The impact of the COVID-19 pandemic on substance use has been complex and varied, if not entirely unexpected. Despite restrictions in access to both licit and illicit drugs, there is evidence of both increased use, and increased harm, associated with the use of certain drugs. Some experts fear an uptick in alcohol consumption among individuals seeking to cope with stress related to isolation, unemployment and general uncertainty, with recent surveys showing increases in both drinking and relapse among individuals diagnosed with alcohol use disorder. The pandemic may also demonstrate the long-term limitations of supply reduction strategies toward the amelioration of illicit drug use (as well as adjacent health and social problems); multiple states, including Pennsylvania, reported surges in opioid overdose in the months following government “lockdowns.” As noted within a previous post, the (re)emerging overdose crisis may follow from drug market disruptions that cause individuals to drastically reduce their opioid consumption, only to resume use at their pre-pandemic levels. For similar reasons, persons in recovery – suddenly cut-off from in-person counseling groups, support networks, or medication-assisted treatment – are particularly exposed to overdose in the wake of relapse, due to reduced tolerance. Indeed, such lessons have already been gleaned in the wake of other “natural” disasters such as Hurricane Maria.
How do protective factors influence substance use in college?
Even as the pandemic has revealed and exacerbated the vulnerability of certain populations to drug-related harms, other groups of substance users may be shielded by new protective factors that accompany dramatic changes in social context. College is a well-known risk environment for problematic alcohol use patterns, including underage drinking, binge drinking, and heavy drinking; yet preliminary data collected by researchers at the Edna Bennett Pierce Prevention Research Center indicates that first-year undergraduates on Penn State’s main campus are drinking less, and less frequently, than their peers in previous cohorts. While returning students, enjoying access to established friend networks, may continue to consume alcohol at higher levels (albeit within smaller groups), new students lacking social capital may see fewer opportunities to imbibe, as the university’s COVID-19 mitigation policies limit recreational activities. They may also face less pressure, and perceive fewer reasons, to overconsume alcohol on the occasions they do drink, with tailgating and other largescale social gatherings indefinitely on hold. A summer 2020 survey of 145 fraternities and sororities found that merely 8.7% of respondents thought it “somewhat or very likely” they would “host parties as usual” this fall.
Why are student-athletes particularly at risk for (certain) substance use?
Shifts in college drinking subcultures may particularly impact student-athletes; ample research suggests that college students who participate in sports exhibit higher levels of alcohol consumption (including binge consumption) than their non-athlete peers. While apparently counterintuitive, such findings may reflect the competitive instincts of individuals drawn to athletics, the unique stresses faced by student-athletes, or group-level normative influences that encourage more frequent drinking. Given the suspension of nearly all fall sports at Penn State this semester, it might be expected that student-athletes especially are drinking less, deprived of not only occasions to socialize, celebrate, and commiserate, but crucial information on their teammates’ alcohol use patterns. It is less clear how changes in the collegiate campus and sports environment might shape the use of other recreational substances, including substances whose use is non-normative or less social. As a member of a research team that is poised to study patterns of opioid use and misuse among Penn State student-athletes, the impact of the pandemic on this subset of drug consumption is of particular interest.
How are student-athletes uniquely at risk for opioid misuse and how may COVID-19 influence that trajectory?
Both anecdotal evidence and scholarly research suggests that student-athletes may be uniquely at risk for opioid, and specifically prescription opioid, misuse, perhaps as a consequence of heightened exposure due to injury. While there is no comprehensive data source reporting injuries among college student-athletes, a 2018 study by the NCAA found that 11% of surveyed student-athletes had used narcotic pain medication with a prescription in the past year, while 3% had consumed drugs that were not prescribed to them. Other research focusing on prescription opioid misuse among a broader swath of college sports participants has yielded much higher estimates of non-medical prescription opioid use (NUPO) among certain sub-populations. Compared with 8% of all college students surveyed, 11.5% of male athletes - and 17.9% of injured male athletes - reported NUPO in the past year. In addition to illuminating one possible pathway into prescription opioid misuse by student-athletes (injury and the medication of associated pain), this study demonstrates the unique risks faced by male athletes, who were nearly twice as likely as their injured female counterparts to engage in NUPO. Both findings might inform predictions around opioid misuse by college athletes in the context of COVID-19.
What about the ongoing postponement of sports and other recreational activities?
With many, if not most, school and recreational sports leagues cancelled since March 2020, it is logical to assume that injury rates among established college athletes have declined, forestalling the injury-to-opioid trajectory for some. This string of events may have especially cut the risk for first-year college students who saw their final high school seasons precipitously shut down; the NCAA has shown that student-athletes are nearly twice as likely to begin prescription opioid use in high school, rather than college. Among athletes suffering chronic or repetitive injuries, another route of exposure to prescription opioids - for acute post-surgery pain - may have fallen off with the postponement of elective surgeries within hospital systems across the country, as COVID-19 infections surged in not only early spring, but mid-summer; conversely, such delays may have forced injured athletes into a sustained reliance upon prescription opioids to manage untreated and progressive pain. (Overall, it remains to be seen how such health system-level disruptions may have impacted the overall availability of prescription opioids, opportunities for their diversion, and the initiation of misuse across the U.S. population.) An inability or unwillingness to attend in-person physical therapy sessions during the pandemic may additionally encourage overuse.
“Reopening” – of schools, sports, gyms, and social institutions at large – may pose its own hazards for the health and substance use of student-athletes. Extended periods of reduced or restricted training are known to heighten athletes’ risks of catastrophic injury, particularly within contact sports; in fact, some orthopedists have already observed a spike in traumatic injuries alongside the limited resumption of fall sports. Doubly conditioned by the “sport ethic” that demands a willingness to push past bodily limits, and norms of masculinity that encourage physical risk taking, males athletes might be expected to suffer injuries, and self-medicate with opioids, at even higher-than-usual levels. New injury may not be a necessary condition for the resumption of prescription opioid use; after spit tobacco, narcotic pain medication is the second most common drug cited by NCAA athletes that is used “specifically to prepare for practice.”
Alongside lower activity levels, the prolonged off-season may also have seen more recreational substance use among student-athletes facing few formal and informal controls. While alcohol, spit tobacco and e-cigarettes enjoy continuous popularity among college athletes, the use of illicit drugs (such as marijuana, cocaine, ecstasy, and even heroin) peaks outside the period of competition. The unique temporality of student-athletes’ drug use may reflect seasonal fluctuations in their social bond to sports. Facing an excess of time, and a temporary detachment from team norms that sanction certain substance use, athletes may enjoy more occasions to experiment, and perceive fewer associated risks, whether physical or social. Here, the use performance enhancing drugs during the pandemic may provide an instructive parallel. Though no official data has been released, the extended lapse in athlete surveillance following from travel bans and social distancing mandates has triggered much concern around a possible surge in doping among elite athletes. As the U.S. Anti-Doping Agency (USADA) pared down out-of-competition testing to “mission critical” levels in the spring of 2020, CEO Travis Tygart speculated that some athletes [were] “going to try to exploit every opportunity they can.”
What are some possible avenues for prevention and harm reduction for the student-athlete population?
As the nation at large continues to face uncertainty regarding the pandemic’s trajectory and a full return to “normal life,” it is difficult to prognosticate the volume and types of different substance use among college athletes across sports and competition levels; indeed, the weight of this uncertainty and accompanying anxiety may represent yet another risk factor for substance use among young adults whose future – athletic, academic, and professional – hangs in the balance.
Still, existing knowledge suggests possible avenues of prevention and harm reduction during the shutdown, and the early stages of sports resumption. Athletic directors and team coaches whose campuses remain on a sports hiatus may still attempt to maintain connections with their student-athletes, remind them of their long-term goals as athletes, and foster a sense of shared commitments and mutual care. Norms-based interventions, which have proven effective in lowering levels of alcohol consumption among college students at large, may be particularly successful at establishing social standards around substance use among student-athletes specifically, particularly when paired with communications that serve to reinforce team identity . These interventions may also be enacted remotely, mobilizing high-influence student-athletes (such as team captains) to convey both health-oriented information and social disapproval for excessive alcohol and other substance misuse. As the spring sports season approaches, trainers and coaches may also seek to proactively avert prescription opioid misuse by being attentive toward the heightened risk of injury after a period of dormancy.
Ultimately, the pandemic may represent an opportunity to better understand, and address, student-athletes’ pathways into and motivations for sport-related substance use.