When is a drug a drug? Pain management, masculinity, and morality

Photo by Sue via Flickr.

“You can’t imagine what it’s like to hear your captain, in a room down the hall, screaming at the top of his lungs as they injected the needle into his rib cage,” said Ronning. “Knowing him, he probably thought we couldn’t hear. He would then walk into our dressing room like nothing had happened. That was inspirational.”

Wagner – Vancouver is Awesome

Robin Lehner has become the centre of a firestorm for the NHL with respect to drug use, workplace exploitation, and player safety; but this is far from a new conversation in sports. Medically speaking, injuries have very clear cut definitions. An injury can be categorized as, “physical damage that results when a human body is subjected to energy that exceeds the threshold of physiological tolerance or results in lack of one or more vital elements, such as oxygen.” Sociologically, however, injuries and the resultant pain are far more fluid concepts.

When Jack Eichel’s medical issues became public fodder, Lehner spoke up and accused the NHL of medical malpractice for the way some teams hand out pharmaceuticals as if they are Tic Tacs. Lehner specifically references tranquilizers and sleeping pills but it has opened a much larger discussion about drug use in general and player safety. According to ESPN, the Buffalo Sabres would prefer Eichel undergo a fusion surgery, which would require a shorter recovery time. Eichel’s doctors, on the other hand, have recommended a lower risk procedure that should have better long-term outcomes. I think the most important thing to note is that the “Under the NHL collective bargaining agreement rules, teams have the final say on how to treat injuries.” So much for the “my body, my choice” rhetoric. Injuries are naturally part of physical activity but how we go about treating those injuries in high performance sport (and even in youth sport sometimes) exposes some misguided priorities.

If sport is where boys become men, pain and pain management is part of that life lesson (This is also an ideology that girls and women have adopted as a way to prove that they are “real” athletes). “War stories” about former injuries and surgeries have become one avenue for male bonding and can help determine hierarchies among men. Still, not all injuries are the same. Visible injuries that result in scars and casts are typically legitimized in ways that invisible injuries, such as post-concussion syndrome and PTSD are not. The clear cut return-to-play timelines for certain physical injuries are legitimized through medicalization (e.g., 6-8 weeks for a fracture to heal). For injuries that do not show up on an X-ray and are subject to personal experience (and honesty), they can raise questions about one’s dedication to the game and/or team. We use sport to normalize pain at a very young age. “Ironman” streaks are badges of honour that the sports media love, but we are starting to learn the true costs of these seemingly heroic feats of athleticism.

Ryan Kesler spoke up last year about his own health struggles associated with Toradol usage. Toradol has been more infamously tied to football. It is drug used in hospitals as a post-surgery painkiller. There is scant research about the long-term side effects of Toradol usage because it was never designed to be used longer than a few days. Toradol is especially dangerous while playing contact sports because it increases the chance of internal bleeding while making the athlete feel no pain. It is a magic potion for getting battered athletes game ready. Toradol usage has gone from a post-injury management tool to a preventative pre-game measure. In Kesler’s reflections, he explained:

“When it was really bad, I used Toradol,” says Kesler. “I never wanted to hurt the team, so I knew I had to play. And to play you’ve gotta take painkillers because if you don’t do that, you’re going to be labelled as a guy that doesn’t battle through injuries and that’s not something I wanted.”

Wagner – Vancouver is Awesome

Little did Kesler know that his pain management regime would result in colitis and Crohn’s disease.

I’m using this opportunity to highlight the award-winning work of King et al. (2014), in questioning what makes a drug a “drug” and how various drugs become moralized through gender, race, and morality. What constitutes a drug is always changing; hence, WADA’s (the World Anti-Doping Agency) ever changing list of banned substances. For example, between 1984-2004, caffeine was included on WADA’s list of banned substances. Yet, coffee is hardly what we conceptualize as a performance enhancing drug (even though many people use it as a daily “drug” of choice). Marijuana is undergoing the process of moving from “street drug” to pharmaceutical, and through that transition is marked as an illicit substance in some places while perfectly legal in others. There are also drugs that have been shown to be both potentially harmful to users and beneficial to athletic enhancement but are not yet on WADA’s list. Thus, the line between what is acceptable drug use versus unacceptable is constantly changing as a result of social, cultural, political, and scientific debates.

Still, while performance enhancing drugs have been marked as taboo for athletes, painkillers are fair game. King et al. (2014) write, “By contrast, the use of painkilling medications in elite sport is treated more dispassionately and has been largely if inconsistently concealed from public view” (p. 250). And, perhaps more problematic, is how team doctors, coaches, and teammates can be complicit in facilitating/fostering drug usage and addiction. Of 644 former NFL players surveyed, “71% claimed to have misused such substances (by, for example, taking more pills than prescribed) and 63% said they obtained them from illegal sources such as teammates, coaches, trainers, and drug dealers” (p.250). King et al. (2014) explain that steroids and painkillers are moralized differently and this difference enables questionable drug usage under the guise of player management:

Steroids are typically labeled as “performance enhancers” whereas opioids are rarely, if ever, understood to fall under this dubious designation, even though both categories of substance can be used to enable athletes to improve or maintain on-field performance. Thus, the distinction between steroids and painkillers has little to do with the ingredients of the respective substances or their effects. Rather, it is linked to a moral judgement that conceives of playing through pain with the assistance of drugs as emblematic of honour and courage, while using drugs to aid recovery from exercise or to build muscle is conceptualized as cheating. (p.253)

I guess the question is: What threshold of “performance” are we using? Is your maximum level of performance without any substance addition the threshold for performance enhancement? Or, is any enhancement considered performance altering? If I have a headache and popping an Advil makes my performance better than it would be without it, isn’t that an enhancement? If my back seizes up before a game and I take muscle relaxers, isn’t that an enhancement over my current physical state? As King et al. (2014) argue, our answers to these questions usually have more to do with perceptions of morality and what is allowed in the moment versus the nitty gritty of the science.

King et al. (2014) use the example of Brett Favre as someone who could be presented as a redemption story and moralizing discourse because his Vicodin addiction was framed as for the team. He needed to manage his pain in order to play, and he needed to play because the team needed him. Therefore, Favre was presented as a “legitimate drug user” and painkillers were coproduced “as a legitimate drug” (p. 252). It is a cycle that feeds unhealthy behaviours and exploitative workplace practices.

A comment posted on Hockey Night in Canada’s Facebook page about Tom Sestito’s experiences with drug use.

Where other recreational drugs or steroids have come to symbolize selfishness, painkillers symbolize selflessness. They are used to achieve a higher cause — to help the team. Painkillers also symbolize hard work. No one is trying to get out of practice or play fewer minutes; thus, painkiller use is virtuous. The Protestant work ethic that forms the foundation of Western sporting character elevates pain endurance as a pious endeavour. Suffering becomes equivalent to dedication. These social and cultural beliefs coalesce to create a situation where “violence and injuries become ‘occupational imperatives’ for professional athletes in North America” (King et al., 2014, p. 260).

One quote that King et al. (2014) highlight in their article comes from former NFL player, Deion Sanders: “Folks I never question a player’s injury but I do question a player’s heart.” Sport has drawn an arbitrary line between injuries and pain. As some of my students pointed out last year, their coaches often question if they are “injured” or if they are “hurt.” A medicalized injury means one is unable to play, but the subjectiveness of pain means that we can debate one’s dedication and desire. And, in an industry where everyone is replaceable, we force athletes into unhealthy decisions. Questioning an athlete’s “heart” is, in many ways, the most insidious thing we can do.

King et al. (2014) also point out that the decades long “war on drugs,” which was a state sanctioned scheme to criminalize young Black and brown men after the Civil Rights movement, set the stage for the racialization of drug use. Arguably, this is why leagues that are largely populated with Black men — the NFL and NBA — have formulated much stricter policies on drug usage than a white dominated league like the NHL:

One manifestation of this response was the introduction of new and tougher drug policies by both [the NBA and NFL]. In the NFL, these policies were legitimated through what was perceived as a “substances abuse crisis” among its players (Sisson & Trexell, 1991), which critics have noted was motivated less by concern for the athletes or evidence that drug use was actually widespread than by a concern for the league’s reputation, particularly among white fans. (p. 254)

By contrast, the NHL has historically been very lenient with recreational drug use. For example, Evgeny Kuznetsov’s cocaine usage was seen as neither here nor there for the NHL because it’s not a listed as a performance enhancing drug. Cocaine is also racialized as a drug for white folks with money; and, therefore, less problematic. When we look at how the penalties between crack cocaine use and powder cocaine differ, it’s hard to argue that it’s not about race (and class). The Anti-Drug Abuse Act passed in the 1980s, included the “100-1” rule, which “required a five-year mandatory minimum sentence for trafficking in 500 grams of powder cocaine or five grams of crack.” This disparity in sentencing drew obvious racial lines and helped undergird the public’s perception of what a drug user looks like. It’s time we expand our understanding of what a drug is and who actually uses them. Athletes are upheld as the pinnacle of health and picturing them surrounded by pill bottles does a lot of work in tainting our fantasies; it also confuses our interpretation of drug addiction.

We tap our sticks and applaud the player that returns to the ice after a big hit or what looks to be an injury. King et al. (2014) warn us to think about these incidents as equal parts grit and determination but also as “medical or technological accomplishment[s]” (p.261). If we really knew what went on underneath the stands to get these athletes ready for competition would we still applaud or would we grimace? If we are so proud of these displays of “grit and determination” why don’t we include Toradol injections and tranquilizer use as part of the pre- and post-game coverage? How would we explain this to the children glued to their television sets dreaming of being like their role models? We say that we value and venerate these athletes but until we lift the veil on their shady work conditions, we as fans are also complicit in perpetuating these expectations. Players are finally demanding that they be treated like human beings and we need to support them in this fight.

Works Cited

King, S., Carey, S., Jinnah, N., Millington, R., Phillipson, A., Prouse, C., & Ventresca, M. (2014). When is a drug not a drug? Troubling silences and unsettling painkillers in the National Football League. Sociology of Sport Journal, 31, 249-266.

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