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OTL: Painkiller use in today's NFL

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STUDY: PLAYERS MISUSE PAINKILLERS First scientific study of prescription painkiller use by retired NFL players shows higher rates of misuse than the general population. PAINKILLER USE IN TODAY'S NFL CONCUSSIONS MAY IMPACT DRUG USE Lisa McHale never understood why her husband became addicted to painkillers. Could his brain have held the reason? ABOUT THE PAINKILLERS STUDY ESPN commissioned the first-of-its-kind study, and the National Institute on Drug Abuse joined as a partner. ADDITIONAL RESOURCES Learn about painkiller misuse resources and treatment options, and view additional video clips and photos.

PAINKILLER USE IN TODAY'S NFL Researchers say painkiller misuse may be prompted by use of the painkillers during players' careers. And while teams have tightened access to the drugs, many players still find ways to get them.

ASHVILLE, Tenn. - Kyle Turley remembers the plane rides home when he first came into the NFL, those hours spent folding his 6-foot-5 frame into an airline seat after a Sunday afternoon full of violent collisions with other 300-pound men.

An offensive lineman for eight years with the Saints, Rams and Chiefs who retired after the 2007 season, Turley said it was commonplace to find comfort in the form of two Miller Lites. But the real relief, Turley said, would come when members of the Saints' medical staff routinely handed out the prescription painkiller Vicodin on the flights home.

"The trainers and the doctors used to go down the aisle and say, 'Who needs what?'" Turley said. "If you had something hurting and needed a painkiller to take the edge off so you could sleep that night, they made sure you had it."

A scientific study conducted by researchers at Washington University in St. Louis found that retired NFL players misuse opioid pain medications at a rate more than four times that of the general population. The study, co-funded by ESPN and the National Institute on Drug Abuse, provides new evidence to suggest the roots of that misuse can be traced to the misuse of painkillers during players' NFL careers. The research findings were published Jan. 28 in Drug and Alcohol Dependence, a peer-reviewed, scientific journal.

When asked about their prescription painkiller use while playing in the NFL, 52 percent of the retired players surveyed said they used prescription pain medication. Of those users, 71 percent admitted misusing the drugs during their playing days and, of that same group, 63 percent said they obtained the pills from a nonmedical source: a teammate, coach, trainer, family member, dealer or the Internet.

"It tells me that there has to be more evaluation, more monitoring," said Linda Cottler, a professor of epidemiology in Washington University's Department of Psychiatry, who directed the research. "That's a problem, I think, that only 37 percent got [prescription pain medications] exclusively from a doctor."

Fighting NFL pain -- the legal risks

Turley, who now leads a country- and rock-infused band, said pain medication was new to him when he arrived in the NFL.

"I never took a Vicodin in college, ever," he said. "I didn't even know what Vicodin was until I got to the NFL."

Under pressure to perform on Sundays, Turley said, players routinely numb their NFL injuries with prescription painkillers and risk long-term debilitating injuries.

"I know guys that have bought thousands of pills," Turley said. "Tons of guys would take Vicodin before a game."

Turley said one physician outside the NFL's network of doctors -- he would not identify the individual by name -- once offered to sell him a bag of 10,000 Vicodin. The going rate, Turley recalled, was $3 per pill. He said he didn't make the purchase.

"Everybody has a guy," Turley said.

The NFL has had a few high-profile cases involving painkillers.

In April 2008, New England Patriots offensive tackle Nick Kaczur was pulled over for speeding in Whitestown, N.Y., while driving back to his home in Massachusetts.

The officer noted in a police report that Kaczur appeared "extremely nervous." The officer said he found a "Ziploc baggie" in the center console, containing four pills, later discovered to be the prescription painkiller Percocet. When he continued searching, the officer found another "Ziploc baggie" in Kaczur's sweatshirt pocket containing 202 OxyContin pills, according to the report.

Kaczur was cited for criminal possession of a controlled substance and speeding. According to court documents, Kaczur told police he'd obtained the pills from a man named "Danny," whom he met at a Boston-area bar months earlier.

At that time, Kaczur was coming off a career year. He'd started 15 games at right tackle the previous season and was part of a Patriots offensive line that allowed just 21 sacks, the fewest for the franchise in 30 years. Faced with an embarrassing criminal case involving illegally obtained prescription painkillers, Kaczur cut a deal, offering to wear a recording device to help investigators from the Drug Enforcement Administration arrest his dealer, "Danny," in exchange for a lighter penalty.

"Danny" was Daniel Ekasala. According to a DEA report, Kaczur met Ekasala in November 2007. For nearly six months, according to court documents, Kaczur purchased "approximately one hundred 80mg OxyContin pills every three or four days from [Ekasala]." In a sentencing memorandum he filed as part of the federal court case, Ekasala's Boston-based attorney, Bernard Grossberg, wrote:

"The Confidential Source [Kaczur] befriended the defendant [Ekasala] and implored him to furnish Oxycodone with the explanation that it was widely used in the NFL and that players, especially interior linemen, needed the painkillers in order to endure the injuries they suffered and in order to continue to play."

Kaczur, who finished this past NFL season on injured reserve due to a back injury, declined to comment to ESPN, as did the Patriots.

Ekasala, who pleaded guilty and was sentenced to 42 months in prison, declined to comment to ESPN for this report when reached at the Federal Correctional Institution in Fort Dix, N.J.

In March 2009, former Philadelphia Eagles defensive tackle Sam Rayburn sent two men into separate pharmacies in his hometown of Chickasha, Okla., with prescriptions Rayburn had stolen from a doctor's office and forged. When a suspicious pharmacist called police, Rayburn was arrested on two counts of attempting to obtain a controlled substance by forgery or fraud. He faced 20 years in prison if convicted.

Rayburn, who pleaded guilty, spoke in detail to "Outside the Lines" about his painkiller addiction, which he said stemmed from NFL-related injuries and at its peak involved consuming more than 100 Percocet pills a day. He avoided prison time by going to court-ordered drug counseling and by submitting to 18 months of drug tests.

"I think if I would have given it another two or three months, it probably would have killed me," Rayburn said of his addiction. "I don't have any doubts whatsoever that it would have turned into a death situation, because I didn't see any way of slowing down."

Last May, former San Diego Chargers safety Kevin Ellison was arrested by Redondo Beach, Calif., police and charged with one count of possession of a controlled substance. Police say Ellison was found in his car in the middle of the afternoon with 100 Vicodin, which he allegedly obtained without a prescription. He was released on a $10,000 bond and has since pleaded not guilty. His case is pending.

Ellison and his agent, Jerome Stanley, both declined to comment to ESPN, but Stanley did tell The San Diego Union-Tribune that Ellison "thought it was a good idea to get enough pain killers to last the season. They were for him to use because of his knee surgery."

In a prepared statement, the Chargers said no one on the team's medical staff ever provided Vicodin to Ellison.

The painkiller revolving door is closing

In his 1994 book, "You're Okay, It's Just a Bruise," former Oakland Raiders team doctor Robert Huizenga describes the freewheeling approach to medical care within NFL locker rooms and the lax controls that often existed for prescription painkillers. Hired in 1983, when he was fresh out of Harvard Medical School, Huizenga described his first visit to the Raiders' medical treatment room:

"On the back wall were slide-out shelves filled with aspirin-like medications, antibiotics, and cold pills. A large brown safe was pushed against the back corner. It housed potentially addictive prescription medications: bottles of Cheracol-X with codeine cough medicine, sleepers and codeine pain pills. The safe door was wide open." "It used to be that every shop ran itself kind of like a McDonald's franchise, and league policy had nothing to do with medical care," Dr. Pierce Scranton, a team doctor for the Seattle Seahawks for 18 years, told ESPN. Scranton also served as a president of the NFL Physicians Society. Scranton, who likened NFL medical care in the 1980s to the "Wild West," said he made a conscious decision to be more cautious with prescription painkillers.

"We made a determination in the late '80s that all prescription medications would be locked away in a locked cabinet," he said. Scranton acknowledged that he was motivated not only by medical ethics but also self-interest.

"No way was I going to go to court because a guy's kidneys shut down because a trainer dispensed medication without my knowledge," Scranton said.

From 1998, the time he entered the NFL, to 2007, the time of his retirement, Turley said he noticed a discernible shift within the walls of NFL facilities with regard to the way prescription painkillers were stored and handed out to players. Prescription painkillers with names like Vicodin, Percocet and OxyContin became more difficult to get from team doctors and trainers.

"My last two years in Kansas City weren't the same. You didn't get it as easily," Turley said.

Baltimore Ravens center Matt Birk, a veteran of 13 NFL seasons, has witnessed a similar evolution in the drug culture inside and outside of the NFL bubble.

"I've played with a few players that have acquired pain meds on their own, through other avenues other than a team doctor," Birk said. "I've known guys who felt like they needed to obtain those medications in order to play."

Those players, Birk said, were all either offensive or defensive linemen. He said the players got the drugs from outside doctors or drug dealers.

In Birk's experience, which includes a decade with the Minnesota Vikings, team doctors were responsible in the way they stored and dispensed prescription painkillers.

"They're pretty cautious. They're not just passing them out," Birk said. "I could count on one hand the times I was given one painkiller. I've never been prescribed a bottle of 30 of them or anything like that."

The prescription pain medications stored at team facilities -- referred to within league medical circles as "common stock" -- are required to be kept under lock and key in secure rooms. Team medical staffs are subject to routine pill-by-pill audits conducted by league security officials, all designed to ensure the medications are stored and prescribed responsibly.

"We as physicians do our best to do the right thing and really be clean," said Dr. Patrick Connor, president of the NFL Physicians Society and team doctor for the Carolina Panthers.

Connor said he was unaware of any players going outside of team doctors to obtain prescription pain medications in order to cope with NFL injuries.

"Players often play hurt," he said. "But no, I don't think that I would take that fact and then jump to the conclusion that there's a pain medication problem."

Even with the league-mandated controls on painkillers, there are recent examples of alleged security breaches.

In April 2010 Geoffrey Santini, a 31-year veteran of the FBI who worked as director of security for the New Orleans Saints, sued his former NFL employer. Santini accused Saints general manager Mickey Loomis of ordering a cover-up after Santini revealed to Loomis that a member of the Saints' coaching staff was caught on a security camera stealing Vicodin out of the team's drug locker.

That same Saints staffer allegedly used some of the 130 stolen pills and provided the rest to another member of the coaching staff, according to Santini's lawsuit. Rather than engage in an alleged cover-up of stolen painkillers, Santini said he quit and sued the Saints for lost wages. While Santini never named names in his lawsuit, he told some media outlets that assistant head coach Joe Vitt was the person allegedly caught on tape stealing the Vicodin pills, and head coach Sean Payton allegedly received some of those pills. Santini withdrew his lawsuit against the club in May; the claims are being handled in arbitration.

He and his attorney, Donald Hyatt II, both declined to comment to ESPN for this story.

Greg Bensel, the Saints' vice president of communications, released a prepared statement about the lawsuit.

"A former employee who resigned just before the 2009 regular season threatened to go public with these unfounded charges unless we agreed to pay him an exorbitant sum of money," Bensel said. "We refused, and now he has gone public. We will aggressively defend these false allegations in court."

In a prepared statement, Payton said: "I have reviewed Geoff Santini's lawsuit and the unwarranted publicity it has received. … I have never abused or stolen Vicodin or any other medication, and I fully support the Saints' position in this matter."

The DEA's shifting focus

According to federal court documents obtained by ESPN, Santini's lawsuit, combined with the arrest of the former Chargers safety Ellison for possession of Vicodin just a month later, prompted action from the federal Drug Enforcement Administration.

In June, DEA agents in San Diego filed a series of administrative inspection warrants and searched the medical facilities of both the San Diego Chargers and San Diego Padres, along with several of the pharmacies that provided medications to the teams.

According to several of those warrants, Dr. David Chao, an orthopedic surgeon who serves as a Chargers team doctor, allegedly wrote 108 prescriptions with himself listed as the patient, an apparent violation of federal drug laws.

RSF Pharmaceuticals, one of the pharmacies involved in the DEA searches, issued a statement saying Chao "did not write prescriptions for himself" and the medications "were for use by the Chargers medical staff to treat players."

The NFL and prescription painkillers

The NFL's medical adviser, Dr. Lawrence Brown, said the NFL has "at least six components of its programs that address the prevention and response to prescription drug abuse or misuse":

1. Education of players during the Rookie Symposium and players enrolled in the NFL Substances of Abuse Program.

2. Ongoing advisories to the medical staffs of teams as a part of the league's Prescription Drug Program.

3. Drug testing of all players to prevent and detect use, largely using the model of federal workplace drug testing.

4. Treatment and monitoring for players who are detected to have misused or abused prescription drugs.

5. Monitoring teams for their prescription/administration of analgesics (narcotic and non-narcotic).

6. An external advisory committee of experts in the area of drug use and abuse (including prescription drugs) to review and comment upon the relevant NFL programs.

Chao was never accused of abusing the medications, and no criminal charges were filed. The case is pending, according to the DEA. The Chargers declined to comment to ESPN, as did Chao, when reached through his attorney.

But the Chargers example helped clarify the legal gray area NFL team physicians frequently find themselves in when faced with athletes in pain.

According to a DEA spokesperson, it is commonplace for NFL team doctors to acquire and store large quantities of prescription painkillers with no patient in mind -- the idea being that team doctors are then prepared when players are injured, in pain and in need of relief. The practice is legal.

But ESPN learned that in August, DEA officials, mindful of the civil lawsuit in New Orleans and the developing situation in San Diego, hosted a meeting in Washington, D.C., which was attended by representatives of the NFL, including Dr. Connor of the NFL Physicians Society. Connor told ESPN the purpose of the meeting was so DEA officials could make certain NFL team physicians fully understood the federal laws governing the storage and safe handling of prescription pain medications.

"There's no question that the DEA is paying closer attention," Connor said. "The pendulum has shifted over to prescription pain medication, just as it was on the performance-enhancing drug issues in the past."

One area of concern for the DEA, Connor said, was the way in which painkillers were routinely given to players on NFL road trips.

According to several current and former NFL players who spoke to ESPN, it was commonplace for team doctors and trainers to hand out pain pills after away games.

Turley's memories of Vicodin being passed out on the team plane during his time with the Saints serve as a typical example.

"You can't do that. It's got to be somebody that's licensed to distribute within the state," said Rusty Payne, a DEA spokesman.

Payne said that only a DEA registrant, a team physician, can dispense prescription pain medication. Team trainers should never hand out the drugs, Payne said.

"The trainers are in a bad position," Turley said. "They are participants in a corrupt system. They are taking orders from team doctors and coaches. They are told to do whatever it takes to keep players on the field."

Leamor Kahanov, a professor at Indiana State University's Department of Applied Medicine and Rehabilitation and a certified athletic trainer, helped write the prescription drug protocols used by the National Athletic Trainers' Association, the governing body for NFL trainers. When told of the accounts of Turley and other players, Kahanov, who has not worked in the NFL, said: "We can't dispense medication. We have no prescriptive authority."

When asked specifically about Turley's account of Saints trainers handing out pain pills on the team plane, Kahanov said: "Whether those claims are true would need to be investigated."

Connor said NFL team physicians have recently taken steps to ensure they're in compliance with DEA regulations. Team doctors in host cities, for example, have now made provisions to make some of their "common stock" prescription painkillers available to visiting teams, Connor said, removing the need for a visiting team physician to prescribe drugs outside the area permitted by the state license.

"The expectation of the DEA is that people follow the rules. But I suppose … the expectation is that everybody will drive 65 mph and not everybody does," Connor said. A different road to the Super Bowl

Back in Nashville, Turley is busy pursuing his new career, which will lead him to this year's Super Bowl. He's in the midst of a music tour that will end in Dallas next week.

For Turley, now 35, the long days and nights spent on the road take their toll. For the past few years he's dealt with post-concussion symptoms, which he links to his NFL career, and frightening episodes of vertigo. Prescription painkillers remain a part of his life.

"I still get painkillers from a source that I have. Some days are worse than others," Turley said. "I've got a little stash of my own painkillers and muscle relaxers. I didn't get them from a doctor."

Turley is also a staunch proponent of legalizing marijuana for medical reasons and said he frequently smokes marijuana to relieve NFL-related pain.

Turley remains angry about the quality of medical care he received while in the NFL. When asked for possible solutions that might reduce the degree to which players rely on pain medications, Turley stressed the need for guaranteed contracts, so players won't feel such intense pressure to play injured.

"The majority of players walk away beaten and tattered," Turley said. "The reality is, it's a violent game, and the violent outcome is pain."

John Barr is a reporter in ESPN's Enterprise Unit. He can be reached through email jbarr-espn@hotmail.com. Enterprise Unit producer Rayna Banks contributed to this report.

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