This is the first story of a new series, Cannabis Country: The New Normal, proudly produced in collaboration with Cannabis Wire – a unique publication exploring issues of regulation, technology, law, criminal justice, and individual liberties at the intersection of this booming billion-dollar industry. 

When asked how many times he’s been injured, former National Football League player Nate Jackson jokes, “how much room you got left on your page?”

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Jackson, six-foot-three and weighing in around 215 pounds with friendly brown eyes and a gentle smile, has been banged up, beat, and battered more times than he can count. As a former tight end and wide receiver for the San Francisco 49ers (2002) – a childhood dream come true – and the Denver Broncos (2003-2008), Jackson recites his list of injuries, starting at his feet, going all the way up to his head: Achilles tendonitis, torn MCL (knee injury), torn groin, dislocated shoulder, broken fingers, cracked ribs, neck trauma, lower back pain, and about three diagnosed concussions. “Football is about smashing your head; part of the culture is who’s toughest,” says Jackson. “If I had a headache, I didn’t tell anybody about it.”

The only medicine that consistently helped Jackson manage his pain and cope with the stress of the sport has been cannabis. He began using it socially in high school, smoking in friends’ cars, and continued to use it during his career in the NFL for therapeutic purposes.

As a boy, Jackson was always hyper, aggressive, and rambunctious, constantly horsing around, sometimes ending up with stitches. He’d act out in class and tell teachers that reading hurt his eyes. “My eyes were totally fine, I just couldn’t sit still,” says Jackson, who believes he had undiagnosed childhood ADHD. When he began smoking in high school, cannabis relaxed him, allowing him to focus more on school and his athletic career. “I think that’s why it stuck with me through my path to the NFL,” he says. During college, Jackson would go back to his dorm with teammates after games to unwind over a joint. “Pipes, bongs, joints, whatever. And blunts,” he adds. “A lot of the guys liked blunts.” But when he went pro, Jackson more often smoked alone and never brought his stash on the road. “I was very serious about my football career. When I did smoke, it was on my own, when I was at home and when I was injured. It was something I did alone to deal with the demands of what I was going through.”

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While official NFL policy bans cannabis, Jackson is among a handful of current and former players who are becoming increasingly vocal about their use. Football players and other athletes say they tend to use cannabis for three main reasons, aside from getting high: pain management (in place of opioid painkillers), protection (brain-wise, especially among football players at high risk of concussions), and in some cases, performance.

Yet, while some players say that coaches turn a blind eye or simply don’t care about their athletes’ cannabis use – so long as they perform well on the field – there’s a disconnect between conversations in the locker room and at league offices. And this is not a reality within just the NFL: The official policies of nearly all major American sports leagues stand with federal law and prohibit cannabis use, while research increasingly points to potential benefits in sports medicine.

Research from around the world has explored the benefits of cannabis and cannabinoids for cognitive disorders and pain management, everything from epilepsy and PTSD to bone loss and neuropathy. Little research exists, however, targeting athletes in particular. That’s why Colorado’s Realm of Caring Foundation – an advocacy nonprofit that also sells the well-known cannabis oil Charlotte’s Web, featured in Sanjay Gupta’s Weed” documentary – in conjunction with Johns Hopkins University School of Medicine’s department of psychiatry and behavioral studies, has launched a campaign to investigate the therapeutic effects of cannabis for conditions most often suffered by athletes. Twenty current and twenty former NFL players, including Nate Jackson, will participate in the initial study protocol, over about three months. With enough data, Heather Jackson, a Realm of Caring co-founder, intends to approach the NFL this year in hopes of starting a conversation to reform cannabis policy so that athletes can medicate without fear of suspension from the league.

For now, the NFL has indicated no intention of reform without ample scientific evidence and support from their own physicians.“The substances of abuse policy is collectively bargained and is a joint NFL-NFLPA (NFL Players Association) program,” said Brian McCarthy, the NFL’s vice president of communications. “We are guided by medical advisers. They have not indicated a need to change. If this changes, it is something we would discuss with the union.”

Under pressure from increasing evidence linking football to the degenerative brain disease CTE (chronic traumatic encephalopathy), and exposure for failing to document all concussions – perhaps one of football’s most common, worst injuries – the NFL may one day regard medical cannabis research more seriously. Eben Britton, former Chicago Bears guard and tackle, said his coach used to joke that football is the only sport in which athletes are in worse shape by the end of the season than in the beginning; though said in jest, this is a stark truth that defines a reality for athletes around the country.

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In the fourth quarter of a Thursday night game in Cleveland, 2008, the Broncos versus the Browns, Jackson found himself airborne, his fingers grasping for the ball, when – boom, he got knocked out. He dizzily came to – the Broncos won! – but Jackson couldn’t move his neck and silently nursed a concussion later that night on the team’s flight back home. “They knew I got knocked out [and] gave me a few muscle relaxers and Vicodin on the plane,” Jackson says. “I felt like I had a severe enough injury to be diagnosed and treated, but I was done with [the NFL’s] approach to treating it.” A bottle of pills was usually the NFL’s answer for injured players’ pain, and some developed addictions to painkillers, Jackson says. (More than 50 percent of former players say they used pain medications “during their playing days,” and among them, 71 percent misused them.) Instead, Jackson opted for “peace of mind,” and smoked cannabis for pain.

Luckily, he said, a Thursday night game meant Jackson had the weekend to recuperate before practice the next week. He told nobody how bad he felt, left his concussion undiagnosed, and spent the next three days bedridden and high, watching TV while wearing sunglasses because the screen was too bright for his eyes. By Monday, he was back on the field.

“There was rarely a moment when I played in the NFL that was pain-free,” says Jackson. “You learn how to deal with pain, not as a deterrent from doing something, but to keep doing that same thing harder.” Football didn’t make Jackson immune to pain, but rather fit his natural disregard for it. “I was always a tough, aggressive kid. Football was for people like me. I never minded physical pain. Football was a way to give it purpose, understand it.”

On game days, adrenaline would wash over his body, temporarily masking the chronic discomfort that plagued him. “As human beings, you’d be amazed at what you’re capable of doing, if it’s something you really wanted,” he says. But on days spent sitting in meetings, watching replays of the game and receiving critiques from coaches, the pain was unmistakable. Every time he got hurt, Jackson became depressed and anxious; his self-worth, tied into his performance on the field, would immediately plummet.

Jackson was always quiet about his cannabis use, however, until he retired from football and went public about it in his 2013 memoir Slow Getting Up. If he hadn’t been so quiet during his career, Jackson could have been forced into drug counseling and risked suspension.

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The NFL prohibits the use of federally illegal substances, in addition to performance-enhancers, such as human growth hormones, stimulants, steroids, and diuretics, which mask the use of these substances. Players are tested for “street drugs” once a year sometime between April 20th and August 9th, and for performance enhancers more frequently. In 2014, the NFL raised the threshold for a positive test of carboxy tetrahydrocannabinol (THC) from 15 nanograms per milliliter of urine to 35 nanograms per milliliter, providing players more leeway. Suspending players for cannabis is a last resort after four positive drug tests. The first positive test for cannabis results in a mandatory two-year drug rehabilitation program where drug testing is more frequent; the second is a two-game fine, or playing unpaid; the third is a four-game fine; the fourth is a four-game suspension; and the fifth is a ten-game suspension.

Heading into the 2015 season, 26 NFL players were suspended on substance abuse policy violations (mostly cannabis) and performance-enhancers.

In the National Basketball Association, players are subject to four random drug tests throughout the season. The first positive test results in a mandatory drug abuse program, the second in a $25,000 fine, the third in a five-game suspension, and the fourth in a ten-game suspension. Former Chicago Bulls guard Jay Williams estimates that 75 to 80 percent of NBA players use cannabis. Cliff Robinson, who played for the Portland Trail Blazers, Phoenix Suns, Detroit Pistons, Golden State Warriors, and New Jersey Nets, was suspended twice for cannabis use. Known as “Uncle Cliffy,” Robinson now advocates for cannabis policy reform and is starting a “Sports Cannabis” brand called “Uncle Spliffy.”

In Major League Baseball, the first positive test for cannabis results in a follow-up drug test. The second positive test results in a 25-game suspension; the third in an 80-game suspension; and the fourth in expulsion from the league (at the commissioner’s discretion).

Unlike the NFL, NBA and MLB, the National Hockey League excludes cannabis from its list of banned substances. The NHL’s drug testing program is designed to target performance enhancers, rather than recreational substances. If cannabis, or a drug like cocaine, is detected, players face no punitive consequences, unless they are convicted of a criminal drug offense. If the drug test results show “a dangerously high level for a drug of abuse such that it causes concern for the health or safety of other players,” players may be subject to enrollment in the Substance Abuse and Behavioral Health Program. Still the NHL’s more lenient policy has led some to fear that cocaine use among hockey players is on the rise.

Other sports, as well, have increasingly lenient policies on cannabis. For instance, in May 2013 the World Anti-Doping Agency, led by the International Olympic Committee, raised the threshold for cannabis to 150 nanograms per milliliter, a tenfold increase. WADA spokesperson Ben Nicholas said the new threshold is meant to target only athletes who use cannabis during the competition period, but not days or weeks prior. “Members want cheaters to be caught for cheating, not for recreational usage,” announced WADA’s Athletic Committee.

Ultra-runner Avery Collins and skier Tanner Hall are among the first professional athletes to be sponsored by cannabis-related companies. Cannabis-accessory kit company Black Rock Originals sponsors Hall, while Collins is sponsored by Incredibles edible company, Mary’s Medicinals, a medical cannabis company, and Roll-uh-Bowl, a collapsible bong company.

“I believe in [cannabis]; it’s a passion of mine,” Collins said. “Ultimately, I saw an opportunity, a niche that didn’t exist. I knew I could make something of it, and I have.” August will mark the two-year anniversary of Collins being sponsored by a cannabis company.

Collins uses cannabis primarily to enhance his practice. “It helps me live right in the moment. It makes things very spiritual,” he says. “You don’t think about anything except the run itself.” Cannabis doesn’t give runners athletic advantages, he adds, but for some, it makes running more enjoyable. “It makes the longevity of a runner’s high last longer, because technically you’re already high.”

In fact the runner’s high and the cannabis high are remarkably similar – both may originate in the body’s endocannabinoid system, a group of endogenous cannabinoid receptors regulating the body’s physiological functions, including appetite, mood, and pain sensation.

While endorphins were once thought to be responsible for the exercise high, it turns out exercise also causes an increase in the endogenous “bliss” chemical anandamide, a naturally occurring cannabinoid in the body. Like cannabinoids found in the plant such as THC, anandamide crosses the blood-brain barrier and activates the same neuronal receptors that cannabis acts upon.

Collins runs between one hundred and 150 miles a week for practice, spends eight to twelve hours a day in the gym, and races four to five times a year. Races range from one hundred to five hundred miles, and can take more than 24 hours to complete, depending on how hilly or flat the terrain is.

“As of right now, cannabis use is accepted during the training process,” he says. During races, cannabis use is prohibited, but most runners aren’t drug tested. “I honestly think they could probably care less about cannabis,” says Collins.

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With medical cannabis legal in 24 states, it’s natural that questions regarding cannabis for medicinal use in national sports leagues would become part of the conversation. Players are becoming increasingly aware of the effects of professional sports on their bodies, former Bears player Eben Britton said. “You saw it this year; I don’t know if there’s ever been such an exodus of young players in the NFL after last season. I think that’s due to a lot of guys being very fearful for their brains and long-term health.” Former 49ers Chris Borland, 25, and Anthony Davis, 26, retired early, specifically citing fear of potential brain injury.

At Boston University School of Medicine, neuropathologist Dr. Ann McKee’s research into the brains of deceased athletes has revealed that at least ninety former NFL players suffered from CTE, a degenerative brain disease found among those who have experienced repetitive head injuries. Symptoms begin within eight to ten years of traumatic brain injury, and include memory loss, mood instability, dementia, vertigo, and suicidality. In 2013, the NFL settled a lawsuit for $765 million upon accusations from retired players that league officials concealed the risks of repeated concussions.

Some athletes, including former offensive tackle Kyle Turley, former Broncos quarterback Jake Plummer, and Ravens current offensive tackle Eugene Monroe, are now pushing for more cannabis research and policy reform, citing the plant’s therapeutic effects, specifically for pain and brain injuries. Currently the National Institutes of Health supports and is conducting a large body of research, totaling more than $110 million in 2015, on the harms and benefits of cannabis. Funded studies include understanding the basic biology of the endocannabinoid system and the therapeutic effects of cannabinoids on pain, substance abuse disorders, and brain injury.

As a pain medication, cannabis may serve as a safer alternative to opioid painkillers, which in recent years have spawned a national addiction and overdose epidemic. Several clinical trials report that inhaled cannabis is effective in alleviating neuropathic pain. In a double-blind study at the University of California, Davis, researchers reported that multiple-origin neuropathic pain significantly declined when patients, who had been unresponsive to traditional pain therapies, inhaled both high and low doses of cannabis. Another clinical trial on healthy subjects who were exposed to painful stimuli revealed that inhaled cannabis and orally ingested THC increased pain tolerance and decreased pain sensitivity. A study in Israel found that a single vaporized dose of whole-plant cannabis helped patients who suffered nerve pain, while research into vaporized cannabis at University of California at San Francisco showed that cannabis’ analgesic properties could help supplement and reduce the need for, and side effects of, painkillers. Massachusetts Senator Elizabeth Warren recently called on the Center for Disease Control to investigate the fact that opioid deaths are lower in states with medical cannabis laws.

Just as research on cannabis and pain relief could support athletes’ claims that it helps their pain management, there is research suggesting that cannabis may also be protective for the brain in some way.

A study at the Hebrew University of Jerusalem found that the activation of endocannabinoids contributes to the brain’s repair mechanisms in the event of brain toxicity, neuroinflammation, and trauma. “This review is focused on the role the eCB [endocannabinoid] system plays as a self-neuroprotective mechanism and its potential as a basis for the development of novel therapeutic modality for the treatment of CNS [central nervous system] pathologies with special emphasis on TBI [traumatic brain injury],” the study states.

A 2016 study at the University of Sao Paulo investigated the therapeutic effects of CBD associated with neurodegenerative conditions and neurogenesis (the growth and development of nervous tissue), as well as its ability to attenuate psychotic, anxious, and depressive behaviors. And yet another research trial with rats showed that CBD and other cannabinoids act as neuroprotective antioxidants, especially in injuries that deprive the brain of oxygen. Other studies have found antidepressant and anti-anxiety effects of the so-called “high-less” cannabinoid called cannabidiol (CBD).

Because very little of the research conducted applies directly to injuries that professional athletes receive, The Realm of Caring Foundation, the nonprofit that conducts cannabis research out of Colorado, recently launched a grassroots campaign called When the Bright Lights Fade to raise funds for a series of studies on cannabis treatment for CTE and traumatic brain injury.

“The purpose here is not to challenge the NFL, the purpose is to try to understand whether and to what degree players are using these [cannabis] products and whether they’re deriving some benefit,” said Dr. Ryan Vandrey, professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine and principal investigator in the Bright Lights study. “Initially, we’re just trying to get a sense of what types of cannabis or cannabis-based products players are using, why they’re using it, and what kind of effect they’re reporting: health benefits, side effects, adverse consequences, and duration of use.”

The initial study will consist of basic biological specimen testing and qualitative interviews with twenty current and twenty former football players, says Vandrey. Based on the information obtained in the first study, researchers will design a quantitative follow-up study to assess current and former NFL players and other athletes. “Generally we will be looking to see if athletes who use [or] used cannabis differ from athletes who don’t [or] didn’t on outcomes of interest. This could range from pain, quality of life, cognitive functioning, substance use disorders, biomarkers of injury, inflammation, etc.”

The types of effects and consequences the study investigates are relevant not only to football, but any contact sport, from mixed martial arts to hockey, Vandrey adds. “You can have a thousand people saying, ‘Yeah, I use cannabis, it’s great for my pain,’ but that doesn’t tell us anything,” he says. “We need to do proper clinical development to know how to use [cannabis] optimally in a therapeutic setting.”

Up to this point, there haven’t been any studies specifically targeting cannabis for CTE, says Dr. Marcel Bonn-Miller, adjunct assistant professor at the University of Pennsylvania Perelman School of Medicine department of psychiatry. Bonn-Miller is working with Vandrey and Realm of Caring on the study. “Part of the problem is that, currently, CTE can only be diagnosed post-mortem,” he says. “There is mounting evidence that CBD can serve as a neuroprotectant, with additional benefit observed for anxiety, depression, and inflammation – all common conditions among athletes. But the real key is understanding how these different [cannabinoids] relate to each other.” While CBD is known to be therapeutic, it’s important to understand the entourage effect, how different cannabinoids function in each other’s presence.

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In 2015, Kyle Turley, former offensive tackle for the St. Louis Rams, the New Orleans Saints, and the Kansas City Chiefs, founded the Gridiron Cannabis Coalition – the first formal coalition of its kind – to spread awareness about medical cannabis for athletes. “What we want is to have the choice for organic treatment for illness or injury that doesn’t come with a side effect of death,” says Turley, who received an early diagnosis for what doctors believe is CTE at the age of 34. After battling opioid painkiller addiction and suicidal thoughts, Turley tried cannabis, which he says helped him get his mind back.

So far, thirty ex-NFL players have teamed up with Gridiron, in partnership with California cannabis extract company Constance Therapeutics, to test cannabis treatment for pain and depression. The study subjects will take cannabis extracts provided by Constance and self-report the results. Like the Realm of Caring study, though, the results will primarily serve as conversation starters, not policy changers (none of this involves the FDA, which oversees clinical trials and drug approval). Nearly half of all retired football players suffer chronic pain, while almost forty percent experience depression.

Eugene Monroe, Baltimore Ravens offensive tackle, is the first active NFL player to speak out on this issue: “The NFL will need to have legitimate information before they remove marijuana from the banned substance list and ultimately not hurt their product in the field. But there’s opportunity in that space also for the NFL to get involved and maybe lead efforts.”

Monroe has since posted dozens of times on Twitter advocating for cannabis research to aid in brain injuries. “CBD may be the smoking gun in curbing these CTE related suicides,” Monroe Tweeted. “I’m not here advocating smoking weed for recreational purposes. However, smoking weed just may protect your brain.”

Former Chicago Bear, Eben Britton, says the NFL’s disconnected view on cannabis, in contradiction with its players’ habits and what science has begun to prove, is based in stigma and image preservation. “The NFL on the surface is a very buttoned up, old fashioned traditional regime,” he says. “They don’t want to piss off the mothers of America whose young sons are going out to play football and their idols are these ‘drug addicts.’”

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Upon his retirement from the NFL, Nate Jackson was dispirited, more so than during any hardship, any injury throughout his football career. “It’s pretty hard, you don’t know where you’re going or what you’re doing,” he says. “I had a lot of injuries, my body was a mess, I was confused about where to go next, and mentally didn’t know what was going on.”

Since retiring, Jackson has lived between Los Angeles and Colorado. He doesn’t play football anymore beyond tossing a ball around on the beach, but he does continue to watch games and plays in a fantasy league with old friends who never went pro. While his schedule is looser than in the NFL, he also wakes up early, adamant about exercising regularly. “If I don’t, my body falls apart, and all the old injuries pop up.” He bikes to the beach, lifts weights, and does core work at the gym.

He tries to write every day, sometimes in coffee shops, sometimes in libraries, and if he can muster up the concentration, at home in his apartment. With his second book almost finished and intentions to keep writing, Jackson says he feels a responsibility to his peers to articulate what some have gone through as players. “For football players moving on with life, you have to find something else you’re passionate about,” says Jackson. “Football is never coming back. Who are you outside that system?”

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Madison Margolin is a journalist from Los Angeles, based in New York. She specializes in covering cannabis and drug policy and has contributed to The Village Voice and other publications. Follow her on Twitter.