Beneath the Helmets and Hard Hits: Cannabis and the Professional Athlete

I had the pleasure of moderating a cannabis and sports panel for NJ’s Cannademix event this past Friday.

There were many mixed emotions upon hearing the news that I was going to be interviewing former National Football League (NFL) players: joy, excitement, awe, humbleness, and gratitude.

After the event was over, my spectrum of emotions grew to include: disbelief, shock, anger, and gut-wrenching disappointment.

As a healthcare clinician and cannabis advocate, I knew I needed to immediately reevaluate and realign my personal views about how to approach this subject in the future.

To set the tone: what is the public’s general perception when they think of professional NFL athletes?

On the lifestyle end, perhaps it’s the mega-contracts for star players worth 10 figures guaranteed. Maybe it’s the Instagram-worthy shots of yacht parties, private jets, and water-front mansions filled with exotic cars. Or possibly the luxury brand-named clothes, watches, and cohorts of beautiful supermodels constantly in tow.

On the field, muscular men with <10% body fat are drenched in sweat highlighting peak physical performance. It’s a constant highlight reel of extraordinary athletic feats in the form of one-handed catches, double toe taps inches from the sideline, and joyous celebrations with every quarterback sack and 3-and-out. It’s the relentless mentality of a superhuman pushing through and overcoming adversity.

No. Matter. What.

Just do it right?

All of this imagery may actually be real… but at what dangerous cost?

The problems that occur behind the scenes and underneath the helmets are devastating, yet the public rarely hears enough about them. Here is a short list of the conversation:

  • Crippling social anxiety to perform for millions of global viewers;
  • Organizational and business pressures of showing up and physically playing on game day;
  • Personality changes and relationships affected by traumatic brain injuries (TBI) including concussions;
  • Increased suicidal tendencies from chronic traumatic encephalopathy (CTE) or swelling of the brain caused by repeat concussions; and
  • Substance abuse stemming from overprescribing/overdispensing of opiates to deal with pain management and injuries.

And this is just scratching the surface.

On the panel discussion, the conversation was candid with players admitting to taking 10+ Vicodins (hydrocodone + acetaminophen) and Toradol (ketorolac) almost daily during their career. Opiates, with a notoriously high abuse potential, are responsible for ~50,000 overdose deaths annually according to the National Institute of Drug Abuse. Toradol is the most potent oral anti-inflammatory pharmaceutical medication available and has a maximum recommended therapy duration of 5 days due to severe side effects of gastrointestinal bleeding and stomach ulcers. 

A player spoke about physical symptoms of performance anxiety before walking onto the field.  Imagine the opening scene from 8 Mile where Eminem is in the bathroom stall vomiting before getting on stage for a rap battle. Now multiply the audience to over 100,000 fans and the bright lights of a physical spectacle like AT&T stadium in Arlington, Texas.

Former Super Bowl champions and star performers lamented about devastating and eventual career-ending physical injuries during their time playing. They spoke about physical ailments they’re still experiencing in life after pro-football, as well as how they’ve changed as a person because of head injuries.

When asked about NFL protocols for long-term pain management, I was met with a head shake and chuckle confirming the absurdity of such a question. When asked about if the NFL takes enough precautionary measures to protect and treat their players, there was a short but concise answer: “No.” 

The stories that were shared on stage felt like it was from a scripted movie.

For the public, it’s extremely easy to watch a player get carted off the field after a gruesome injury on the TV and say “Oh well, he knew what he was getting into when he chose to play football.” Or even believing that the minimum NFL salary of $660,000/year is an appropriate tradeoff for this type of risk. 

This is the same public that has probably never put on pads in a locker room because of a genuine passion for the game; that has never experienced an injury that they may or may not ever fully recover from in their entire lifetime; that has never known anybody suffering from symptoms of early-onset Alzheimers or dementia from CTE. Type in “NFL CTE” in Wikipedia and see what shows up. I dare you. 

The problem? NFL players are financially motivated to hit performance-based incentives on the field from their contracts. Organizational pressures to either win/play in games or be replaced next week are labeled simply as “just the nature of the business”. On top of that, give players an out with liberal prescribing/dispensing of potent pharmaceutical medications and it can easily muddy their decision of playing through injuries or sitting out for a game. This perfect storm sets players up to make an impossible decision – their career or their health. 

The stories about professional athletes discounting physical injuries and ignoring their bodies just to be able to perform on game-day are true. However, the warrior mindset and win-at-all-costs mentality of a professional athlete are seemingly romanticized.

Here’s the silver lining. Every single player on stage shared their personal relationship about how cannabis positively impacted their ability to address these issues. At the end of the day when the helmet comes off, there lies a human being just like you and me – 206 bones, a ~3 lb. brain, perhaps a tad amount more muscle mass than average, and a thriving endocannabinoid system (ECS).

 All of these professional athletes spoke passionately about their relationships with cannabis. Some were rooted in teenage years while others were newfound recent discoveries of the medicinal benefits of the plant. They all confidently and proudly detailed their cannabis consumption habits even during high points of their career. 

Beyond the several documented pain management benefits that cannabis provides, cannabis culture allows players to get back to their original purposes and relearn how to enjoy the game. Perhaps the social nature of sharing a joint off the field after intense practices allows teammates to develop a more tightly-knit bond. Or maybe the anxiolytic relief that cannabis provides allows them to tune out crowds and external pressures and simply focus on the game they once played out of passion instead of necessity. 

There is NO pharmaceutical drug on the market that can address both pain management/recovery and mental health simultaneously. 

Cannabinoids like tetrahydrocannabinol (THC) primarily bind to CB1 receptors of the ECS. Opiates bind to mu-opioid receptors and act as a depressant on multiple physiological pathways including respiratory function. The majority of fatal opioid overdoses occur when the person’s breathing slows down and eventually stops completely. Multiple clinical studies have demonstrated that cannabis usage taken concomitantly with opiates have either led to reduced dosages required or even complete elimination of opiate use in cases. 

In regards to mental health, psychoactive cannabinoids impact perception and outlook of consumers. To some, euphoria might be listed as a negative side effect, but for others, it’s a purposeful intention. The expression and ability to curb racing thoughts of anxiety and/or aiding with sleep is a centerpiece of cannabis and its positive mental health benefits. 

All in all, their message was clear: It’s time to end the stigma surrounding cannabis consumption.

Recently this year, the NFL has made significant adjustments in support of cannabis policies within the league. The league’s new collective bargaining agreement with the NFL Players Association (NFLPA) changed its cannabis policies to eliminate random drug testing during the off-season, increase the minimum threshold of a “dirty” test, and eliminated game suspensions for positive drug tests. Also in June of this year, the pain management committee of the NFL and NFLPA pledged $1 million to studying cannabis and pain management.

Is that enough? 

Not in the slightest, but it’s a good start.

As cannabis normalization sweeps across the nation, the decision for athletes turning to natural plant-based alternatives for pain management and mental health should be applauded. With an average of 16.9 million viewers for the NFL alone, an immense platform is available to speak out on the health benefits of cannabis and larger issues of social justice and health equity for all. That number will be multiplied exponentially as other major national sports organizations loosen their cannabis policies as well.

I don’t know about you, but I’m ready to cheer for these guys in post-retirement just as loudly, if not louder than I did when they were on the field.

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