On Medical Marijuana Versus Opioids, the NFL May Finally Be Coming to Its Senses

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Last week the NFL sent out a trial balloon, suggesting that they were working alongside the players’ union to agree on a “less punitive” measure towards current athletes who elect to medicate their chronic pain with marijuana rather than the standard league regimen of ragingly addictive, organ-destroying opioids. In recent years, the league’s draconian policy towards pot users has been one of the sports world’s most under-reported scandals, with stand-up, star players like Washington’s offensive team captain and perennial All-Pro left tackler Trent Williams suspended for four games for toking, while serial-spousal abusers like former New York Giants kicker Josh Brown endured half that sanction for domestic violence charges.

This supersedes the league’s garden-variety hypocrisies and Deflategates and impossible to grasp celebration rules. Sometimes the bumbling by league hierarchy can be kind of funny. The years-long effort to prove that catching a football isn’t really catching a football unless you make a “football move” AND the ball can’t touch the ground, except sometimes it’s okay and who can really know what is authentically true? is so thoroughly untethered from sanity that it has become a sort of vexing in-joke for fans and players alike.

But there is nothing remotely funny about the NFL’s prohibition on marijuana. It represents a direct and senseless assault on the quality of life of the very players who make this dangerous game such irresistible theater. It has no basis in medicine and does nothing to impact competitive balance. Whatever thin strand of legality undergirds the thinking behind this rule unravels daily and at an increasing rate of speed. Four years ago the Super Bowl was contested between two teams playing in states where the purchase and recreational use of marijuana is fully legal. Nevertheless, the league has persisted in fining and suspending players — sometimes for seasons at a time — for a legal, victim-less activity rooted in self-preservation.

To be absolutely clear, the science of marijuana and pain management is promising but not fully settled. I spoke with Dr. John Halporn, the director of outpatient palliative care and a senior physician at the Dana-Farber Cancer Institute in order to get his perspective on the realities of pain management and the differences between marijuana and opioids. Regarding marijuana’s potential to relieve pain Halporn says, “The hope is that marijuana or some extraction of marijuana like CBD is an effective pain medicine, and I think at times it is an effective pain medicine. But it is not as reliable as opioids are. The relief is not as consistent.”

Halporn describes marijuana as a highly complex entity containing as many as twenty-plus psychoactive chemicals. “It’s usually pursued for the THC effect, which is relaxation and high, and not necessarily medicinal. But there are starting to become available strains of marijuana which may not cause the high, but do provide the pain relief people are after. In Massachusetts we’ve been able to recommend marijuana for pain with specific strains that just contain the CBD and don’t provide the high. You don’t get sleepy, you’re not altered. It doesn’t contain the psychoactive effects the NFL is probably most worried about.”

While the science of marijuana and pain relief remains a work in progress, the jury is in on the devastating toll of opioids.

“The profession is really changing as to the question of whether the long-term use of opioids is really helpful — meaning six months or longer — but many doctors now doubt that after six months there is any pain relief benefit. However, anyone using opiates that long everyday will certainly become dependent. The risk of using a marijuana extraction to treat pain is almost non-existent. Dependence disorder or misuse is extremely unlikely. It is safer than starting or committing them to long-term use of opioids.”

So if he were a team doctor caught between the sometimes contradictory mandates of caring for a player’s long-term health and the pressure to get them back on the field as quickly as possible? “I think it’s a complex ethical question whether physicians should be enabling people to tolerate pain in order to perform at a sporting event. It’s certainly the individual’s choice to endure pain and injury, but is it the aim of medicine to mask their pain to allow them to keep playing and performing? I think opiates have a role in acute pain following a fracture or a surgery, but anyone who needs opiates to tolerate the pain of playing, I don’t think we should be encouraging that.”

This, in a nutshell, is the dilemma facing current NFL players. Engage in a promising, non-harmful regimen of pain management and thereby risk suspension, stigma, and loss of wages, or make peace with a status quo that all but guarantees the onset of dependency and deleterious long-term health ramifications. That any individual should have to make such a calculation is tragic. That this is the consequence of the NFL’s imperious, feckless and arbitrary prejudices makes it unconscionable.

As exemplified by the current series of concussion lawsuits filed by former players, which will run until 2065 and ultimately cost the league as much as a billion dollars, the NFL has a long history of short-term thinking and mercenary attitudes towards its most crucial employees. And for all of its predominance in American sports culture, there is evidence that the league’s hold on the general public is waning. Last year’s ratings were down, young players like the Ravens’ John Urschel are retiring early out of fear for brain injury, and global expansion has proven a tough sell relative to the NBA and MLB. They may not know it, but the NFL could use a win. Let’s hope they recognize the easy one that lay before them.