you are being pushed from below by kids who are younger, stronger, faster and determined. You do what you have to do.

 

  I blame the players a lot less than the sycophant's and hangers on and people wanting a piece of their income who will glad hand and do their bidding. For a price. 

[pilldoc]

@yave1964

 

Excellent post ....the Boogaard book sounds really interesting.   Thanks for sharing your perspective.  I agree will it all.