Beyond the War on Drugs? Notes on Prescription Opioids and the NFL

Drugs and Consumer Capitalism: Contestations and Contradictions

By the time OxyContin—the opioid most often referenced in stories about former players—came on the U.S. market in 1996, American consumers had been well schooled in the idea that medical consumption was part of what constituted a good middle-class life (Herzberg, 2010; Woloshin, Schwartz, Tremmel, & Welch, 2001). Their schooling occurred within a broader context in which consumption had become not simply an ideal but an obligation of proper citizenship. Since the late-1970s, this consumerist logic has merged with governmental-corporate strategies to devolve responsibility for health to the individual, with the effect of massively expanding the purposes for which pharmaceuticalized drugs are used (Greene, 2007; Moynihan & Cassels, 2005; Petersen, 2008; Williams, Martin, & Gabe, 2011).

Pharmaceuticalization (Williams et al., 2011), or what we can think of as the legal drug culture of the “respectable classes” (Herzberg, 2010), does not proceed seamlessly, however. For opioid use, like all drug use, is bound up with tensions that exist at the very core of consumer capitalism: On the one hand, the ability to consume drugs freely to function—as a productive worker, a self-responsible citizen, or, in the case of alcohol, a fun-loving and socially well-adjusted member of the society—is an expectation, if not an obligation of proper citizenship. Within this framework, former NFL players, whose pain is made believable through vivid media portraits of corporeal breakdown, are positioned as legitimate users of prescription painkillers. ¹ On the other hand, consumer subjects are required to exercise unceasing self-discipline lest their ingestion practices become excessive or unseemly (Derrida, 2003; Featherstone, 1982; O’Malley & Mugford, 1991; Race, 2009; Reith, 2004; Sedgwick, 1994). Thus, when the self-care practices of such players threaten to expose cultural contradictions by moving beyond what is framed as sensible and responsible self-medication they must be opportunistically “scooped off,” to use Kane Race’s (2009) term, so that morally sanctioned consumption may continue apace. Such a process becomes especially crucial when subjects who use painkillers become seen as a fiscal burden on the state, or on the NFL and its retirement fund.

Viewed from this perspective, stories about former players and their opioid dependencies might best be understood as sites for the enactment of deep-seated tensions between about what counts as responsible or irresponsible consumption, as texts where the excess that these players represent may be scooped off and managed. The process of discursive management that unfolds shapes narratives about prescription painkiller dependence that appear empathetic, but which under close scrutiny are revealed to inadequately account for the institutional pressures that shape drug use or pathologize drug users. For example, a 2011 episode of ESPN’s Outside the Lines documentary series on painkillers in the NFL, which was one catalyst for current interest in these drugs (King et al., in press), begins as a devastating story about long-term bodily damage suffered by some former players and ends as a morality tale about opioid misuse in which Dan Johnson, former tight end for the Miami Dolphins, is shown struggling with an addiction and an inability to tell the truth. This is not to suggest that Johnson’s dependent relationship to opioids is a fiction; rather, it is to point to the way that seemingly benign portrayals such as this may occlude the social and economic conditions—the working environment of the NFL, the marketing of prescription drugs, the inaccessibility of effective pain management, and the challenging financial circumstances—that help produce such relationships in the first instance.

Shifting notions of responsibility are compounded by the NFL’s public relations response to concerns about opioid use, which has been to make opportunistic claims about the problem of painkillers exceeding the league and thus, by implication, not of its making: “The whole issue of pain meds is a big, important issue in our society well outside the NFL,” Jeff Pash, the NFL’s executive vice president, told the Washington Post in a 2013 interview (Jenkins & Maese, 2013b). At one level, Pash is correct. Due to the aggressive and often misleading marketing strategies of pharmaceutical companies and the compliance of their allies at the Food and Drug Administration, sales of prescription painkillers—and overdoses ascribed to their use—have skyrocketed since the late 1990s; in the process, opioids have become the focus of major public concern. Among the most frequently cited statistic is the 300% rise in the sale of opioid painkillers in the United States since 1999. Growing consumption has been accompanied by a threefold increase in deaths from drug overdoses in the period 1990 to 2008, with prescription drugs allegedly involved in 14,800 deaths in 2008 alone, more than heroin and cocaine combined (CDC, 2011). At another level, however, it should go without saying that it is disingenuous for the NFL to discount the very specific circumstances that encourage and enable widespread painkiller use among its players.

NFL crisis management strategies notwithstanding, narratives about the “prescription drug epidemic,” and about former NFL players, are helping to unravel the hierarchical distinction between prescription opioids and street opioids that has held sway for so long. Opiates have been regulated in the United States since 1914. Oversight of the import, manufacture, distribution, and possession of these substances emerged out of complex conjunctures of racist and anti-immigrant hostility forged through accusations about the alleged threats, sexual and narcotic, posed by Black and Asian men to White women (Musto, 1999). The particular social hierarchies organizing drug regulation have shifted over time, but street materializations of opiates, such as heroin, have remained central to the punitive and racially discriminatory approach toward “illicit” drug users and suppliers that define the war on drugs; even as billions of dollars have been spent on promoting their pharmaceutical equivalents to doctors and their patients (OxyContin, for instance, is just one or two molecules removed from heroin in its chemical structure). But in recent years, more resources in the administration of the war on drugs have been devoted toward the illicit distribution and consumption of licit drugs, particularly prescription opioids. As with past drug panics, professional sport is emerging as a key site for the performance of moral regulation and legal sanction: It turns out that the research study that formed the basis for the Outside the Lines episode was proposed and funded by the National Institute of Drug Abuse, the research arm of the U.S. government’s drug war. Moreover, stories of players arrested for prescription painkiller-related charges are becoming increasingly common (Associated Press, 2011, 2012; ESPN, 2008; Jensen, 2009).

The main approach undertaken to manage the contradictions inherent in opiate regulation and in distinctions between licit and illicit drugs has been to focus less on the chemical properties of suspect substances, or on the physical dangers that consumption is thought to present, and more on the ways that drugs are used or “misused.”

Indeed, a focus on misuse is a virtual requirement since these drugs are licit, and authentic reckoning with the hazards posed by prescription pharmaceuticals, the drugs of choice for many middle- and upper-class Americans, remains largely excluded from dominant discursive regimes. Unlike heroin use, which because of the drug’s illegality is defined as deviant no matter who uses it and for what purposes, prescription opioid use becomes viewed as a problem only when its procurement or ingestion deviates from methods approved by professional authority; that is, when it is taken in greater quantities than prescribed, when it is stolen from a pharmacy, when it is sold by a person with a prescription to a person without one, when it is procured by a patient who is “doctor shopping,” or when the drug’s slow release formula, touted by its manufacturer as a deterrent to addiction, is subverted by the simple act of crushing the pill with a thumbnail and then snorting or injecting the fine white powder that results. Unsurprisingly, the NFL’s Policy and Program for Substances of Abuse replicates such logic by defining “abuse” of prescription drugs as the “use of a prescription drug without a prescription issues to the player by a licensed health care provider,” or the use of a prescription drug more than 30 days after the expiration date of the prescription (National Football League, 2010).

Hence in the ESPN Outside the Lines episode, “misuse” is presented as the central problem facing former players. The narrator tells the audience that 63% of players who used opioids during their careers “obtained them illegally.” Dan Johnson, we are told, took over 1,000 Vicodin tablets per month, acquiring the pills through the Internet, acquaintances, and overseas shipments. No acknowledgment is made of the role of team doctors or trainers in creating or maintaining player dependencies (even though Johnson has made it clear elsewhere that he also received plenty of authorized doses), or of the fact that it is possible to become reliant on opioids, or indeed to overdose, when complying with doctors’ recommendations. Johnson is also shown to have lied in his first interview about the amount of drugs he was taking at the time it was filmed, and when he is “finally willing to tell us the truth about his drug abuse,” he reveals that he feared being cut off by his doctor had he been forthright with ESPN about taking two to three times more pills than prescribed.

Conclusion: Beyond Bifurcation

While Johnson is depicted here as a reckless, if sympathetically portrayed, hyperconsumer, it is also possible to read him as an exemplary citizen who is taking responsibility for his health as prescribed—if not by his doctor, by the broader neoliberal culture in which he lives. Regardless of how one chooses to read this particular vignette, it is evident that concerns about the use of prescription opioids among professional football players offer a stage for the ideological performance of shifting and contested notions of responsibility and that they force us to rethink simple or convenient distinctions between licit and illicit drugs, drug users, and suppliers.

As debates about painkillers in the NFL rage, it is vital to hold the league accountable for the long-term health and safety of its players, but to do so in ways that undermine rather than intensify pathologizing and punitive approaches to drug use. Rather than defending certain forms of procurement and use, and criticizing others, such distinctions must be brought into question. As of now, there is growing recognition that the structure of the NFL workplace needs to change, but little acknowledgment of the need to reexamine the premise of the drug war or, on a smaller scale, NFL drug policy and practice. In a recent article in this journal, Dylan Bennet (2013) argues that the NFL approach reinforces the punitive tradition in U.S. drug policy by (often publically) punishing players with enforced abstinence, suspensions from work, and loss of pay. While Dylan focuses on illegal psychoactive drugs such as ecstasy and marijuana, his powerful case for the reform of NFL policy in favor of a harm reduction approach could—and should—be applied to painkiller, steroid, alcohol, and other substance use. Such an approach would allow for a more honest accounting of which drugs do what and for whose benefit (for drugs do do something), one not so “overdetermined by established ethico-political norms” (Derrida, 2003, p. 20). Viewed in this light, current concern about prescription painkiller use among NFL players offers an opportunity to broaden our frames of reference for understanding drugs in sport, to make connections across arbitrarily drawn categories of substance that reinforce economic and social hierarchies, and to intensify pressure on elite sport institutions—and the state—to revisit the disastrous and futile war on drugs.