**This essay was nominated for the Dickerson Prize for First-Year Writing.
Lost in the Weeds: Marijuana in Three Major American Sports
Abstract
American laws surrounding marijuana are confusing, inconsistent, and often downright contradictory. Faced with these laws, major sports leagues have had trouble regulating the use of marijuana among their players. They could let players do whatever they want as long as they’re not caught by the authorities, but many of the leagues believe they have a responsibility to encourage good role models that don’t use “drugs of abuse,” like marijuana or other recreational drugs. Nonetheless, these leagues know that marijuana is a powerful and effective painkiller that can assist their professional athletes. In considering this duality of effective painkiller and sometimes illegal ‘drug of abuse,’ the NFL, the MLB, and the NBA have banned marijuana use, but adapted very ineffective ways of testing athletes for their use. This article analyzes two major effects of these policies, surreptitious marijuana use and prescription opioid overuse. While the latter is obviously bad, surreptitious marijuana use is also bad for sports because there is a third accurate characterization of marijuana besides drug of abuse and painkiller: weak performance-enhancing drug (PED). Surreptitious marijuana use also takes advantage of the unfairness inherent in inconsistent marijuana laws. This article proposes new rules that could be implemented in major sports to try to curb exploitative, performance-enhancing marijuana use and opioid overuse, while still keeping players more pain-free and abiding by federal law.
Introduction
The NFL, the MLB, and the NBA are the richest sports leagues in the world, with annual revenues of $14 billion (Soshnick & Novy-Williams, 2019), $10.3 billion (Brown, 2019), and $7.4 billion (Adgate, 2018), respectively. All three of these leagues prohibit and punish the use of marijuana (“2017 NBA-NBPA,” 2017; “[NFL] Policy,” 2018; “[MLB]’s Joint,” n.d.) by their players, and yet estimates of marijuana use have been reported by former players to be as high as 89% (Perez, 2018) of players in the NFL, 85% of players in the NBA (“I think 85,” 2018), and around 37% of players in the MLB[*] (Alexander, 2017; Chaffee et al., 2015). This contradiction exists because of testing that is purposefully insufficient and inconsistent, allowing players to get away with marijuana use so long as they are careful about hiding it. Players who do listen to the rules and choose not to consume marijuana are often overprescribed opioids by team doctors to deal with the pains that come with being a professional athlete. These three leagues have taken half-measures, banning marijuana, but offering lax testing and small, slowly increasing punishments.
Though the leagues do not admit it, these intolerant marijuana rules exist in part because of the federal government’s laws on marijuana, namely its designation of the drug as an illegal Schedule I drug alongside LSD and heroin. These leagues sparingly enforce these laws because marijuana and marijuana extracts (like CBD) are legal at the state level in a growing number of states. Further enabling their lax enforcement, these leagues all distinguish marijuana from performance enhancing drugs despite the fact that marijuana is known both scientifically and anecdotally to enhance performance in many ways, including but not limited to its ability to relieve pain. Such poorly enforced and oversimplified rules have allowed some players to ignore the rules and gain an unfair advantage by consuming marijuana and has forced other players, who do follow the rules, to consume large amounts of opioids in an effort to control their pain. Marijuana’s nuanced effects on pain and performance, coupled with its complicated legal status, should be reflected in the rules and practices of all American sports leagues, instead of the currently deficient laws stipulated by the NBA, the NFL, and the MLB.
The Rules
The three leagues have similar current policies surrounding marijuana, but the NFL’s is the most complicated and carries the most severe punishments. In the NFL, marijuana is banned as a “substance of abuse,” distinct from drugs that enhance performance, yet testing is extremely minimal. There is pre-employment testing for players who were not contracted players during the last NFL gameday (this can apply to both rookies and veterans). There is also a preseason test offered some time between April 20th and August 9th at the discretion of the Medical Advisor, a physician hired by the NFL and NFLPA (“[NFL] Policy,” 2018). This preseason test is done by position group, meaning all the players who play one position on the same team are tested together, usually early on in training camp (“I smoked,” 2018). The pre-employment test and annual preseason tests make up the sum total of mandatory testing for all players (“[NFL] Policy,” 2018).
The rules governing an NFL player once he has tested positive are convoluted and difficult to understand, but they mandate that a player is very slowly punished for his use, though the largest punishments can be quite severe. Upon a positive test, self-admission, or a behavioral issue like a criminal charge, the player enters a three-tiered intervention program overseen by the Medical Director, another NFL and NFLPA physician with even more power than the Medical Advisor. In Stage One of the program, the Medical Director gives the player a treatment plan and may test the player as much as he sees fit to make sure he is abiding by the plan. Stage One violations of the treatment plan result in a relatively minor fine of the player’s salary. The player’s time in Stage One lasts only 90 days, and he then leaves the intervention program, unless the Medical Director keeps him in Stage One or sends him to Stage Two, something that might occur in the case of another positive test. If graduated to Stage Two, the player is subject to random testing no more than ten times a month. In Stage Two, the punishments are as follows: upon first Stage Two violation, a salary fine, then a salary fine or a 4-game suspension depending on the player’s history in the program, and then a 4-game suspension if he was previously just fined or a 6-game suspension if he was previously suspended for four games. In addition to the suspension, this third Stage Two violation also sends the player to Stage Three. If the player doesn’t have any Stage Two violations, the Medical Director may discharge him from the intervention program after one year, or he will be automatically discharged after two years without further violation. If the player finds himself in Stage Three after a total of five positive tests, the sixth marijuana offense (the first in Stage Three) is met with a 10-game suspension, and the seventh (the second in Stage Three) is met with a suspension of at least a year. A player in Stage Three also does not leave Stage Three for at least two years, and without the intervention of the Medical Director, will stay in Stage Three for the remainder of his career (“[NFL] Policy,” 2018). The NFL’s rules and testing procedures essentially mandate that unless thoroughly unable to stop using marijuana, any player can avoid significant discipline.
Opting for a much simpler system, the MLB has the most lax testing rules of all three leagues, only testing for drugs of abuse if there is reasonable cause to believe the player is using. Upon a positive test, the offending player enters a Treatment Program overseen by the Treatment Board of one physician and lawyer appointed by the Commissioner and one physician and lawyer appointed by the Player Association. If the player breaks the rules of his Treatment Program by using marijuana, he is subject to increasing fines never exceeding $35,000. However, if the player shows “flagrant disregard for his Treatment Program,” the Commissioner may punish the player however they see fit (“[MLB]’s Joint,” n.d., p.40). These rules allow for rampant marijuana use without any consequences, unless “flagrant” use is discovered; then the consequences are entirely within the discretion of the Commissioner.
The NBA’s policies match up with those of the NFL and MLB in their small, increasing punishments, but they take by far the strictest approach when it comes to testing by conducting exclusively random tests. They conduct these random tests four times throughout the season and two times in the offseason. Upon a positive test, the offending player is entered into the Marijuana Program, which is separate from protocol related to both performance-enhancing drugs and other drugs of abuse. Another positive test results in a $25,000 fine, a third results in a 5-game suspension, the fourth results in a 10-game suspension, the fifth results in a 15-game suspension, and so on in infinite increments of five (“2017 NBA-NBPA,” 2017). All three leagues have different rules, but each of them bans the drug, uses variously lax testing to catch users, and then punishes those users very slowly and mostly unsubstantially.
The Effects of the Bans and Their Poor Enforcement
Some players have taken note of the poorly enforced nature of these rules and decided to ignore the bans and focus on avoiding positive tests. As mentioned earlier, former players have estimated use in the NFL, NBA, and MLB to be up to 89%, 85%, and 37%[†] respectively. Without random testing in the NFL and the MLB, players simply know when not to have marijuana in their systems. Since the annual NFL preseason test often occurs in the first weeks of offseason workouts, once a player is tested, they can use marijuana freely knowing they won’t be tested until the next offseason (“I smoked,” 2018). In the NBA, even with random testing, a user as prolific as Matt Barnes was only caught twice, despite including marijuana in his gameday routine (“I think 85,” 2018). He explains, “I understood how much I could smoke and get it out of my system before my next test" (Gwilliam, 2018). Even when a random test is scheduled for the next day, it can still be subverted, as it was in the case of one college player in 2004 who drank a detox drink, two gallons of water, urinated, and passed the test (Kirshner, 2018). Another college athlete, this time a Division 1 soccer player, used multivitamins, salt pills, and lots of water to fool multiple NCAA tests as well as a preseason test in Major League Soccer (Kirshner, 2018). The leagues can have as harsh rules as they want, but until their testing procedures become significantly harder to skate around, the only players they will catch are the ones truly addicted or dependent, like Josh Gordon, who cannot seem to stop taking the drug (Yang, 2018).
Some players accede to the rules in place surrounding marijuana by using other drugs that numb the pain they deal with, namely opioids. In a survey of 644 retired NFL players, 52% used opioids during their careers, with 71% of those athletes reporting misuse of the drugs (Cottler et al., 2011). One former NFL player, Nate Jackson, said that OxyContin was “eaten like candy” in the NFL (M. Kaplan, 2016). Steve Kerr, the head coach of the NBA champion Golden State Warriors, asserted that Vicodin is prescribed to athletes “like it’s vitamin C” (Gottlieb, 2016). Diverting players away from marijuana and onto opioids isn’t a good idea, and most Americans know why: many users of opioids find themselves using heroin when it becomes difficult to acquire enough prescription opioids to affect their increasingly tolerant bodies. This trend of graduating from prescription opioids to heroin is documented in professional sports as well, according to Dr. Sisley, a doctor leading an FDA-approved cannabis study (M. Kaplan, 2016). There is a history of heroin addiction in the NBA, MLB, and NFL, with players such as Chris Herren (Lee, 2019) in the NBA, Jeff Allison (Farragher, 2004) in the MLB, and Erik Ainge (Cimini, 2011) in the NFL. Even if the players don’t graduate to heroin, prescription opioids alone can put players like into a “dark place,” as they did with Bo Scaife (“I smoked,” 2018).
PED, Painkiller, or Vice: Marijuana’s Versatility
The rules in these leagues paint marijuana as a drug that is notably not in the same category as performance-enhancing drugs like steroids, but is this classification correct? The simple answer is no. The reason is two-fold: first, marijuana is a painkiller, and when the pain is killed, performance will naturally be enhanced. Second, the drug enhances performance in other ways too, including but not limited to increasing blood flow in the limbs (Beaconsfield et al., 1972), metabolic rate (Zwillich et al., 1978), and heart rate (Avakian et al., 1979), as well as aiding relaxation (Kennedy, 2017). Some of these performance-enhancing benefits are reported both anecdotally and in some scientific papers, albeit ones with small sample sizes.
Despite the general lack of clinical trials, marijuana is well-known for its pain-killing abilities. It has been used to treat pain for thousands of years and has been especially effective at treating joint pain (Miller & Miller, 2017) and neuropathic pain (Aviram & Samuelly-Leichtag, 2017). Many athletes agree that marijuana numbs the pain. Eben Britton, a former NFL offensive lineman who played three games while under the influence of marijuana, said he took the drug for numerous reasons, one of them being his shoulder pain (M. Kaplan, 2016). Nate Jackson, a former NFL tight end, also took the drug for various aches and pains (M. Kaplan, 2016). Ryan Clady and Bo Scaife, two other former NFL players, used marijuana to treat pain as well (“I smoked,” 2018). Kenyon Martin, a former NBA player, also smoked marijuana and experienced its pain-killing effects during his career. Before one particular game that Martin wasn’t planning on playing in due to injury, Martin smoked marijuana and felt relieved enough to play in the game (“I think 85,” 2018). This example brings up many questions as to the ethics of all painkillers, firstly their nature as potentially performance-enhancing drugs (PEDs). For one, numbing pain can obviously enhance performance, but the classification of all things that kill pain as PEDs would certainly produce a slippery slope. Is something as common and harmless as Icy-Hot a PED? A second question also emerges: are substances that kill pain actually good for an athlete to take? One could easily make the argument that numbing the pain allows a player to ignore symptoms of real injuries and risk even further injury. Though we won’t address this second question further in this paper, with this kind of ethical analysis, it becomes unclear where the definition of painkillers should end and PEDs begin. Furthermore, how does a “drug of abuse” like marijuana, incorrectly classified as neither helpful, legal painkiller nor PED, fit into the equation?
Though marijuana’s pain killing nature already give it a performance-enhancing quality, it has other performance-enhancing qualities as well, something demonstrated by a fair number of studies (Beaconsfield, 1972; Avakian, 1979; Zwillich, 1972). Before delving into these, it is important to note that this opinion that marijuana can enhance performance in any way other than pain relief is not universally shared. Dr. Gary Wadler, author of “Drugs and the Athlete,” has noted that marijuana negatively affects hand-eye coordination, motor coordination, concentration, tracking ability, and perceptual accuracy for up to 36 hours after usage (“Marijuana,” n.d.; Bieler, 2016). He even wrote that the drug has “no performance-enhancing potential” (“Marijuana,” n.d.). One study showed that marijuana causes coughing and loss in peak work capacity (Kennedy, 2017). However, marijuana having negative effects on some does not rule out its being a performance-enhancing drug. Many PEDs only enhance performance some of the time for some people anyway.
The first of the studies that do show marijuana’s performance-enhancing effects outside of pain-killing is entitled “Marihuana smoking — Cardiovascular effects in man and possible mechanisms” by Beaconsfield et al., published in the New England Journal of Medicine (1972). This study demonstrates how marijuana-smoking increases the blood flow in limbs such as the forearm, calf, and hands, as demonstrated in ten volunteers who had never smoked marijuana before (one woman and nine men, all of whom were physician volunteers). Another study, “Effect of marihuana on cardiorespiratory responses to submaximal exercise” by Avakian et al. (1979), published in Clinical Pharmacology and Therapeutics, details the increases in heart rate before, during, and after exercise, though notably in only six male subjects, all of whom were chronic marijuana smokers. A third study, “The Effects of smoked marijuana on metabolism and respiratory control,” by Zwillich et al. (1978), published in the American Review of Respiratory Disease, demonstrated an increase in ventilation and a parallel increase in metabolic rate (also known as oxygen consumption) in a similarly small sample size of eight male subjects, this time taking the approach of selecting people who had smoked marijuana before, but were not described as chronic users. While additional studies exist, the main idea should be clear; there have been studies, albeit with small sample sizes, demonstrating some effects of marijuana use that seem advantageous to sport, beyond killing pain.
Though reporting fewer quantifiable effects than the ones discussed in the aforementioned studies, former players have also mentioned the performance-enhancing effects of marijuana outside of pain relief. Eben Britton said the drug “cements your surroundings” in addition to its pain-killing properties and declared that the three games he played on the drug were some of his best (M. Kaplan, 2016). Chauncey Billups, a former NBA point guard, said he had wanted his teammates to smoke, since it helped with their anxiety and allowed them to focus on the game plan (Payne, 2016). Nate Jackson, a former NFL player, listed three performance-enhancing effects in an interview with the New York Post, recalling, “Marijuana improved my hand/eye coordination. Being high on cannabis allowed me to see the game on a different level. It made me a more creative player” (M. Kaplan, 2016). Shaun Smith, a former NFL player who smoked marijuana before every game, said the drug made him feel “unstoppable,” making him feel mellow and ready for the game (“I Smoked,” 2018).
Summarily, marijuana is not simply a “drug of abuse.” It is a legitimate painkiller and there is some evidence that it is a PED even beyond its already performance-enhancing pain killing qualities. Not every player would be helped by using marijuana, but since many players and studies have found it performance-enhancing, it is performance-enhancing. A drug does not need to enhance every user’s performance universally and uniformly to be performance-enhancing. This dual nature of marijuana as painkiller and PED contradicts policies in all three of these major sports, and it calls for some new ones.
The Solution
The solution is simple and three-pronged: independent pain doctors abiding by federal law, stricter testing and punishment, and player education. The first of these, independent pain doctors, would solve the problem of team doctors sacrificing the health of their players for team success by prescribing excessive amounts of opioids known to make some players sedated and/or addicted (M. Kaplan, 2016). Instead of asking team doctors, who have an interest in their teams’ success, to deal with players’ pain, these leagues could ask a national association of pain doctors, like the American Society of Regional Anesthesia and Pain Medicine, to establish a group of independent pain doctors. These doctors could each be placed with a team for a term of one or two years upon which they would switch teams or leave the job, preventing any long-term interest in the teams’ success but also allowing them to become familiar with the team’s players. One could say that this solution is an expensive way just to solve the problem of players being high, but players being high isn’t the real problem; the real problem is that players are given OxyContin and Vicodin with an alarming lack of consideration as to whether it is healthy for them. There is also the question of fairness in the semi-regulated consumption of marijuana because of its performance-enhancing potential.
Another possible solution, as executed by NHL (E. Kaplan, 2019), is to let players do what they want so long as it’s legal. Not only does this not hold up because marijuana can be performance-enhancing, but it also doesn’t hold up because of federal law and the unfairness stemming from large variations in state laws. Only four states, Nebraska, Kansas, South Dakota, and Idaho, allow no public access to any form of marijuana (“State Medical,” 2019), and none of these states necessarily house any players in major sports.[‡] Nonetheless, this doesn’t mean that every player lives under the same marijuana laws. Many players live in states where marijuana is legal recreationally, and many players live in states where marijuana is legal medically, and some players even live in states where only medical cannabidiol (CBD), an extract of marijuana, is legal. Among these states where marijuana is legal medically and not recreationally, there is anything but uniformity. In Oklahoma, all any adult needs are the signature of a board-certified physician, $20, and a two weeks waiting period (United States, Oklahoma Governor, 2016), but in Louisiana, despite it also being legal medically, medical marijuana isn’t even available yet from the two entities that are allowed to grow it: LSU and Southern University (Gee, 2018). A central idea of sport is fairness, and allowing athletes to abide by vastly different state laws is unfair. Furthermore, federal law only allows for the sale and possession of marijuana products with THC concentrations of less than .3% (115th Congress, 2018), legalizing CBD but not marijuana. This is a law that national organizations such as these leagues should follow, for both liability purposes and so as not to promote federal crime and drug use to their legions of young fans. Since the solution of freedom doesn’t hold up because of federal law, unequal state legalities, and marijuana’s potential as a PED, a large and expensive measure like independent pain doctors is necessary to uphold fairness and avoid opioid overuse.
In addition to independent doctors, there must be frequent, random pre-game testing for pain medication, both opioids and cannabinoids, to confirm that players are abiding by the requests of their independent pain doctors. If they aren’t, there must be harsher punishment. Once independent pain doctors are hired, it should be considered cheating to consume marijuana above the level prescribed by these doctors. This type of overconsumption would be performance-enhancing in its ability to numb pain, relax, enhance blood flow in the limbs, increase metabolic rate, or to provide any other known benefit. Offseason use of the drug, so long as it’s legal, should not be investigated or prohibited, since competition hasn’t begun and there is no evidence of long-term performance-enhancing effects equal to that of PEDs banned year-round, like steroids. If a player is caught during the season using marijuana or opioids in an amount greater than what the independent pain doctors have prescribed, they should be punished along a quickly ascending scale. To punish their first violation, they should be fined a small proportion of their salary. If caught again, they should be given a small suspension of possibly just a single game in the NFL or five in the NBA. If caught a third time, they should face a more meaningful suspension (perhaps half a season), and if caught a fourth time, the player should be suspended for a season and entered into a treatment program about drug abuse that will decide if and when he is reinstated.
Finally, these professional athletes must be properly educated on the dangers of marijuana. While only CBD use should be allowed by these leagues during the season, offseason use of marijuana should be permitted where legal, which necessitates proper education. One danger of marijuana use is dependency, regardless of how the marijuana is consumed (Karila et al., 2014). If the marijuana is smoked, there are potentially long-term health risks in the lungs including higher risks of lung cancer and Chronic Obstructive Pulmonary Diseases like bronchitis (Chatkin et al., 2017). As one study puts it, “the adverse effects of smoked marijuana would at the very least be comparable to that of tobacco smoking” (Tan & Sin, 2018). Marijuana use also increases the risk of developing vascular diseases (Barker, 2018). In addition to marijuana causing a player to be a danger to himself, he can also be a danger to others. Driving under the influence of marijuana is incredibly dangerous, and players should be reminded of and educated about this in detail. Smoking marijuana in front of children can be detrimental to their lung health as well (“Children in the Home,” n.d.), and since many professional athletes have children, this too should be stressed. Marijuana should be used in professional sports as the helpful painkiller that it is, but it is by no means harmless, and players should know all of the risks both for themselves and for those around them.
Conclusion
For too long in America’s three most lucrative and most watched leagues, marijuana has been treated as a harmful drug with no positive effects, yet it is ineffectively and rarely tested for. Players are encouraged to hide their marijuana usage or abide by the rules and consume prescription opioids in unhealthy doses. Marijuana can be harmful, but one of its extracts, CBD, is a helpful, safe painkiller, and players should be able to use it in this way. Pain specialists should be hired to assess players’ pain needs, and use outside or above what these doctors recommend in order to gain a competitive advantage should be treated seriously with a quickly ascending scale of punishments. Frequent, random, pre-game testing with little notice should be used to catch abusers. In addition, players should be educated thoroughly on all the risks associated with marijuana and CBD use. Prohibitive yet lax rules on marijuana have caused numerous cases of pain medicine misuse and abuse, as well as numerous cases of unfair marijuana use. If all three of the aforementioned additions are made, independent pain specialists abiding by federal law, stricter testing and punishment, and thorough player education, the problems of pain medicine abuse and unfair marijuana use in elite sport could be greatly reduced.
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[*] This statistic was more complicated to get. No former or current player has estimated the exact percentage, many have said it’s a lot, and one of them, Dirk Hayhurst, said marijuana use was about as common as smokeless tobacco use in 2014. The Chaffee et al. study that is cited estimates smokeless tobacco use at 37% in 2015, so considering Dirk Hayhurst’s statement, I thought it was fair to estimate MLB’s marijuana use at 37% as well.
[†] See earlier note on this statistic.
[‡] Players who play for Kansas City teams may decide to live in Kansas, but by no means are they required to (nor should they, if they want to consume any form of marijuana).