Star Tribune series revealed the dark side of NFL's big hits.
Former football players like to joke that there's another name for the "minor car crashes" they survived. In football, they're known as "plays."
With violent collisions a key part of America's favorite game, it's clear why so many players leave the field -- and eventually, the sport -- with the lingering aches and pains of car accident victims. Given that, reports of widespread use and abuse of painkillers by current and former players, while troubling, should come as no surprise.
A disturbing series of stories in the Star Tribune this week underscored the sport's physical toll on players and raised new questions about the quality of medical care provided by the National Football League. The NFL already faces lawsuits from players alleging that the league didn't inform them of the long-term risk of concussions.
The Star Tribune stories focused on a troubling new issue: whether the league is doing all it can to protect players from the risks inherent in misusing pain medications.
Interviews by sports writer Dan Wiederer painted a grim scenario: pressure-filled locker rooms where aging or injured players fearful of a subpar performance too often have easy access to prescription painkillers from team physicians.
Of particular concern: The routine use before games of an injectable prescription drug called ketorolac, sometimes sold under the name Toradol. The drug is typically used for people who've had surgery, and has been shown to deliver pain relief comparable to morphine.
Ketorolac belongs to the same family of drugs as ibuprofen, though it has the unique quality of being an injectable. Like other well-known drugs in its family, it's not without risk. Side effects include increased risk of heart attack, stroke and bleeding, which is a big concern when players are at risk for a concussion. Ketorolac may also cause liver inflammation or kidney problems, according to the Physicians' Desk Reference.
It's worth noting that those are the known side effects in the general population. Its use in athletes -- who subject their bodies to unusual levels of exertion or trauma -- have not been studied. That should be a major red flag for straying outside the drug's usage guidelines, which call for limiting use to five consecutive days.
And yet, Wiederer found that many players blithely take the drug on a preventive basis before games -- possibly up to 16 to 20 times a season.
According to the Star Tribune series, there's talk of a league ban on the drug. That would be premature and potentially counterproductive, because players may turn to another pain med -- those with similar risks or even worse, including addiction. "You can ban it, but to what end? Then everybody takes 800 milligrams of ibuprofen, and it's all the same,'' said Dr. Tanya Hagen, an associate team doctor for the Pittsburgh Penguins, sports medicine fellowship director at the University of Pittsburgh Medical Center and head physician for Robert Morris University. (Ibuprofen can also increase risk of bleeding.)
What's clear is that more information is needed about the drug's use by athletes, and what can be done to alleviate the pressure on players to take the field despite being hurt. The NFL Physicians Society deserves credit for an off-season push to inform team docs of ketorolac usage guidelines. Teams such as the Vikings, which require players to sign a waiver acknowledging the drug's risks, also stand out for taking a proactive approach.
The NFL needs to gather hard data on ketorolac's use in the league and track complications from it. If the new team physician guidelines don't reduce misuse in a year or two, the NFL should reevaluate the drug's place in the league and take stronger precautions. Safeguards are also needed at the college level to protect even younger players from misusing the drug.
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