The term narcotics is commonly used to refer loosely to a broad range of drugs, from marijuana to cocaine. More accurately, the narcotic drugs consist of opium and its derivatives, also known as opiate drugs. The most common opiate drugs include heroin, morphine, and codeine, and their use leads to a sense of numbness resulting from the suppression of the central and autonomic nervous systems. Because of these properties, narcotics are used as effective painkillers or analgesics. In fact, morphine and heroin were commonly used as over-the-counter pain relievers in the early
1900s, but their widespread use was regulated as soon as the addictive properties of narcotic analgesics were revealed. Today narcotic analgesics are used in the treatment of chronic pain, and their local application is thought to minimize the side effects, such as sedation, respiratory depression, and nausea, produced by other local anesthetics. Systematic and long-term use of narcotic analgesics, however, is not free of undesirable short and long-term side effects (e.g., cardiovascular disease, opioid-induced hyperalgesia, cognitive dysfunction, immunosuppression, drug addiction) that may offset the benefits of pain relief.
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Narcotic Analgesics in Sport
Although there is no scientific consensus about the ergogenic properties of narcotic analgesics, athletes still use these substances for performance enhancement purposes. Narcotic analgesics are principally used to alleviate pain resulting from musculoskeletal injury and to induce euphoric states. Through pain reduction before or during the competition, and by lowering the pain associated with injury or fatigue, narcotic analgesics may enable sports participation and provide a competitive advantage to overtrained or injured athletes. For instance, athletes may resort to narcotic analgesics in order to recover quickly and cope with the pain caused by injury or fatigue in tournaments requiring continuous participation and effort within a limited time frame, such as the Olympic Games and world championships. Furthermore, given their mood-altering properties, narcotic analgesics can be used to alleviate negative emotions, psychological stress, and performance anxiety; thus, they elicit an indirect performance enhancement effect by improving the athlete’s morale. Due to their mood-altering effects, narcotic analgesics may be more common in combat sports and sports requiring fine motor control.
Regulating Narcotic Analgesics
Because narcotic analgesics are highly addictive, harmful to health, and can be used to provide an unfair competitive advantage, their use has been officially regulated by several sporting organizations and authorities, including the International Olympic Committee (IOC), the World AntiDoping Agency (WADA), and national anti-doping organizations (NADOs). According to the WADA 2012 list of prohibited substances, the following narcotic analgesics are banned:
- Diamorphine (heroin)
- Fentanyl and its derivatives
- Methadone and morphine
- Oxycodone and oxymorphone
Under specific circumstances, WADA may allow the use of prohibited narcotic analgesics for therapeutic use in athletes, but this requires strict implementation of the Therapeutic Use Exemptions (TUEs) scheme and proper medical supervision.
Epidemiology of Narcotic Analgesics
The use of narcotic analgesics is not widespread compared to other pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and beta-agonists. The overall prevalence of narcotic analgesics for therapeutic uses in sports is less than 1%. This is probably due to the fact that their use may yield a positive doping test and because other drugs (NSAIDs, cyclooxygenase-1 [COX-1], cyclooxygenase-2 [COX-2] and related enzymes) can be equally or more effective and elicit analgesia without the reported side effects of narcotics. However, the use of narcotic agents outside competition is an issue of major importance. There is vast anecdotal evidence in daily press about athletes who become addicted to narcotics, and as a result, they cannot train or compete at high level and accordingly withdraw from sports.
Preventing Abuse of Narcotic Analgesics: The Role of Education
Preventing abuse of narcotic analgesics mainly rests with the physician’s knowledge and perspective on therapy and treatment of injury and pain. Thus, strategies to prevent the abuse of narcotic analgesics by athletes should target medical and paramedical professions involved in sports (e.g., sports medicine physicians, physiotherapists, athletes, and coaches). Furthermore, strategies should incorporate specialized training courses in medication and nonmedication strategies for pain management, as well as for raising awareness about the risk for drug addiction. The available evidence shows that such educational programs have increased sports physicians’ capacity to treat acute and chronic pain conditions by minimizing the addictive effects of narcotic analgesics, or even without using any medication at all. In addition, the implementation of prescription monitoring and surveillance systems for dispensing and administration of narcotic analgesics would further prevent the abuse and trafficking of narcotic analgesics in sports. Finally, athletes should be also educated on the harmful health and performance side effects of narcotic analgesics.
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