Game of Pain, part 1: CBD hope?
Written by Nicki Jhabvala
PUBLISHED APRIL 22, 2016
The former Broncos’ quarterback and other retired and active NFL players believe cannabidiol, or CBD, a nonpsychoactive compound in cannabis, could be an alternative to potent painkillers used by players in the league.
First in an occasional series looking at issues surrounding pain management for football players
BOULDER — Nestled at the base of the Flatirons and tucked behind a dog park is Jake Plummer’s oasis, a row of three-wall handball courts at the East Boulder Community Center. It’s 9:30 a.m. on a Saturday and he has just arrived on his silver Giant bicycle decorated in stickers of local breweries to the sound of a rubber ball beating against the concrete wall — TH-WAP, TH-WAP, TH-WAP — and the beat with Bob Dylan’s “Knockin’ on Heaven’s Door” humming from a wireless speaker.
“Hey, Mr. Jake Plummer!” a man shouts as Plummer leans his bike on a tree, unstraps the small Denver Broncos cooler carrying a couple of cans of Pilsner and shakes a few hands. Here the former Broncos quarterback is a regular among a group of about 20 players from their mid-20s to well into their 70s.
“It’s hard with these young cats,” Plummer said as he straps on his goggles and tightens his gloves. “I’ll go til I’m stiff. Maybe two or three games.”
Plummer credits yoga for helping keep him on the court. And visits to a chiropractor. The jogging and cycling. The acupuncture. Even the dry needling he started.
When the Bright Lights Fade
A group of retired NFL players, led by former Broncos Nate Jackson and Jake Plummer, as well as current Ravens tackle Eugene Monroe, have teamed with CW Botanicals, and its non-profit partner, the Realm of Caring, in an effort to raise at least $100,000 to fund initial studies of CBD.
Researchers at Johns Hopkins University and the University of Pennsylvania will join forces to survey about 20 current and 20 former NFL players regarding whether they’ve used CBD, as well as their injury and medical history. Once they get the data the researchers will design a study on how the body processes CBD in an effort to see how much CBD players can safely consume long term.
The ultimate goal of the “When the Bright Lights Fade” campaign is to implement a more expansive clinical study on CBD and its potential in treating symptoms of concussions and chronic traumatic encephalopathy.
“CTE and concussions are the big thing right now. That’s what everyone is talking about in the media and the real focus in terms of player health. But from my perspective, I want to know about everything,” said Dr. Ryan Vandrey, a professor of behavioral pharmacology at Johns Hopkins and one of the lead researchers for the studies. “I want to know about pain, I want to know about post-surgery issues, I want to know about concussions and post-concussion symptoms. I want to know about former players and the behavioral health-related things that have been associated with CTE.”
But especially cannabidiol, or CBD, a nonpsychoactive compound in cannabis that gained notice a few years ago in treating epilepsy in children and has been shown to have anti-inflammatory and pain-relieving properties.
Plummer and many other retired and active NFL players believe the compound is an effective alternative to the potent painkillers they receive while in the league and that players should be allowed to use it.
So he and four other ex-NFL players, as well as one current one, have teamed with a Colorado hemp producer and its partnering non-profit to raise money for research to find out if CBD is a safe and viable treatment for not only pain but also symptoms of concussions and chronic traumatic encephalopathy (CTE).
The mission of their campaign — “When the Bright Lights Fade” — isn’t necessarily to advocate for the NFL’s approval of marijuana, though many believe weed should be legal for players to use, but to first work with researchers at Johns Hopkins University and the University of Pennsylvania to study football players’ use of cannabinoids and the body’s tolerance of them long term.
“Do we have the silver bullet? Do we have the remedy? I don’t know,” Plummer said. “I sure would like to find out.”
Seeking safer alternatives
Throughout his 10-year career as an NFL quarterback, Plummer was cognizant of the physical and mental pain he was inflicting on himself. As much as he tried to avoid painkillers, there were times when he needed the assistance.
“There were guys in college that were taking Percocets all the time and drinking beers,” he said. “It was rampant. I had done that a few times, but the effects afterward, the day after, just the feeling I had, I hated it. It made me feel detached. In 10 years (in the NFL), I took maybe 20, where I could come out of a game and be like, ‘I need to make this flight home, because it hurts like hell just sitting here.’ But if I had had (CBD), I would much rather have done that.”
Others would too.
Former Broncos tight end Nate Jackson has spoken candidly of the abuse his body took playing football. Torn ligaments. Torn muscles. Broken bones. Chipped bones. Separated shoulders. A dislocated shoulder. Misaligned clavicles. Lower spine trauma. Brain trauma. And more.
First family of CBD
The Stanley brothers — Joel, Jon, Jordan, Jesse, and Jared — entered the marijuana industry in 2008 in Denver. They began to grow a strain that helped put CBD on the map in 2013, when CNN documented the plight of 5-year-old Charlotte Figi, who had a rare and severe form of epilepsy called Dravet Syndrome. Figi suffered hundreds of grand mal seizures a week. When medical treatments failed, Figi’s parents took a gamble on cannabis.
The Stanley brothers’ high-CBD, low-THC strain of cannabis that was infused in oil helped to significantly reduce the number of Figi’s seizures. The product, which drew a waiting list of families seeking the same results for their children, later became known as Charlotte’s Web.
The Stanley brothers founded CW Botanicals and a nonprofit, the Realm of Caring, which helps families afford cannabinoid treatment.
Over the years, CW has grown from a small family-owned upstart to a global operation with dozens of employees and multiple greenhouses and dispensaries scattered across Colorado. Millions of dollars in technology, and teams for quality control and research and development, are housed in its new Boulder lab alone.
He was the first player to get involved with the Bright Lights campaign, joining CW Botanicals and the Realm of Caring, its non-profit partner for cannabinoid advocacy and education. He did it not because he wants NFL locker rooms to become smoke-filled retreats with trainers handing out joints. He simply wants players to have options — effective but safer options than the prescription painkillers and illegal drugs he admittedly used in desperation when he played.
CBD, he believes, is one.
“I didn’t take Vicodin or Percocet before practices or games,” Jackson said. “It was not something that I wanted to try because football is too much. It’s too violent. You got 11 guys coming to take your head off, so I didn’t want to chance it.”
Pills and injections are the norm in football, and the long-term health concerns are great. Players have often cited the unwelcome side effects — lethargy, depression, stomach pain, the risk of addiction — and some have chosen to self-medicate instead, often with marijuana.
Last summer, Plummer added CBD to his regimen. He ingests the oil and rubs the gel on his wrists and back. He doesn’t get high, but he is able to play two to three games of handball with “the young cats.”
“I’ve used every tincture and fad known to man that comes through to claim pain relief,” he said. “This one really does give me some relief in the area of discomfort.”
Anecdotal evidence and preclinical research, often on animals, suggest CBD is effective in treating neuropathic pain and inflammation without getting users high; tetrahydrocannabinol, or THC, is the psychoactive ingredient in cannabis.
Cannabidiol, or CBD, is one of nearly 100 cannabinoids in cannabis that is believed to have many medical benefits without getting users high. Studies and anecdotal evidence have found CBD helps people cope with the following diseases and symptoms, among others:
- Neuropathic pain
“We’re talking about something with a safety profile that looks like vitamin C, but because it comes out of the controversial world of cannabis, people immediately associate it with a dangerous drug,” said Joel Stanley, the CEO of CW Botanicals. “Nothing could be farther from the truth.”
CW’s product, called Charlotte’s Web, is made from hemp, distinct from marijuana and legally defined as having no more than 0.3 percent THC. It’s believed that no player could consume enough of the product to cross the NFL’s allowable limit of 35 nanograms of activated THC per milliliter of urine. But any amount poses a risk.
“These guys, if they want to just take care of their bodies, they can’t out of fear that they would test positive,” said Ryan Kingsbury, CW’s chief communications officer. “If they test under it, it’s not a big deal. I’m confident it won’t, but I don’t want to tell a guy who has a multi-million-dollar deal that it won’t.”
Kingsbury estimates at least 30 active and retired players use some form of CBD from CW Botanicals, with the former group clearly believing the rewards outweigh any risks.
As more states — up to 24 now, plus the District of Columbia — have legalized medical marijuana, calls for the NFL to change its substance-abuse policy have grown louder.
The league and the players association, which both declined to grant interviews for this story, agreed to alter the policy in 2014 and raise the THC threshold from 15 ng/ml to 35 ng/ml. Players are tested only once in the offseason, but violators are entered into an intervention program that calls for additional random tests and penalties that range from fines to one-year suspensions without pay.
In the context of a 16-game season, the penalties are severe.
“Do you ever hear of any other professional athletes getting popped for weed other than in football? You never do,” said Jackson, who estimates at least 50 percent of NFL players use some form of marijuana. “It’s really not happening anywhere but in the NFL, and it’s funny because the NFL is really the one sport that needs it most. (Players) use it because they need it, and it’s not stopping them from being the very best at what they do. Why are we punishing them for it?”
Plummer said change can’t be demanded without more science, so part of the Bright Lights’ initial studies will focus on how much CBD a player can consume without testing hot.
But the “what ifs?” are there: What if the NFL simply raised its THC limit to ensure those taking hemp-based CBD products wouldn’t fail a test? What if CBD could be prescribed by team trainers via a therapeutic-use exemption?
After all, that exemption is how former offensive lineman Eben Britton was allowed to take Adderall, a medication that helped with pain from injuries but took him on an emotional roller coaster. In 2013, his first year with the Chicago Bears, Britton suffered a torn muscle on the bottom of his right foot. He still has no feeling in that foot. His shoulder was dislocated. And by the end of every season, he would have to wear casts on his thumbs and now has arthritis in his fingers. He has pain in nearly every joint.
Marijuana in sports
A look at how the NFL’s THC limit and disciplinary system compares to those of other professional leagues and organizations:
NFL: 35 ng/ml THC
Players are tested once in the offseason. The first violation enters the player into an intervention program. Penalties for further violations: two-game fine, four-game fine, four-game suspension, 10-game suspension, one-year ban.
NBA: 15 ng/ml
Players face random tests up to four times a season (no marijuana testing in offseason). First violation and/or reasonable cause enters the player into program. Second violation: $25,000 fine. Third: Five-game ban. Subsequent violations: Five games longer than previous suspension.
MLB: 50 ng/ml
Players tested only if league or union finds reasonable cause. Noncompliance with treatment plan warrants fines, not to exceed $35,000. Player suspended only if he “flagrantly disregarded” rules or if commissioner deems him a threat to others players’ safety.
Marijuana is not on the list of banned substances. Players are tested for drugs of abuse, but only to monitor use. League and union will reach out to player for help after multiple failed tests, but no policy for discipline.
Olympics (World Anti-Doping Agency): 150 ng/ml
Violators face suspensions ranging from three months to one year.
“Every guy on the team is a prescribed a bottle of anti-inflammatories of one kind or another, whether it’s Cataflam, Indocin, Aleve, Tylenol, Advil. Every guy is taking that (stuff) every single day,” Britton said.
Baltimore Ravens offensive tackle Eugene Monroe saw up close how much Britton struggled when they were teammates with the Jacksonville Jaguars. He remembers the play that blew out Britton’s shoulder at Kansas City, and he remembers when Britton walked around Jaguars headquarters with an IV drip for eight weeks after contracting an infection following back surgery.
“You’ll find these stories across every locker room in the NFL,” Monroe said. “When you talk to someone’s family members, if you talk to a player’s wife, I guarantee you she’d be able to paint a vivid picture for the struggles that her husband goes through on a daily basis. I’m talking about out of season too, because injuries don’t magically go away.”
Monroe, the only active player involved in the campaign, said he has never used marijuana or CBD. He donated $10,000 to the cause, but he can’t and won’t risk failing a drug test.
“It’s hard to read how beneficial CBD is and not be able to take it, knowing that all of the symptoms that I’m experiencing as an athlete could potentially, or will be, remedied because it’s happened over and over again for people all over our country,” he said. “There’s no reason for the NFL or other sports to test their players and punish them for consuming a substance that is benefiting them.”
Players in a catch-22
Mark Schlereth, a former Broncos guard who is an NFL analyst on radio and TV, never used marijuana or CBD while playing — and still doesn’t. He never smoked or drank alcohol. He took team-prescribed painkillers when needed, but only when needed.
He left the NFL in 2001 with three Super Bowl title rings, a body that was relatively intact despite numerous surgeries and a lucrative second career awaiting him, at ESPN.
But he hasn’t been pain-free for a long time.
“I haven’t known anything but pain from the time I was 18 years old,” he said. “I wake up 10 times a night because my shoulder hurts or my back hurts or my knee is bothering me. I don’t know what it’s like to lay my head on a pillow at night and wake up the next morning without waking up eight to 10 times. That’s normal to me. And I think most guys find whatever normal is and you just kind of adjust to it.”
Schlereth said the NFL became more regulated in how it administered prescription painkillers about midway through his 12-year career. But rules alone haven’t spared addiction.
In 2014, a record 47,055 deaths from drug overdoses occurred in the U.S., and opioids were involved in a record 28,647 (61 percent) of those, according to the Centers for Disease Control and Prevention. Vicodin, Percocet, morphine, codeine — drugs often given to NFL players to relieve pain — are part of a nationwide epidemic.
Players often are in a Catch-22: They need the drugs to stay on the field and to stay on the team. But in taking them, they run a high risk of becoming addicted and further destroying their long-term health.
“Guys abuse opiates and painkillers and everything else,” Schlereth said. “So if there’s compelling research that says (CBD) is helpful, I don’t know why the NFL wouldn’t want to help players.”
Contradiction part of marijuana assessment
CBD sits in a legal gray zone.
Per the Controlled Substances Act, marijuana is a Schedule I drug, a classification for substances such as heroin and LSD that are deemed to have no medicinal value and are a high risk for abuse. Although hemp is from the same plant species as marijuana, it is defined as cannabis with no more than 0.3 percent THC and is afforded legal protections that producers say allow them to sell and ship their products to all 50 states.
But the crossover has led to contradiction.
The U.S. Department of Health and Human Services has a patent, “Cannabinoids as antioxidants and neuroprotectants,” that says compounds in cannabis are useful in treating neurodegenerative and autoimmune diseases, as well as inflammation. What’s more: Synthetic THC is a Schedule III drug that doctors can prescribe.
The murky legal status of cannabis has hindered clinical research on CBD and given physicians pause in recommending it.
“I think the issue a lot of us have with some of the marijuana derivatives is we still don’t know the long-term neurological consequences,” said Dr. Rachel Brakke-Homan, who specializes in non-invasive pain management and spinal injuries at Colorado’s Sports Medicine and Performance Center. “So I’m very cautious with those medications and I really don’t recommend them. … I tend to focus on all of the other treatments first, just because there is more evidence.”
A 2011 study by researchers at Washington University in St. Louisand commissioned by ESPN found that 52 percent of retired NFL players used opioids during their career and 71 percent of those reported abuse.
It’s unlikely for someone to die of a cannabis overdose, let alone nonpsychoactive CBD.
“Opioids can cause a fatal overdose — morphine, heroin, oxycodone — because if you take too much, those molecules bind to the receptors in the brainstem and prevent you from breathing,” said Dr. David Casarett, a physician and researcher at the University of Pennsylvania and the author of “Stoned.” “But since there are no cannabinoid receptors in the brainstem, marijuana won’t. You could certainly have a really interesting couple of hours — hallucinations, paranoid delusions, the whole bit — but you won’t die because of an overdose.”
Several studies have found CBD even counteracts the psychoactive effects of THC and could be beneficial in treating some addictions.
But it doesn’t mean it works for all. And it doesn’t mean it’s free of side effects. Any long-term ones are unknown.
“I wouldn’t stake my entire reputation on saying that it works, but there are a lot of researchers who think that of all the ingredients in marijuana, it might be CBD that has much or even more of an effect on that neuropathic pain than THC does,” Casarett said. “As far as I know, there really haven’t been studies on brain trauma except for some very preliminary laboratory studies — studies that cannabinoids may be protective after strokes induced in mice in the laboratory. That’s a huge leap to say there’s cellular evidence of neuroprotection in a mouse in a laboratory, so we should start giving it to football players.”
Plummer was a rarity in his day. While countless players are forced out of football by injury, he voluntarily left the NFL at age 32.
“I was lucky,” he said. “I didn’t want to have a bad (injury) at that point in my life and my career. I don’t think I could have made it through it.”
In recent years, players have begun to look ahead, just as Plummer did nine years ago, primarily because of an increased focus on concussions and subsequent brain damage.
Just over a year ago, San Francisco 49ers linebacker Chris Borland retired after only one season at age 24 because of head injuries. Green Bay Packers rookie wide receiver Adrian Coxson called it quits six months later having never played in a regular-season game because he feared one more hit could “possibly kill me or be life-damaging.” (A month earlier, he had been taken off the practice field by an ambulance with a Grade 3 concussion.) And this month, Buffalo Bills linebacker A.J. Tarpley announced his retirement at age 23 after playing only one season in the NFL, also citing concussions.
Talk of brain injuries and CTE has reached a fever pitch in the NFL, but research and knowledge of the disease still is in its infancy. The same holds true for CBD, only funding for its research pales in comparison. The players involved in the Bright Lights campaign hope the early studies that are funded will spur a larger clinical examination of CBD’s effectiveness in treating not just injuries but also symptoms of concussions and CTE.
Plummer hopes he and his fellow players will soon be armed with enough clinical proof of CBD’s benefits to initiate a conversation with NFL officials. And he really hopes for change — change that will help other players be able to hit the courts with the “young cats” ’til they’re stiff. Maybe go two or three games.
“We’re hoping (NFL officials) talk to us about it if they really, truly care about the players and their health and well-being — not just while they’re making millions of dollars from the NFL, but when they’re done and when they’ve moved on,” Plummer said. “Joe Montana can’t live an active lifestyle, Jim McMahon has headaches all the time and is in pain. These are the legends who prance out at halftime during the 50th Super Bowl, and they’re suffering. People don’t know that, but when they read about it and see it, that’s when I hope there’s action taken.”