Preeminent Harvard psychiatrist Lester Grinspoon smoked pot with Carl Sagan (a lot), which prompted him to write two books about cannabis, Marihuana Reconsidered (1971) and Marijuana, the Forbidden Medicine (1993). Dr. Grinspoon asked us to consider running an open letter he'd written to the commissioner of the National Football League, Roger S. Goodell, imploring him to actively support research into using cannabis to treat long term head trauma, and we felt his thoughts are worth sharing.
As both a medical doctor and one of millions of fans who enjoy professional football as a spectator sport, I'm becoming increasingly uncomfortable with the growing specter that many of the athletes I cheer from the sidelines will one day pay the steep price of developing Chronic Traumatic Encephalopathy (CTE) due to concussions and other repetitive brain injuries incurred in the course of their profession.
Already the NFL has offered former players $765 million to settle a lawsuit charging your organization with knowingly concealing a link between traumatic brain injury and pro football, an agreement later struck down by a judge who feared that sizable payout could actually prove far too small to adequately cover all current and future cases of CTE. So it's not hard to imagine the NFL's liability eventually growing to well more than a billion dollars, a staggering figure that nonetheless pales in comparison to the human toll paid in terms of pain, suffering, and untimely death among former players.
To your credit, you recently showed a willingness to explore all possible means of alleviating the frequency and severity of CTE cases in the NFL, including the controversial idea that compounds found in marijuana could play a vital role in protecting player's brains. Asked about that very possibility, you said: “I'm not a medical expert, [but] we will follow medicine and if they determine this could be a proper usage in any context, we will consider that."
Given the severity of the problem, however, I think you, and the NFL, must go beyond simply following the medicine, and help lead the way by directly funding research to determine if cannabis—including preparations with no psychoactive effects, such as those with a high-cannabidiol (CBD) to tetrahydrocannabinol (THC) ratio—can indeed provide significant protection against the damage of repetitive concussions.
Already, many doctors and researchers believe that marijuana has incredibly powerful neuroprotective properties, an understanding based on both laboratory and clinical data. But unfortunately, the extensive research required to definitively determine cannabis's ability to prevent CTE will require millions of dollars in upfront investment, and despite the great promise many now see in cannabinopathic medicine, it's hard to imagine who else has both the motive and the means to provide such funding.
Typically, a new medicine reaches the market because a pharmaceutical company pays for research to establish both its efficacy and safety. But it's highly unlikely that a pharmaceutical company will get involved in studying cannabis as a treatment for CTE, because the plant (and its natural components) can't be patented, and would therefore likely fail to provide an adequate return on investment even if developed into a successful treatment.
The only other potential source of funding is the US government, which remains inexcusably resistant to any clinical study designed to examine marijuana's potential benefits.
Fortunately, the NFL's pockets are plenty deep enough to launch a serious, intensive research program designed to determine whether or not some combination of cannabinoids is effective in preventing the consequences of concussions. This would not only be a great public service, it's in the league's own financial self-interest. Especially since so few other promising options exist for alleviating the problem.
Attempts to improve protective equipment can only go so far without seriously diminishing the skills and capacities of the player. The helmet as currently designed is excellent at protecting the skull, but not its contents—the brain. And given the limitations imposed by physics, anatomy and neurophysiology, I question how much more any helmet design can do to limit the frequency or severity of concussions. I also see little potential in further rules changes to adequately address this issue, without altering the game so severely that it no longer resembles football as we know it.
Which means we must explore the potential for internal protection of the brain. This research will not be quick or inexpensive, but it must happen. In the meantime, I implore you to immediately stop subjecting players to drug tests for marijuana, so they no longer face severe penalties for choosing a potentially life-saving medicine that can be used legally in twenty states.
Lester Grinspoon M.D.
Emeritus Professor of Psychiatry
Harvard Medical School