By Dr. Michael D. Lewis, MD, MPH, Colonel (Retired), U.S. Army, and CV Sciences Medical Advisor
The NFL recently awarded $1 million to two teams of medical researchers at the University of California, San Diego, and the University of Regina to study the impact of cannabis and CBD on pain management. The first study, "Effects of Cannabinoids on Pain and Recovery from Sports-Related Injuries in Elite Athletes: A Randomized Clinical Trial," and the second study, "Naturally Produced Cannabinoids for Pain Management and Neuroprotection from Concussion and Participation in Contact Sports," are poised to further our understanding of the applications cannabis and CBD can have in sports. Funding these studies demonstrates the NFL's commitment to providing its players with safer, less addictive alternatives to opioids for pain management. Additionally, these initiatives also signal a significant evolution in how the NFL approaches preventive medicine, treating sports injuries and normalizing cannabis consumption among professional athletes.
While continued mainstream support for cannabis research is encouraging, we at CV Sciences have a few concerns about the methodology of these NFL-funded studies. In order for cannabis products to be regarded as a legitimate therapeutic by the medical community, current and future studies must adhere to rigorous research methods.
Analyzing the Limitations of the NFL-Funded Research Studies
Regarding the University of California, San Diego study, we believe there are limitations to researchers only using isolated CBD and THC instead of broad-spectrum or whole-plant extracts. Isolated cannabinoids miss out on the entourage effect – the phenomenon whereby the effects and health benefits of the plant as a whole are greater than its individual parts. We also have concerns about clinical subjects exclusively vaping CBD instead of consuming through other methods. While vaping provides an immediate sense of relief, it is short-lasting and may not address chronic pain. Ingestible products, on the other hand, have a slower onset time but have relatively prolonged effects. Combining the two dosing methods would provide study participants with both short-term longer-lasting pain relief.
While the anticipated study methodology will eventually be published, it is important to also note that pain management outcomes can be very subjective. Consequently, we hope researchers establish realistic and attainable study outcome parameters and evaluate more objective pain indicators, such as inflammatory blood markers.
There are also several potential limitations to the University of Regina study that should be addressed. Firstly, researchers must clearly define "neuroprotection" and other outcome measures to ensure the validity of the study and to prevent misinterpretations. Making data as objective as possible is crucial.
To understand the full scope and impact of the study, the scientific community will also require further insight into the duration of the trials, dosing regimens, types of CBD being utilized and if players will have access to CBD, THC or a combination of cannabinoids. Furthermore, protection and prevention research is notably complex because it requires larger sample sizes and a longer study period to conduct high-quality research. Researchers should keep all of these factors in mind to truly understand the applications of cannabis in preventing and treating injuries.
CBD as a Safer Alternative to Opioids
While the outcomes and methodologies of these studies have yet to be determined, the NFL’s research investment marks an essential step in legitimizing CBD as an alternative to opioids. The U.S. opioid epidemic remains a serious public health crisis and is a significant problem among current and former NFL players.
A 2011 study found that 52 percent of retired NFL players reportedly used prescription pain medication throughout their careers. Of those, 71 percent said they misused their prescriptions. Notably, those who misused opioids while playing were three times more likely to abuse the drugs today. Finding safer alternatives to opioids for athletes is critical in preventing drug addiction and overdose deaths. The NFL's potential new rules regarding cannabis and funding research could offer more natural alternatives for players trying to prevent injuries, manage pain and extend their careers.
Building a Body of Knowledge Around Cannabis and CBD for Pain Relief
Due to the constraints of prohibition, cannabis research is still a relatively new field. However, recent studies have demonstrated promising outcomes supporting the medical benefits of cannabinoids like CBD. The most substantial scientific evidence supports its effectiveness in treating some childhood epilepsy syndromes, such as Dravet syndrome and Lennox-Gastaut syndrome (LGS), which typically don't respond to anti-seizure medications. Epidiolex, which contains pure CBD and is used to treat these conditions, is the first cannabis-derived medicine ever approved by the FDA.
“Cannabinoids and Pain: New Insights From Old Molecules,” published in November 2019, concluded that current evidence supports the use of medical cannabis in the treatment of chronic pain in adults. The researchers also found that cannabinoids themselves (regardless if they’re plant-derived or synthetic) and endocannabinoid-directed therapeutic strategies have been shown to be effective in treating various animal models of pain (acute nociceptive, neuropathic, inflammatory).
"Cannabis, Alcohol and Cigarette Use During the Acute Post-Concussion Period" published in Brain Injury in October 2019 found that even though cannabis use didn’t affect concussion recovery time, cannabis use was associated with a lower symptom burden in the third and fourth weeks after injury.
"Cannabidiol use and effectiveness: real-world evidence from a Canadian medical cannabis clinic," published in the Journal of Cannabis Research in June 2021, suggests CBD treatment has a beneficial impact on pain, anxiety and depression symptoms, as well as the overall wellbeing of patients with moderate to severe symptoms.
These cannabis research studies are some of the first to be conducted at a high level and point towards a positive future for the targeted uses of cannabis as scientifically-backed medicine for patients.
Cannabis as an Adjunct Therapy for Athletes
We must temper our expectations around these NFL-funded studies' potential outcomes. Both concussions and pain management are complicated issues and require a holistic approach. CBD is not going to be a magic-bullet solution. Cannabis may have a role as an adjunct therapy in addition to existing medical treatments for chronic pain and concussion recovery. Other adjunct therapies have been studied for sports performance and recovery that have shown significant results.
Acupuncture, low-load blood flow restriction training, and eating a whole foods diet have been found to be effective for pain control and enhancing recovery from injury. Adjunct therapies like these are already used by doctors and trainers who work with professional athletes, and cannabis and CBD may prove to be another tool in their recovery toolkit. However, additional research is required to understand the broader medical applications and health benefits of cannabis.
Regulators and Consumers Must Be Wary of Misinterpreting the Results of These Studies
When it comes to cannabis and CBD studies, the medical community, regulators, and consumers must be very careful about misinterpreting results. These interpretations can have real-world consequences.
For example, in a 2014 TCU study that explored how omega 3s and fish oil could prevent concussions, the misinterpretation by one sports medicine physician in Philadelphia who published a study in response to the research, in which he erroneously concluded fish oil causes concussions, led the NCAA to put fish oil on its non-permissible substance list. Thankfully, the author of the original study eventually published a follow-up article in 2019 explaining the misinterpretation and pleading for the NCAA to once again make fish oil a permissible substance, and the NCAA overturned its decision.
This example illustrates the damage misinterpretations can cause. The NCAA should have done its due diligence and had experts carefully read the original study, rather than taking one sports medicine’s word at face value. We hope the NFL and other sports leagues dive deep into cannabis research, note the flaws and gaps and seek further knowledge so they can make wise decisions that will benefit the health and well-being of athletes. To lessen the impact of misinterpretations and to legitimize cannabis and CBD as viable medicines, we need more studies and a larger body of work around the health effects of these substances.
An Encouraging Step in the Right Direction
Cannabis research is an evolving body of work that needs consistent support and funding to make a real difference. The fact that the NFL is funding the University of California, San Diego and the University of Regina studies is encouraging, but it’s important to note where these studies fall short and how they can be improved. Using CBD and cannabis therapy as an adjunct treatment to prevent and manage pain and concussions seems promising, but there is still a lot more work to be done. Nevertheless, funding the research is a step in the right direction and we hope this investment will serve as a catalyst for more privately funded studies to be conducted and push the FDA to make more definitive decisions around regulation. Through rigorous studies and high-quality research, more medical and science professionals, and eventually politicians, will start to consider CBD and cannabis as credible alternatives for preventing and managing pain and concussions.
