The NFL’s Pain Management Problem

Editor’s Note: Today’s post comes from contributing editor Bob Beach. Beach is a Ph.D. candidate in history at the University of Albany, SUNY.

The National Football League (NFL) has a pain management problem. It also has a marijuana problem. The league currently regulates marijuana use among its players as part of its Policy and Program on Substances of Abuse. Revised in 2018, the program tests players for marijuana (and other “substances of abuse”) once every year during a set time (during the offseason). 

The threshold to trigger a positive test is a relatively small 35 nanograms of THC per milliliter. To get a sense of how much that is relative to common testing thresholds, one source suggests that, “following a single marijuana use, THC is unlikely to be detected in the urine beyond 3 days at the 50 ng/ml cut-off level and beyond 7 days for the 20 ng/mL cutoff level.” If a player fails a test, they face fines, suspensions, and more frequent and random testing. 

Often touted more as an “intelligence test” than a drug test, at least for marijuana (are players smart enough to stop smoking weed prior to the testing window?), the program still ensnares new players every season, including David Irving, who recently quit football live on Instagram while smoking weed, following a failed drug test which triggered an indefinite suspension by the league.

In 2006, Miami Dolphins running-back Ricky Williams was suspended for an entire season for three failed marijuana tests (under a prior league drug policy). Williams was roundly criticized for choosing marijuana over football, a decision judged at the time as immature even as Williams touted marijuana for its health benefits. In 2016, Williams appeared in a Sports Illustrated cover piece and film, which largely vindicates his decision. 

Screenshot 2019-10-03 at 8.21.26 AM

Sports Illustrated video, which you can watch here

In the interim, and in support of the NFL relaxing its marijuana position, retired players like Irving have come out publicly as marijuana users. As the public’s attitude toward marijuana has changed, the NFL’s policy is chided (and mocked, in the case of Irving) as a relic of an outdated policy position, especially as more teams’ states (the latest being Illinois, home of the Chicago Bears) enact medical cannabis and adult use regimes. But more importantly, cannabis-based therapies are being touted as breakthroughs in pain management in the midst of the league’s apparent prescription drug problem.

In 2016, former NFL Quarterback Jake Plummer pushed the NFL and NFLPA to conduct a prescription drug monitoring study, to gauge the extent of prescription drug use among players, and in 2017, the NFLPA filed a grievance related to allegations that teams overprescribed opioids and other painkillers to treat players. The NFL and NFLPA recently announced the creation of new committees to address player health and safety issues and appear to be addressing these issues.

Of interest here is the Joint Pain Management Committee that will (among other things) study alternative therapies using a Prescription Drug Monitoring program to measure the extent and efficacy of current therapies. The use of the term “alternative therapies” in the mandate, which is commonly associated with emerging CBD/THC therapies, fueled speculation that the NFL was on the brink of major concessions on its marijuana policy.

The list of NFL (and other professional) athletes who publicly use marijuana is too lengthy to account fully here. A 2018 Bleacher Report story featured several NFL and NBA players speaking on camera in favor of marijuana use for various reasons. Former players from Joe Montana, to Rob Gronkowski, to Reuben Droughns, to Chris Long and Kyle Turley, have come out in favor of changing the policy. A lot of these players also happen to be working with or for companies trying to push new cannabis-based products to market. 

In a cbs.com interview in April, former defensive end Marvin Washington, who is currently in the CBD business and part of a lawsuit trying to remove cannabis as a Schedule I drug, sums up these former players’ arguments nicely, “Would you rather guy [sic] use the opiates — which are highly addictive and damaging to your body — or would you rather use a plant that’s natural non-toxic and it’s healthy for you?” 

But is CBD more effective (or more healthy) a pain management therapy than opioids? For its part, the NFL’s Chief Medical Officer Allen Sills was quoted in the LA Times dismissing these kinds of claims: “I think that the science, unfortunately, has lagged behind a lot of the popular opinion and press on this,” Sills said. “We have a lot more opinion than we do science on the use of marijuana for pain.” Points readers, too, will recall recent posts (here and here) regarding the explosion of CBD drugs along with a 2011 guest blogger series by Siobhan Reynolds (the first appears here) about the many misconceptions regarding pain management with opioids. 

We can, and certainly will, continue to study and debate the efficacy of CBD (and THC) as legitimate therapies for any number of ailments (an 2014 open Letter from Lester Grinspoon to Roger Goodell published in Vice suggests cannabis could address the concussion/CTE issue). There is also a need to take all of this public advocacy for CBD use among former NFL players, driven as it is by the potential explosion of profit in the CBD business, with a grain of salt. What seems clear for now is that the research proving CBD/THC’s efficacy for pain management is infinitely less plentiful than the scientific research touting the safety and efficacy of a well-managed opioid regime. But to this end, the NFL, and society at large, is hamstrung by current opioid policies which continue to be informed by reactionary drug regulators.

Ultimately, larger policy decisions are likely to have a greater impact on the NFL’s approach to pain management than their joint committees are likely to do. As the perhaps cynical brain trust of the NFL acknowledges, we still don’t have long term clinical research on the effectiveness of cannabis drugs for many ailments, much less pain management. In terms of the league’s marijuana policy, as the Substances of Abuse policy falls under the current collective bargaining agreement (p. 178), any future concessions on marijuana will likely require a substantial concession by the players (like adding more games to the regular season).

[Roger Goodell and DeMarcus Smith, of the NFL and NFLPA respectively, are at the helm of substance abuse policy negotiations in the next CBA in 2021.]

But the bigger question, perhaps beyond the boundaries of this forum, is whether the NFL and NFLPA should seriously think about the cause of their overwhelming pain management problem, and their marijuana problem. Instead of blaming opioids or touting CBD, NFL owners and players need to come to terms with the brutality of their sport.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s