The First Down: How High School Athletes Get Hooked on Drugs

On Jan. 21, 2007, Tony Hoffman woke up looking down the barrel of a police officer’s gun.

Officers had been called to the Fresno, California, home by a real estate agent preparing a showing. They were planning on collecting an overdose victim.

“[The realtor] thought I was dead,” Hoffman said. “The police were told I had overdosed.”

Hoffman had broken into the house the night before, the latest stop on his nomadic journey since becoming homeless that winter.

“At the time, I was selling drugs to sustain my habit,” Hoffman said. “But I was using more drugs than I could sell. And then I started losing friends.”

Hoffman had begun supplementing his daily habit — 1,480 mg of oxycodone and a quarter-ounce of cocaine — with methamphetamines. As his friends started to drift away, so did his housing prospects, eventually landing him on the street.

Just a half-decade earlier, he was receiving corporate endorsements as the top-ranked amateur on the BMX circuit. Now, after waking up in a stranger's house to the sight of a cop's gun, Hoffman found himself sentenced to four and a half years in prison.

He was no stranger to being at odds with the law. Three years before, he had been given felony probation and ordered to undergo substance abuse treatment following an armed home invasion.

But almost immediately after leaving rehab, Hoffman said, he began drinking again. And with the drinking, his oxycodone and cocaine habits returned.

“I was just a young guy,” Hoffman said. “I didn’t understand addiction; my parents didn’t understand addiction; I didn’t get that these pills were the same as heroin.”

Now a motivational speaker, world-class BMX coach and head of a non-profit that instills healthy habits in teenagers and young adults through action sports, Hoffman shares his story as a cautionary tale to prevent his past from becoming someone else’s future.

He believes a new rule in Massachusetts allowing high school athletes to come forward and seek help for substance abuse could alter the course of their lives; Hoffman likes to think if given the opportunity to address his painkiller use as a teenager, he might have been able to prevent his own from spiraling out of control.

There was the marijuana, the drinking, the cocaine and the methamphetamines. There was the drug dealing; there were the arrests. There was Hoffman at 18, listening to his friend asking him if he wanted to try oxycodone, describing it as “Vicodin on steroids.”

But before that, there was Hoffman, a senior in high school and rising BMX star who had just had his wisdom teeth removed, being handed a bottle of Vicodin to help ease the pain.

Easing the Pain

Sports take an undeniable toll on an athlete’s body. Whether it is a minor sprain or fracture, or a major operation such as Tommy John or ACL reconstruction, athletes often find themselves on the sideline.

According to a study conducted by the University of Colorado-Denver that measured injuries in high school sports from 2005 to 2013, between 1.1 and 1.5 million athletes reported sports-related injuries yearly.

Dr. Robert Nascimento, chief of Sports Medicine at Newton-Wellesley Hospital, said that many procedures his department performs necessitate prescription medication during the initial stages of recovery.

“A lot of the procedures that we do are extremely painful — either large surgeries or reconstructions — that require pain medication at least to get through the acute phase,” Nascimento said.

But, Nascimento said, he warns his patients about the effects of chronic use of the medication he prescribes.

“We carefully tell them that this is something that’s needed for their well-being in the short term,” Nascimento said. “But certainly they’re very dangerous given the position [patients] are going to be in mentally. It’s going to be easy for them to want to take more of it to feel better.”

According to Nascimento, doctors have to walk a fine line when determining the best course of treatment. After the initial phases of recovery, he will often cease prescribing some of the more addictive drugs and prescribe higher-dose anti-inflammatories or a combination of non-addictive medication.

“It’s almost a catch-22. In the medical profession we’re highly judged on keeping our patients comfortable,” he said. “We want to keep them comfortable but not comfortable enough to where they go into a downward spiral.”

Nascimento added that alternative forms of recovery, such as massage therapy and physical therapy, are sometimes implemented to reduce an athlete’s dependency on pain medication.

But sometimes that’s not enough for an athlete itching to get back out on the field.

“It seems like everybody’s just a little bit afraid of injury before it happens; athletes, especially in collision sports, fear it a little,” Nascimento said. “But they don’t actually grasp it until it happens — it’s devastating to them.”

Taking Action

Prior to any chemical health violation, a student's request for and enrollment in a substance abuse treatment shall not in and of itself constitute a violation of the chemical health/alcohol/drugs/tobacco Rule 62.

Last July, the rule change was entered into the rule book of the Massachusetts Interscholastic Athletic Association, a nonprofit organization comprised of representatives from 378 high schools that regulates high school athletics in its member schools.

The rule encourages athletes who have not failed a drug test to come forward and seek help for substance abuse without being penalized for violating the organization’s drug policy.

"We wanted to change the rule for people who recognize that there's a problem," said Norfolk District Attorney Michael Morrissey, who spearheaded the change. "We don't want to discourage people from coming forward."

Morrissey first petitioned the MIAA to amend its regulations in 2014, and last December he helped provide Screening, Brief Intervention and Referral to Treatment training to 80 school nurses, athletic trainers and athletic directors from across Norfolk County.

Under the new rule, athletes who have not failed a drug test can self-report and seek treatment without repercussion.

"To me it's one of the most straightforward rules we've ever seen," MIAA Associate Executive Director Richard Pearson said. "If we can afford teens this chance to evaluate and make decisions to correct their direction in life, I think that's a darn good thing."

Now there is an outlet for athletes to seek help, but will they use it?

A Warrior’s Mentality

Randy Grimes was midway through his nine-year NFL career when he began taking handfuls of painkillers every day.

“The older guys taught me to do whatever I had to do to stay out on the field and not get the reputation as someone who was a whiner or always injured,” said Grimes, an offensive lineman for the Tampa Bay Buccaneers from 1983-1992. “If I wasn’t out there someone else would be.”

Grimes said he initially didn’t believe his painkiller use was a problem, a mindset validated by his teammates, doctors and trainers.

“I never really saw it as an addiction,” Grimes said. “I saw it as a necessary evil for my job.”

Grimes’ drug use spiked during his retirement, amplified by nagging injuries, the addictive qualities of painkillers and the loss of his identity as an athlete.

“I didn’t know what I was if I wasn’t a football player,” Grimes said. “But I just couldn’t stop taking them; it didn’t matter how many houses or jobs or relationships or money I lost.”

Now an intervention specialist at Behavioral Health of the Palm Beaches, the 55-year-old former pro established a program that works with former athletes who wrestle with no longer being able to compete.

“I understand the mind, the ego, the entitlement that comes with being an athlete,” Grimes said. “I also understand what it’s like to not be an athlete anymore; to have the one way people identify you taken away.”

According to Dr. Philip Veliz, a research assistant professor at the University of Michigan who studies the sociology of sport and substance abuse, this deep-rooted identity can amplify injuries in an athlete’s mind.

“They grow up with sport, they build a lot of their social network and connections through sport,” Veliz said. “They get invested; sometimes injuries do happen, and they want to be on the playing field.”

A 2013 study co-authored by Veliz in the Journal of Adolescent Health examined opioid use among teenage athletes and those who did not participate in sports; it found male athletes had higher odds of being prescribed opioid medication and misusing it during the previous year than their non-athlete counterparts.

The study found no discernable correlation between sports participation and odds of medical use, medical misuse and non-medical use of opioids among female athletes.

“Boys grow up learning to play through pain; to not show emotion or really discuss your problems, in a sense,” Veliz said. “If you do have a problem, you’re not really encouraged to talk about it.”

Veliz said that coupled with the desire to keep their position on the team, male athletes will often misuse painkillers while recovering from injuries. This can lead to serious problems as an adolescent enters young adulthood, as Tony Hoffman learned when his painkiller use as a teenager evolved into cocaine and methamphetamine addiction in his twenties.

“Adolescents who misuse opioids are much more susceptible to substance abuse disorders,” Veliz said. “If used appropriately, we find associations where they don’t have disorders.”

Grimes agreed that this mentality of playing through pain, particularly among athletes in contact sports, can contribute to abuse of prescription drugs and an unwillingness to come forward.

“We as athletes have been told our whole lives that we take care of business and we take care of it ourselves,” Grimes said. “It starts in Little League and pee wee football; every year that warrior mentality grows, until you’re in high school and people are stronger, faster and hit harder. The warrior mentality makes us think that we’re in control and we can stop anytime we want to, but we can’t.”

The MIAA Rule in Effect

Many speculate the MIAA’s new rule could help curb prescription drug use before it becomes an addiction.

Steve Dembowski, coach of the Milton High School football team, said that in 22 years of coaching, there have been two or three times when he’s felt completely blindsided by one of his athlete’s admissions.

“It usually happens coming out of the summer; a kid comes in and probably makes it about a month or so, and all of a sudden they’re standing in front of you and quitting the team,” Dembowski said. “And you don’t understand why they’re quitting — they typically play, they come from good families — you don’t see it coming at all.”

As a coach, Dembowski said, it’s hard to tell if an athlete is developing a problem.

“You don’t go to the doctor’s appointment, you’re not familiar with who’s dispensing the meds at home — you’re not privy to it,” Debowski said. “You see an athlete maybe two, two and a half hours a day, so you don’t get the full picture.”

But for those who have studied substance abuse and struggled with it themselves, retention of sport in an athlete’s life can be a valuable asset for preventing a downward spiral.

“Sometimes sport is the only thing [athletes] have; it’s their only identity or tunnel of vision that they have for themselves,” Hoffman said. “I think that’s why it’s important that we work with these athletes. If they lose the sport to substance abuse, chances are they’re going to go off deep.”

But, according to Hoffman, the change will likely not happen overnight.

“Most kids are going to say, ‘Yeah, they say you’re not going to get in trouble, but what about the social stigma?’” Hoffman said. “It’ll be hard to come forward at first, but I think it’ll make an impact once we see success.”

Nascimento said the rule validates substance abuse and other mental health issues as real medical problems instead of perceived weaknesses.

“This is one of those things where now people can say, it’s OK for me to have this problem as long as I can get help,” Nascimento said. “I think we’re probably still years away from most everybody being comfortable doing it, but I think it helps at this point.”

He added, “It shows we’ve come a long way in realizing what kind of problem substance abuse is. In Massachusetts and in general, it’s a major problem, and we’ve taken long enough ignoring it.”

And for Grimes, the rule not only provides a low-pressure method of seeking help before an athlete experiences repercussions or lost eligibility; it also helps an athlete acknowledge a problem early on and address it.

“Looking back I wish I would’ve sought recovery while I was still playing,” he said. “It’ll save them a lot of misery; it’ll probably save their lives.”

Photo courtesy of Daniel X. O'Neil via Flickr