Eight retired National Football League players, including Richard Dent and Jim McMahon, filed a federal class action lawsuit against the league on Tuesday, accusing the NFL of illegally supplying them and other players with dangerous painkilling and anti-inflammatory drugs that allowed them to play through injuries but resulted in addiction and harm. What are the specifics of the suit, and what do they potentially mean for professional football? Glad you asked:
Hold up. NFL team doctors giving players painkillers to play through injury? Duh. Football's a rough, violent sport. One-hundred percent injury rate. And besides, these guys knew the risks. What's the big deal here?
The big deal, according to the lawsuit, is that team doctors -- under the NFL's auspices -- "intentionally, recklessly and negligently created and maintained a culture of drug misuse, substituting players' health for profit." The players claim that (a) they weren't informed of the health risks that came with using particular painkillers and anti-inflammatories, either in isolation or when combined with other drugs; (b) team doctors deployed and prescribed drugs in an illegal, unethical and unsafe manner; (c) A and B were systemic and league-wide.
Okay, but why would the NFL and/or team doctors potentially put players in harm's way? Aren't the highly-skilled athletes on the field every Sunday the league's most valuable assets?
Sure. But only when they're on the field. To borrow from Bill Parcells, you "can't make the club in the tub" -- and you can't expect multibillion-dollar television deals, public funding for stadiums and a nation of fantasy football addicts to stay satiated if your perpetually-injured workforce spends too much time healing up. As the lawsuit puts it:
… more games, longer seasons, shorter recovery between games, plus bigger and stronger players, equals more frequent and debilitating injuries. That is problematic for the League, which needs players on the field on every given Sunday so the money can keep rolling in …
… the reality is that the faster a trainer or doctor gets his players back on the field, the more likely the team will field its best players. This premium product consumed on Sundays, Mondays and certain Thursdays ultimately drives the NFL profit machine through television, marketing, merchandise and endorsements. Therefore, trainers and doctors are under pressure to mask a player's pain with medications and designate a hasty rehabilitation schedule, even if it inevitably trades one injury for the next …
So who are the retired players in the lawsuit?
Jeremy Newberry, Roy Green, J.D. Hill, Ron Pritchard, Ron Stone, Keith Van Horne, Dent and McMahon -- all of whom played between 1969 and 2008. According to the players' lawyers, more than 500 other retirees have signed on to the suit.
What are they asking for?
Punitive damages, NFL payment for any and all player medical care needed as a result of the league's alleged pharmacological malpractice, an immediate end to harmful NFL medical practices and an injunction that would create a league-funded testing and monitoring program to help prevent addiction and diagnose injuries and disabilities related to the use of painkillers and anti-inflammatories.
What kind of drugs are we talking about?
Percodan, Lidocaine and Prednisone. Celebrex, Vicodin and Indocin. Novacaine, Halcion and Voltaren. Toradol, Naprosyn and … really, how much time do you have?
According to the lawsuit, the NFL's pharmacopoeia breaks down into three categories:
* Opioids: Narcotic drugs that act to block and dull pain. Highly addictive. So addictive, in fact, that they are generally prescribed on a short-term basis. If you've ever had your wisdom teeth pulled and subsequently run out of painkilling pills before running out of pain, you probably were prescribed a limited course of opioids.
* NSAIDs: Short for Non-Steroidal Anti-Inflammatory Medications. Ease both inflammation and pain. All have blood-thinning properties and can cause serious harm when used improperly.
* Local Anesthetics: Injectable painkillers that numb a particular area of the body. Generally used for minor surgery.
Oh, and also, the players in the lawsuit claim they were given uppers and downers -- including amphetamines and barbiturates -- in order to both perform and sleep. From the lawsuit:
… while Ron Pritchard played … amphetamines in the form of yellow and purple pills were available in jars in the locker room for any and all to take as they saw fit … Valium and Quaaludes were available at all times. Pritchard describes a routine on the nights before games where, either at dinner or during bed check, trainers would give players sleeping pills or downers. The next morning, they would be provided uppers for practice or the game …
… when Jim McMahon and Richard Dent began playing, amphetamines were available in jars in the locker room for any and all to take. Only after the deaths of Don Rodgers and Len Bias were the jars removed, though NFL doctors and trainers still gave players amphetamines whenever they wanted …
… while Keith Van Horne played for the Bears, the players were given Halcion and other medications, along with beer, to help sleep at night. Also, bowls of Supac (a high-dose mixture of caffeine and aspirin) sat out in the locker rooms. Many Bears players took Supac with their morning coffee as part of the day's ritual …
If that last part is true, it sounds like a pretty good way to turn someone into a junkie.
It does, doesn't it?
So how did the NFL and team doctors allegedly misuse painkilling and anti-inflammatory drugs?
Let's count the ways. First, quantity. Drug doses that were too high, taken over periods of time that were too long. It's one thing to administer an opioid like Vicodin for a few days or a week; it's another to administer it for an entire NFL season, especially when long-term opioid use has been linked to decreased liver and kidney function, respiratory problems and potentially fatal heart inflammation.
Next, "cocktailing" -- that is, mixing drugs in a way that exacerbates potential side effects. A Toradol shot shouldn't be chased with a handful of Advil pills or any other NSAIDs. Combining opioids and acetaminophen can result in liver failure. Combining opioids and alcohol can kill you. In fact, most of these drugs don't play well with alcohol. Yet according to the suit:
… the named Plaintiffs experienced the same post-game ritual of trainers handing out medications, including pain killers and sleeping aids, to be washed down by beer. When teams were traveling by plane, the NFL trainers would have the medications in a briefcase and would walk down the aisle, handing out pills or placing them on players' seats in contravention of Federal law while the players were provided with beer at the back of the plane. Doctors were aboard these flights, knew the players were drinking alcohol and being provided various medications, yet said nothing to them about the risks of these medications, or of mixing these medications with alcohol …
What were the alleged results of painkiller misuse?
Long-term harm. Because players were able to play through pain, the suit claims, they sustained lasting injuries that would have healed with proper rest and care. Moreover, some painkillers have been linked to inhibited healing in a wide variety of orthopedic injuries. McMahon suffers from arthritic hand pain and extreme shoulder pain. Stone has severe elbow and knee pain. Dent played eight weeks with a broken bone in his foot and now has permanent nerve damage.
Meanwhile, Van Horne has heart problems. Green -- who allegedly was also given trauma IVs while playing -- has suffered high blood pressure, three heart attacks and failing kidneys that required a transplant since retiring. According to the suit, Newberry "currently has Stage 3 renal failure and suffers from high blood pressure and violent headaches for which he cannot take any medications that might further deteriorate his already-weakened kidneys."
Yes! Drug addiction. The lawsuit claims that both Dent and McMahon became dependent on painkillers -- at one point, the latter man was taking as many as 100 Percocets per month.
Then there's Hill's story:
... Mr. Hill received hundreds, if not thousands, of pills from trainers and doctors, including but not limited to NSAIDs, Codeine, Valium and Librium. No one from the NFL ever talked to him about the side effects of the medications he was being given or cocktailing. He left the League addicted to painkillers, which he was forced to purchase on the streets to deal with his football-related pain, a path that led him to other street medications. He eventually became homeless and was in and out of 15 drug treatment centers for a period of over 20 years until overcoming his NFL-sponsored drug addiction …
Wait a second. "NFL-sponsored" seems a bit harsh. Like overheated lawyer language.
Maybe it is. On the other hand, painkiller abuse and addiction is hardly uncommon among former players. The lawsuit quotes liberally from a Washington University study of 644 former NFL players which found that:
* Ninety-three percent of the players sampled reported pain and 81 percent of the players perceived their pain to be moderate to severe;
* Players who misused opioids during their NFL career were 3.2 times as likely to misuse in the past 30 days as NFL players who used just as prescribed;
* Comparing former players who used opioids as prescribed to those who misused, the study showed that "misusers had increased odds for poor health at retirement," were less likely than non-users to report excellent health in the past 30 days, more likely to report knee, shoulder and back injuries and over 6 times as likely to report 3 or more NFL injuries;
* The overall rate of misuse during NFL play was 37 percent -- 2.9 times higher than a lifetime rate of non-medical use of opioids among the general population of a comparable age.
Okay, but still, these players are adults. Big boys. They understood what could happen, and they took those drugs anyway. Right?
Not according to the suit. The plaintiffs claim that no one from the NFL ever talked to them about the dangers of mixing drugs; taking large quantities of drugs; taking drugs for extended periods of time; the addictive potential of certain drugs; the potential for more severe or long-term physical injury as a result of taking drugs that masked pain.
Instead, the suit alleges, players were often not even told what drugs they were being given:
… the named Plaintiffs all received the bulk of their pills not in bottles that came with directions as to use but rather in small manila envelopes that often had no directions or labeling. The player would receive the envelope and be told to take it …
For his part, Van Horne claims he played on a broken leg for an entire season -- and wasn't told about the actual extent of his injury for five years, during which time he was "fed a constant diet of pills to deal with the pain."
If all of that is true, it sounds unethical. And maybe illegal. Is it?
If it's true? Yes on both counts. The suit claims that the NFL failed to provide appropriate prescriptions, keep adequate medical records and give individual patients proper evaluations. It also claims that teams allowed athletic trainers -- not physicians -- to effectively act as drug dealers, distributing Schedule II and III controlled substances to players.
All of the above violates federal and state law. A story from the lawsuit is illustrative:
… Van Horne was prescribed Percodan by a physician with no affiliation to the NFL after a foot or ankle injury. Days later, the Chicago Bears' Head Trainer Fred Caito called Van Horne into this office. Caito proceeded to lambast him for obtaining the Percodan because it led the Drug Enforcement Agency to issue a letter to the Bears inquiring why Van Horne was obtaining Schedule II medications.
When Van Horne told Caito that a physician had prescribed the drug, Caito responded that was not the problem. The problem was that the Bears ordered painkillers before the season started under players' names, including Van Horne's. Van Horne had thus put Caito in a bad spot by obtaining the Percodan because there were already DEA records that hundreds of painkillers had been ordered in Van Horne's name, even though Van Horne had no need for the medications the Bears had ordered at the time the order was placed …
As for professional ethics, the lawsuit cites the American Medical Association's guidelines for the duties of sports medicine physicians:
… physicians should assist athletes to make informed decisions about their participation in amateur and professional contact sports which entail the risks of bodily injury. The professional responsibility of the physician who serves in a medical capacity at an athletic contest or sporting event is to protect the health and safety of the contestants. The desire of spectators, promoters of the event, or even the injured athlete that he or she not be removed from the contest should not be controlling. The physician's judgment should be governed only by medical considerations …
If team doctors really were handing out unmarked, pill-stuffed manilla envelopes, prescribing harmful drug cocktails and sending players back on the field to suffer greater injury, then it's hard to argue their judgment was governed by medical considerations.
Long-term damage. A lack of informed consent. Bad medicine. Hmmm. This all sounds a bit like the concussion and brain damage lawsuits filed against the league. I saw "League of Denial." Did the NFL sponsor and create bogus science here, too?
No. But if the league and its doctors did what the suit claims, they certainly ignored the science that already existed. After all, the side effects of substances like Vicodin and Lidocaine aren't exactly a mystery -- prescription drugs are tested extensively before receiving FDA approval.
Take Toradol, which is usually used for post-operative pain relief. A study of 30 NFL teams published in 2002 found that in the 2000 season, 28 squads regularly administered injections of the drug, with 26 of those teams using Toradol on game days. Two teams refused to use the drug, citing potential complications that included kidney failure and increased risk of bleeding. Calling for further investigation, the study concluded that "given that bleeding times are prolonged by 50% 4 hours after a single [shot of Toradol, use] on game day may deserve reconsideration in contact sports."
Did the NFL and its team doctors reconsider the use of a dangerous operating room drug -- one banned by some European countries -- that also proved popular among players as a pre-game numbing agent? A drug that helped injured players suit up, and players on the field feel invincible? A drug that enabled harder hits, longer careers, less time in the rehab tub and increased game-day abandon? A drug, the suit claims, that had Newberry, Stone and other San Francisco players habitually and unthinkingly lining up in their locker room, pants down, ready to receive shots in the ass?
Yes. Eventually. In 2012, the NFL Physician Society formed a task force to examine Toradol use. An entire decade later.
Um, what took league doctors so long?
Who knows? All they had to do was put down the blank manilla envelopes and look at Toradol's FDA warning label, which notes that the drug:
* Should not be used for more than five days;
* Should not be used to treat minor or chronic painful conditions;
* Can cause ulcers, gastrointestinal bleeding and stomach/intestinal perforation at any time;
* Increases the risk of stroke;
* Should not be used on anyone with a high risk of bleeding;
* Should not be used as a prophylactic analgesic before surgery or trauma;
* Should not be used in conjunction with other NSAID medication.
In addition, research suggests that Toradol may cross the blood-brain barrier, be pro-inflammatory in the brain and increase the risk of concussion-induced microhemorrhaging.
Okay, so maybe Toradol isn't the best drug to give football players. What did the NFL's task force end up recommending?
According to the Washington Post, the task force recommended that Toradol not be used prophylactically; that it be limited to players with a known injury; that it shouldn't be used in any form for more than five days; and that it shouldn't be used concurrently with other NSAIDs.
But Toradol isn't banned outright?
Nope. NFL Physicians' Society president Matt Matava told the Post that team doctors are free to "do with Toradol as [they] see fit."
Yipes. Overall, the lawsuit paints a bleak picture of a business that can't function without poisoning its most important employees. How credible are the lawsuit's allegations?
Specifically? Hard to say without exhibits and depositions. In general? Pretty credible.
Two years ago, Paul Solotaroff of Men's Journal published an investigative report which concluded that the NFL is "so swamped by narcotics that it closes its eyes to medical malpractice by many of its doctors and trainers. It does so not because it lacks the will to police its staff and players, but because the game itself could not survive without these powerful drugs." Meanwhile, the Post published an extensive 2013 article on NFL painkiller abuse that included the following passage:
… when linebacker Scott Fujita, a 10-year veteran free agent who has played for the Kansas City Chiefs, New Orleans Saints and Cleveland Browns, was in his prime, he used prescription drugs four to five days a week in order to play. He estimates this put him on the low end of usage among his teammates.
On Thursdays, Fridays and Saturdays, Fujita might rely on Celebrex or another anti-inflammatory. If the pain from a specific injury was really bad, the linebacker might turn to Vicodin or Percocet. On Sundays, he'd get a Toradol shot before taking the field. Then with fresh aches and pains, he'd spend Mondays on another pill to help recovery. Tuesdays and Wednesdays, though, were always different -- "your chance to detox a bit."
"We called it DFW," he said. "Drug-Free Wednesday."
Fujita says he has suffered dozens of injuries during his career, from cuts requiring stitches to broken fingers to separated shoulders and torn muscles. To manage the constant pain, he has used "everything under the sun" …
"People spend so much time talking about HGH, steroids, and I think these are the real performance enhancers," Fujita said …
Any other supporting evidence?
Former Denver Broncos tight end Nate Jackson once told me that when he obtained his complete NFL medical file following his retirement -- via subpoena in a worker's compensation case -- he was shocked at the difference between the way his injuries were described to him by team trainers and the actual information in print. Or consider former Oakland Raiders team physician Rob Huizenga, who wrote in his book You're Okay, It's Just a Bruise that:
… I thought I could be a team doctor and risk the potential game-day pressures and conflict of interest. I took away the candy jar (of painkillers), explained risks, encouraged second opinions, talked openly about steroids, speed and growth hormone, discouraged numbing shots, and preached priorities. I thought I could medically treat the Raiders players like my other private patients and still please management.
I was wrong.
When was Huizenga's book published?
Nineteen-ninety four! That's three years before --
-- before the lawsuit claims a NFL general manager said that painkiller abuse was "one of the biggest problems facing the league right now."
Ugh. Has anything changed?
Earlier this year, I spoke to a recently-retired, longtime NFL player about Toradol. Here's what he told me:
… I have kids now. I was toward the end of my career. I read the literature. The second I made the decision to stop taking Toradol, I was not the same player. When I turned on film, I wasn't even close to the same guy. I was that much more in pain and almost afraid of contact.
I remember one time, I saw a player have a concussion the week before. Next week, he's lining up to get a Toradol shot. I said kind of casually, 'I don't know if that's a good idea for you to get that shot.' The trainer and doctor look at me like, 'don't be an a--hole. The player asks, 'what's up?' I tell him the risks. He gets the shot. The trainer and doctor want to debate me about it …
Surely a NFL team would never keep a sketchy doctor around.
Hey, where was -- and is -- the NFL Players' Association in all this? Shouldn't they have spoken up about substandard player medical care, like, decades ago?
What is the NFL's response to the new lawsuit?
League spokesman Brian McCarthy told the Associated Press yesterday that "we have not seen the lawsuit and our attorneys have not had an opportunity to review it."
How do you expect the NFL to respond in court?
As is the case with the concussion lawsuits, expect the league to argue that the painkiller suit falls under collective bargaining agreements with its players, and therefore should be resolved via arbitration. If that fails, ESPN legal analyst Lester Munson believes the NFL will attempt to have the painkiller suit folded into the pending concussion settlement -- a legal and public relations move that, in theory, would settle all of the league's messy family business.
What if the case goes forward?
Then the discovery process will begin. Players' lawyers will sift through team and league medical records and depose doctors and executives; league and team lawyers will do the same to the retired players. Expect ugliness, finger-pointing, he-said/he-said disputes and a legal war of attrition. From the same retired NFL player:
… while there certainly has been an egregious failure to disclose risks of med[ications], I wonder how you'd prove that. I was never informed of risks of Toradol -- or anything else -- yet when I reviewed my medical records, the team doc[tor] professes each week, in writing, that risks were discussed with the patient. Never once happened …
Is the NFL doing anything about the problems alleged in the suit?
Not at the league level. According to suit, however, several teams and league doctors have restricted Toradol use and put stricter controls on painkiller drug supplies.
Is that enough?
Hardly. If the NFL was serious about tackling its drug problem -- and providing better medical care to its athletes, to boot -- it would end the lucrative, conflict of interest-ridden practice of having doctors pay teams for the privilege of treating players; stop pushing extra playoff games and an 18-game season; increase roster sizes to better accommodate the reality of a 100 percent injury rate; structure contracts so players aren't financially incentivized to play through injuries in a way that causes long-term damage; discourage the use of addictive medication, and provide more recovery resources to players who develop substance abuse problems; and generally treat its workforce like the valuable human assets they are, as opposed to a bunch of old Christmas toys to be broken and tossed in the back of a closet.
What are the potential larger implications of this lawsuit?
It's easy to draw a line between painkiller abuse -- which allows athletes to play longer and hit harder -- and the league's concussion crisis, which increasingly looks like a matter of cumulative and compounding brain damage. And speaking of damage, what does it say about the sport of professional football itself when allegedly rampant medical misconduct is par for the course? When you need a special drug-free day of the week? When the use of Toradol and Vicodin and trauma IVs and everything else is less performance-enhancing than performance-enabling?
Speaking of PEDs, didn't the NFL just suspend Indianapolis Colts linebacker Robert Mathis for using Clomid, a banned female fertility drug?
Yes. In fact, the league released a statement defending its decision that read, in part, "the drug for which Mr. Mathis tested positive is not approved by the FDA for fertility in males and is a performance-enhancing drug that has been prohibited for years."
So the NFL is citing the FDA? That seems ironic.