On a cold day in February 2011, doctors and athletic trainers from the NFL’s 32 teams gathered at a hotel ballroom in downtown Indianapolis. Under scrutiny for its handling of prescription drugs, the league had invited the Drug Enforcement Administration , and an official named Joseph T. Rannazzisi made the trip from Washington armed with more than 80 slides of charts, photographs and bullet points about federal laws that govern how the doctors can medicate professional football players suffering from pain and injuries.
The presentation was called “NFL Physicians Briefing: Obligations and Responsibilities under the Controlled Substances Act and Code of Federal Regulations.” It did not unfold as planned.
The NFL doctors grew defensive, then angry, according to participants in the room, as Rannazzisi lectured them on their duties and responsibilities in the context of the opioid epidemic that was sweeping the country. The doctors felt they were being compared to pill pushers, and the meeting became confrontational. “He was treating everyone like a criminal,” said one doctor in attendance.
The teams’ medical personnel were unhappy with the DEA official’s tone, his message and the laws he was outlining. Groans, catcalls and even some boos filled the hotel ballroom at times.
“I’d done hundreds of presentations,” Rannazzisi said in a recent interview. “I’d never experienced that before.”
“It was about as contentious as you can imagine a professional meeting getting,” another participant said.
After the meeting ended, the doctors returned to their teams and continued administering powerful painkillers and anti-inflammatories in ways that often ran counter to federal guidelines. It would be four years until the NFL fully instituted rules and practices that addressed the DEA’s concerns over the way teams travel with pain medications, store them at their practice facilities and administer them on the road.
The issues Rannazzisi warned team doctors about would become the heart of a DEA investigation into the NFL’s prescription drug practices and the crux of a lawsuit involving more than 1,800 former players who say teams improperly medicated them during their playing careers. The lawsuit paints a cavalier attitude within the NFL about the quantities of drugs distributed to players and alleges teams were reckless in the way they handled, stored and transported medications, failing to maintain proper records and allowing nonlicensed personnel, such as team trainers, to dole out prescription drugs.
One trainer, for example, said his team was at a “competitive disadvantage” because it wasn’t using a powerful anti-inflammatory called Toradol like other teams at the time, according to a court filing. The former players cited documents obtained in discovery that showed in one calendar year the average team prescribed nearly 5,777 doses of nonsteroidal anti-inflammatory drugs and 2,213 doses of controlled medications to its players.
The 2011 Indianapolis meeting marked a flash point for the NFL in which team medical personnel were advised of the federal laws they later would be accused of violating. Those in the Indianapolis ballroom say the doctors were particularly frustrated to learn they couldn’t travel with prescription-strength medications across state lines to road games, as they had for years.
At one point, Rannazzisi said, a doctor raised his hand and asked why the president is able to travel with drugs aboard Air Force One. The DEA official explained that Air Force One is a military plane and statutes allow exemptions for military aircraft to move drugs around the country.
“I’m thinking as I’m saying this, ‘This is surreal,’ ” Rannazzisi recalled. “So he says, ‘The military is exempt? Well, think of our players as warriors every Sunday on the field of battle.’ I was stunned.”
Citing pending litigation, a spokeswoman for the NFL Physicians Society declined to comment. The NFL delivered a response Thursday to an inquiry from four Democratic members of the House Energy and Commerce Committee and cited the meeting, saying that team doctors previously had been told by the DEA that they were in compliance with federal law.
“It represented a significant departure from the way that team physicians in all sports had been practicing medicine for decades,” Dennis Curran, the NFL’s senior vice president and general counsel, wrote the lawmakers. “Much of this advice contradicted written and oral advice that DEA agents had provided to individual teams over time.”
The 2011 meeting followed unrelated DEA investigations into team drug practices in San Diego and New Orleans. The DEA had briefed league personnel at least three times in the previous year, and NFL officials felt a presentation might bring all 32 of the teams up to date on the federal laws that regulate prescription drugs. In a recent interview, Rannazzisi said he wanted the doctors to understand, “you can’t just do whatever you want to do.”
“And the funny thing was, I was there to help them. I wasn’t looking to take action against anybody,” he said. “I wanted them to understand if they were doing what I think they were doing — if they were just handing out drugs to players — they weren’t doing the players a service as patients.”
Midway through the presentation tailored for the NFL, Rannazzisi shared a slide of “Frequently Asked Questions,” which highlighted many of the potential problem areas the DEA had identified, including: Is it a violation to keep controlled substances at an unregistered location? Is it a violation if I travel with controlled substances? Is it a violation to issue a prescription for a controlled substance in a state that I am not registered in?
“But basically, everyone got so [angry], they didn’t buy into it. The message was lost,” said a doctor who was in the room. “The league understood the message because they’d had other meetings with the DEA, but the league chose to ignore it.”
At the time, Rannazzisi was the deputy assistant administrator at the DEA, heading up the Office of Diversion Control. He retired from the DEA in 2015, having delivered hundreds of presentations and testifying before Congress nearly three dozen times.
As part of his presentation, Rannazzisi told the team doctors about the national opioid epidemic, and he explained that in Florida, pain clinics were raking in millions of dollars by liberally prescribing addictive painkillers.
“He was lumping all of the NFL doctors with the pain factory doctors,” said one team doctor who attended the meeting. “. . . The whole thing went over like a lead balloon.”
Late in the meeting, Rannazzisi said, a doctor from the Dallas Cowboys complained that federal statutes don’t take into account the challenges posed by professional sports teams that travel out of state for games.
“I told him, ‘The law is the law,’ ” Rannazzisi said. “He said, ‘Well, my owner knows members of Congress, and he’ll get the law changed.’ ”
In March, The Washington Post published details of the former players’ court filing in their lawsuit against the NFL’s 32 teams that alleges instances in which team and league officials were made aware of abuses and likely violations of federal law. In most cases, the teams were either slow to respond or ignored the regulations entirely, the players said.
The day after the article appeared, Rep. Pete Sessions (R-Tex.) introduced a bill in Congress that essentially would allow professional sports teams to travel for up to 72 hours with unlimited amounts of prescription drugs. They could administer those drugs on road trips as long as they kept proper records.
“I believe this is an extremely important issue for all doctors, sports doctors in particular, and this bill will provide them with the opportunity to provide their athletes and patients with much-needed medical care under the authority of the DEA,” Sessions said.
Sessions introduced a similar measure in December 2011, nine months after the heated DEA meeting with NFL doctors in Indianapolis, and another in July 2015. Neither got out of committee. Sessions’s office said the Cowboys’ longtime team doctor, Daniel Cooper, first brought the issue to the congressman’s attention.
Sessions’s district includes parts of Dallas and suburbs to the north and northwest of the city. Even though neither the Cowboys’ headquarters nor their stadium is based in the congressman’s district, the team has taken a recent interest in helping Sessions keep his office.
Campaign finance reports show that the Cowboys never donated to the 11-term congressman before his most recent reelection bid in 2016. That’s when the family of Cowboys owner Jerry Jones became active donors. The most an individual can contribute to a candidate in an election cycle is $2,700. Within a two-day period in December 2015, Sessions received that exact amount from Jones, his wife, all three of his children, each of his children’s spouses and four of Jones’s grandchildren — a total of $32,400.
Sessions also received $5,000 from the NFL last year, in addition to a $1,500 donation in 2012. Cooper has made three donations to Sessions, totaling $2,000, but none since 2007. He sent a letter to Sessions in January 2012, according to a court filing, urging for a change in the law.
A spokesman for the Cowboys declined to comment. Sessions’s office did not respond to questions about Jones’s campaign contributions or possible influence on the proposed bill.
Other lawmakers had a markedly different response to the claims outlined in the ex-players’ lawsuit. Four House Democrats reached out to the NFL and the DEA, demanding answers to questions about the use of prescription medications in professional football and the way the NFL and the DEA have investigated the matter.
“These allegations suggest a troubling lack of respect for the laws governing the handling of controlled substances, and raise questions about the league’s dedication to the health and safety of its players,” the lawmakers, all members of the House Energy and Commerce Committee, said in a letter to NFL Commissioner Roger Goodell.
In 2010, the league’s drug practices began drawing increased scrutiny from federal authorities. The DEA office in San Diego investigated the pro sports teams there after a Chargers player was found with 100 doses of Vicodin in his possession during a traffic stop. At the same time, the DEA’s New Orleans office was looking into the Saints regarding the theft of controlled substances. An Atlanta Falcons internal memo that same year, revealed in the recent court filing, stated: “We were also under the radar of the DEA because of the large amount of controlled substances ordered.”
In August 2010, a group of team doctors joined Elliott Pellman, the league’s former medical adviser, in Washington to meet with the DEA. Rannazzisi gave a presentation similar to the one he would deliver six months later in Indianapolis.
The ex-players’ lawsuits filed in 2014 and 2015 drew the attention of Department of Justice, particularly the U.S. Attorney’s Office for the Southern District in New York. Later in 2015, the DEA acknowledged the existence of a widespread investigation and said agents had interviewed NFL team doctors in multiple locations. Rannazzisi’s slide show from the Indianapolis meeting was shared with investigators, who also were briefed on what transpired in the hotel ballroom.
In November 2014, the DEA conducted surprise inspections of NFL teams in three cities to see whether they were still traveling with controlled substances. None were found, according to the former ex-players’ complaint in the lawsuit, because “the clubs were tipped off by a DEA employee in advance of the raids.”
Any case against the NFL teams or their doctors carried inherent complications.
“These doctors are all independently licensed and registered, so they’re the ones with the obligations, not the sports teams,” said Larry Cote, who formerly worked as associate chief counsel for the DEA’s diversion section. “That’s where the DEA and the U.S. Attorney’s Office have problems bridging that gap and holding sports teams liable when it’s really the obligations of the doctors.”
While some doctors might contend any infractions were relatively minor, Cote said that record-keeping violations can sometimes be indicative of larger problems.
“When you’re talking about traveling with the drugs, when you’re talking about administering the drugs in states where most often the doctors aren’t licensed and when you’re talking about trainers having unfettered access to the drugs, that’s where you’re getting into serious violations and potential for diversion misuse,” said Cote, an attorney at Washington-based Quarles & Brady who specializes in compliance and enforcement issues related to the Controlled Substances Act.
The league had long discussed the idea of allowing local doctors to prescribe and distribute drugs to visiting teams, but some teams scoffed at the idea, fearful it would increase the risk of injury and put them at a competitive disadvantage because medical information would be shared. A handful of teams piloted the program the next year. Four years later, in 2015, the NFL’s “visiting team medical liaison program” went into effect, and since then team physicians aren’t supposed to administer prescription medication at road games. The league says all of its teams are in compliance with the Controlled Substances Act.
“I would say some of the changes were immediate, but it took some time to get it done,” said a person familiar with the meeting and the league’s policies and procedures in this area.
In a response to questions about the Indianapolis presentation, a DEA spokesman said “during the meeting a number of issues pertaining to the transportation and dispensation of controlled substances were discussed.
“DEA has since learned that the league has taken steps to address the issues discussed,” the spokesman said.