Introduction Although previous research suggests that the overall prevalence of analgesic use is similar between youth elite athletes and age-matched student controls, a greater proportion of use among athletes is directly related to sports participation. Such use may reflect inappropriate and potentially harmful usage patterns. This study aimed to quantify the extent of inappropriate sport-related analgesic use and explore athletes` experiences with such use. Materials and Methods 690 youth elite athletes (15-20 years) reported the number of days and reasons for analgesic use weekly over 28 weeks. Inappropriate analgesic use was defined as: 1) treating pain/injury before sport participation for =7 weeks, 2) analgesics for pain prevention =1 week, 3) opioid use =3 weeks, and 4) being classified as either frequent or persistent users via group-based trajectory modeling. A mixed-effects logistic regression model, expressing odds ratio (OR), was used to assess gender differences in prevalence of inappropriate analgesic use. To explore athletes` experiences with inappropriate use, 9 focus group interviews with 32 athletes were analyzed using thematic analysis. Results Totally, 328 events of inappropriate analgesic use were reported by 229 athletes (33%) during the observation period. Girls/women had significantly higher odds of inappropriate use than boys/men (OR 2.98, 95% CI: 2.27-3.90). The thematic analysis suggested limited knowledge and neglect of risks, and that inappropriate use was influenced by external pressures, and reinforced by a culture emphasizing short-term performance. Conclusion Inappropriate analgesic use is common among youth elite athletes and appears to be influenced by gender and sociocultural factors.
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