What does NFL brain injury have to do with medical marijuana?

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It’s become increasingly clear over the past decade that NFL players are at very high risk of developing chronic traumatic encephalopathy. For many people familiar with the research that has been done to date, there’s not much question that this risk is real. That’s why the evidence in a new study published on Tuesday is at least confirmatory if not conclusive. Now there’s not much doubt that NFL players who spend any time in the game are likely to develop brain damage.


That's a risk that everyone's talking about, as they should be. But there's another aspect of the story that hasn’t received much attention. At least, not yet. and that's the link between brain health and medical marijuana.

First, let's summarize the most recent evidence linking professional football with brain damage. That study started in 2008, when a group of researchers created a brain bank to store the brains of NFL players and others. The overarching goal of that project was to define the effect that trauma has on the brain, and the bank included the brains of NFL players and military veterans. The study that was published on Tuesday described the pathology results of 202 former football players. Half of them were younger than 66 years old, and on average had played football for 15 years.

The most significant finding speaks for itself: of 111 NFL players from the sample 110, or 99%, had evidence of traumatic brain injury. Moreover, those players with a professional football history had worse pathology compared with those who played semi-professional, high school, or college football. That fact is important because it suggests not only that football-related trauma is responsible for brain injury, but also that there may be a dose effect. In other words, more exposure may lead to more and worse injury.

So what does chronic traumatic encephalopathy have to do with medical marijuana?

To see why that connection makes any sense at all, we need to go back a few months ago to the NFL draft in Philadelphia. Shortly before that event, the NFL Commissioner Roger Goodell made it very clear that marijuana use in the NFL would not be tolerated.

Goodell’s statement is ironic for two reasons. First of all, Commissioner Goodell is apparently extremely concerned about the risks of marijuana use among NFL players. That’s odd, because the risks of marijuana use are really quite modest, and still unclear. Especially compared to the substantial, and very well-described risks of traumatic brain injury.

I'm not saying that marijuana carries no risks. In fact, there are risks of addiction and withdrawal. Those risks aren’t as common or as severe as they are with other drugs like opioids.

Nevertheless, we know exactly what the risks of traumatic brain injury are. In fact, I think it's safe to say that by comparison to the potentially devastating injuries sustained in the course of repeated trauma, any risks of marijuana use, in particular medical use, are really quite small.

And that brings us to the second reason that the commission statement is ironic. Not only does he seem to be focusing on the wrong risk to players’ health, but he may actually be rejecting use of a potential solution.

Although the field of medical marijuana research is still very new, and there's a lot we don't know, there have been some interesting hints that some of the ingredients of medical marijuana might be useful in protecting the brain against a variety of injuries.

One study in rats used synthetic cannabinoids, which are molecules produced in a laboratory but which are similar to those found in marijuana. That study found that those cannabinoids can decrease inflammation in response to injury. Interestingly, that study also found cannabinoid receptors buried in plaques that are associated with Alzheimer’s Disease, suggesting a potential link with dementia.

And there may be other neuroprotective effects that we haven’t explored. For instance, in another study, researchers found that one ingredient of marijuana, cannabidiol (CBD) reduced the size of strokes in mice, using a model in which the middle cerebral artery was blocked. Does that mean that CBD is a neuroprotectant? Or might it somehow change blood flow? We don’t know. Yet it’s preliminary studies like these that generate a lot of enthusiasm for cannabinoids, raising hopes that they might not merely treat symptoms, but could actually treat or prevent brain disease and brain injury.

Don't get me wrong, I'm not saying that medical marijuana is an antidote to all brain injuries. And I'm certainly not saying that regular medical marijuana use would prevent the type of brain injuries that are becoming increasingly obvious in football players. However, we do know that when NFL players step on the field they are facing a substantial risk of brain injury. We also know that those risks increase significantly over time with every game. So it seems odd to me that while we’re not taking that risk as seriously as we could, the NFL is overly concerned about the risks of medical marijuana, which are really quite small in comparison.

It's far too soon to advocate for the use of medical marijuana to improve the brain health of NFL players, although that's a recommendation that would no doubt delight the medical marijuana industry. However, it's certainly reasonable to suggest that the NFL should support research that examines the protective effects of medical marijuana.

Research is one part of the $765 million settlement that the NFL reached with players in 2013. Some of that research funding might be used to ask, for instance, whether players who use marijuana medically or recreationally have a lower risk of traumatic encephalopathy. That sort of study wouldn’t be definitive, but it would help. And given the severity of the problem, which is becoming increasingly hard to ignore, we need all the help we can get.

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