Pubdate: Mon, 06 Jun 2016
Source: Washington Post (DC)
Copyright: 2016 The Washington Post Company
Contact:  http://www.washingtonpost.com/
Details: http://www.mapinc.org/media/491
Author: Adam Kilgore

MEDICAL MARIJUANA AND THE NFL

Ravens' Monroe Advocates for Removing Cannabis Ban

Baltimore - Eugene Monroe made up his mind, his conviction steeled by 
obsessive research. He would advocate publicly for medical marijuana 
use in the NFL. He knew he would create consternation inside a 
powerful, conservative institution. He understood it might jeopardize 
his career as a Baltimore Ravens offensive lineman.

And the first skeptic he faced was his wife, Nureya.

When Monroe first shared his self-appointed mission in December, 
Nureya was confused. She had understood marijuana as illegal and 
dangerous since childhood, and ever since they met at the University 
of Virginia, she had known her husband as a health-shake-chugging, 
gluten-free, dairy-free, pescatarian athlete who didn't use marijuana.

"That conversation," Nureya said, "was a lot of me rolling my eyes."

But once Monroe described peer-reviewed studies and explained the 
benefits, she learned the difference between cannabis compounds. Her 
initial skepticism dissipated. "It definitely has allowed me to say, 
'Wow, this is something that can help people,' " Nureya said.

Monroe has moved to trying to win over the NFL, volunteering for a 
role nobody assigned him, a crusade born of his own principle. In 
May, he became the first active player to publicly call for the NFL 
and NFL Players Association to remove cannabis from their list of 
banned substances and permit medical marijuana to treat chronic pain 
inherent to professional football, which he believes - and some 
research attests - will reduce the league's glaring reliance on 
addictive opioid pills. He wants the NFL to further study the 
potential for cannabis to prevent or treat concussions. He donated 
$80,000 to University of Pennsylvania and Johns Hopkins researchers 
to further study marijuana use in professional football players.

Monroe's outlook derives from both first-hand experience with 
concussions and pain-killing pills and watching how former teammates 
have suffered. Monroe, 29, is at the peak of his playing career, 
seven seasons behind him and two years into a five-year, $37.5 
million contract. He realizes he plays in a league in which players 
can be suspended entire seasons for testing positive for marijuana or 
tumble in the draft if their marijuana use is made public. His coach, 
John Harbaugh, has said pointedly Monroe does not speak for the 
Ravens organization.

"To this point, I understand why no one but me as an active player 
has said anything about it," Monroe said. "It's a banned substance in 
our league. Speaking about it can honestly ruin someone's career if 
the wrong team gets wind of it and has adverse opinions on it. But my 
health is more important than the opinion of someone who could be my 
employer now or my future employer. . . .

"There's enough anecdotal evidence already to say, 'Hey listen, we 
know it's not toxic. We know it's safer than what we're already doing.' "

An NFL spokesman had little to say about Monroe's campaign, referring 
to comments Commissioner Roger Goodell made in February before the 
Super Bowl. "We always review our drug policy," Goodell said then. 
"That is something that our medical professionals do on a regular 
basis. We have had discussions with them in the past about that, not recently."

Quietly, though, the NFL has shown interest in Monroe's campaign.

Jeff Miller, the league's senior vice president for player health and 
safety, and neurological surgeon Russell Lonser, a member of the 
league's head, neck and spine committee, spoke Thursday afternoon on 
a call with the researchers Monroe has funded to learn more about 
their study. The league officials, while not endorsing Monroe's 
stance, requested the talk and were eager to hear more about it.

"They are interested in learning more about the potential for 
cannabinoids to help current and former players, as is evidenced by 
them taking the call, and also expressed a desire to learn more," 
said Marcel Bonn-Miller, an adjunct assistant professor at the 
University of Pennsylvania school of medicine. "They are definitely 
showing genuine curiosity, and they are definitely not throwing up roadblocks."

Monroe's advocacy comes as America's views on marijuana continue to 
shift and the country's opioid crisis grows starker. Twenty-four 
states plus the District of Columbia have legalized medical 
marijuana, with more likely by year's end. Four states plus the 
District have legalized it in full. Meanwhile, overdoses related to 
prescription pain medication caused 19,000 deaths in 2014, the latest 
figures released by the American Society of Addiction Medicine. The 
number rises to nearly 40,000 when heroin overdoses are factored in, 
and prescription pain killers can lead to heroin use.

"In my mind, there's no comparison if we just started from scratch in 
the year 2016 and looked newly at which class of drugs worked better 
to treat pain and side-effect profile up to and including death, in 
the case of opioids," said Daniel Clauw, a University of Michigan 
professor who has performed studies comparing opioids and cannabis. 
"You put the two next to each other, and there really is no debate 
which is more effective to treat pain. You would go the cannabinoid 
route instead of the opiate route."

On Wednesday afternoon at a local juice bar, Monroe outlined his 
stance. He is a skilled and disciplined messenger, amiable yet 
forceful, eloquent but not conversational. His response to an 
interviewer's first question lasted more than five minutes. He does 
not present himself as a radical but rather as an emissary of 
common-sense science that has been dismissed owing to outdated 
stigma. When it was mentioned that there is no conclusive proof that 
cannabis aids in concussions, Monroe casually interrupted, "The U.S. 
Department of Health has a patent - 6630507 - defining it has 
neuroprotective capabilities in the event of traumatic injury to the brain."

Earlier this year, as Monroe gathered information and prepared to go 
public, Nureya posed a question to him. "What do you want to come out 
of this?" she asked.

"I want to break down the doors," Monroe replied. "And if I can get a 
huge organization like the NFL to acknowledge this is something we 
can do to help people, if the NFL can say we're looking into 
marijuana research for our players, the stigma is going to leave."

Focus on the issue

Growing up in Plainfield, N. J., Monroe said, he saw drugs destroy 
lives in his community and "I would get as far away from it as 
humanly possible." He said he still does not use cannabis out of fear 
of failing an NFL drug test. "I can't afford to take the hit," he said.

Monroe's interest in the topic began in 2013, when he watched the CNN 
documentary "Weed" by physician Sanjay Gupta. It featured children 
who curbed debilitating seizures by using medical marijuana. Monroe 
grew curious about the application of medical marijuana to treat NFL 
players' pain.

What he learned shaped his current pitch: The NFL must reform its 
policies on marijuana because the status quo leaves players 
vulnerable. Whereas opioids can lead to addiction, organ damage and 
overdose, cannabis is not addictive and doesn't cause death. Cannabis 
can treat chronic pain as effectively as opioids, and in cases in 
which opioids are necessary, such as after surgery, using cannabis 
reduces the necessary dosage, thereby reducing the risk of addiction.

He learned the differences among at least 113 cannabinoids marijuana 
contains. THC is the psychoactive compound, the reason recreational 
users seek it. But cannabidiol, or CBD, provides analgesic and 
anti-inflammatory properties. CBD can be extracted into oil and 
administered in pill form that doesn't render a high. Monroe came to 
believe the majority of what he had been taught about marijuana was a 
lie, the harm it caused overblown and the potential benefits ignored.

The issue came into personal focus for Monroe last season. He 
suffered a concussion the first week of the season in Denver. Sitting 
in the visiting locker room, he had no idea how he had gotten there. 
Flying to California that night, team trainers gave him Tylenol, 
"which did nothing," he said. The next day, he couldn't open blinds 
in his room because the light hurt too much, and he could barely walk 
down the hallway to see a doctor because he was so dizzy.

Following the season, he underwent shoulder surgery and took pain 
killers. They made him queasy, so he stopped. He felt he needed a 
different option, and he thought about all the other players facing 
similar pain, dependent on addictive pain killers.

Before he started publicly touting his view, Monroe spoke with NFL 
Players Association representatives, but he found them less 
responsive than he hoped. He didn't reach out to any one with the Ravens.

"And quite frankly, I didn't need to," Monroe said. "This is a matter 
that can't wait."

The NFLPA did not respond to multiple messages seeking comment. The 
NFL did not indicate any change from its previous stance, which is 
that it will listen to medical advisers and has found no reason to 
change its view.

Monroe has seen some interest from league personnel. During a passing 
conversation, he said, a Ravens team doctor inquired about what he 
had learned regarding cannabis.

"He had seen some of the statements I've made, and he was interested 
in becoming more educated," Monroe said. "He understands, 
country-wide, we have a problem with how we prescribe pills to manage 
pain. And this can be a healthier option."

In public comments, Ravens owner Steve Bisciotti largely has supported Monroe.

"Obviously Eugene is a pretty stand-up, professional guy," Bisciotti 
said at the NFL owners meetings in March. "To have an opinion about 
something like that is partial to being a leader if it matters to 
him. We're not the ones taking that physical abuse. We're not talking 
about a kid that's been suspended three times coming out and saying 
that. I respect Eugene a lot, and I think all he asked for is more 
studying on the subject."

A potential blessing

Some experts say cannabis could provide a solution to the NFL's 
thorniest problem. Past research suggests but has yet to prove that 
cannabis may play a role in preventing and treating concussions. CBD 
has been shown to have neuroprotective properties. Animal research 
indicates CBD could protect neurons and mitigate effects from 
concussions by protecting the brain nerves and tissue by attaching to 
receptors in the brain.

Lester Grinspoon, a professor emeritus at Harvard and one of the 
first medical marijuana researchers, said players not only should be 
allowed to use cannabis but encouraged to take it before they play.

"We have no guarantee this is going to work," Grinspoon said. "But if 
you can take anything away, evidence shows it is neuroprotective. I 
would have each individual take a capsule an hour or two before they 
play or practice. It's better than nothing."

Monroe's donation was a boon for a field that faces hurdles. Grants 
are hard to come by because marijuana remains a Schedule I substance 
and illegal in so much of the country. There is a relatively thin 
canon because for years the vast majority of studies focused on the 
harm, not the potential value, of marijuana.

The researchers plan two observational studies, Bonn-Miller said, one 
on former players and one on current players. Along with providing 80 
percent of the funding for the studies, Monroe provided insight about 
the design and helped create a network of current players willing to 
participate.

"We wouldn't be where we are without him," Bonn-Miller said. "The 
findings from this can inform a lot of groups. It's directly driven 
by NFL players right now, but it has widespread implications, that 
there are a lot of groups that are going to benefit, not just NFL players."

Monroe could have waited until after his playing career to speak out. 
He believes his message would have fallen on deaf ears had it not 
come from an active player.

"My life is literally at risk here," Monroe said. "Like I said, I've 
got children, man, and I worry for my future. I've already had a few 
concussions. It's time for us to grow up, to move past 'Reefer 
Madness,' to understand this as real medicine."
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MAP posted-by: Jay Bergstrom