Nick Cain: Dan Carter & Co need to be protected from medics

Rugby Union should be on red alert following the cortisone injections given to Dan Carter, Joe Rokococo and Juan Imhoff to get them through last season's Top 14 final.
At the outset it should be said that there is no suggestion that any of the three Racing 92 overseas stars are drug cheats who were abusing cortico-steroids, which is the medical name for the traces found in the blood samples taken from them after the final. Furthermore, soon after the story of the traces broke the three players were cleared of any wrongdoing by a French rugby Federation enquiry.
However, that does not exonerate our sport for its often passive and smug “it doesn't happen in rugby” attitude towards potentially damaging drugs like cortisone. The point brought home sharply by the case involving former New Zealand fly-half Carter and his two teammates is twofold.
First, that there is the potential for abuse because Rugby Union's procedures around the administering of a drug as powerful as cortisone are extraordinarily lax.
Unlike in cycling where a Therapeutic Use Exemption (TUE) has to be applied for with corticosteroids eight days in advance of competition, in this instance the French regulations were too elastic. All that was required was for the Racing doctor to file a declaration of usage to the FFR anti-doping department after he had administered the injections.
The leeway this leaves for the potential abuse of performance enhancing drugs like corticosteroids is significant. The pressure on medical staff to prescribe such drugs for mild or bogus injuries is not difficult to imagine, especially in an increasingly lucrative and competitive professional contact sport like Rugby Union.
It is a big loophole, and it needs to be closed as a matter of urgency, because we have ample evidence of the damage that weak regulatory systems and tolerance for drug usage have done in other sports, with cycling, swimming and track and field athletics the most obvious.
The second issue it raises is the duty of care to players. Carter, who had an injection for a knee injury, said in an interview with the Le Monde newspaper after he was cleared last week that “he didn't know enough about corticosteroids” to comment on whether the eight day rest in cycling should apply to Rugby Union.
When he was told that those stipulations apply in cycling because it is considered dangerous, and that it could enhance performance inside that time frame, Carter said, “Okay, it's the first time I've heard that”.
However, Carter – who revealed he had also had another cortisone injection before the 2015 World Cup semi-final – did reveal that he had some knowledge of the potential risks. He said: “I know you can't take them on a weekly basis – there's a limit may be to two a season… so you know the risk associated with it as a player…not the exact detail associated with the medicine, the long-term damage and things like that, therefore you put your trust in the doctor that he's making the right decision.”
The question this raises is when does the duty of care that this sport – and its countries and clubs – owes to players become blurred by the desire of those players to play through injury to achieve their dreams – even if it involves taking steroid painkillers which could have a later impact on their physical well-being.
This instance is a case in point, with Carter, Rokococo and Imhoff prepared to take the risk. They were rewarded with French championship medals when Racing beat Toulon 29-21 in front of 90,000 at the Nou Camp in Barcelona. For the record, Carter kicked five penalties to clinch victory, with his fellow ex-All Black Rokococo scoring Racing's decisive try. It was a day they will never forget.
However, their success should not be allowed to mask the fact that any drugs given to them to recover from their injuries in order to play the match must be subjected to much greater scrutiny. This should start from the default position that they should be given only in exceptional circumstances, with the health risks made clear to the player in question. There should also be agreed annual and career limits for players which should not be exceeded.
Tommy Smith, the Liverpool hard man of the Seventies known as the ‘Anfield Iron', can tell us a thing or two about the risks of having too many cortisone injections. So can many of the other professional footballers who played in the same era.
Eight years ago Smith did an interview in which it was revealed that, at 63, he often used a wheelchair because of osteo and rheumatoid arthritis. He also had two plastic knees, and a replacement hip and elbow, and had suffered the indignity of having his disability benefits stopped because he hobbled out at the 1996 FA Cup final to take a penalty as part of the charity fundraiser.
Smith recalled: “My knees were knackered even before they started giving me cortisone. The truth was in those days footballers were not treated that well… there were times when I shouldn't have played, and the club knew this. There were matches when they needed me, or sometimes I needed the money.”
The lesson we can learn from footballers like Smith is that the pressures to play will always be there, and sometimes players have to be protected from themselves. And from cortisone.