Opioids versus Cannabis in the NFL, UFC, and Other Professional Sports

When Peter Cervieri of Future Cannabis Project invited me to discuss the topic of opioids and cannabis in football, UFC, and other professional sports, my first reflection was how much the world has changed from a decade ago.

Back in 2009, there was no serious conversation about cannabis and professional sports, and barely any concern about opioids. The one continuity from those days until now is that players who used cannabis faced legal trouble. We're now at a point of reexamination of the therapeutic value of cannabis, but we still have a long way to go to understand and validate the opportunity.

Changing Attitudes to Opioids

Meanwhile, the last decade has brought significant change for opioids. Back in the late 2000s, opioids issues were just beginning to get on the radar. In 1996, when Green Bay quarterback Brett Favre admitted toVicodin addiction, no broader reaction to the issue was discernable. It was not until the later 2000s and early 2010s that I started hearing from football, hockey, and baseball teams (and their doctors) after compliance inquiries and investigations initiated by the DEA over controlled substance security compliance. Back then, NFL, NHL, MLB and other pro teams had relationships with doctors who were, in some cases, running in-house pill mills: plenty of Vicodin and other opioid medications were freely available. Players weren't being examined by physicians. Medical records were not being maintained. On some teams, trainers were dispensing medications. Medical management of athletes was minimal to non-existent. I saw a parallel to the Hollywood problem: an environment of entitlement in which doctors assumed that the rules didn't apply because of the celebrity of the people they were supplying with medication.

Fast forward to today: Players and teams are much more aware of physical risks, from concussions to nerve damage to a host of on-the-field and training injuries. Players, teams, and team doctors have a new level of awareness of the risks of physical dependency. Doctors are much more aware of their accountability for overprescribing or loose dispensation practices. Overuse of opioids and addiction among players is still a problem, but it is getting much more attention than it used to.

Changing Attitudes to Cannabis

The attention to opioid dependency and the associated risks has made the issue of alternative therapeutics, including cannabis, all the more interesting. As I share in The United States of Opioids, I made the decision to get involved on advising on medical uses of marijuana for two reasons. First, the vast, unexplored terrain of the healing properties of cannabinoids — based on the suppression of research as a result of marijuana's Schedule I status under the Controlled Substance Act — made it one of the most promising opportunities to identify alternatives to opioids. Second, while opioids are killing people and putting lives at risk with rising overdose rates, cannabis is not. As I write in the The United States of Opioids, "there is no cannabis crisis to parallel the opioid crisis for a simple reason: cannabis isn’t deadly. There is no dose at which people overdose on cannabis and stop breathing. Cannabis doesn’t kill people by poisoning them. Most of the examples of cannabis dangers have to do with bad decision-making by people who are high, such as getting behind the wheel of car under the influence and causing traffic accidents."

Meanwhile, the promise of cannabis therapeutics is enormous. Just as the human body has receptors that make opioids such a powerful form of medication, humans are also hardwired internally with a separate system of cannabinoid receptors in every organ that interact with the cannabinoid compounds. The fact that we are wired this way has important potential for scientific and therapeutic discoveries.

These scientific advances have driven interest in cannabis as an alternative medication for pain. Unfortunately, much of this research has happened outside of the United States, because the Schedule I controlled substance status continues to obstruct domestic research. In a handful of formal drug approvals (Marinol, Cesamet, and Epidiolex), the FDA has approved a handful of cannabinoid-based medications for conditions other than pain relief, and a handful of other countries (including Canada) have approved a cannabinoid medication, Sativex, for particular kinds of pain relief, such as to alleviate cancer pain and for symptomatic relief of neuropathic pain related to multiple sclerosis and other conditions.

While the jury is still out on the broader picture of cannabis and pain relief, research has supported the claim that cannabinoids may reduce inflammation and resulting pain. The research also suggests that cannabinoids may not directly reduce pain. Instead, THC and other cannabinoids may simply make it easier for people to regulate the emotional dimension of pain and associated sensations. At the present time, the most that can be said about cannabinoids in terms of an alternative solution to opioids for pain is that they hold out promise that requires further exploration. The recent rescheduling of non-THC compounds derived from hemp-sourced cannabis to Schedule II under the Farm Bill is likely to accelerate research on CBD and other cannabinoids such as CBN and CBG.

Reluctance to Open Up the NFL to Cannabinoid Therapeutics

Fast forward to 2019, and cannabis use is much more widespread among players. We've seen dozens of pro athletes from various sports not only seeking cannabinoid therapies, but directly involved in various cannabis ventures.

Unfortunately, you wouldn't know anything has changed to review League policy. In the NFL, for examples, players utilizing cannabis still need to evade drug testing as NFL Commissioner Roger Goodell maintains a rejectionist stance on its therapeutic use. (Drug tests for cannabis are annual, as opposed to more frequent testing for steroids and other performance enhancing drugs. Players who test positive for THC are forced to undergo further testing with the possibility of suspension after two positive tests and the potential to be disqualified altogether.)

The NFL Players Association (NFLPA) has supported exploring the potential of cannabis for pain management and requested data on player usage of opioid painkillers usage, but discussions with the league seem to have gone nowhere. Player requests for therapeutic use exemptions (TUEs) for cannabis have been rejected.

Given the interest level from players and developments outside of professional sports, the continued intransigence of cannabis from League leadership is disappointing, to say the least. In the face of health concerns relating to opioid dependency and addiction (and broader concerns over other health dangers of professional football, like concussions), the NFL would do well to reevaluate and liberalize rules related to player requests to use cannabis therapeutically. In the meantime, professional athletes may have more access to opioids than other people in pain, but face a parallel challenge in barriers to access to alternative modalities of pain treatment.

Harry Nelson is the author of The United States of Opioids: A Prescription for Liberating a Nation in Pain (Forbes 2019). He is the founder of Nelson Hardiman, LLP, the largest healthcare/life sciences law firm in Los Angeles.