Last week, every footballer in England and Wales received an email warning them about a painkiller that, until now, they might never have realised could put them at risk.
The warning came from the Professional Footballers’ Association and, to put it into context, the drug in question, tramadol, is described as “evil” by one of the players who has found out the hard way how dangerous it can be.
“The concern we have is there is an explicit acknowledgement that it is an addictive substance,” says Ben Wright, the PFA’s director of external affairs. “It’s habit-forming, it’s an opiate and it’s often referred to as being in the same family as heroin. It can sound like an extreme comparison, but it is fairly well accepted.”
Tramadol is a strong, prescription-only painkiller that has been cited by Chris Kirkland, the former Liverpool and England international goalkeeper, as the source of an addiction that came close to destroying him.
On January 1, the World Anti-Doping Agency (WADA) will add tramadol to its prohibited list and, from that point onwards, anybody caught with it in their system will face a lengthy ban.
That, however, is causing concerns among the football authorities when there is considerable evidence that an indeterminable number of players are either using it, or reliant upon it, as a perfectly legal part of their routine.
“Somebody is going to get caught,” says Kirkland. “I’m glad this ban is happening because it’s a dangerous, dangerous drug. But you’re not going to eradicate it and somebody will fail a test, it’s inevitable. It’s going to be extremely tough for a lot of players because there will be many who rely on it.”
The Athletic has spent weeks looking at the scale of tramadol use within the sport and, though the secrecy around its use makes it difficult to establish all the facts, there are several key issues our investigation has highlighted:
- WADA has delayed the ban to take into account the addictiveness of tramadol and give users more time to wean themselves off it
- There is a strong possibility that some, or many, users are taking it in secret, without their clubs’ knowledge
- Players who have become dependent talk about it wrecking their lives. In Kirkland’s case, it left him suicidal
- Footballers buying supplies off the internet as “pain pills” without knowing the dangers or that it will soon be banned
This is why the PFA, as the players’ union, has taken the unusual step of emailing its members, including 5,000 current footballers, to highlight the risks and make it clear there is a deadline approaching, beyond which there will be serious consequences.
“We wanted to force a recognition among players that this is coming down the line and if they need support, now is the time to start doing it rather than it becoming, with the deadline looming, an anti-doping issue,” says Wright.
Do the relevant authorities agree with Kirkland that it is “inevitable” there will be footballers banned for having it in their system?
All that can be said for certain is that the Football Association, the Premier League, the English Football League and the Women’s Super League are acutely aware of the risks. The clubs are, too, which is no surprise because the punishments are likely to be severe.
“Ultimately, if you fail a test, you risk a significant ban,” says Wright. “From our understanding, the risk is a two to four-year ban.”
Ryan Cresswell, a Sheffield United academy graduate who went on to play for Bury, Rotherham United, Southend United and Northampton Town, started taking painkillers after suffering a knee injury.
“Tramadol is strong stuff,” he says. “Have I had it? Yeah. Did it knock me sick? Yeah. Would I attempt to train on tramadol? No. I wouldn’t attempt to get behind the wheel of a car on tramadol. If you’re playing football… I’m not being funny, but you can’t. It knocks you off your feet.”
Cresswell spiralled into addiction issues involving sleeping pills and alcohol and was admitted into the Sporting Chance clinic, the rehabilitation centre set up by former England defender Tony Adams, before managing to turn his life around.
“I had my first knee operation the day before my 17th birthday when I was a scholar. It was cartilage that needed repairing and that lasted for nine years. But once that went again, I was in pain. I took anti-inflammatories and painkillers to manage it. Not just paracetamol, but codeine, co-codamol and tramadol. It just completely numbed me.
“It’s not a good feeling to have. You don’t feel anything. It’s scary. It’s not normal to be taking eight or nine tablets a day and I realised I needed help.”
At 35, Cresswell is the manager of Sheffield FC — recognised by FIFA as the world’s oldest extant football club — in the Northern Premier League. His view is that there are other painkillers that, as far as he is aware, are used more commonly than tramadol. On that basis, he would be “highly surprised” if any footballers are caught out by the change in legislation.
“Banning tramadol is a positive step, but will it make a huge difference in the world of football? I highly doubt it. I don’t think tramadol will be found in too many players’ systems, whereas codeine, diclofenac and naproxen — things that rot your stomach — are rife.”
What this tells us is that there are contrasting views, even among former tramadol users, about the scale of risk and the likelihood, or not, of players falling foul of the WADA rule change.
But it is easy to understand why the PFA is operating a better-safe-than-sorry policy when it has already been contacted by players who have their own concerns.
In 2019, Tyrone Kirk went public about his dependency leading him into a destructive path of crime and homelessness. Kirk, who had spells with Scunthorpe United, Macclesfield Town and several non-League teams, ended up living on the streets, taking up to 30 tablets a day.
“I went from being a professional footballer to homeless in just a few years,” he said. “I wanted to get help from a professional but I was ashamed. I was embarrassed. Being a professional footballer at a young age, I have pride in myself, you know?”
Kirkland’s story is a stark reminder — along with Dele Alli’s recent disclosure about being addicted to sleeping pills — that playing at the highest level does not make you immune.
“I found out when I went into rehab that I was taking the equivalent of six shots of heroin a day,” says Kirkland. “It is an evil, evil drug. It nearly killed me, and should have killed me.
“At the start, it gives you a good feeling. It makes you feel happy, if you have anxiety or anything like that. I was using it for pain, yes, but I was using it for anxiety more than anything. But it messes you up mentally. I knew after three months that I was in trouble, that I’d become reliant on it.
“In the end, you build up such a tolerance to it, it doesn’t really do anything. It’s just that your body needs it, because you’re addicted.”
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Now 42, Kirkland’s career included spells at Sheffield Wednesday, Wigan Athletic and Coventry City. He first went public last year and says that, since then, he has had “lots of phone calls, lots of messages from inside and outside football, as well as other sports, even celebrities. It’s a massive problem. A lot of people in football are on it. It’s huge in rugby, which speaks for itself with the hits they take”.
Kirkland credits his recovery to the support he had from family and friends. His wife, he says, keeps a drugs-testing kit to act as “the biggest deterrent” for him not to lapse again.
“April 17, 2022, was the last time I took tramadol. The next 10 days were horrendous. I was cramped up in a room, I was feeling sick, I was vomiting, I couldn’t eat anything, I was having hallucinations. I’d got to the point where I didn’t want to put another tablet in my mouth. I got through it, but it wasn’t pleasant at all and I wouldn’t wish it on anyone.
“It was a 10-year period for me and for eight and a half years of that, I was on tramadol. For the other year and a half, I had come off it and gone into rehab. Even then, I went back on it three times. I tried to get off it many times. If you are trying on your own, it’s almost impossible.”
Michael Bennett, who made more than 150 league appearances for clubs including Brighton & Hove Albion, Brentford and Charlton Athletic, is now the PFA’s director of player wellbeing. In that role, he has seen, close up, the effect tramadol can have on people in the sport.
Now 54, he also knows from his own experiences, having suffered a serious knee injury during his playing career, how easy it is for footballers to become reliant on painkillers.
“I took them before training and before matches,” he says. “You get two to three tablets to take every day and, even when the issue is not there any more, you’re still taking the medication, or storing it in case you need it again. It’s quite easy to get sucked in and become dependent.”
In Bennett’s case, it was never tramadol. His understanding, however, is that it is “on the scene” at most, if not all, professional clubs.
“We’re in an industry where your body is put on the line every day. There can be only 11 places. So players are going to do what they have to do, to play, to earn their contracts, to sustain their careers. You can see how easy it is for players to be caught up in this. Some might not even realise they have an issue.”
As well as writing to its members, the PFA has publicised the issue — “Don’t wait to seek help” — on its website.
“When Chris came forward, it made other players and former players look at their use of tramadol,” says Bennett. “Chris was using it for back pain. Then he left the game and was still using tramadol because it was part and parcel of everyday life.
“That’s the issue we have with some players at the moment. They have used it for helping with injuries and, rather than stopping when their bodies are in a better place, it has become second nature.”
Usually, WADA would enforce a ban within two to three months of announcing it. With tramadol, however, there was an understanding that its addictive nature meant more time was necessary. The announcement came in October last year, meaning users had 14 months to wean themselves off it.
“There is an acknowledgement that it is an addictive substance and that people are going to need a little while to come off it,” says Wright. “It needs to be done in a managed way rather than a ban being announced in October, starting the clock and having three months to withdraw from something you might not even realise you are addicted to.”
That clock is ticking down, though. “Regular users often do not realise they have developed a reliance on it,” says the email sent by the PFA to its members. “If you use tramadol, you should urgently speak to your club and medical staff about how this will need to be managed, and what the new rules mean.”
In the same email, however, there is an acceptance that some footballers might be “concerned” about letting their clubs know. In those circumstances, players are asked to contact Bennett and his colleagues in the PFA’s wellbeing department. But the obvious response is: will they?
“There will be players who won’t go anywhere near the PFA and won’t want to tell their clubs,” says Kirkland, who makes the point that he does not regard tramadol as a performance-enhancing drug.
“You try to hide it, you’re sneaky. You think you will never get caught and that you will get away with it. Because this is what addiction does to you. It tricks your mind. It makes you think what you are doing is good, when it is completely the opposite.”
Kirkland knows from his own struggles how far footballers will go to cover it up. Many, he suspects, will be getting prescriptions from their own doctors.
“My advice to those players is, ‘Listen, get in touch with me, I will try to advise you the best I can, the PFA will too — get in touch with people who have been through what you are going through’. It’s not easy getting off tramadol. But the upside is that, when you do get off it, you are a much better person, in a much better place.”
Whatever you’re going through, you can call the Samaritans in the UK free any time, from any phone, on 116 123.
FRANK provides a confidential service in the UK to anyone wanting information, advice or support about any aspect of drugs. You can call free in the UK, from any phone, on 0300 123 6600.
(Additional material: Tom Burrows)
(Top photo: iStock; design: Samuel Richardson)