Professional as well as college and even high school football players are subject to injury as a routine part of game play. The wear and tear on their bodies frequently results in players developing chronic pain. What was once called "dementia pugilistica" in prize fighters, has beennewly recognized as Chronic Traumatic Encephalopathy (CTE), which is brain injury as the result of the regularly encountered head trauma, causes difficulties for players long after they have left the sport. Both of these problems are usually a lifelong problem for those so affected. Treatment of the pain has usually been in the form of non-steroidal anti inflammatory agents and prescription opioids, both of which can cause even more problems for those players. The commonly used Toradol (a very potent NSAID) injections can result in ulcers, gastrointestinal bleeding, increased risk of strokes, heart attacks and kidney damage. The opioid medications have risks of addiction, sometimes intolerable side effects and the risk of respiratory depression and death. CTE is without any good treatment options at present, although lithium (a drug with high toxicity unless very closely monitored and managed) has been used to decrease the higher risk of suicides in these people.

With an estimated 80-90% of players using cannabis despite the leagues ban, perhaps the players have already found an alternative which works for their pain. The NFL Players Association has been supporting changes to the rules to allow its use. Many players, often retired, have also been outspoken advocates for the use of medical cannabis. Previously, the league has claimed there were no benefits to medical cannabis but has now announced they will conduct research into more effective treatments for the players. Research into cannabis as a treatment is now on the table.

Politics aside, cannabis has been shown to help with the types of pain common in these athletes, without the risks and toxicity the commonly used medications present. The symptoms of CTE can be managed with careful selection of cannabis strains but even more interesting is the possibility cannabis may provide some protection against the worsening of CTE. Proteins build up in the brains of CTE patients, similar to the other degenerative brain conditions like Alzheimer's disease. Cannabis seems to decrease the inflammation in the brain and decreases the amount of these proteins which build up causing the brain damage and symptoms of this disorder. As always, more research needs to be done.

With the long historical safety record of medical cannabis, the very real risks to the usual treatments for pain and no treatment at all for CTE, there is very little downside in using it in the treatment of these patients. Let's hope the NFL seriously considers changing their playbook and allows medical cannabis use in their players instead of punting on second down. Such an acknowledgment would go a long way in removing the stigmas of medical cannabis use and perhaps more people will understand: medical cannabis is medicine.

Brian Nichol MD
Cannabis Expert