This weekend the New England Patriots, Denver Broncos, Arizona Cardinals and Carolina Panthers will battle it out to determine which two teams get to play in this year’s Super Bowl. That much you know. What most people don’t realize, however, is that the players on these teams may be relying on a drug called Toradol to get them through this 18th NFL game of the season.

In fact, according to many former players, coaches, and a growing number of lawsuits, Toradol—or “Vitamin T” as it’s referred to by players, is the drug that keeps many of the league’s players on the field every Sunday.

What Exactly is Toradol?

Toradol is a nonsteroidal anti-inflammatory drug (NSAID), similar to aspirin or ibuprofen (the active ingredient in Advil).  The active ingredient in Toradol is ketorolac tromethamine, which was created for use in hospitals to help patients manage pain following a surgery. The drug is designed to relieve pain without causing its user to lose consciousness. It was first approved for use by the FDA in 1989.

Toradol is also designed to be used for only a short period of time. According to the drug’s label, use “should not exceed five days … because of the potential of increasing the frequency and severity of adverse reactions associated with the recommended doses.” The label advises against use for treating “minor or chronic painful conditions.”

How is Toradol Used by the NFL?

By the early 2000s, Toradol had infiltrated NFL locker rooms. A study published in 2002 on use of Toradol within the NFL showed that 28 of 30 teams that responded used the drug, and that usage on gameday was reported by a whopping 93 percent of those teams. Former head coach Tony Dungy told ESPN “practically everybody” in the NFL is using Toradol.

The way those NFL teams reportedly put the drug to use is problematic for multiple reasons. According to a handful of former and current NFL players, almost everyone who used Toradol is using it beyond that “five days and never again” window. Like way, way beyond it.

Scott Fujita

Drew Bennett, a former wide receiver with the Tennessee Titans, said he received an injection every single week during the last six years of his career. Scott Fujita, a long-time linebacker who played for the New Orleans Saints, Cleveland Browns and others, remembered team employees asking players whether they needed Toradol before games, sometimes in the middle of a team flight to a road game. Rex Hadnot, a former offensive lineman, said he was given Toradol once a week for nine years.

A recently released book, entitled NFL Confidential: True Confessions From the Gutter of Football, written by a current NFL player who chooses to hide his identity and go by the name “Johnny Anonymous,” states that Anonymous pops three Toradol pills before every game, and that many players do the same.

Toradol’s Side Effects

The list of side effects from use of Toradol are vast. Peptic ulcers, gastrointestinal bleeding, an increased risk of stroke, renal failure, onset of hypertension and kidney damage are just a few of the most serious examples.

According to that same 2002 study, Toradol can also cause bleeding times that are prolonged up to 50 percent—which would seem especially problematic for someone playing a contact sport.

The doses of Toradol allegedly used by teams exacerbate those risks. Toradol’s label states that “increasing the dose beyond a daily maximum of 40 mg in adults will not provide better efficacy but will increase the risk of developing serious adverse side effects.” In a piece by ESPN from 2011, Eddie Matz wrote that “NFL players typically get injected with a 60 mg shot because it acts faster.”

Former NFL Players Speaking Out

These side effects have led to a slew of lawsuits from former NFL players who claimed they were never told by the league or their teams the damage their frequent use of Toradol would have on them in both the short and long term.

In 2011, a group of 12 former NFL players sued the NFL, claiming that the frequent administering of Toradol led to the worsening of “high-risk” injuries, including concussions. Many of those players, who include former New Orleans Saints wide receiver Joe Horn and former Arizona Cardinals tackle Matt Joyce, say they now suffer from afflictions such as depression, anxiety, insomnia and memory loss.

Joe Horn

“They don’t meet with you to tell you what will happen five years later,” Horn told the New York Times. “Had I known that there were going to be complications, I wouldn’t have taken the shots.”

Jeremy Newberry led a charge of over 600 former players in a lawsuit against the NFL in 2014, which also alleged that the NFL illegally provided them with Toradol and other pain killers without alerting them to the side effects. Newberry specifically blames Toradol for the failure of his kidneys. The case was eventually dismissed, but not because of its merit. A federal court ruled that the case must first be heard in arbitration under the league’s collective bargaining agreement before it can be brought to the federal level.

Former Pittsburgh Steelers lineman Chris Kemoeatu just announced he would be suing his former team over allegations that they injected him with with Toradol despite knowing of his kidney issues that began as a child. In 2011, Kemoeatu began experiencing kidney failure, ending his NFL career prematurely. He says the injections he received, without being told the risks, sped up the demise of his kidney.

Allegations became so plenty and so frequent that in November of 2014, the DEA launched a surprise investigation into prescription drug abuse in the NFL. According to the Washington Post, the investigation was based on a “suspicion that NFL teams dispense drugs illegally to keep players on the field in violation of the Controlled Substances Act,” and was spurred on by the aforementioned 2014 lawsuit brought by Newberry and over 600 others.

Continued Use of Toradol in the NFL Today

Despite the NFL Physicians Society issuing a 2012 report that suggested Toradol be administered only to treat existing injuries and not as a “prophylactic against gameday pain,” that hasn’t stopped Vitamin T from continuing to be used in NFL locker rooms. The NFL has very lax rules on the distribution of drugs in its locker rooms, only stating that they must be taken “legally” and by prescription. Each team physician has the authority to determine the right amount of a certain drug to give to a player, and each player’s condition is unique. With no real oversight, you can see where issues arise.

A recent piece written by former NFL player Matt Bowen for ESPN, detailing how injured players like Ben Roethlisberger and Jeremy Maclin might get their bodies right to participate in the playoffs, discusses how Toradol would most likely be the drug of choice to propel these men through their pain and get them back on the field.

Despite the lawsuits, improved knowledge of side effects and even a federal investigation, NFL players are still flocking to Toradol as the way to ensure they’ll be playing on Sundays. Numbing their bodies of both previous and current pain is how someone like Roethlisberger might be tossing 60-yard passes a week after suffering a partially separated shoulder. And that is the greatest danger of all.