'Ibuprofen handed out like smarties'

An investigation into the use of painkillers and other non-therapeutic medications in football has revealed a culture of substance abuse within the game that is harmful to players' health.

"A Kick On Pills," a cross-border study carried out by German public broadcaster ARD and the investigative research center Correctiv, found that over half of footballers questioned in an unrepresentative survey used painkillers several times throughout a season, and that more than 40% took them for non-therapeutic reasons.

In addition to the survey of 1,142 amateur players, the researchers also spoke to over 100 former and current Bundesliga players, as well as club doctors, who raised acute concerns over the prevalence of painkillers in the game.

'Handed out like smarties'

"I have noticed in the past 14 years that ibuprofen is handed out like smarties," said former Borussia Dortmund defender Neven Subotic, who currently plays for Union Berlin. "For every little thing, they give you ibuprofen as standard."

Subotic spoke of the pressure that clubs are under as result of the money at stake in the game. That pressure, he said, filters down to the coaches, to the doctors and to the players.

"In football, you always get these typical macho comments which make players feel guilty about not being able to play through the pain or through an injury," he said. "In the end, it's the player who is under the most pressure. He can't play unless he takes painkillers."

"You just have to function, you have to play. You have the next international tournament coming up and you don't want to miss out or underperform because of a bit of pain," added Dani Schahin, a former Hamburg, Fürth, Düsseldorf and Germany under-20 striker.

"Eventually, I simply couldn't play without painkillers. Even when I was fine, I took pills prophylactically so I could play freely and not worry about whether my knee would start hurting."

Thomas Frölich, a sports physician who has worked with top German coaches including Joachim Löw, Felix Magath, Ralf Rangnick and Julian Nagelsmann and who is currently the team doctor at Bundesliga side Hoffenheim, said he speaks regularly with players about the use of painkillers, but admits that it's not always easy to say no.

"If someone comes to me 45 minutes before kickoff, I cannot argue with him for half an hour, so I am a little more generous," he said. "But you have to try and get them out of the habit because they often have no pain at all."

'Misuse' of painkillers

Since 2002, FIFA has been monitoring the use of painkillers in the game. In 2018, world football's governing body found that one in four players at the World Cup in Russia were taking painkillers before each match. At the under-17 and under-20 World Cups in 2005 and 2007, almost half of players took painkillers.

"When we evaluated the numbers, we saw that the consumption of medications is enormous," the Swiss physician Jiri Dvorak, who led FIFA's investigation, told the researchers. "Taking painkillers for prophylactic purposes is misuse. It absolutely cannot be justified scientifically and is counterproductive."

As well as addiction, abuse of painkillers can lead to severe physical conditions, the study reports.

"There is a clear link between death caused by a heart attack and the use of nonsteroidal anti-inflammatory drugs," said Gunnar Gislason. The Danish researcher worked on a 2018 study that found that diclofenac, an anti-inflammatory popular among footballers, increased the chances of developing heart problems in the 30 days following ingestion.

"These medications affect the cardiovascular system," Gislason said. "We know they affect blood pressure. We know they affect the kidneys."

'Painkillers should be banned'

The researchers from Correctiv and ARD presented their findings to Fritz Keller, president of the German Football Association (DFB). Keller was "shocked" by the quantities of painkillers being taken by amateurs.

"This is actually counterproductive," he said. "Amateur sport is supposed to keep you healthy and not to break you. Painkillers as prevention — that's just stupid."

The DFB has said that it will try to draw attention to the issue and that it is planning a webinar for clubs. But experts and players alike are unanimous in their demands for even more action.

"I believe the whole system is missing an official who can ensure that everything is done properly," said veteran defender Subotic. "We need information about what happens after the career ends and the cases should also be made public anonymously — as a warning."

Former FIFA physician Dvorak was explicit: "[Painkillers] should be banned if they are not absolutely necessary."