You don’t need to go very far to find stories of recent NFL players lining up for Toradol, the powerful painkiller they can’t play without. They talk about it the way you might talk about your daily vitamin. In 2013, Fred Smoot described it and other painkillers as “like popping aspirin.” Nate Jackson called lining up for his weekly shot just another part of staying on the field. Chris Kemoeatu described finding out he had a failing kidney and wondering if the Pittsburgh Steelers knew and still shot him full of the stuff. Even the Players’ Tribune, the People magazine of sports media, has no problem acknowledging that the NFL can’t live without Toradol, leading Eugene Monroe’s plea for medical marijuana in football with the now well-known image of the “T train.”
Toradol isn’t a secret; it’s just easier for all involved, from the owners down to the fans, to not think about it. Doing so would entail wrestling with what it means that NFL teams shoot up countless men with a painkiller so powerful it’s used in hospitals to prevent pain after surgery just so they can play—a usage one of the drug’s creators calls drug abuse. Toradol hasn’t been infused with the boogeyman quality of steroids or Oxycontin, but that doesn’t make the NFL’s reliance on it any less horrifying.
So there’s no surprise that the name Toradol is all over the latest NFL lawsuit.
Toradol is a nonsteroidal anti-inflammatory drug, part of the same class of painkillers as Advil and Aleve, and was approved by the U.S. Food and Drug Administration in 1989. But a dose of Toradol is far more powerful than its over-the-counter counterparts, putting Aleve to shame. Researchers sometimes compare its effects relative to morphine. Considering that the overuse of Aleve and other NSAIDs can be bad for kidneys and the renal system, Aleve itself is limited to at most 10 days in a row. It seems logical to assume that overusing Toradol is dangerous. But that hasn’t been studied—perhaps because, as Louis Bien wrote last year in SBNation, there is no reason to do so. Toradol is meant for highly controlled and limited use in hospitals only (emphasis added is mine).
It was indicated specifically for the relief of severe post-operative pain. Its regular use—say, 16 times a year for several years—has never been clinically studied as a result. Toradol was contraindicated for use beyond five continuous days, reduced to two in its 2015 updated monograph. It comes with a black box warning from the FDA, the strongest that the administration requires, prohibiting its use in patients with preexisting renal problems or who are concurrently using other NSAIDs, a practice that former players — like Rhett and the Kemoeatu brothers — and former team doctors both say is common in the NFL.
Within the hallowed halls of football, medical concerns have been raised, but they haven’t accomplished much. In 2002, a study was published on the use of Toradol in the NFL, according to the latest complaint filed in the lawsuit. The study recommended “reconsideration” for the use of Toradol in contact sports because of concerns that it can prolong bleeding times by 50 percent four hours after a getting a shot of it, the lawsuit says. In 2012, according to the lawsuit, an NFL task force recommended that Toradol not be used as preventative medicine before playing football “in light of the FDA’s admonition ‘that [the drug] not be used as a prophylactic medication prior to major surgery or where significant bleeding may occur.’”
But ultimately that same task force gave the league a reprieve on Toradol because, per the lawsuit, “the medical literature is ‘deficient in terms of the ethical considerations implicit with the administration of injectable medications in the athletic setting solely for the athlete to return to competition.’”
One of the men who helped create Toradol, Robert Greenhouse, said he first heard about the drug being taken by athletes in the case of R.A. Dickey, who used it to pitch through a foot injury. After that, he looked into what was happening and told SBNation, “I regard that as drug abuse. If you use it in a way that it was not intended, if you use it in a way that actually is harmful to the person, that in my mind is drug abuse.” He added: “When I was told about this, I said, ‘My goodness, this is the stupidest thing I’ve ever heard of and these guys should be jailed.’”
The logical move would be to say that since nobody knows the effects of long-term, weekly use of Toradol, no one should do it. It’s not worth the risk. But the thinking in locker rooms, and especially the NFL, seems to be because no one knows what could happen, that makes it okay to keep shooting up. A team physician with the New York Giants told the New York Times back in 2012, after Dickey’s use of it got attention, that Toradol was so prevalent in the NFL that “some players, he said, ‘barely think of them as medicine.’’’
According to the most recent complaint field in the painkiller lawsuit, use of Toradol and other drugs in the NFL looks like this.
For example, on October 13, 2014, 27 teams responded to a survey and noted that an average of 26.7 players (more than half of the active roster) per team took at least one dose of Toradol per game. On September 24, 2010, Paul Sparling (Bengals Head Trainer) e-mailed Dr. Jill Eippert (Bengals doctor): “We, for example rarely dispense more than 12 – 20 Vicodine 5/500 a game, whereas I know others that will routinely dispense 90+ each game.” On October 18, 2007, Dave Granito (Assistant Athletic Trainer of the New England Patriots) e-mailed to Erika of Sportpharm (a provider of the Medications to the Clubs): “I need to order 5 boxes of Toradol 60mg/2ml inj (2E6) total of 50 doses. And I have to have it before we leave for Miami on Saturday afternoon. Please touch base if this is an issue.” Erika responded: “I have placed an order for an afternoon delivery, so I should have this to u friday AM.” And in a memo e-mailed to all Team Physicians and Head Athletic Trainers on October 31, 2008 by Dr. Brown, he stated: “Another observation is the report of the number of prescription medication pills provided to a player on a single occasion, from as few as one to as many as 40 pills at one time” (emphasis added).
A Minnesota Vikings head trainer in 2006 sent a memo saying the club was at a disadvantage because it wasn’t regularly dishing out Toradol.
Dr. Anthony Yates with the Pittsburgh Steelers testified, according to the lawsuit, that Steelers players lining up for their Toradol shots—the T train—had been going on for “at least the previous 15 years.” Former Steeler Troy Sadowski recalled in the latest complaint that “before every game he played for the Steelers at home, syringes of Toradol would be lined up in the locker room with players’ numbers, not their names, on them.” A letter sent from the NFL’s Lawrence Brown to Yates is described in the complaint as finding this:
It also notes that during the “calendar year 2012, the [Steelers] medical staff ... prescribed 7,442 doses of NSAIDs [again, 53-man roster] compared to League-wide average of 5,777 doses of NSAIDs per Club. Regarding controlled medications, [the Steelers] prescribed 2,123 doses of controlled medications compared to League-wide average of 2,270 doses of controlled medications per Club.
Those numbers don’t even put the Steelers in the top five users in the league.
“By total doses, your Club ranks 10th in the greatest volume of NSAIDs provided by an NFL Club and 14th in the greatest volume of controlled medications provided by an NFL Club.”
Even if Toradol is eliminated from football, that won’t end what amounts to an unending arms race in which each team seeks to put bigger, faster, stronger, and more indestructible guys out than their rivals have on the other side of the line. Toradol isn’t the first dangerous drug of choice for the NFL, just the latest in a history that the lawsuit’s complaint outlines this way: “Quaaludes and amphetamines beginning in the mid-1960’s, Vioxx and OxyContin beginning in the 1970’s, Percocet and Indocin in the 1980’s and, beginning in the 1990’s, Toradol.”
Football is hardly the only team sport to dope its players up like race horses, but none carry the physical and mental toll of what is, for now, America’s most beloved combat sport. Football is inherently a process of pain management and, as with concussions, you can’t talk about pain killers without asking the nagging question of can you divorce a sport based on an act of violence—hitting another human being—from the consequences of violence itself. All the science out there says a price must be paid for all the tackles, hits, body slams, and concussions, and it’s paid exclusively by the players and their families, not the coaches, not the team doctors, not the owners, and certainly not the fans in the stands. It seems highly likely that all this Toradol usage will have some kind of serious consequence; it seems just as likely that no one who matters will care.