This isn't a common column topic. But I think it's a noteworthy one.
Over the last several years, as the opioid crisis swamped America, there has been a parade of athletes coming forward with painful and personal stories. Hall of Fame quarterback Brett Favre admitted last month he was in rehab twice for post-surgical addiction to Vicodin.
Retired basketball star (and ESPN announcer) Jay Williams said a reliance on Vicodin, OxyContin and Percocet led to addiction after surgery. Former Detroit receiver Calvin Johnson said Vicodin was handed out, "like candy" after some games. Tiger Woods had two forms of painkillers in his system, including the generic brand of Vicodin, when passed out in his car last August. On and on.
Enter George Caldwell with some hope. If you're a Dolphins fan, you may have seen Caldwell, even if you didn't notice him. He was the team doctor for 17 years until 2013. He has a Fort Lauderdale practice specializing in adolescent sports surgery for shoulders and knees.
Everyday events led Caldwell to search for how to minimize opioid use by patients: He once told a patient she didn't need any more Vicodin, though she got some elsewhere and was hospitalized after overdosing; in talks with peers he became aware pills not used by patients were often taken by their friends; a report showed someone with a one-day supply of opioids had a 6 percent chance of taking them a year later and a 12-day supply resulted in a 24 percent chance.
Plus, even as opioids were all in the news, Caldwell noticed a lack of research on proper amounts to help patients after surgery.
"How many pills should a teenager with an ACL surgery have?" he said. "We have almost nothing in the literature in sports medicine."
Finally, occasional calls from patients in pain after surgery made him study ways to improve his craft. He started his own research. Some of it was detailed medical research, like finding specific nerves responsible for pain in shoulders and knees to anesthetize during surgery rather than the more common larger nerves. That meant less pain and a smoother recovery.
He also made sure patients were more educated. He met with them the day after surgery, as he normally does, to calm concerns, answer questions and discuss opioid use and pain management.
"I was noticing I rarely re-filled the prescriptions," he said. "I was rarely having major problems. But when I went into the literature I was finding things like rotator cuff patients were taking about 116 pills, start to finish, surgery to sometimes six months out. I was only prescribing 20 or 30 even before I started this project."
But he didn't know how many of those 20 or 30 were actually taken. So he began tracking his patients' opioid use in various sports surgeries over the nine months. He found of 234 patients undergoing knee and shoulder arthroscopic surgeries, 35 percent needed no opioids.
In more painful surgeries like the aforementioned rotator-cuff, 26 percent of patients took no opioids and 87 percent took 10 or fewer. In ACL knee surgery, the average amount his patients needed were four tablets. Instead, they used more over-the-counter pills like ibuprofen for pain.
He'll present his findings this month to the Florida Orthopedic Society under the technical heading: "Minimum Opioid Usage and Pain After Surgeon Administered Local-Regional Block for Outpatient Arthroscopic Knee and Shoulder Surgery."
The less-medical thought is: Good news on the frontlines of opioids. A recent story in The Pediatric Journal said, "The magnitude of the problem of prescription opioid use and abuse by children and teenagers is overwhelming."
The adult sports confirms as much. Retired Heat player Rex Chapman admitted this year to taking 40 Vicodin a day in retirement. Favre said he took up to 15 Vicodin at a time. A Washington University study showed 52 percent of retired NFL players use painkillers.
Caldwell's findings aren't a solution to the larger crisis. But they're a good step. And steps are what's needed right now.
About the Author
