I’m ready. It’s a warm, midsummer day in the Austrian winter sports resort of Seefeld. The aroma of fir trees saturates the air. The tires of my mountain bike are full, and I have already had a first test ride. Stretched out before me is a white, pebble trail that leads from the small mountain village of Mösern through a fir forest in the Austrian Alps, and pastures that extend to the sports fields. At this precise moment, the football players of the Bundesliga club RB Leipzig are training there, finishing warm-up exercises with a view of the ski jump. They will have to pass me on their way out.

Many international clubs travel to Austria to prepare for the summer season. In the shadow of the Alps, the Champions League semi-finalist Ajax Amsterdam, as well as several clubs from England and Russia, are getting ready for the 2019 tournaments. They use the time to brace themselves for the stress of the coming months. Now, the players from Leipzig are doing circuit training in front of me.

It’s been three months since nine colleagues and I started our investigation into painkiller abuse in football. As a journalist, you sometimes have to follow unusual paths. At this point in time, we‘ve made 73 phone calls and written countless emails. We’ve contacted physicians, officials, and football professionals from the German Bundesliga with requests to tell us about their experiences. Some of them asked to have their name redacted. Others spoke out openly.

They talked about Voltaren, opioids, and infusions. Some mention performance-enhancing substances and painkillers distributed in locker rooms as if they were candy, and report dubious practices in clubs abroad. Others do not want to say anything. It is particularly difficult to approach active players. They are shielded by their clubs.

I look further down the slope, trying to see if anybody is already there. On one side of the mountain is the training ground, reserved for two weeks by their club. On the other side, the luxury hotel where the players spend the training season. Unlike racing cyclists who train up to eight hours per day, football players – even professionals – get a large chuck of free time in between practices. They idle away the hours playing PlayStation or poker. The players from Leipzig come to the sports field twice a day, for an hour and a half each time. After that, as I observed the day before, most players will ride their bicycles on the gravel road for 3 kilometers back to the hotel. Once there, no one from the club’s press department will be present.

This could be my chance. My plan is to catch up with them by bike, say hello, and start a friendly conversation. “Oh, so you’re professional football players?” Then, I’ll skillfully approach the subject of interest. As a journalist, I’m looking for players who will talk about their everyday life – injuries, pressure, recovery – about testing limits, and about painkillers. Because that is exactly what our investigation is about.

The largest five European football leagues – located in England, Germany, Spain, Italy, and France — generated more than 15 billion euros in the 2017/18 season. The European Championship, a competition across 12 countries — now cancelled due to COVID-19 — was posed to earn another billion euros in revenue. Needless to say, the football industry is thriving. It is a product that pays as long as the competition is fit. With millions to be earned in salaries and bonuses, there is also incentive for players to stay in the game.

By 35, most players are at the end of their career. But until then, many want to earn as much as possible. The pressure to perform is high. If your body starts gives out, it must be helped – with painkillers and possibly other substances. Because, in this business, hardly anyone can afford injuries or pain.

The first players are approaching. Three, then seven, then eleven on bikes. The training is over. Midfielder Kevin Kampl is part of the group, recognizable by his bleached hair. I also recognize Timo Werner and Marcel Sabitzer. I turn onto the gravel path and let two of the players from Leipzig pass me. Three more follow. They are riding pretty fast. Is the return trip part of the training? I accelerate and try to at least keep up with the next group, fighting my way up the slope – but I still can’t get close. The headwind caused by two midfielders carries away my timid “hello”, and the hope of getting insider information with it. After two minutes even the last one in front of me has disappeared into the fir forest. Bundesliga professionals. On e-bikes. Faster than a curious journalist.

In 2002, the world football association, FIFA, started to research the abuse of painkillers in football. FIFA experts were soon able to prove that painkillers are part of everyday life at the World Cup. In 2018, one in four players in Russia took painkillers before each match — one particular player even used three different painkillers. The findings of the Under-17 and Under-20 World Cups in 2005 and 2007 were also shocking: almost half of the players took painkillers while competing at the tournament.

FIFA’s internal research into painkillers was developed by physician Jiri Dvorak. Under his leadership, and after several tournaments, the sheets showing the medications taken by all national players during the 72 hours before kick-off were evaluated. “The result was devastating,” says Dvorak. “When we evaluated the numbers, we saw that the consumption of medications is enormous.”

In an interview with CORRECTIV and ARD Doping Editorial Team, Dvorak remembers a sheet in which all 23 players confessed to having taken Voltaren, and some of them even to having taken an additional painkiller. Another table showed five different medications given to a young player for a single match. “Taking painkillers for prophylactic purposes is misuse,” says Dvorak. “It absolutely cannot be justified scientifically and is counterproductive”.

The 71-year-old Swiss citizen with Czech roots stopped working for FIFA in 2016. The new president, Gianni Infantino, closed the entire medical research department previously headed by Dvorak. Today, the physician demands that “[p]ainkillers should be banned if they are not medically necessary”.

FIFA’s figures show that painkiller abuse is not just a problem in German football. Most football players stay silent about their experience with Voltaren and other medications. Their stories only appear occasionally in press reports.

One of them is Daniel Agger, who played 232 matches for Liverpool in the Premier League. “I have taken too much anti-inflammatories in my career, my body could not cope with it,” he said in an interview with the Danish newspaper Jyllands-Posten in 2016. Throughout his entire career, he had taken painkillers in excess of the recommended dose. The spring of 2015 was no exception: at this point he had switched to the Danish club Brondby and wanted to play at the local derby despite an injury. He took four tablets in the hours before the match. On the field, he no longer had control over his body and had to be substituted after half an hour. A short time later he had to end his career, at the age of 31. “Maybe my story will make other athletes take fewer pills,” said Agger.

Stories like Agger’s prompted us to address the painkiller abuse with journalists from other major football-playing nations and to speak with more professionals. From. There, CORRECTIV and ARD Doping Editorial Team began collaborating with French journalists from France 2 and with colleagues from Italian La Stampa and Investigative Reporting Project Italy (IRPI).

Even though the considerable amount of painkiller consumption has been acknowledged for the past 18 years, the general reaction to their abuse seems absurd from a medical standpoint: more and more matches and competitions are being held, posing additional challenges for the players, only intensifying the pressure and scope of abuse.

Unlike doping agents, medications for pain and inflammation in competitive sports are generally legal — something that several insiders think is wrong. “You can simply perform better with painkillers,” says Hans Geyer, a doping researcher from Cologne. The scientist demands that painkillers be classified as doping agents. “Painkillers,” says Geyer, “are extremely harmful to health.” According to the definition by the World Anti-Doping Agency (WADA), a substance must be included in the list of prohibited drugs if it fulfills two of a total of three doping criteria. Painkillers conform to two criteria on account of the increase in performance and the damage to health. This is how Geyer sees it.

We started our investigation looking into the abuse of prescription drugs in football. For this purpose, CORRECTIV and ARD Doping Editorial Team joined forces. It soon became clear: beyond prescription drugs, the abuse of painkillers is also a problem – and possibly a more pressing one.

In response to a survey, 1142 amateur footballers shared their experiences with painkillers and doping. We also interviewed over 100 professional football players, most of them from the Bundesliga. Some finished their careers in the 1990s and early 2000s, others of them only recently. Three of them are currently playing. All of these professionals shared their experiences with us. One of them is Jonas Hummels, the younger brother of the national player Mats Hummels.

In December 2015, nine days before Christmas, Jonas Hummels was suffering from severe pain. His knee had been plaguing him for months. Before training, he took the painkiller Arcoxia. After sprinting away, he suddenly came to a stop, screaming. His kneecap was pressing on a nerve. At this point, jumping and landing after a header would simply no longer be possible.

“You could tell me nine times that I was taking too many painkillers. And nine times I would not have listened to you,” Hummels says today. At the time, though, he remembers ignoring the consequences of the substance abuse.

One week later, Hummels faced the Bundesliga club Bayer Leverkusen alongside his team, the Spielvereinigung Unterhaching. They were one of the final 16 teams left in the DFB Cup. It could be the highlight of his career. Hummels was the captain of the third-division club and normally, he would lead his team onto the field. But he already had to give up that plan. At the very least, he wanted to be part of the team on the field, to get out there somehow, maybe even substituted in.

Before the match, Hummels tried taking the usual painkillers but realized they don’t work. The pain is too strong. His body had built up a tolerance. But he desperately wanted to be on the field and the team’s physician wanted to help him, too, before a match that would be so important to the captain. The orthopedist suggested a local anesthesia to Hummels. It was his only chance.

Hummels agrees. One hour before the match, the physician injects Hummels’ knee four times and presses the serum into his veins. Three hours later, his team loses the cup match against the first division’s Leverkusen 1-3. Hummels did not play for a single minute, but he was there. He later described the evening as a “supreme highlight”.

That night was the end for Jonas Hummels. With cruciate ligament ruptures and cartilage damage in both knees, Hummels could hardly climb stairs without feeling pain at the age of 25.

Like Hummels, many players rely on the short-term effects of painkillers. Sometimes they know absolutely nothing about possible long-term consequences. But they can be severe: Muscle injuries, damage to kidneys, liver, and joints. Arthrosis at a young age, and a higher risk of heart problems.

In some cases, players develop questionable routines that may only become dangerous for them at a later time. The story of a player who wants to remain anonymous and played for years in the lower professional leagues in Italy is an example of this. “Every Saturday evening before the match, I would go to the hospital, where a friend of mine injected cortisone into my fingers or legs so I could play the next day,” says the former goalkeeper, who is now a coach. As a thank you for the treatment, he would give the doctor a bottle of wine. During his career he played in multiple leagues, and some of his teammates played for different A-series clubs.

He ended his career at the age of 41. “I could no longer jump to the right, but I made a good wage and needed the money,” he says about his health at the end of his sports career. For years, his family had been able to live on what he earned as a semi-professional football player. Today, he says, “I ruined my body.”

In addition to visits to the hospital, he also used painkillers on his own for more than 20 years, among them Aulin, which has the active ingredient nimesulide. “Before each game, I would take two Aulin tablets, without water.” By the end of his career, he was on the brink of kidney failure and had already undergone five operations.

Such testimonials show how painkiller abuse slowly turns into addiction. Despite our failed investigation with RB Leipzig at Seefeld, we still succeeded in having conversations in Austria with the managers of other Bundesliga teams that were also preparing for the 2019/20 season in the Alps. We held an off-the-record conversation with a Bundesliga physician there and received telephone numbers for further research. At the end of a trip that took us through six training camps, it is at least clear that we have to talk to more people in the professional football system if we want to learn more about substances and methods.

Unlike Hummels, most former football professionals do not want share their history with painkiller abuse. They do not even want to be quoted anonymously. A “tough guy mentality” permeates the sport. Few people even dare to talk about weaknesses after finishing their career. Their stories show how, for decades, footballers have become ill due to the use of painkillers. Stiff feet, early arthrosis, life-threatening atrial fibrillation; they now have to live with these physical issues for the rest of their lives.

In spring, we meet Thomas Frölich, TSG Hoffenheim’s team physician. During his time in paid football, he has worked with numerous successful coaches, such as Joachim Löw, Felix Magath and Ralf Rangnick, and most recently, Julian Nagelsmann. He is often with the team, says Frölich, which means he can control access to medications. He only releases tablets “in limited quantities”.

However, even Hoffenheim’s team doctor eases access to medication as kick-off draws closer. “If someone comes to me 45 minutes before the match, I cannot argue with him for half an hour, so I am a little more generous,” said the team doctor. Frölich said that again and again, players who are new to the club ask him for painkillers, often out of routine. “Then you have to try to get them out of the habit,” says Frölich. “Because he often has no pain at all.”

In addition, football clubs cannot constantly control their players. Common pain relievers are actually available in low doses in any pharmacy without a prescription. For example, ibuprofen brands is sold over the counter, up to a dosage of 400 mg.

An anecdote from 1998 shows the consequences of taking painkillers without medical control. At the time, Frölich’s VfB Stuttgart was in the UEFA Cup Winners’ Cup final match against Chelsea. The team doctor had prescribed Voltaren for a player, but he spat blood after the match. The reason: the player had also taken aspirin on his own volition. The combination of the active ingredients of both medications increases the risk of gastrointestinal bleeding. Frölich gave the player infusions and kept stayed by his bed. The player survived the night. At some point his stomach stopped bleeding.

Jonas Hummels also remembers medicine cabinets filled to the brim with painkillers. If you wanted ibuprofen, you usually got it. A former Bundesliga player, who wishes to remain anonymous, says that a few years ago a physiotherapist was standing at the entrance to the team’s bus and was holding a bag of painkillers: everyone could help themselves freely before leaving for the match.

The conscious use of medication to improve performance in professional football has already played a role in the past. A court case against Riccardo Agricola proves that. The Italian was a doctor in the dominant Juventus team in the 1990s, which included the players Alessandro del Piero, Didier Deschamps, and Zinedine Zidane. Agricola was accused of systematically influencing player performance by means of medications. “It turned out that the majority of the medication was not used in accordance with prescriptions and therefore not for the treatment of specific diseases,” says the first-instance judgment in 2004, to which CORRECTIV and ARD Doping Editorial Team gained access. The Juve professionals did not receive painkillers for therapeutic purposes. “If there is no possibility of using painkillers, it would not be easy to play all the matches of the championship,” two former players of the team are quoted as saying in the case file.

At that time, prosecutor Raffaele Guariniello led the investigation, and the 79-year-old man still feels frustrated so many years later. “I didn’t have a single witness who wanted to speak,” he told us over the phone. The code of silence of professional football applies any time and anywhere.

Neven Subotic is the only active professional player who agreed to speak publicly about painkillers for our investigation. We met him at CORRECTIV’s office in Berlin. Spring is approaching but it’s still cold outside.

Subotic started his professional career at the age of 18 with the 1. FSV Mainz 05 under coach Jürgen Klopp. Later Klopp brought him to Dortmund. Twice, Subotic and his club were named German champions. Today, he plays for Union Berlin. In total, he has played more than 200 Bundesliga matches. He also stood on the field with the Serbian national team at the 2010 World Cup.

“I believe the whole system is missing an official who can sure that everything is done properly,” says Subotic. At the moment, football regulations work through the transfer of pressure. It is about earning more money. The clubs needs to be successful, and so the coaches feels pressured. The coach passes on the pressure to their assistant coaches or to the physicians. “And in the end, it’s the player who gets the most pressure. He can’t play unless he takes painkillers.” The central defender also played in France for a year and a half, where the system is similar – as well as the problematic consumption of painkillers.

He hardly uses painkillers himself, says Subotic, and that he’d rather miss a match. At the same time, he observes how ibuprofen is distributed for “every little pain”. He advises younger players to act on their own and regularly seek an opinion from external doctors who do not have a conflict of interest with the club. “And in the end, it’s the player who suffers the most pressure and who has the most to lose,” Subotic says. If a player sustains permanent damage, he is quickly out on his own.

Neven Subotic demands that players must also learn more about the medications that are often part of their day-to-day work. “What I have noticed in the past 14 years is that ibuprofen is distributed like candy. For every little pain they immediately give you ibuprofen,” says Subotic. He says he wishes that the effects of painkillers on former football players were investigated. “We need information about what happens after the career ends and the cases should also be made public anonymously – as a warning.”

In recent years, three studies have provided answers to the question of the harmful effects of painkillers. They confirm that the regular use of painkillers increases the likelihood of experiencing significant heart problems. In a 2011 study, Swiss researchers found that diclofenac (Voltaren) and etoricoxib (Arcoxia), both popular among footballers, increases the risk of dying from cardiovascular disease. Danish scientists also found that diclofenac significantly increases that risk. The same applies to ibuprofen. And two years ago, another Danish study confirmed that diclofenac increases the rate of developing a heart problem during the first 30 days after ingestion.

“There is a clear link between death caused by a heart attack and the use of nonsteroidal anti-inflammatory drugs,” explains Gunnar Gislason. He is one of the Danish researchers who works with heart related risks. “These medications affect the cardiovascular system. We know that they affect blood pressure, that they affect the kidneys.” As a result, painkillers can indeed kill. So is the story of one player from France.

On April 6, 2018, Samba Diop comes home from training. The 18-year-old plays for the second division club Le Havre AC. He was doing lighter training after having to stop for a few weeks because of mononucleosis. When he gets home, he tells his mother that he does not feel well. He gets worse, vomits several times, and collapses on the way to the toilet at 3:30 a.m. His mother calls an ambulance.

The young talent is supposed to sign his first professional contract in the coming days. Were it not for the hip pain that has plagued Diop for weeks, he would also be playing an important match the next day. He talks to the medical department about it and, after the daily training, is sent to see a physician who injects him with the painkiller ketoprofen, which is often used for osteoarthritis. “I’m going to die and it’s because of the injection,” Samba later tells his mother at home. Arame Diop recalls this dramatic moment at the end of last year in a conversation with the media outlet Loopsider. There, Samba’s mother describes the night and the course of events.

Samba Diop is taken to the hospital in the middle of the night, where his condition worsens, and he dies in the morning. “I want the club to tell me the truth, that’s all,” said Arame Diop, more than a year later, to the media outlet Loopsider.

The autopsy report, which CORRECTIV and ARD Doping Editorial Team obtained access to, states multi-organ failure as a preliminary cause of death – a possible side effect of ketoprofen. However, for two years, no definitive answers have been given regarding the cause Samba Diop’s death . “The autopsy leaves the cause of death open. It is not possible to know the exact reasons. But it excludes some options such as a pre-existing heart condition,” says Yassine Bouzrou, who represents the Diop family in a lawsuit against the club. It is about who is to blame for Samba’s death. The family has sued the authorities of the club and the physician for manslaughter.

For two years, lawyer Bouzrou has been asking for complementary analyses and investigations. Since there has been no response by the French justice system, he threatens to bring the case before another court, Bouzrou told a collaborating France 2 reporter.

The Diop family still lives in uncertainty. Was the injection of painkillers the cause of Samba’s death? The silence of those responsible speaks volumes about an industry in which painkillers help players to perform – but often at their own risk.

The issue of painkiller abuse in football does not always have such drastic consequences. According to our survey of over 1,100 football players, which cannot be considered representative, over half of participants used painkillers several times throughout a season to play football. More than 40 percent took painkillers not for therapeutic reasons, but to increase their performance.

Very few are concerned with the consequences for their health. At the same time, hundreds report negative consequences: stomach problems, as well as liver and kidney damage. Several also reported becoming addicted to opioids when over-the-counter painkillers no longer worked.

Half of survey participants said they did not know about the increased risk of heart disease caused by painkiller use. Rather, amateur footballers reported that their coaches had given them pills before the match. When it comes to painkiller abuse, amateurs and professionals play in the same league.

The German Football Association has always seen itself as protecting the interests of German amateur football players. Its current president, Fritz Keller, has been in office since September 2019. In mid-May we met Keller at the DFB’s headquarters in Frankfurt am Main and show him the results of our survey.

Keller looks concerned. He sends a clear message in a time when for-profit football is accused of focusing more on the money than on the health of players. Painkiller abuse is not entirely new to him, said Keller. But at the professional football club SC Freiburg, which he headed for a long time, it was pointed out that the pills should not be taken in advance for possible injuries. “Painkillers as prevention, that’s just stupid.”

But this is exactly how many amateur footballers use these medications. Keller says that this “shocked” him. “We absolutely have to go to our national associations and simply raise awareness through the trainers.” The DFB’s president summed up the painkiller issue by stating: “This is actually counterproductive. Amateur sports is intended to keep you healthy and not to break you.”

For Keller, painkiller abuse is a problem for society as a whole. In regards to football, he said he would “check everything immediately and also draw attention to it in order to keep our athletes healthy”. He also wants to implement whatever measures the DFB is able achieve in this matter.

Just days before publication, the DFB clarified an earlier response to CORRECTIV’s findings about painkiller abuse in football: “Regarding the sensitization of amateur clubs, the DFB is currently planning an online webinar for clubs about the consumption of painkillers with doctor Toni Graf-Baumann”, wrote a representative for the German Football Association in an email. Graf-Baumann, an expert in pain treatment, has been considered an authority about this problem for decades, especially in football associations. He is also a member of DFB’s anti-doping commission. In their written response, the DFB also announced that they will be holding future conversations with the Federal Agency for Health Education.

As for professional football, the DFB representative wrote there are “no hints” that the consumption of painkillers in German football is different from other professional leagues in Europe. “This careless approach to painkillers and its many risks makes clear that much more educational work is needed.”

From the perspective of the two professional football players Neven Subotic and Jonas Hummels, measures against painkiller abuse are also necessary for highly paid players. “As far as I know, there is no major educational work done by clubs because they are also under pressure to get players fit as quickly as possible,” says Subotic. Hummels also believes that “raising such public awareness would really make a lot of sense”.