Despite stated label risks of possible fatal heart attack, stroke or organ failure, college football players across the country are still being given injections of a powerful painkiller on game days so they can play while injured, an ABC News investigation has found.
The drug, a generic version of Toradol, is recommended for the short-term treatment of post-operative pain in hospitals but has increasingly been used in college and professional sports, and its use is not monitored by the NCAA, the governing body of college sports.
Only two of the country's top football programs, Oklahoma and the University of Nebraska, reported to ABC News that they have limited or stopped the use of the drug in the wake of growing concern about its risks.
Oklahoma said it stopped using the painkillers in 2012 after using them repeatedly in 2010 and 2011.
Nebraska said its doctors now restrict its use.
"While team physicians reserve the option to use injectable Toradol, it is rarely prescribed, and its use has been avoided this season following reports of heightened concern of potential adverse effects," Nebraska said in a statement to ABC News.
The top two college football programs, Notre Dame and Alabama, refused to answer questions from ABC News about the painkiller. They play for the national college championship on Jan. 7.
Controversy surrounding the drug has grown this year following claims by former USC lineman Armond Armstead that he suffered a heart attack after the 2010 season, at age 20, following shots of generic Toradol administered over the course of the season by the team doctor and USC personnel.
"I thought, you know, can't be me, you know? This doesn't happen to kids like me," Armstead told ABC News.
The manufacturers' warning label for generic Toradol (ketorolac tromethamine) says the drug is not intended for prolonged periods or for chronic pain and cites gastrointestinal bleeding and kidney failure as possible side effects of the drug.
In addition, like other drugs in its class, the generic Toradol label warns "may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction (heart attack), and stroke, which can be fatal."
"This risk may increase with duration of use," the so-called black box warning reads.
In a lawsuit against the school and the doctor, Dr. James Tibone, Armstead claims the school ignored the stated risks of the drug and never told him about them.
"He was a race horse, a prize race horse that needed to be on that field no matter what," said Armstead's mother Christa. "Whether that was a risk to him or not."
Armstead says he and many other USC players would receive injections of what was known only as "the shot" in a specific training room before big games and again at half-time.
"No discussion, just go in. He would give the shot and I would be on my way," Armstead told ABC News.
Armstead said the shot made him feel "super human" despite severe ankle, and later shoulder pain, and that without it, he never could have played in big USC games against Notre Dame and UCLA.
"You can't feel any pain, you just feel amazing," the former star player said.
USC declined to comment on Armstead's claims, or the use of Toradol to treat Trojan players.
An ABC News crew and reporter were ordered off the practice field when they tried to question USC coach Lane Kiffin about the use of the painkiller. USC says the ABC News crew was told to leave because they had not submitted the appropriate paperwork in advance to attend the practice session.
Later at a news conference promoting the Sun Bowl, where USC was defeated earlier this week, Kiffin said he had no idea when or if Toradol was being used on his players, or about its risks.
"Well, if that was the case then, yeah, I did not know that until you told me," Kiffin said. "You educated me, thank you."
USC and Dr. Tibone have asked a judge to throw out Armstead's lawsuit, and in a brief interview with ABC News, Dr. Tibone denied any wrongdoing.
He said he could not comment on whether he failed to tell Armstead of the possible risks of the prescription painkiller, because of the pending lawsuit.
The team doctor did confirm to ABC News that he used Toradol to treat Armstead's pain and that he continues to use the drug on other USC players.
"These are young, healthy people," he said. "We still use it, we use it diligently."
Whatever the possible risks, an expert on medical ethics, Professor Arthur Caplan of New York University, said team doctors have an obligation to tell players.
"Even if you're the team physician, you still have to follow the standard of care and informed consent," Caplan told ABC News. "You better be disclosing all risks."
In addition to Oklahoma and Nebraska, only four of the other top college football programs questioned by ABC News said Toradol is not used by their team doctors: Ohio State, Oregon State, Boise State and Georgia.
Most schools refused to answer whether players are treated with Toradol, but four confirmed its doctors use the painkiller: Clemson, Texas A&M, San Jose State and USC.
In professional sports, the NFL, NHL and NBA allow the use of Toradol but require teams to keep close track of injections and report the information to the league.
The NCAA, the governing body of college sports, has no such requirement to regulate or even track the use of painkillers, a spokesperson told ABC News.
In a statement, the NCAA said it requires member schools to follow state and federal laws about medical treatment and prescription medicine, and publishes guidelines that include "best practices" for the handling of medication. "NCAA members have decided that it is their individual responsibility to assure compliance with appropriate medication and treatment guidelines," said the statement.
"If we keep track of what happens to, let's say, horses in horse racing, don't we owe it to the athletes to keep track of what's going on in college sports?" asked Professor Caplan.
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