Could Medical Marijuana Be a Game Changer for Treating Athlete's Pain?
A ban on the use of medical marijuana by the National Football League (NFL) and the NFL Player’s Association could go up in smoke—that’s the case if players advocating for the use of cannabis to treat chronic pain get their way.
Although official NFL policy bans cannabis, a growing number of players (both current and former) are becoming increasingly vocal about using cannabis in place of opioids to treat pain, believing it is more effective and less addictive.
Football is a notoriously punishing sport and players routinely suffer from painful injuries often taking heavy-duty pain killers to treat them. Given the current climate of concern about the overprescribing of opioids, the players’ position may be gaining ground.
Football and Brain Injuries
Although banned on the federal level, individual states continue to pass laws allowing residents to use medical marijuana to address pain and other effects of illness (as of this writing, some form of marijuana use is legal in 25 states and the District of Columbia). As NFL players become increasingly aware of the detrimental effects of football on their bodies, some are pushing for more research and policy reform—hoping their efforts will result in an endorsement of using medical marijuana for pain management and for treating sports-related traumatic brain injuries (TBI), where it largely remains prohibited.
The National Institute of Neurological Disorders and Stroke’s website defines TBI as a type of brain injury that results “when a sudden trauma causes damage to the brain.” Professional football players, in particular, can be especially prone to TBI due to the aggressive nature of the sport and the fact that their heads often experience severe impact during play. In fact, a study presented in April, 2016 at the American Academy of Neurology (AAN) annual meeting revealed that as many as 40% of former NFL players showed signs of TBI, which is much higher than among non-athletes. Not surprisingly, the researchers also found a correlation between the length of a player’s career and his likelihood for showing signs of TBI.
This study comes on the heels of the growing recognition that football players are at especially high risk for chronic traumatic encephalopathy (CTE), a condition caused by repeated TBIs and blows to the head, which eventually cause the brain to deteriorate. While CTE can only be confirmed by studying a player’s brain after his death, a number of former and current NFL players today have reported signs that could suggest this condition, including memory loss and dementia.
Using Cannabis to Prevent and Treat Pain
The latest research findings suggest that medical cannabis may be able to treat TBI and prevent CTE, thus improving the quality of life for players at high-risk for these conditions.
“The idea is that [cannabis] may be beneficial for treating brain trauma, as studies have shown that the cannabinoids found in cannabis—most specifically cannabidiol (CBD)—activate [receptors in the brain] that can provide protection against neural damage following acute and chronic brain damage,” explained Scott Weiss, DPT, ATC, CSCS FACSM, the co-owner of Bodhizone Physical Therapy & Wellness in New York City. In other words, the chemicals medical marijuana contains can offer a protective factor, both before trauma to the head, and also after the trauma occurs, thus potentially lessening the effects.
An Alternative to Opioids
Cannabis has been used for thousands of years as a safe and useful means of providing pain relief. Medical cannabis can be an effective alternative to long-term use of opioids, including morphine and oxycodone (OxyContin), especially for patients with fibromyalgia, degenerative arthritis, spinal cord injury, neuromuscular disorders such as amyotrophic lateral sclerosis, and multiple sclerosis, among other conditions.
Addiction to opioids has been a growing problem—along with the risk of overdosing—particularly for athletes who use them to manage the effect of injuries that occur on the field. That’s why many cannabis proponents believe marijuana offers a safer alternative, without all of the dangerous side effects.
“The school of thought is that the use of marijuana, specifically cannabidiol (CBD) [a part of the cannabis plant that offers therapeutic benefits without psychoactive effects], helps ease pain and relax the central nervous system,” Dr. Weiss said. “As a pain reliever, it is well documented that marijuana, and specially CBD, can block specific receptors in the brain, and can alleviate severe pain and soreness.”
However, being natural doesn't mean healthier. Like opioids, marijuana can be habit forming and is associated with abuse potential and risk of dependency in susceptible patients. It is also contraindicated for pregnant women, individuals with coronary heart disease, and/or those with a history of psychiatric disorders such as schizophrenia or bipolar disorder. Another downside—using marijuana impairs driving (drugged driving) and there is also evidence that it negatively impacts brain development, particularly in adolescents.
Medical Marijuana and the NFL
Yet despite the potential that marijuana holds for people at risk for repeated trauma to the head and the body, the NFL includes all marijuana on its list of banned substances for players, regardless of state laws and medical needs. As a result, the stakes are high for players who want to use medical marijuana, since a positive drug test has ramifications.
NFL players are drug tested yearly during training before the start of football season, sometime between April 20th and August 9th. In addition to illegal substances—including marijuana—the NFL prohibits the use of performance enhancing agents such as human growth hormones, stimulants, steroids, and diuretics, which mask the use of these substances. Players who test positive are referred to the league’s substance-abuse program and undergo more frequent testing. Additional violations result in greater punishments including fines, suspensions of play, and a one-year ban from the league. Suspending players for cannabis is a last resort after 4 positive drug tests.
The NFL has not yet responded to Practical Pain Management’s requests for comment about the future of medical marijuana in professional football, however NFL Commissioner Roger Goodell has told various news outlets that the league’s medical advisers continue to look at the research but still do not have enough evidence to warrant a change in the league's position.
Could the Clock Run Out on NFL Policies?
One person who is leading the charge to try to change this fact is Michael Cindrich, a medical cannabis attorney in California who serves as the Executive Director of the San Diego branch of NORML (National Organization for the Reform of Marijuana Laws). Mr. Cindrich is also co-founder of the Gridiron Cannabis Coalition, an organization that’s working with former NFL players who grappled with pain in the past and are now speaking out about the importance of making marijuana available for athletes who suffer from chronic pain and increased risk for injuries.
“The Gridiron Cannabis Coalition has a multi-pronged goal, including helping the NFL to change its substance abuse policy to accept cannabis, and to advance research on the use of cannabis to prevent and treat injuries and pain,” Mr. Cindrich said, adding that it can also have a protective effect as well. “Cannabis can act as a second helmet to protect the brain in the event of traumatic injury."
Mitch Earleywine, PhD, author of Understanding Marijuana (Oxford University Press), professor or Psychology at the University of Albany and leading researcher in psychology and addictions, explains the protective process this way. "Cannabinoids are extremely powerful antioxidants. Injured brain cells are essentially like food rotting very quickly and the antioxidants would minimize the rotting," Dr. Earleywine said.
On the research side, the Gridiron Cannabis Coalition is "working on different studies, including a study through Stanford University where approximately 30 players will be given different strains of cannabis through different ingestion methods to see the benefits they get,” he explained. “We are also in the process of opening treatment centers where former players can detox from pharmaceuticals and get involved in more natural treatment methods,” he said.“It’s also been shown to delay the onset of Alzheimer’s and dementia,” he said, adding that a lot of players are using cannabis now, despite the NFL regulations, and they find that it brings them mental benefits such as clearer thinking and improved memory.
A Challenge to Setting National Policies
Dr. Weiss pointed out that one major stumbling block to change is the fact that medical marijuana laws vary by state, posing a challenge to create national standards.
“As major sports programs, like the NFL, are nationally, if not internationally, run, it creates a huge problem for the possibility of treatment, and is undoubtedly the biggest limitation when it comes to prescribing,” he said.
Nonetheless, the fact is that allowing medical cannabis use by athletes may be an idea whose time will come sooner rather than later, if the players and pro-marijuana folks have their way.
“Based on the current status of the most recent studies, it is not unfathomable that the NFL, or other professional sports institutions should revisit this topic [in the future] and seriously reconsider current policy,” Dr. Weiss explained.
“Football, rugby, wrestling, triathlon, and marathon running are the sports where athletes would benefit the most form medical marijuana. These activities can take a major toll on the body and marijuana may ease the pain of the intensity needed for them,” he said.
In the meantime, advocates believe more research is needed to truly understand cannabis and its benefits and risks. “The use of medical marijuana will be a topic of discussion for a long time—even after any legislation that may legalize it,” Dr. Weiss said.
The debate also extends well beyond the boundaries of the football field into the homes of people grappling with chronic pain and potential head injuries caused by recreation sports and activities.
If you are considering medical marijuana, or as a parent to relieve pain in a child, Dr. Weiss said it’s important to involve a physician in order to make the most educated decisions. (The use of medical marijuana to treat sport-related injury pain in teenagers whose brains are not completely developed is extremely controversial.)
“Never self medicate! If you strongly feel that medicinal marijuana may be a good treatment for you, or for your child, it is imperative that you talk with your doctor about it for safety reasons and also to go through all the proper channels to see it through,” he said.