Painkillers: A big, and unregulated, part of college football

Garrett Anderson, all 6 feet, 4 inches and 307 pounds of him, was in pain.

"I was trying to play with a high ankle sprain and a broken hand at the same time," South Carolina's senior center said.

So before a 2007 game, Anderson received a shot of Toradol, a painkiller that is the injection drug of choice in college football locker rooms before and during games, or immediately following wins and losses that hurt more than most people realize.

"I had a (Toradol) shot after the Wake Forest game," Clemson senior cornerback Crezdon Butler said. "I had a neck injury and we had a long bus ride home after the game. I knew I wouldn't be able to make it -- sleeping and relaxing -- without a shot."

Needles get stuck into Gamecocks, Tigers, Citadel Bulldogs and players from colleges all around the country every Saturday. It's not just Toradol, a brand-name painkiller and anti-inflammatory also known by the generic name ketorolac. Marcaine (or the generic bupivacaine) is an injectable drug used to numb specific body parts.

Pain is an understood but under-reported part of college football. The use of painkiller injections is much less discussed and -- unlike the distribution of extra hamburgers or ballcaps to recruits -- almost completely unmonitored by the NCAA, the ruling body of most college athletics.

NCAA surveys are scant, with the Indianapolis-based organization admitting that it is unaware of the type and amount of painkillers injected into players each week.

Studies on painkiller prescription abuse among college football players are non-existent, despite a warning from NCAA-approved addiction counselor Marcus Amos that the problem is "rampant."

But there almost certainly were injections

Saturday when Clemson played at Maryland and South Carolina hosted S.C. State. At halftime of last week's upset of No. 4-ranked University of Mississippi, quarterback Stephen Garcia took some kind of shot -- he said it was cortisone, an anti-inflammatory steroid that is not a painkiller -- to get back on the field. C.J. Spiller, Clemson's Heisman Trophy candidate, went to the locker room during the first half of last week's 14-10 loss to Texas Christian University and said he took a shot before returning to a game in which he compiled 227 all-purpose yards.

"I did what I needed to do," Spiller said of his brief hiatus.

Tim Tebow too

South Carolina administered a total of 169 Toradol injections to players on game days over the 13 games of the 2008 season, according to records obtained by The Post and Courier.

Using the trade name of the drug for the 2007 season, South Carolina players received 133 ketorolac injections over 11 games (the school did not provide information for its 2007 game against the University of Kentucky).

Clemson gave 92 Toradol injections and seven Marcaine injections on game days during its 13-game 2008 season and 30 Toradol injections and 23 Marcaine injections over its 13 games of the 2007 season.

Players' names are not listed in the documents because federal privacy law protects the identity of individual painkiller users.

South Carolina delayed providing its records but relented after The Post and Courier reminded the university it was in violation of the Freedom of Information Act.

Players at the Football Championship Subdivision level (formerly NCAA I-AA) get painkiller injections, too. The Citadel administered 16 Toradol shots over its 12 games of the 2008 season.

Tim Tebow, Florida's All-American quarterback, revealed last month that he hurt his throwing shoulder in the 2008 opener against Hawaii and took painkiller shots before every other game during the Gators' national championship season.

Only doctors or nurses are authorized to give injections, though the NCAA does no spot-checking.

Toradol is a painkiller and anti-inflammatory "like Advil or Aleve, maybe a little bit stronger and in an injectable form," said Dr. David Geier, sports medicine director at the Medical University of South Carolina.

Toradol is used commonly in professional sports, including football, hockey and soccer.

Toradol/ketorolac shots are intramuscular, usually given in the buttocks or upper arm. Marcaine is a numbing drug injected into a specific body part such as a sore shoulder, Geier said.

Doctors and trainers say the drug does not cause players to risk further injury because it doesn't completely deaden the pain. The players can still feel it, just not as much.

"I don't think fans or our moms would be surprised," South Carolina senior defensive tackle Nathan Pepper said. "It's not like it's a shot of morphine or anything."

Not for everyone

Some players, such as senior cornerback Chris Chancellor of Clemson and junior defensive end Cliff Matthews of South Carolina, said they have not taken painkiller shots.

Matthews played with a broken bone in his right hand for most of the 2007 season, an injury suffered in practice just before his first college start. He said he never asked for or received a shot.

Rodney Paulk, a Gamecocks junior linebacker, said he regularly took Ibuprofen pills before 2008 games.

"But no shots," said Paulk, who is out for the remainder of 2009 after suffering a torn knee ligament in South Carolina's 7-3 victory at N.C. State in the season opener.

Sometimes players approach team medical staffers asking for pills or a painkiller injection. Other times, doctors or trainers suggest or recommend a shot, or oral medication such as Advil or Tylenol.

"If the athlete comes in and says, 'Hey, I'm sore,' or they have an injury or they have an injury during a game, it's a way to kind of kick-start the recovery process," Clemson Director of Sports Medicine Danny Poole said of Toradol injections.

Shots also keep the best players on the field, but not all schools think painkiller injections are a good idea. Coastal Carolina over its 12 game days of the 2008 football season gave out a total of 62 Ibuprofen pills, 39 Aleve pills and eight Tylenol pills.

But zero shots.

"Everybody does it a little bit different," Coastal Carolina Head Athletic Trainer Dwayne Beam said. "Not to say we would never give an injection in the future, but we're just very conservative."

'Something you assume'

Coaches, particularly head coaches, generally are not consulted when it comes to painkilling medication given to players.

"I don't get involved in any of that," South Carolina head coach Steve Spurrier said. "That would be between the player, doctor and trainer. Basically, as a coach, all I say is 'Can he play or not?' If they clear him to play, we play him. If they say 'He can't play,' we don't play him."

Poole and South Carolina Director of Sports Medicine John Kasik said their doctors do not give shots on the sideline. But players occasionally return to the locker room during games for shots, or take Toradol/ketorolac orally on the sideline.

"The great thing about Toradol is it's not only a pain medicine, it's also an anti-inflammatory," Poole said.

"It's not the kind of pain medicine people might think of that makes you feel very strange or drowsy. Toradol does not make you feel drowsy at all. It's a very safe medicine. It's almost like taking Tylenol, in a way. Plus it's also got the anti-inflammatory going for it."

Reducing inflammation and swelling is another way to treat pain.

Thomas Austin is familiar with the process. Clemson's senior left guard, considered by NFL scouts one of the best offensive lineman in college football, sprained an ankle against Florida State as a sophomore.

"I got Toradol at halftime for the next five or six games in a row to keep going," Austin said. "I know a lot of guys use it. All it does is lessen the pain a little bit. You still play with some pain so you know if it's really hurting you or not."

Austin said he has "complete trust" in the Clemson medical staff.

"They've been doing it for a long time and I believe they know what they're doing," Austin said. "For me, I want to get on the field and I'm going to do what it takes to do that."

Austin and Anderson are arch-rivals, a Tiger and a Gamecock set out on another "braggin' rights" collision course. But the fellow offensive linemen don't differ much in their views of painkiller medication.

"It's something you assume you're going to have to go through when you play college football," Anderson said. "We put our bodies through a lot of pain. We put on all kinds of pads but we hit each other as hard as we can.

"Taking a shot is not something you necessarily want to do because you want your body to last as long as possible. But what it comes down to is we want to go out there and play."

Reach Gene Sapakoff at gsapakoff@postandcourier.com or 937-5593.