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In the white paper sent to teams’ medical staffs, the committee says, “CBD is a promising compound, but the extent of its use in the United States outpaces the level of evidence.” It adds that small clinical studies have suggested that CBD may be effective for treating neuropathic pain, but it is difficult to know the purity and potency of many products, because they are purchased from unregulated sources. The white paper also says that multiple controlled trails show cannabis and two FDA-approved cannabinoids are effective in treating chronic pain and neuropathic pain, but those trials used small sample sizes and short follow-up periods, raising concerns about what can be extrapolated from the trials.

The Pain Management Committee of the NFL and the NFL Players Association held a fact-finding forum Tuesday with manufacturers of products that use CBD in sports medicine. The session was designed to give the medical experts on the committee an update from companies that produce and distribute CBD products about scientific research and evidence regarding the use of CBD products, and more information about which products are available, and how their use could benefit patients.

The NFL’s current drug policy includes a ban on THC, a substance found in marijuana and some CBD products, which are both derived from cannabis plants. NFL players have long called for the league to allow the use of marijuana for pain management. The issue has become even more urgent as states continue to legalize the use of medical marijuana, and as the abuse of opioids originally prescribed for pain relief has become a national crisis.

The co-chairs of the committee recently sent to NFL teams twowhite papers that, in addition to suggesting alternatives to opioids for pain management, explain the committee’s view of the current state of research on CBD products and marijuana use.

“The NFL-NFLPA Pain Management Committee is a jointly formed committee tasked with providing advice to the league and union regarding recent developments in the area of pain management for elite athletes,” the league and the players’ union said in a joint statement. “In furtherance of its duties, the Committee has been asked to brief the parties on the current state of pain management and alternative therapies, including cannabis, cannabinoids and CBD. The Committee invited manufacturers of CBD products to share their research today so the Committee may hear and consider the possible scientific evidence base for CBD use as a pain management alternative. This meeting was an educational and scientific exercise and does not impact the jointly administered Policy and Program on Substances of Abuse. We look forward to the continued cooperative work of the Joint Committee.”

The NFL maintains that there is not enough research and information on the use of CBD to treat acute and chronic pain, although today’s session is a clear indication that the committee is continuing to look at the exploding use of CBD, and whether research will support anecdotal evidence that CBD products could help manage pain. With the next collective bargaining agreement being negotiated, the expectation is that a new agreement could include a different policy for marijuana.

The paper concludes with this warning: “Of course, cannabis remains a banned substance under the NFL Policy for Substances of Abuse. In addition, the potential problems associated with cannabis, from acute impairment of driving, addiction, and exacerbation of psychiatric disorders such as depression and anxiety, make it a substance to approach with extreme caution.”

“There is a need for better information, better science,” Hill said.

The pain management committee of the NFL and the NFL Players Association will provide $1 million in funding for research into pain management and cannabinoids, the committee announced Tuesday.

Up to five grants are expected to be awarded around Thanksgiving.

Dr. Allen Sills, the league’s chief medical officer, said another question looms over the use of medical marijuana that the league hopes will be answered with more research: how does using cannabis and CBD to treat pain affect performance in elite athletes?

For years, the NFL suspended players if they tested positive for marijuana multiple times. That changed with the collective bargaining agreement approved a year ago. Now, the league wants to know more about how safe cannabis and CBD are and if they work, particularly as a potential alternative to opioids — an interest that follows broader societal concerns about pain management and the use and risks of powerful opioids.

The request for proposal is the next step in the NFL’s shift on the use of marijuana by players, some of whom have long maintained that it was safer for them to use marijuana to treat pain than to take prescription medication.

Dr. Kevin Hill, the co-chair of the pain management committee, director of addiction psychiatry at Beth Israel Deaconess Medical Center and the author of Marijuana: The Unbiased Truth about the World’s Most Popular Weed, said that right now, the level of interest in the use of medical marijuana far exceeds the level of evidence available.