In May 2019, The NFL announced the establishment of a Joint Pain Management Committee (NFL-JPMC) to develop "uniform standards for club practices and policies regarding pain management and the use of prescription medication by NFL players.” The NFL-JPMC will review and submit policy recommendations for adoption into the new 2021 Collective Bargaining Agreement (CBA), which will be ratified in terms negotiated in conjunction with the NFL Players Association (NFLPA).

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If the NFL-JPMC made its recommendations today, only a small number of potential treatment avenues would receive approval, in line with a conservative evaluation of current scientific findings. Despite such a theoretically limited list of approved cannabis treatments, the committee would almost certainly endorse cannabis treatments for chronic pain and neurodegenerative disorder symptoms. These are widespread conditions in the NFL, afflicting nearly every player. Therefore, the NFL will be forced to reformulate policy governing drug-testing, fines, suspension, and expulsion.

Shifting Away From The NFL’s Legacy Of Selectively Punishing Cannabis Users

The NFL punishes any use of cannabis under the current CBA agreement (effective through 2020). Under current CBA rules, players are subjected to drug testing just one time, randomly, each year. Former New York Giants Running Back Tiki Barber, calls these so-called ‘dummy tests’ easily avoidable. Notable NFL stars, such as Ricky Williams and Josh Gordon, however, have lost their entire careers due to the repercussions stemming from failing a first drug test. Failing a single drug test triggers increased league scrutiny, more random drug testing, major fines, and potential removal from the league.

Despite the risks, players report widespread use of cannabis in the NFL. In his fourth year, talented Cowboys defensive end David Irving announced his retirement (on Instagram) in response to a forced suspension stemming from failing multiple random drug tests. Irving lambasted the NFL’s regulations, saying that 80% of players smoke cannabis, anyway. NFL Champion and 2014 Pro Bowler Marcellus Bennett estimated that number as high as 89%.

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The call to allow for medical cannabis in the NFL has been amplified by the media continually producing reports outlining the devastating effects a career in football has on the body and mind. Based on these stories, the NFL’s primary customer base is learning about the horrors players endure after and even during their playing career. In this emotionally charged interview, former NFL linebacker Keith McCants outlines a life of anguish resulting from his six years of play. The public and players increasingly view cannabis not as a cure-all, but as a therapeutic tool to help soften the processes by which a body punished for football entertainment decays.

The NFL’s Cultural Resistance to (Medical) Cannabis

Beyond the zeitgeist of fans and players calling for medical cannabis, the scientific community has quietly produced a credible body of researched publications supporting medical uses for cannabis that directly applies to the NFL. The league’s refusal to offer any sort of conciliatory allowance or soft policy change, outside of scheduled CBA negotiations, tells of the conservatism within the NFL’s governing body.

Elsewhere in the world, cannabis-use has been sanctioned by the most prestigious sports organizations. Following the World Health Organization's 2018 recommendation that CBD be dropped from all drug-control conventions, the Olympic Committee approved CBD for its athletes. The decision was based on findings that CBD presented no potential for bodily harm or performance enhancement among Olympic athletes.

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World Health Organisation headquarters, Geneva, north and west sides. Source: Yann Forget

In stark contrast, prominent NFL owners and representatives defend policy positions ranging from scientific skepticism to overt opposition. Arthur Blank, owner of the Atlanta Falcons, who in the 10th largest potential cannabis market, shared "concern about the gateway effect [cannabis] has on other drugs.”

The gateway drug argument actually still divides the scientific community but likely doesn’t apply to the social milieu of the performance-driven (prescription-powered) NFL locker-room. Chief Medical Officer of the NFL, Allen Sills, presented the fan pressure to allow medical cannabis as a false duality. In an interview with USA Today, Sills critiqued “a narrative that says, ‘I have severe pain: I’m either going to take opioids or marijuana.’ … [but] there are many other treatment strategies.”

Sills further states that popular opinion has outpaced the science supporting cannabis as an alternative to prescription painkillers. Harking from that same article and perspective of science-based skepticism, Dr. John York, head of the NFL Owner’s Health and Safety Advisory Committee and former cancer research scientist, echoes Sills, calling the scientific consensus “very unsettled.”

York explains that “marijuana has not been legalized in a manner in which you can do studies.” The NFL’s executive leadership and owners seem to publicly advocate a conservative appraisal of cannabis science, and that is unlikely to change even if the NFL-JPMC produces a neutral or pro-cannabis reporting of the scientific consensus.

We examine the science below…

Cannabis-Based Treatment of Arthritis, Sleep Disruption, and Chronic Pain

Joint pain, knee-joint, man, background iStock / busracavus

The violent nature of NFL football causes players to accrue chronic pains and physical limitations during and after their professional career. Cannabis offers a novel therapeutic option with a unique capacity to mitigate chronic pain, largely through anti-inflammatory effects.

Arthritis is a painful limitation of joint movement that afflicts 11.7% of U.S. males by age 60. Among players studied in a 2009 report, 40.6% of retired NFL players reported arthritis stemming from injuries sustained during their playing careers. There is a scientific consensus that cannabinoids’ anti-inflammatory effect reduces inflammation implicit in arthritis. While the NFL is concerned with player health following retirement, pre-treatment with cannabis would not necessarily prevent the onset of arthritis, and so the NFL would not consider cannabis for this affliction.

Former NFL players report a high incidence of Sleep Disruptive Behavior (SDB), according to a 2010 study on sleep. 100% of the study’s participants reported disruptive snoring and 23.9%, reported sleep apnea, compared with a prevalence of 3 to 7% in the general population. The scientific community remains divided:

This 2013 study and 2017 Minnesota State Medical Cannabis policy decision agrees that “cannabinoids, primarily nabiximols, are an effective treatment to improve short-term sleep outcomes in individuals associated with obstructive sleep apnea syndrome …chronic pain, and multiple sclerosis.” Conversely, The American Academy of Sleep Medicine (AASM) rejects these findings, and this 2018 literary review also 'respectfully disagrees,' citing “insufficient evidence of effectiveness, tolerability, and safety” of cannabis treatments.

Essentially, evidence exists that cannabis helps relieve pain that hinders sleep, but not necessarily that it promotes good sleep. Because the evidence is unsettled and the NFL observes a conservative stance on the benefits of cannabis, it’s unlikely policy would allow cannabis be prescribed, over other sedatives, to aide sleep. 

Cannabis has been found to affect chronic pain through multiple analgesic (defined as pain relieving) mechanisms, including Endocannibinoid System CB1 and CB2 receptors but also, as was discovered in 2018, a multitude of less-understood mechanisms requiring further study. A 2011 review of scientific literature suggests that Nabilone (A THC-derivative primarily used in cancer treatment) is more effective than a placebo in treating chronic lower back/spinal pain. 

A 2012 study found Nabilone “significantly more effective than ibuprofen in reducing pain intensity” among NFL players suffering from Medication Overuse Headaches (MOH), a condition resulting from consuming too much medication. These studies support Nabilone as an effective treatment option for NFL players. The NFL-JPMC is likely to conclude that a converging consensus supports the use of cannabis in treating chronic pain.

Cannabis and Neurodegenerative Decay

Headache area on brain X-ray, 3D illustration. iStock / Iaremenko

NFL players suffer from a dramatically increased incidence of brain damage sustained during even short playing careers. Repeated Traumatic Brain Injury (TBI) causes the onset of brain decay which has the potential to develop into a variety of neurological diseases.

Treatments for these diseases addresses symptomatic relief exclusively, because curing neurodegenerative disease remains beyond the capabilities of modern medical science. Cannabis offers a novel therapy for treating neuroinflammation and metabolic dysfunction key in the spread of brain decay.

Importantly, cannabis lacks the low levels of neurotoxicity attendant to medicines targeting neurodegenerative symptoms. Experimental Cannabis procedures have demonstrated the amazing capacity for cannabis to stunt the spread of damage caused by TBI, which could have a transformative effect on medical treatment in the NFL.

Tragic, high-profile cases, such as those of Junior Seau and Aaron Hernandez, illustrate the effects of brain trauma during and following an NFL career. An explosive 2017 study found 87% of players afflicated with neurological degeneration associated with the onset of Chronic Traumatic Encephalopathy (CTE).

he study found CTE in the brains of 87% of 202 deceased football players, including 110 of 111 (99%) NFL players, 48 of 53 (91%) college players, and 3 of 14 high school (21%) players. Another landmark study from 2012 concluded that former NFL players are more than three times more likely to die with a neurodegenerative disease. The same study found incidences of Alzheimers (AD) and Lou Gehrig's disease (ALS) at four times the rate of the general population.

Cannabis is an effective alternative option for treating the symptoms of TBI, neurological disorder, and neurological disease. In 2018, researchers used medical cannabis to treat TBI/concussion symptoms, including headache, mood swings, sleep disorder, focus issues, and dizziness. 80% of the 4,123 patients experienced “significant improvement in activity level and symptoms” with medical cannabis.

Naturopathic symptom relief through cannabis should be researched and integrated as a primary, secondary, or even alternative prescription (further study required) for the damage sustained by TBIs during and after an NFL player’s career. The NFL-JPMC is likely to approve the use of cannabis in some limited capacity, according to developing scientific opinions.

Potential for Cannabis as a Revolutionary Therapy for Neurodegenerative Disease

Cannabis might possibly be the first known treatment capable of arresting and even reversing the spread of neurological deterioration and onset of neurodegenerative disease. A 2015 study found cannabis administration after a TBI rescued learning and memory abilities in young adult male rats. Attempts to recreate this stunning finding in humans have failed due to biological differences — however the study remains of the utmost interest, worthy of continued followup and even increased research attention.

Dr. Everett J. Lehman, author of Neurodegenerative causes of death among retired National Football League players (2012) states that “inherent properties … of cannabis botanicals … offer distinct advantages over the current single-target pharmaceutical model and portend … [revolution for] neurological treatment in effective interventional and even preventative treatment.”

At the very least, cannabis is a proven treatment for symptomatic relief following TBI. That, alone, offers NFL doctors an alternative therapy with a sound scientific foundation. The NFL-JPMC is likely to adopt cannabis on that basis, but findings suggesting that cannabis might help heal intractable neurodegenerative diseases, such as Alzheimers and Dementia, represents an extremely desirable medical outcome for the NFL for many reasons.

Recent disturbing findings about the prevalence and effects of CTE have greatly decreased youth participation in football activities and damaged the NFL’s international brand. Cannabis-based research and intervention into neurodegenerative disorders, though experimental, presents the NFL with a low-risk, high-reward opportunity to heal players and the NFL’s damaged reputation.

Our Predictions For The Future Of The NFL

The NFL-JPMC is likely to approve a measure allowing the administration of cannabis and/or cannabis-derived medicine for a short list of disorders, including chronic pain and possibly TBI symptoms. Acquiring a medicinal cannabis prescription from an NFL team will require a multi-stage, expert-led assessment to generate individualized and closely-monitored regiments.

The NFL will negotiate strict terms for these assessments and will implement measures to ensure the minimal effective level of dosing to discourage drug abuse. The NFLPA is likely to be offered, and accept, a limited, team-mediated cannabis distribution program that bars players from accessing public dispensaries for the reason that the minimal amounts prescribed by them doctors could become a gateway to heavier consumption of cannabis at abusive levels. Extraneous cannabis consumption might also disrupt other prescribed medications’ efficacy.

The new CBA agreement between NFL and NFLPA will also have to overhaul the NFL’s punishment scheme for failed drug tests because of the broad utility of cannabis in treating everyday pain. It is likely the NFL will adopt a system similar to the MLB, which identifies and targets players only if they flagrantly disregard doctor or team rules.

Whatever the final terms, they will likely be common-sense enough, but not without the NFL ownership imposing strict control measures as well as an in-built research component dedicated to assessing implementation and possible expansion of the NFL’s limited cannabis pilot program.