On Tuesday, the NFL Players Association filed a grievance related to the use of Toradol by team physicians, and specifically to requests that players sign a waiver as a precondition to administration of the drug, waiving the teams of all liability for its use. The grievance seeks to nullify any waivers already signed related to Toradol and to mandate that team physicians cease requiring players to sign releases as a condition of medical treatment.
ProPlayerInsiders has obtained a copy of the waiver required by the NFL teams, which is the subject of the grievance, and a copy of the waiver is attached below.
Toradol, known generically as ketorolac, is a non-steroidal anti-inflammatory drug (NSAID) used to reduce pain and inflammation. It is frequently used to treat moderate to severe pain for short term use, such as with patients after surgery.
NSAIDs as a class include commonly used pain killers like ibuprofen and aspirin, but Toradol doesn’t have nearly the long history of safe use that those other compounds have. Furthermore, it was designed specifically for short term use, primarily by oral administration, and was not designed for regular by injection, as it is commonly used throughout the NFL season to reduce pain and keep players on the field.
Toradol presents a whole host of potential health problems. The drug can cause kidney problems and stomach problems with long term use. The FDA guidelines state that the drug should not be used longer than 5 consecutive days, and while the drug is primarily used on game days, the use of the drug every weekend throughout a four month NFL season is not the way that the drug was designed or tested.
Even shorter term use of Toradol can inhibit the formation of blood clots, similar to the way that aspirin is used to inhibit blood clot formation for heart patients or patients at high risk of stroke. The difference from those uses is that a player engaging in the violent world of NFL football has a high risk of injury that could cause internal bleeding, including internal bleeding in the brain, and any form of internal bleeding is significantly worsened by the use of a drug like Toradol.
Furthermore, constant injections to reduce the perception of pain can result in players continuing to stay in the game after moderate injuries, greatly increasing the chances of a severe injury.
The waiver asks that NFL players to take all risks related to the use of the drug, abrogating the NFL of any responsibility for their doctors administering the drug. The request is troubling on many levels, as players frequently feel pressured by the team to get back in the game after an injury in order to keep their job. Although the waiver may lay out the risks and be presented in the guise of “educating” the players, it is ultimately a document that the players will feel forced to sign and seeking to wash the NFL’s hands of responsibility for a drug administered by some of their employees (the sports medicine staff) to other employees (the players).
The waiver states:
I HEREBY AGREE TO VOLUNTARILY ASSUME AND ACCEPT ANY AND ALL RISKS RELATED TO TAKING TORADOL, WHETHER KNOWN OR UNKNOWN, INCLUDING RISK OF MEDICAL COMPLICATIONS, PERSONAL INJURY AND DEATH.
The waiver highlights the conflict of interest that can arise between doctors employed by the team and the interests of the players, when the interests of the team and the health and welfare of the players are at odds. The NFL can’t paper over its responsibilities for player player safety and for the actions that take place within team facilities.
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