As Peter Gent described vividly in his 1973 book “North Dallas Forty,” the NFL used to be the Wild West when it came to prescription pills — players grabbing fistfuls and popping them like candy, doing whatever they felt was needed to get through their injuries and stay on the field.
Even into the 21st century, players would line up 20 deep before a game to get their inflammatory injections — “the Toradol train,” as NFL Players Association medical director Thom Mayer called it.
“At that time, no one knew who got it, how much they had gotten, and no one knew how many times they had gotten those injections,” Mayer said.
The NFL in 2019, though, is in a much different place. As Mayer said, “We’re long past that now.”
In May, the NFL created several new programs to address pain management and mental health, and one of the most interesting initiatives is a Prescription Drug Monitoring Program (PDMP). The NFL now has an internal database in which every pill that a player is prescribed — whether from the team’s doctors or a player’s own, unaffiliated doctor — will be logged and easily accessed by all 32 teams.
Now when players bounce from team to team, each medical staff will know exactly what a player is taking and what he is dealing with.
“It’s a very positive step, and one which was jointly arrived at in a way that works for the people who have pain and the people who are treating that pain,” Mayer said. “We can finally say who got what, which medication, for how long, and the reasons for that.”
The other programs that were created in May were a Joint Pain Management Committee, with representatives from the NFL and NFLPA to conduct research and establish NFL policies; and a decree that each team must appoint a Pain Management Specialist who possesses certain agreed-upon credentials.
Of course, the NFL didn’t arrive at these policies on its own volition. Former Chicago Bear Richard Dent filed a class action in 2014 over the NFL’s distribution of painkillers, and the widow of former fullback Chuck Evans filed a separate one in 2015. The DEA raided several visiting team locker rooms one day in 2014 in relation to the Dent lawsuit, looking for evidence of wrongdoing by team doctors and trainers. And in 2017, the NFLPA filed a non-injury grievance against the league for how team doctors were distributing painkillers and not ensuring compliance to “all federal, state, local requirements, including all ethical rules . . . and professional standards.”
Both lawsuits were eventually dismissed earlier this year, but the legal spotlight plus the union’s grievance led to the creation of this database.
“The league, the NFL Physicians Society responded when the Players Association said this isn’t safe and shouldn’t be done,” Mayer said. “This is a tremendous success story. It really makes a patient a part of the team when it comes to pain management.”
The NFL’s PDMP is similar to the databases that are now present in 49 states and the District of Columbia (Missouri is the lone holdout).
“This isn’t just about pain pills or opioids. This is about other strategies for treating pain and other strategies for the prevention of pain,” said Dr. Allen Sills, the NFL’s chief medical officer. “And I think it’s a very positive advance. It really goes to the root of not only knowing what patients are taking, but making sure there aren’t drug-to-drug interactions. We all know that medicine that’s siloed and non-communicative is not in anyone’s best interest.”
Sills noted that teams were required to document prescriptions in the past, but medical files weren’t as easily shared between teams.
Sills hopes that the creation of the database will accelerate the league’s research with pain management — not only with opioids, but also Toradol and CBD and several other medicines.
“What’s new about this program is the league and the PA will review all this data and will come up with recommendations for how we can improve, and also what research questions we may need to derive from this,” Sills said. “Because we’re also both interested in trying to improve what we’re doing and find better ways of treating and preventing pain.”
“If you look at the history of concussion, we really were able to start understanding concussions when we were able to document exactly what was happening,” Sills added. “As soon as we understood exactly how many concussions were happening, and where and when, then we can start to think about it in preventative strategies.
“I think this is another step on that pathway. Once we understand what the patterns of treatment are, we’ll be better able to inform and ask important questions and to get better as a league around this issue.”
Sills said the NFL’s Wild West days are long behind it, but the league still has a lot it can learn about how players deal with and overcome pain.
“We’ve been in a very different place, certainly over the last decade, with how pain is approached in the league. The idea that players are lining up to get shots before games, you don’t see that happening in our locker room anymore,” Sills said. “I think we’ve seen a lot of progress in that area, but obviously this program that we’re rolling out takes that to a whole ’nother level.”