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Whatever It Takes To Stay In The Game

Jay Conner/Tribune photo

Brad Culpepper, a former nose tackle for the Bucs, says he had no problem getting off pain medications when he retired from pro football in 2000, but some former NFL players aren't so lucky.

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By JOE HENDERSON | The Tampa Tribune

Published: December 28, 2007

The Tampa Bay Buccaneers were having a great season, and nose tackle Brad Culpepper didn't want to miss a minute.

An injured right heel had limited his practice time for weeks and even forced him to use crutches.

But as the Bucs kept winning and drawing closer to their goal of reaching the Super Bowl, Culpepper understood what it would take to stay on the field.

For about eight weeks during the 1999 season, he followed a regular routine, taking several doses of Vicodin, a powerful painkiller, just to get through weekdays.

Game day required more medication, plus a pregame injection of Novocaine to numb the heel.

The problem became worse when he snapped the plantar fascia in his foot during the last game of the regular season.

It did not stop him.

"I wasn't not going to play — especially for something like that," he said. "If I can't injure myself worse, then give me all the pain meds you can so I can get out there."

So when the Bucs reached the NFC Championship game at St. Louis, 275-pound Culpepper said he received "eight or nine" Vicodin pills from the Bucs along with the Novocaine injection. A recommended adult dose is four to six pills daily, but it didn't matter.

"If I had to take 20, I would," he said.

Drugs such as Vicodin carry warnings about the danger of addiction and potential damage to the liver and other organs, but Culpepper, now a lawyer in Tampa, said he had no problem leaving the pills behind. He retired from football after the 2000 season but has remained physically active, even completing a marathon. He said he uses only small amounts of medication now to combat routine aches and pains.

Green Bay Packers quarterback Brett Favre voluntarily entered the NFL drug treatment program in 1996 because of an addiction to Vicodin to combat the pain from injuries. He was taking up to 13 at a time. He returned to the field after completing treatment and continues to play today at a high level.

Favre's admission created a brief stir, but the public's focus soon turned elsewhere. Doctors say the problem hasn't gone away, though. They are seeing large increases in the number of current and former football players either addicted to or physically dependent on painkillers.

"Pain meds are 10 times more common [in sports] than steroids," said Alex Stalcup, a California doctor who treats many athletes with addiction problems. "As a group, they are given huge amounts of opiates without any critical judgment to their use.

"When I see them, they have been using very large amounts — very large amounts — often for a year, or two, or three. They're trying to keep their careers going, and they have a monster drug habit."

The NFL acknowledged the problem and said players have been suspended for abusing pain medications — although it would not identify how many violations occurred or what drugs were involved.

"Team physicians prescribe medication to players as necessary to help manage injuries. Although we have seen no evidence of significant misuse of painkillers in the NFL, we recognize that some players may obtain analgesics from other sources in a potentially dangerous way," NFL Senior Vice President Greg Aiello wrote in an e-mail.

"Addiction to painkillers occurs throughout the general population, and we will continue to closely monitor it as it relates to our players."

For some players, drug use to numb the pain is as much a part of their preparation to play as tape or shoulder pads.

Former Bucs defensive end Simeon Rice, who has played with three teams, said, "I know guys who get shot [with painkillers] before every game. I know guys who go through a whole ritual every day just to practice — take shots, get pills.

"I've had guys walk up to me [in the locker room] and ask, 'You got those Percocets? You got those Dr. Feelgoods?' Maybe if you took it away for like a month — say the NFL doesn't pass those things out — it might show how much people really rely on those things. It might open some eyes."

The Prevalence Of Pill Poppers

Doctors say they are only now beginning to understand the scope of the problem. Stalcup said he sees college and even high school players in his clinic along with current professional players.

"Percentage-wise, it's the fastest-growing group," Stalcup said. "Drugs come in trends, in waves. The current wave is pills, pills, pills. We see pretty regularly young athletes who have lost control. We're in big trouble with pill opiates.

"If I wanted to score some pill opiates, the first person I'd see is a football player. Doctors hand 'em out in large quantities to jocks because they figure he's in pain, so by all means give him all he wants. Give him a refill. Everybody knows what's going on, and nobody says anything."

It's also easy to obtain the drugs from Internet pharmacies, many of which require only an order form and a credit card. Or they can try to shop around for prescriptions from several physicians — a practice known as doctor-shopping. And long-term pain is a powerful motivating force.

"The body is not meant to take the punishment that is administered in the NFL," former Miami Dolphins star Mercury Morris said.

While playing for the University of Florida, former Bucs linebacker Scot Brantley needed knee surgery and was prescribed Percodan for the pain.

"I know I got addicted to that," he said. "It really scared me, so I quit cold turkey. It just made me feel odd, made me say stupid stuff. I figured out right away that I needed to get off that stuff."

But that's not always easy. Brantley said he had a flashback this summer after he had hip replacement surgery. Doctors gave him OxyContin as part of his postoperative regimen.

"I took two or four of those things, and I started getting that old feeling [of addiction] again," he said. "I stopped right away. But I know guys use that stuff. When you're playing, the last thing you want to do is come out of a game because the guy behind you will take your job.

"That affects you and your family, so you'll do what you can to stay out there. Guys might not want to say it, but that's how they feel."

Dave Pear, a Bucs nose tackle from 1976 to 1978 and the team's first Pro Bowl player, said abuse "is so widespread, but the problem is that football teaches you to work through it. If you have a problem and ask for help, it's a sign of weakness."

Bucs defensive end Kevin Carter, a 13-year veteran of the NFL, said, "I think it's something that definitely needs to be addressed.

"I've seen guys who take way too many painkillers. It happens. Obviously we're in the kind of business where people are more prone to get addicted to something. People find a vice to get them through it."

NFL Does Monitor Medications

Like all NFL teams, the Bucs have a medical staff that treats players and hands out medications if warranted.

"It's not like there's a giant candy jar out in the open that you just go stick your hand into and pull out the meds," Culpepper said. "They keep it under lock and key."

Culpepper said it took more than general aches and pains to get medication and that if doctors suspected players didn't need the pills to combat specific injuries, the players would be refused.

Bucs team physician Joseph Diaco, citing privacy issues and team policy, wouldn't talk about the team's medical procedures, except to say the staff is generally conservative about handing out painkillers.

Medication is supposed to be dispensed only with the approval of the team doctor, and under the league's substance abuse program, a player can risk suspension for misusing prescription medicine.

Aiello said the league conducts an annual audit of pain medication prescribed by team doctors and requires the league's health insurance provider to audit prescription medication claims by players. If the painkillers show up during regular drug tests given to the players, it can raise a red flag that will cause the league to monitor the players more closely.

"Our medical advisers to the substance abuse program are addiction medicine experts and have other addiction specialists available for consultations to players and teams," Aiello said. "Those consultations are mandatory when directed for cause by the program doctors."

Players who abuse meds may be increasing their risk of a lifelong habit along with the potential for greater injury because their pain is masked. The medication may allow them to get on the field, but the influence of the drugs on motor skills and reaction time can impede performance and leave them vulnerable to more injuries.

"I don't think the American public has any idea of the number of [players] out there running around on the field every day who are loaded," Stalcup said. "I tell them they're in danger. They say, 'Doc, I get $130,000 a game. I'll deal with it later.' They have brief careers, a high risk of trauma, and they'll take as much dope as they need to carry on their careers."

Going To Break Down

The abuse of pain medication isn't confined to football players. Local law enforcement officials say they see the problem throughout society, and the American Medical Association estimates that 10 percent of Americans are dealing with chronic pain.

There are no reliable numbers on how many people are addicted or physically dependent on medications.

"Pain in America tends to be a problem for just about anybody," said Douglas McKeag, director of the Indiana University Center for Sports Medicine. "This isn't unique to professional sports. We see a lot more arthritis — particularly arthritis that isn't being tolerated — and we're seeing it younger. The whole idea of playing through pain leads to more pain. We're seeing more intense training for an athlete than we've ever seen in the past."

"Many people who excel in sports today have participated in that sport since they were a small child. You see the tennis players today, baseball pitchers or the football players. If you continually stress certain parts of the body without giving them relief, you will probably wear out that particular part of the body."

But when a sport is as violent as football, the need to combat intense pain can drive a person to do whatever is necessary to get relief.

"There is no answer on this," Culpepper said. "People say there is no easy answer, but I don't think there is an answer."

Reporter Joe Henderson can be reached at (813) 259-7861 or jhenderson@tampatrib.com.

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