In Hockey Enforcer’s Descent, a Flood of Prescription Drugs

[sarsippius]

http://www.nytimes.c...&pagewanted=all

In Hockey Enforcer’s Descent, a Flood of Prescription Drugs

In his final three seasons playing in the National Hockey League, before dying last year at 28 of an accidental overdose of narcotic painkillers and alcohol, Derek Boogaard received more than 100 prescriptions for thousands of pills from more than a dozen team doctors for the Minnesota Wild and the Rangers.

A trove of documents, compiled by Boogaard’s father, offer a rare prescription-by-prescription history of the care given to a prominent, physically ailing athlete who struggled with addiction to some of the very drugs the team doctors were providing. The scores of prescriptions came before and after Boogaard’s entry into the league’s substance-abuse program in September 2009 for an addiction to painkillers and sleeping pills.

Among the findings:

¶ In a six-month stretch from October 2008 to April 2009, while playing 51 games, Boogaard received at least 25 prescriptions for the painkillers hydrocodone or oxycodone, a total of 622 pills, from 10 doctors — eight team doctors of the Wild, an oral surgeon in Minneapolis and a doctor for another N.H.L. team.

¶ In the fall of 2010, an official for the Rangers, Boogaard’s new team, was notified of Boogaard’s recurring abuse of narcotic pain pills. Nonetheless, a Rangers team dentist soon wrote the first of five prescriptions for hydrocodone for Boogaard after he sustained an injury.

¶ Another Rangers doctor, although aware that Boogaard also had been addicted to sleeping pills in the past, wrote nearly 10 prescriptions for Ambien during Boogaard’s lone season with the team.

The records reveal the ease with which Boogaard received prescription drugs — often shortly after sending a text message to a team doctor’s cellphone and without a notation made in team medical files. They also show the breadth of the drugs being prescribed, from flu medications and decongestants to antidepressants and anti-anxiety pills.

Most striking, though, are the narcotic painkillers and sleeping pills, which Boogaard had a history of abusing.

“To see him have all that access to those doctors and all those prescriptions, that is mind boggling,” said Dr. Louis Baxter Sr., the executive medical director of the Professional Assistance Program of New Jersey and immediate past president of the American Society of Addiction Medicine. “He had such easy access to prescription medicines.”

The records paint an incomplete picture. They do not show what Boogaard told doctors or the degree to which he may have misled them. They do not indicate what the doctors knew, if anything, about Boogaard’s pursuit of drugs bought illicitly on his own. They do not reflect whether the doctors knew what other doctors were diagnosing or prescribing.

But, at the least, the records raise questions for hockey and professional sports of all kinds. Do team doctors communicate with one another about the care they are giving or the drugs they are prescribing? Do they demand to see a player before writing a new prescription? Are team medical records monitored and complete? How much information is shared among doctors, team officials and administrators of programs like the N.H.L.’s Substance Abuse and Behavioral Health Program? Can a hockey player, especially one paid to inflict and to absorb pain, continue a career with an addiction to painkillers? And what role does the league play in all this?

The N.H.L., teams, team doctors and substance-abuse program directors involved in Boogaard’s care all declined to discuss any of that.

The league, the Wild and the Rangers were given specific examples of the care that Boogaard received. Each released two-sentence written statements defending the care and citing the guidance of the league’s Substance Abuse and Behavioral Health Program.

None of the doctors mentioned in this article would comment. Neither would Dr. Brian Shaw or Dr. David Lewis, co-directors of the Substance Abuse and Behavioral Health Program that they founded in 1996 through the N.H.L. and its players association. They took on oversight of Boogaard’s care after he was placed in rehabilitation in 2009. Dr. Lewis is a psychiatrist on the staff of the Canyon, a rehabilitation center in Malibu, Calif. Dr. Shaw is a psychologist based in Toronto.

Little is known about their program, even within the N.H.L.’s league offices. The league, saying that privacy is paramount, has said that it does not know at any one time which players are enrolled in the program. Requests to interview the directors, even about the general parameters of their program or their ability to oversee three leagues with more than 1,500 athletes, have been routinely denied.

A Player Needing Help

Derek Boogaard was an unlikely N.H.L. star. When he was a boy, his limited hockey skills were offset by his size and his willingness to use his fists. Raised in small-town Saskatchewan, he grew into a feared 6-foot-8 brawler.

He became one of the most popular players for the Wild before signing with the Rangers for $1.6 million a season. It was a rare sum for an enforcer, someone whose role is like that of a playground bodyguard — to intimidate, and occasionally beat up, opposing players, whether to settle a simmering dispute or to excite the crowd.

In six N.H.L. seasons, Boogaard scored 3 goals and was assessed 589 minutes in penalties.

His life was explored in a three-part series in The New York Times in December.

After Boogaard died on May 13, 2011, his family donated his brain to researchers at Boston University. In October, the family learned that Derek had chronic traumatic encephalopathy, or C.T.E., a brain disease caused by repeated blows to the head. For now, it can only be diagnosed posthumously, but some of the symptoms include memory loss, impulsivity and addictive behavior.

But Boogaard’s father, Len, wanted to know more. He has been a member of the Royal Canadian Mounted Police for most of 30 years, much of it as a small-town street cop. He set out on a hunt for documentation of his son’s life and the care he received as things went from bad to worse to unthinkable in Derek’s final years.

He requested and received Derek’s medical records from the Wild. The Rangers initially refused, but Boogaard eventually received them through the players association. He asked for records from the private practices of team doctors, too, and received them from most.

It seems certain that the records received were not complete. Many were missing pages. One practice’s file did not include a particular doctor who cared for Boogaard extensively. A dentist sent X-rays with no explanation.

Len Boogaard also obtained pharmacy records for his son through various drugstore chains. They provided store-by-store accounts of Derek Boogaard’s prescriptions, with dates, doctors, medications and dosages. After discovering the four-digit number used to identify Derek Boogaard to the drug-testing lab used by the N.H.L.’s substance-abuse program, Len Boogaard was sent his son’s drug-test results. He obtained a stack of notes from Derek’s stays at two California rehabilitation clinics.

He had hundreds of pages of Derek’s cellphone records. He organized the phone numbers of doctors and substance-abuse program officials to determine Derek’s day-by-day contacts with them. He had Derek’s bank and credit-card records, showing everything from fast-food purchases to binges of ATM withdrawals totaling thousands of dollars, believed to be used when Derek bought more painkillers from dealers.

Len Boogaard knows that his son supplemented his drug habit with purchases of pills from dealers in Minneapolis; New York; and Regina, Saskatchewan. But he has found no sign of abuse until injuries sustained in fights were followed by steady streams of pills provided by team doctors.

“Derek was an addict,” Len Boogaard said. “But why was he an addict? Everyone said he had ‘off-ice’ issues. No, it was hockey.”

At 7:11 p.m. on the date Derek Boogaard died, about an hour after the Minneapolis police say he was given at least one Percocet (oxycodone and acetaminophen) pill by his brother Aaron, Derek called Dan Cronin, a counselor for the league substance-abuse program, phone records show. The call lasted a minute. Boogaard and Cronin then exchanged seven texts over a 12-minute period. Boogaard went barhopping with friends and Aaron that night. Aaron and another brother found Derek’s dead body in his apartment the next afternoon.

Len Boogaard later contacted Cronin to ask about the nature of the exchange, wondering what his son’s last messages were to the counselor helping oversee his care. Cronin, in an e-mail, cited “privacy rules” and declined to answer Len Boogaard’s questions. He declined to answer questions from The Times, too.

Dr. Lewis and Dr. Shaw, co-directors of the program, referred all questions to the league and its players association. The N.H.L. provided a written statement: “Under the auspices of the NHL/NHLPA Substance Abuse and Behavioral Health Program, an NHL player receives individualized — and confidential — medical treatment, care and counseling. Based on what we know, Derek Boogaard at all times received medical treatment, care and counseling that was deemed appropriate for the specifics of his situation.”

The players association declined to comment. The Wild and the Rangers responded with short, written statements.

“The Minnesota Wild treated Derek’s medical status in accordance with the NHL/NHLPA Substance Abuse and Behavioral Health Program as we do with all our players,” the Wild wrote. “Due to patient-doctor confidentiality, the team is not able to comment further.”

It was pointed out to the Wild that most of the team’s care being questioned by Boogaard’s father came before Boogaard entered the program. The Wild stood by its statement.

The Rangers wrote: “We are confident that the medical professionals who treated Derek acted in a professional and responsible manner and in accordance with their best medical judgment. They took extraordinary steps to coordinate the medication prescribed for him with the professionals in charge of the NHL-NHLPA Substance Abuse and Behavioral Health Program.”

The Times shared Len Boogaard’s research with several outside experts in the drug and addiction fields. Most were reluctant to comment on Boogaard’s precise care without knowing the specifics of his injuries and the corresponding advice and counseling he may or may not have received.

But they took note of the persistently high dosages of medications Boogaard was prescribed, and the seeming lack of a primary doctor overseeing his care.

Baxter, from the American Society of Addiction Medicine, cited a three-step process for addicts: detoxification, rehabilitation and continuing care.

“Continuing care is probably the most important part,” Baxter said. “And it looks like he didn’t have much of that.”

Boogaard’s case provides a window into a world usually shuttered to outsiders. Like most major professional sports teams, the Wild and the Rangers have many doctors — eight for the Wild, seven for the Rangers — from orthopedic surgeons to dentists.

Team doctors are rarely seen by fans or journalists, but their decisions can determine everything from who plays in the next game to the long-term direction of lucrative careers. The doctors presumably want to provide top-notch care, and might have been chosen by the teams based on strong reputations. But their unusual role suggests an inherent tension in their work. Players, accustomed to pain and concerned about contracts, want to play. Teams, with fortunes riding on wins and losses, are eager for their top players to perform. The doctors usually have private practices, which they often market by boasting of their team affiliations.

Team doctors often want to help athletes return to competition, so “the tendency is to overtreat,” said Dr. Jane Ballantyne, a professor of anesthesiology and pain medicine at the University of Washington. She also noted that because the famous athletes have access to virtually any doctor they want, they often receive whatever treatment they want.

Gregory J. Davis, professor of pathology and lab medicine at the University of Kentucky, and an assistant state medical examiner for the Commonwealth of Kentucky, said he saw no “smoking guns” in the list of prescriptions. But he had plenty of questions.

“What does leap off the page is that this is a guy who is in desperate need of some help,” Davis said.

Multiple Prescriptions

There were few signs of trouble during Boogaard’s first few seasons with the Wild, beginning in 2005, when he quickly established himself as a leading enforcer.

Documents show a marked shift after Oct. 16, 2008, when Boogaard lost a tooth during a fight with Florida’s Wade Belak. While it is unknown what drugs Boogaard received in South Florida that night, he was given a prescription for hydrocodone (often known by the brand name Vicodin) several days later by a Wild team dentist.

That was the start of a 33-day stretch when Boogaard received at least 195 hydrocodone pills from six doctors, records show. He received pharmacy prescriptions for most, but records indicate that some were dispensed directly from doctors, including the Wild medical director Sheldon Burns, a family practitioner who is also medical director for the N.B.A.’s Minnesota Timberwolves and a team physician for the Minnesota Vikings of the National Football League.

The hydrocodone prescriptions provided more narcotic painkillers in about a month than Boogaard had in his first three N.H.L. seasons combined, records show. And injuries and prescriptions kept coming.

Burns and Dr. Dan Peterson, who share a practice in Edina, Minn., prescribed 110 more hydrocodone pills from Dec. 4 to Jan. 1, records show. In April, with his season over, Boogaard had operations a week apart on his nose and shoulder.

During a 26-day period that month, Boogaard received prescriptions for 150 oxycodone (usually sold under brand names OxyContin or Percocet) and 70 hydrocodone pills from four doctors — the surgeons, plus Burns and Peterson.

“The problem with athletes is that they do get multiple injuries and therefore are given multiple courses of opiates,” said Dr. Ballantyne, the pain expert from the University of Washington. “A single course of opiates might be O.K. for normal people who only get injured once in a blue moon, but when injuries are frequent, it can easily turn into chronic treatment instead of just acute treatment. And athletes are at high risk of developing addiction because of their risk-taking personalities.”

The painkiller prescriptions stopped during the 2009 summer off-season. By then, Boogaard had found illicit sources for pain pills from street dealers, according to his family and friends.

Dr. Peterson and Dr. Burns continued to prescribe Ambien — five times, 30 pills each, over about three months of the off-season. Ambien, with a recommended dosage of one 10-milligram pill a day, is considered a short-term solution to sleeping problems, usually limited to a few weeks. The drug’s warning label notes that it can impair coordination and exacerbate depression, which Boogaard showed signs of having. It also says that overdoses can be fatal.

By fall, it was clear to those close to him that Boogaard had a drug problem, and the Wild caught on, too. During training camp in September, he was quietly placed in the league’s substance-abuse program, assigned to a live-in rehabilitation clinic in Malibu, Calif., because of an addiction to narcotic painkillers and sleeping pills.

Publicly, the Wild reported that Boogaard was taking time off to recover from a concussion.

On Oct. 9, 2009, when he rejoined the Wild as the team was on a West Coast trip, Boogaard signed a one-page document describing an “aftercare” program. The form was also signed by Dr. Shaw and Dr. Lewis of the league’s substance-abuse program, and Cronin, the alcohol and substance-abuse counselor.

The sheet directed Boogaard to abstain from any medications, including alcohol, “not specifically approved by Program Doctors or prescribed by Minnesota Wild Team Physicians.” Among other things, it said Boogaard must attend three “12 step” meetings a week and keep in “regular contact” with program officials. He would be randomly drug tested. It is unclear how much of any of that Boogaard did.

On Oct. 21, in the Wild’s first home game after Boogaard’s return, Boogaard

Colorado’s David Koci in a fight.

Team doctors seem mostly to have stopped prescribing narcotic painkillers and sleeping pills during the 2009-10 season, after Boogaard’s rehabilitation assignment. Most of Boogaard’s prescriptions were for Trazodone, an antidepressant, and Tramadol, a different type of painkiller. Another prescription, in March, was for acetaminophen and codeine.

Highlighting the difficulty of treating a player subjected to continual pain without the use of powerful pain pills, Boogaard also received at least eight injections of Ketrolac Tromethamine, commonly known as Toradol, including six in a 10-day stretch of January 2010 after a shoulder injury. He often received acupuncture as a painkiller substitute, too.

Boogaard’s contract expired at the end of the season. The Wild made little attempt to re-sign him. But he was still only 28, with a lingering reputation for being among the toughest men in the league.

On July 1, 2010, Boogaard signed a four-year, $6.5 million contract with the Rangers.

Inside Information

The Rangers knew about Boogaard’s addiction problems. Doug Risebrough, a senior official with the Rangers, had spent about a decade as the general manager of the Wild. He drafted Boogaard in 2001 and instructed coaches to turn him into a big-league enforcer.

When Boogaard was sent to rehabilitation in September 2009, he called Risebrough, who had been fired by the Wild months earlier. In June 2010, now working for the Rangers’ front office, Risebrough met with Boogaard for a couple of hours, Len Boogaard said.

Once signed by the Rangers, however, Boogaard did not make a good impression. He reported to training camp overweight, slow and lethargic. Boogaard quickly clashed with the team’s demanding coach, John Tortorella.

In October, Derek’s brother Aaron told their father that Derek had been abusing pain pills with increasing regularity late in the summer. Derek demanded that Aaron mail to New York a large stash that Derek had left behind in Minneapolis. Aaron refused.

Len Boogaard sent an e-mail to the Rangers on Oct. 13, 2010, requesting a conversation with Risebrough. Risebrough called the next day. Len Boogaard said he told Risebrough about Derek’s renewed drug problem.

Two days later, Derek called his father and, according to Len Boogaard, complained that General Manager Glen Sather had called him into his office, demanding the truth and threatening to trade him. Derek, apparently unaware that it was his father who had notified the Rangers, did not explain why Sather was upset, and Len Boogaard did not press him. The Rangers were on top of it, he thought.

Derek Boogaard continued to play and fight. And he increasingly received prescriptions for drugs that the Rangers knew he had previously abused.

On Oct. 21, 2010, a punch from Toronto’s Colton Orr broke a three-tooth bridge in Boogaard’s mouth. Three days later, Boogaard hurt his hand in a fight with Boston’s Shawn Thornton.

On Oct. 26, a Rangers dentist, Dr. Joseph V. Esposito, citing an “emergency,” prescribed 20 hydrocodone pills, the first of five prescriptions written over several weeks, totaling 64 pills.

It appears that decision might have come in consultation with the league’s substance-abuse program. On the evening of that first hydrocodone prescription, Boogaard spoke briefly with Dr. Shaw and Cronin.

Outside experts noted the difficulty of treating a painkiller addict for ongoing pain. Some suggested that one way to treat people addicted to painkillers was to use other longer-term drugs, such as methadone, for chronic pain, as part of maintenance therapy that includes steady counseling. Cutting off all pain medications, they said, can lead to severe relapses in some patients.

On Nov. 16, two days after Boogaard had his nose broken by Edmonton’s Steve McIntyre, Boogaard received another hydrocodone prescription from Dr. Esposito, who shares a practice in Hartsdale, N.Y., with another Rangers team dentist. Boogaard also received a prescription from another Rangers team doctor, Andrew Feldman, the director of sports medicine at St. Vincent Medical Center, for 40 pills of Tramadol, a mild narcotic. It is unclear if Dr. Esposito and Dr. Feldman knew of each other’s prescriptions.

“The doctor who prescribed Tramadol was probably thinking it’s better than hydrocodone, but it’s still addictive,” said Dr. Ballantyne, the University of Washington pain expert.

Those appear to be the extent of painkillers prescribed by Rangers doctors. But Boogaard, as he had in Minnesota, found illicit dealers, his family and friends said, especially after his season ended Dec. 9. That was when he sustained a concussion in a fight with Ottawa’s Matt Carkner.

Boogaard never played again. Publicly, the Rangers said Boogaard was struggling with postconcussion syndrome, but that was only part of the story.

Over the succeeding months, Boogaard continued to be prescribed medication — particularly Ambien, about a dozen times. By several accounts, Boogaard drifted through wild mood swings and erratic behavior — breaking down in tears one day, buying expensive toys like night-vision goggles the next. Bored and lonely, he was sending and receiving more than 10,000 text messages a month in early 2011.

Among those he communicated with were Cronin and Dr. Shaw, hundreds of times. Boogaard was subjected to at least 19 drug tests during his season with the Rangers, most of which showed him testing positive — initially for antihistamines and decongestants, then Xanax, an antianxiety medication. By spring, Boogaard was testing positive for hydrocodone and other narcotic painkillers.

It is unclear what ramifications, if any, there were for testing positive on more than a dozen drug tests. But Boogaard was not sent to rehabilitation until he struggled to stand up on the ice in front of coaches and teammates during a skating session in early April.

On Dec. 1 and 4, Boogaard tested positive for Xanax, although there is no record of it being prescribed to him. On Dec. 16, Dr. Ronald Weissman, a team doctor and cardiologist based in White Plains, prescribed 20 pills of Xanax. Records show he did it after consultation with Dr. Lewis, the substance-abuse program co-director.

Dr. Weissman’s notes also say that Boogaard, on Dec. 14, complained of “chronic insomnia.” Dr. Weissman wrote that he previously spoke with Dr. Lewis about Boogaard’s past abuse of Ambien. He prescribed Restoril, another sleeping medication.

But early on Dec. 24, having just landed in Minneapolis for Christmas, Boogaard texted the Wild’s Dr. Peterson. Later that day he had a prescription for 30 Zolpidem, the generic version of Ambien — one of at least four such prescriptions that Dr. Peterson wrote for Boogaard after Boogaard joined the Rangers.

On Jan. 6, 2011, Dr. Weissman prescribed Boogaard five pills of Ambien. While it is unknown what sort of guidance, if any, Dr. Weissman received from the substance-abuse directors, it was the first of nine Ambien prescriptions, the latter ones for 30 pills, that Dr. Weissman wrote for Boogaard over three months.

Len Boogaard said he saw one of those Ambien bottles when he visited Derek in January. Dated the day before, and labeled with Dr. Weissman’s name, the bottle contained only 10 of the 14 prescribed pills. A day later, six more were gone. On the third day, the bottle was empty, Len Boogaard said.

On the fourth day, a man came to collect a urine sample from Boogaard. Boogaard knew about the timing of the test several days ahead of time. The results came back negative.

At that point, however, the drug tests did not check for Ambien/Zolpidem, the records show, despite Boogaard’s past addiction problems with the sleeping drug. It was not added to the list of drugs to test for until April, the drug tests show.

Later in January, another doctor, a neurologist keeping tabs of Boogaard’s postconcussion symptoms, prescribed 30 pills of Zolpidem. Dr. Peterson, the Wild team doctor, prescribed 30 more on Feb. 2, when Boogaard was in Minnesota. And Dr. Weissman of the Rangers began increasing his dosages to 30 pills every week or two.

A friend reported seeing Boogaard in March crushing and snorting Ambien. By March, friends and family said, Boogaard was spending thousands of dollars on pain pills from a man on Long Island. He kept pills in Ziploc bags and plastic Easter eggs he sometimes carried in his pockets.

By then, Boogaard had tested positive several times for opiates like oxycodone. In early April, Boogaard flopped on the ice during a skating session and was confronted by an assistant. Within days, Boogaard was in California for another extended stay in substance-abuse rehabilitation, his second in about 18 months.

On May 12, granted a second long leave of absence from the rehabilitation facility, Authentic Recovery Center in Los Angeles, Boogaard returned to Minnesota. He went out with friends and his brother Aaron. A day later, Aaron and Ryan Boogaard, Derek’s other younger brother, found Boogaard dead of an overdose on the bed of his Minneapolis apartment.

Len Boogaard has considered lawsuits. But he said that taking the N.H.L. and those with ties to it to court could take a financial and time commitment that he could not afford. He cited the example of Steve Moore, a Colorado Avalanche player attacked on the ice by Vancouver’s Todd Bertuzzi in 2004. A long-awaited trial is scheduled to begin later this year.

“It’s not the money,” Len Boogaard said. “But in eight years, how many more players are going to go through something like what Derek did?”

A version of this article appeared in print on June 4, 2012, on page A1 of the New York edition with the headline: In Hockey Enforcer’s Descent, A Flood of Prescription Drugs.

[JackStraw]

I just read this article. I don't know how anyone can excuse the way team doctors (and officials) handled this. In the end they don't seem much different than drug dealers preying on the addictions of kids on the street.

[hf101]

Part of the problem is Boogaard probably didn't go through insurance with many of the prescriptions, where he would have drawn a red flag.

[JackStraw]

Part of the problem is Boogaard probably didn't go through insurance with many of the prescriptions, where he would have drawn a red flag.

I don't think many addicts go through their insurance company to get their drugs. Team doctors and the league's substance abuse program should have seen the red flags. And it seems like they did, they just ignored them.

[hf101]

@JackStraw

Team doctors and the league's substance abuse program should have seen the red flags. And it seems like they did, they just ignored them.

Agree, so then who should be gate keepers? The NHLPA? Should team doctors have to submit records?

[JackStraw]

@JackStraw

Agree, so then who should be gate keepers? The NHLPA? Should team doctors have to submit records?

I would think that at a minimum, once a player has entered the league's substance abuse program the team doctors should be in contact with the program to so that they know what's going on. I'm not sure if that happens now or not but it would seem to be a no-brainer. Continuing to prescribe massive amounts of these drugs is like playing Russian roulette with the guy's life. Somebody has to have a view of the overall picture.

[hf101]

@JackStraw

The NHL could probably be a gatekeeper too, but part of the problem is with prescription drugs and the write to privacy acts, let alone players are playing for two different countries.

[sarsippius]

I just read this article. I don't know how anyone can excuse the way team doctors (and officials) handled this. In the end they don't seem much different than drug dealers preying on the addictions of kids on the street.

Keep in mind this is hardly an isolated incident.....in my opinion that is, but I'm sure this scenerio is repeating itself with other players as we speak

[JackStraw]

@hf101 - Yeah, the NHL could (and probably should) be a gatekeeper, except that according to the article the league doesn't know what players are in the substance abuse program at any given time. The ultimate gatekeeper is always going to be the doctor. The kind of things they discuss in the article really seem like a question of medical ethics, do you continue to prescribe addictive drugs to a patient who you know has a history of addiction? And then not report it in the team's medical records? The league and the player's association basically make their own rules, but physicians are legally and ethically accountable for what they do.

I guess the problem is, usually nobody knows what the doctors do. In this case Boogaard's father did the work to get all this information. Hopefully it will lead to something positive.

[JackStraw]

Keep in mind this is hardly an isolated incident.....in my opinion that is, but I'm sure this scenerio is repeating itself with other players as we speak

I agree. I'm sure this happens pretty frequently, in other sports too.

[sarsippius]

All this lack of accountability from some physicians, and my doctor balks at prescribing me flexoral when my back locks up so badly I can't move my arms neck or head.....

[hf101]

Worthy of a read.

Hungry Ghosts: On the NHL's Failure to Take Care of its Own

by Ellen Etchingham

When Derek Boogaard died, the hockey world had almost forgotten about him. He’d been off the ice for six months, reportedly suffering from chronic post-concussion symptoms, not practicing with the team, often not even in New York.

Like many players on the long-term IR, his activities were of little interest to the fans or the media. Like many aging enforcers, his absence was acceptable and unremarkable. Maybe he would come back, maybe he wouldn’t, but either way, nobody was exactly holding their breath. Every time the Venerable Sidney goes off the roster, the hockey world immediately launches into a tense Crosby-Watch, but there was no such thing as Boogaard-Watch.

Ironically, Derek was more dead to the hockey world while he was still living than he has been since. After his overdose, and especially after the three-part New York Times exposé on the trajectory that brought him there, his hungry ghost has haunted the NHL. He died a bad death, and in some way- indirectly, maybe, through neglect and denial and various other sins of omission- he died at our collective hands. The responsibility the hockey world never took for his life has become a responsibility we cannot escape for his death. We think about it still.

Now, nearly a year later, the NYT has come out with a follow-up piece tracing Len Boogaard’s attempts to puzzle out the train of causation that led his son to that fatal combination of alcohol and Percocet. While the first NYT series posited CTE as the proximate cause of Derek’s trouble, Len’s research tells a somewhat different and equally troubling story. Piecing together four years of medical records, cell phone logs, and financial documents, what emerges is the outline of a massive addiction problem. Dozens of doctors, hundreds of prescriptions, thousands of pills, year after year, from 2008-2011. Boogaard was a huge man, true, but looking at the list of medications and the frequency with which they were prescribed, he also must have built up a huge tolerance. It’s a list that looks like it would kill a normal person ten times over. It’s insane.

It makes me wonder if, in focusing so much of our outrage and guilt over his death on CTE, we are missing an even more important issue. As this Slate article points out, the popular conversation about CTE has outpaced the science.

Journalists and sports fans routinely assume a direct link between CTE and psychological and emotional problems that has not entirely been proven. While the signs of the disease have been found in post-mortem in the brains football players who did suffer and died badly, like Junior Seau, they’ve also been found in the brains of ex-players who were by all accounts mentally healthy. It is possible that, in pinning all our fears on concussions, we are overlooking the other factors in athletes’ lives that predispose them to addiction and mental illness.

Professional sports are a world of pain. We seldom consider this, although we are well aware of the frequency and severity of injuries. But though we see people getting hurt all the time, we don’t see very much suffering. Players are always presented to us placidly lying down for stitches, joking with media about their knee rehab program, smiling through broken teeth. They don’t look like they’ve been hurt. They don’t look like people who’ve suffered something. They seem fine. So we wince and laugh and praise their toughness, and go on with our lives figuring that they’re somehow just a more badass class of person than ourselves.

We thought Derek Boogaard was the ultimate badass. His reputation was built on a facade of incredible strength and implacable toughness. The Boogeyman. People loved to see him absorb pain and inflict it in equal measure, confident that he would always come out in the post-game interviews smiling and amiable, reassuring us that nobody really got hurt.

But the medical records make it amply clear that he was in constant pain.

We thought Derek Boogaard was tough, and maybe in the beginning he was. But by the end, his toughness was a chemical cocktail of painkillers, antidepressants, and sleeping pills. How often does this happen? How much of what we call stoicism in hockey is really just numbness? How many men in this game, every day, are only able to keep doing this job because of their own personal narcotic blends? The relationship between CTE and addiction is still being studied. The relationship between taking many hundreds of Vicodin and addiction, however, is pretty well established. We don’t need any additional scientific research to understand that people who get hurt a lot and get prescribed a lot of intensive-strength pain medication are likely to form some very bad habits. We already know that.

And yet, despite the fact that hockey obviously puts players at high risk for addiction, despite the fact that hundreds of players throughout the history of game have died or declined due to problems with drugs both legal and otherwise, the NHL’s treatment programs remain a mystery. We are assure that they exist, of course, that resources are available and everything is being done and it’s all under control, but no specifics are ever offered. No interviews are ever given, no courses of rehabilitation ever outlined. As much as we complain that the NHL’s supplementary discipline and officiating offices operate shrouded in secrecy, these are models of transparency compared to the NHL’s drug abuse treatment programs.

Len Boogaard’s findings do not show much evidence of coherent policies to either prevent addictions or treat them. Derek’s problem was conspicuous, and yet seemed to have no trouble finding team doctors willing to continue prescribing him pills, often without an examination or even a notation in his file. His treatments do not appear to have been overseen by any one physician. Rather he was able to cobble together an assortment of both team and non-team doctors who were willing to prescribe overlapping courses of Vicodin and Percocet amounting to over a hundred pills per month. These he supplemented with additional drugs from street dealers, as well as prescriptions for sleeping pills. His use in 2008 was so extreme that the Wild forced him into treatment and, to their credit, tried to subsequently enforce a regimen of strictly non-narcotic painkillers through the 2009-2010 season. However, he continued to suffer from chronic pain and was still taking regular cycles of pills and injections. Although technically ‘clean’ of the drugs he’d been in treatment for, his body was still regularly full of supplementary chemicals. The man was still struggling.

And then, after all of this, the Rangers signed him to a four-year, $6.5 million contract. A month into it, one of their team doctors prescribed him Vicodin again.

Let this sink in for a minute. The New York Rangers, who knew through Doug Risebrough that Derek Boogaard had developed a serious painkiller problem with the Wild and that he had already been through rehab once, hired him to be their long-term enforcer. Think about that logic: Hey, let’s take a guy who’s already got a bunch of chronic injuries and has already struggled with a narcotic addiction of epic proportions and pay him a disproportionately huge salary to deliberately re-injure his already chronically broken hands and face for four years. The New York Times piece notes “the difficulty of treating a player subjected to continual pain without the use of powerful pain pills.” It was so difficult for the Rangers, apparently, that they didn’t even try. They put him back on the same stuff he’d gone on rehab to get off of.

On subjects like this, the sort that provoke moral outrage, people tend to throw around words like ‘sickening’ and ‘disgusting’ pretty lightly, but in this case, I don’t think there’s any other way to think about it: the Ranger’s decision to sign Boogaard and use him in that role, knowing what they knew, is ****** sickening. It is absolutely morally bankrupt. To take a man who has already just barely scraped through a painkiller addiction and put him in the path of so much more goddamn pain, pain of the sort that may well be impossible to treat without resorting to the same drugs he can’t safely touch, is beyond irresponsible. To then prescribe him those very drugs again is abusive and exploitative. It’s almost sadistic.

To me, and you may disagree but let me make the case, the worst thing about hockey is not that it damages people. It’s that it makes use of damaged people. Players’ desire to keep playing no matter what the cost to themselves, teams’ desire to squeeze whatever value they can out of a contract no matter what the cost to the player, and fans’ perverse perception that there is nothing worse in the universe than a promising career that ends early; these three factors conspire to keep guys in the game who should not be there anymore. There are some things- and among these I would include chronic concussion symptoms, serious addictions, and signs of severe mental illness- that should not be played through. There are some things that should end a hockey career.

This is a very dangerous game. It destroys people. In fact, it has a long, horrible history of destroying people, of taking talented boys and using them until there’s nothing left to use, leaving behind damaged men made old before their time, with chronic pain and psychological baggage and no marketable skills. In the olden days, for many men the end of a pro hockey career meant the beginning of a life of menial labor and alcoholism. As I’ve discussed before, the All-Star Game was actually invented as a solution to this problem, to create pensions for ex-players and their families, to raise money so that men who’d been ruined by hockey could survive.

Nowadays, we have little sympathy for the idea that players can still be ruined by hockey. We think of the retired as spoiled millionaires who probably spend the rest of their lives blissfully playing video games and boating drunkenly. But if the Boogaard case makes anything clear, it’s that the money does not necessarily mean much in the face of serious post-hockey damage. All his millions did for him is buy him drugs and isolation. All they did was fund his death.

Hockey is a sport that needs aftercare. The NHL needs treatment programs for addiction and mental illness that are not focused on getting men back into the game but on getting them out of it. It needs mechanisms for identifying the guys who are suffering seriously and getting them off the ice, into rehab, and eventually into post-hockey careers. For the bright and the talented, there are always job offers, for the superstars there is always the option of a comfy, shiftless retirement, but pro hockey is full of men who never played enough years or a big enough role to accumulate millions, who sacrificed much of their education and personal development in pursuit of the dream. Fans are apt to justify not caring about them by pointing out that there’s no reason why the professional transition from sports to non-sports should be especially traumatic, but as the Slate article points out, we have ample evidence that it is anyway. Whether or not you believe it’s a valid problem, it remains a real one.

The NHL/NHLPA substance abuse treatment program needs to be more and it needs to be more public. Not with names, of course; privacy is essential to such programs, although I bet a successful treatment-and-transition initiative would generate more than a few guys who’d love to tell their stories. But even anonymously, there needs to be some public awareness of what the program is and how it’s helping. We, as fans, need to know that the game we love and the League we pay are taking some responsibility for the damage they do. We need to take some of the stigma off of players who have such illnesses and make use of such programs. Hiding it behind a wall of complete secrecy only contributes to the impression that addiction is shameful and the League doesn’t give a **** about players who suffer from it.

In our alarm over CTE and brain trauma, we focus entirely on causes, but what if we’re wrong about the causes? What if the problem isn’t really concussions at all? What if concussions, in the end, only account for a small fraction of hockey-related psychological problems? What if we reduce concussions and pat ourselves on the back for doing something while dozens of players are still suffering the exact same problems Boogaard had due to chronic pain, closeted mental illness, and dysfunctional treatments for both? We believe that the League must reduce head hits, and it must, but even with a dramatic decline in concussions, hockey will still cause pain and it will still cause addiction. There is no simple equation: eliminate fighting, give out enough punitive suspensions and no one will ever suffer like Boogaard again. There will always be physical damage in hockey. There will always be psychological damage in hockey. The measure of the League isn’t whether it has the godlike power to prevent pain from happening, it’s how it treats those who’ve gotten the worst of it.

By that measure, it failed Derek Boogaard miserably, and for all we know, it is continuing to fail other players right now. Until it learns how to take care of its own, this League deserves to be haunted.