July 11, 2016 - Dr. David Chao
Monday Morning MD: Giving out pain medicine "like candy"
Calvin Johnson created a stir with his in-depth interview this week. The recently retired Detroit Lions wide receiver spoke candidly about a wide range of topics. At one point the likely future hall of famer compared giving out pain meds to handing out candy. The way Johnson’s interview was promoted, it seemed like the nine-year veteran was going to slam the NFL and the Lions medical staff. In reality, after watching the interview in its entirety, I don’t feel that is the case at all and agree with a majority of what Megatron said. Let’s analyze the top five highlight quotes. “Team doctors and trainers were giving them (pain medications) out like candy.” If Johnson was referring to the accessibility of pain medication, where players could obtain pain medication thru the team doctors, that is indeed true. NFL players do not have to go to the local retail pharmacy like the rest of the world. However, that hardly means that pain medication wasn’t controlled and medically indicated. No formal prescriptions are written, because scripts are only needed if one is to the pharmacy. That doesn’t mean there wasn’t appropriate documentation and control. Doctors manually record each pill administered or dispensed. Team physicians chart or dictate every encounter to document medical examinations and use of medications. Players use to make fun of me for “talking to myself” into my dictaphone on game day. Most people are not aware that each medication, narcotic or otherwise, is tracked. Teams have a mandatory quarterly drug audit where every pill is accounted for. When news of the painkiller lawsuits came out, several players jokingly asked me how come I never “hooked them up” and why pain pills were not more plentiful to them. Johnson acknowledges that medication availability became more difficult in the later half of his career. Toradol for prophylactic use was discouraged and team doctors were no longer allowed to travel with any narcotic medication for road games. It was typical for a team athletic trainer to walk up and down an airplane aisle after a road game to pass out Advil or Tylenol, which can be considered painkillers. "The team doctor, the team trainers, they work for the team” This is certainly true. Keep in mind, team doctors only work for the NFL as a side job. They all have university or private practices and only a minor portion of their income is related to the team. To think that physicians would jeopardize their personal careers by knowingly mistreating players defies logic. Johnson added "and I love 'em, you know”. “They're some good people, you know. They want to see you do good.” I agree that a medical staff wants to return a player to the field and that goal is in alignment with players’ desires to stay in the line up. “You can't take Toradol and pain medicine every day” I certainly agree with this statement. During my 17-year tenure as team physician, we never used medication on a daily basis or to get thru a practice. Toradol, a strong anti-inflammatory with pain relieving properties which is in the same category as Advil, was used sparingly. Ketorolac, the generic name, is typically limited to 20 doses over a five-day period. Players received no more than 20 doses across an entire season. Our club even performed a Toradol study that showed it was safe to be used this way and presented it at the NFL Physicians Society meetings. On game days there may have been a line for Toradol, but players just didn’t jump into line. The use of medication was predetermined and consented. No one was forced or encouraged to take Toradol or pain pills to play. In fact, players were the ones asking for the medications. We rarely used Vicodin or other narcotics as we felt that might interfere with the mental aspects of football. "Concussions happen” There is no question that concussions are unavoidable in football. Johnson didn't come out and blame the league for knowingly putting players at risk, but he described a culture that demands that players play. There is no question the culture has changed but it is far from perfect as the Case Keenum situations still occur. Megatron missed only nine games in nine seasons and was listed on the injury reports for his ankle, knee, Achilles, shoulder, thumb, quadriceps, groin, thigh, hand, foot and back. Interestingly, Johnson was never listed for head injury, although he acknowledged he had his “fair share” of concussions. Note the second half of Johnson’s career was played with a spotter in the sky, sideline video injury review and independent neurotrauma specialists on the sideline. “Catching the ball hurt” I don’t doubt that Megatron played thru pain. He described getting his knee drained 12 times during one season. I have witnessed the everyday pain he spoke about. There is no question that catching a pass with his deformed finger with a boutonniere injury would be painful. He waited until retirement to have surgery, as the long recovery would have cost him game time. Fortunately, Johnson made over $100 million in his career, another few million wouldn’t change his life and he chose health. It does seem he had some gas left in the tank and there were other factors. He hinted at the Lions lack of winning. “If we would have been a contender, it would have been hard to let go. If the Lions could get out of their own way…” Johnson has the most receiving yards and touchdowns for any player to never win a playoff game. His 2008 team was the only team ever to go 0-16. For the most part, I agree with what Johnson said and I hope he makes the Hall of Fame. He harbored no grudges, made no accusations, nor pointed any fingers. There was honest dialogue from his point of view. This type of frank discussion from a players perspective only helps football and helps fans understand the game behind the scenes. Thanks for letting me share some of my reaction to his comments.