Getting Off the T Train

Before kickoff on game day, in NFL locker rooms all over the country, players wait in line to drop their pants. We call it the T Train.

I play for the Baltimore Ravens, and if we’re at home there’s a small office sectioned off from the training room in M&T Bank Stadium that we use. If we’re on the road the visiting locker rooms don’t usually have sufficient space, so we just go to a corner of the training room. The T Train is nothing more than a bunch of really large guys waiting to pull their pants down to get shot in the butt with Toradol, a powerful painkiller that will help them make it through the game and its aftermath.

Instead of an injection, some players opt for an oral form of Toradol. The effects are the same, though, and can last through the next day. Some guys don’t feel any pain for two days. Of course, that’s the point of these drugs — they block out the pain and reduce inflammation. But they also temporarily mask injury. That’s not a good thing if you get hurt during a game — you might need to address your injuries right away. But you feel nothing, so you do nothing.

When I was playing college ball at Virginia, I tore my shoulder up in a game against UConn in 2007. I was blocking Dan Davis, a defensive tackle who had been my high school teammate in Plainfield, N.J. At some point in the game I had hit Dan and felt something shift in my shoulder — but there was no immediate pain. Why would there be? I had gotten a T-shot before kickoff. The team doctors examined my battered shoulder on the sideline. My labrum was destroyed. I played the rest of the year while being treated with a combination of pharmaceuticals and physical therapy. When the season was over, my labrum was surgically repaired and I began a steady course of opioids and anti-inflammatories.

Football is pain. There’s no way around it, and by no means am I complaining; it’s the sport I love. But make no mistake about it: For 60 minutes every Sunday, millions of fans are watching men in helmets and pads literally put their bodies on the line for the game. As long as football is played, athletes will seek a way to deal with the pain.

I’ve sustained many injuries since the Jaguars took me in the first round of the 2009 NFL draft. (My season was actually cut short last year because I had to undergo surgery for another torn labrum.) For almost every injury, I was treated with prescription opioids — which is standard operating procedure in the NFL.

Last season I suffered a concussion in Denver on the first drive of our first game. Initially no one noticed — not even me, really. I somehow played a few more snaps before I hobbled to the sideline at the end of the possession. But as I meandered to the bench the symptoms set in quick. I got dizzy. My head was throbbing. Immediately everyone who laid eyes on me — my teammates, the training staff, our team doctors — knew there was a problem. After just a single series, I was done for the day.

We flew to Oakland that night. The Raiders were coming up in Week 2, and we had a lot to think about after our 19–13 loss to the Broncos. But I had other problems. The higher the plane soared, the more intense the pressure in my head became. I received a few doses of Tylenol, but the pain was unbearable and I suffered the entire night. The team doctors prescribed Ambien to help me sleep and Topiramate to ease my headache, but they didn’t seem to do much. On top of that, their list of possible side effects seemed endless: dizziness (I was already dizzy); weakness (I was already so weak I was having trouble walking through the hallways of our hotel); headaches (had that covered); weight loss (I’m an offensive lineman in the NFL — I need every ounce of my lean mass); cognitive problems (could be the drugs, could be the concussion); and most concerning, addiction. I was confused, and not just because I had a head injury. How were these drugs helping me?

I know that I signed up to play one of the most physically demanding sports on the planet, and I love this game. But I can’t ignore the facts. The NFL and its athletes are not immune to the opioid epidemic in our country. Indeed, retired NFL players are more likely to misuse opioids than the general population because of unavoidable and recurring chronic pain. Football players also have a high risk of developing brain diseases such as Chronic Traumatic Encephalopathy (CTE) due to repeated head trauma suffered on the field. Given all this, it’s little surprise that retired NFL players misuse prescription painkillers at a rate more than four times that of the general population. There has to be a better way. There is a better way.

On March 9, 2016, I became the first active NFL player to openly advocate for the use of cannabinoids (medical marijuana) to treat chronic pain and head injuries. The NFL relies heavily on opioids to get players back on the field as soon as possible, but studies have shown medical marijuana to be a much better solution; it is safer, less addictive and can even reduce opioid dependence. Some studies have also shown that cannabidiol (CBD) — one of the more than 100 cannabinoids found in marijuana — may function as a neuroprotectant, which means it can shield the cells in the brain from injury or degeneration. We need to learn more about this.

But to the NFL and the NFLPA, marijuana is a banned substance. End of story — even with the mounting evidence of the effectiveness of cannabinoids. A lot of NFL teams are located in states where medical and/or recreational marijuana has already been legalized (a few states in the U.S. have actually legalized it for both purposes). In fact every team that has won the Super Bowl since 2012, including the Baltimore Ravens, is in a state that has passed some form of progressive marijuana legislation. And the U.S. Department of Health and Human Services even holds a patent (U.S. Patent 6630507), which labels cannabinoids found in marijuana as both anti-inflammatory and neuroprotective, two things that are crucial to the health of NFL players’ bodies and brains. Yet the Drug Enforcement Administration continues to insist that marijuana is a drug with no currently accepted medical use, and that’s enough for commissioner Roger Goodell. “I agree there have been changes [regarding the efficacy of medical marijuana], but not significant enough changes that our medical personnel have changed their view,” he said in February. “Until they do, then I don’t expect that we will change our view.”

I’m not here advocating for NFL players (or anyone) to get high and party while breaking the law. What I’m talking about is the responsibility of the NFL to care for its players. Nineteen players were suspended last season for testing positive for “substances of abuse,” and for some, their careers may be over. Why? For using something that can actually help people? How can a league so casual about the use of addictive opioids take such a hard line on a drug that might provide a safer alternative?

We must make a change. I’m calling for the NFL and the NFLPA to take three actions:

  1.     Remove marijuana from the banned substances list.
  2.     Fund medical marijuana research, especially as it relates to CTE.
  3.     Stop overprescribing addictive and harmful opioids.

It’s time for the league to change its practices to better protect players and to set an example for our younger athletes. Painkillers are a part of the college game, too — I know from personal experience. Football is a violent game at every level.

I’m not asking the NFL to prescribe players cannabis. I’m calling on the league to remove its testing protocols for cannabis. It just makes sense.

Why do I care so much about this? I’ve watched teammates and some of my best friends battle with opioid addiction. I got a call recently from an old teammate at the University of Virginia who told me that one of our former UVA teammates — a guy who was a few years ahead of me and who mentored me before going on to play in the NFL — had gotten addicted to pain pills and had essentially vanished. He has left his home for the streets and is now addicted to heroin. My heart is broken for him and his family. There’s a good reason that Senator John McCain is calling for congressional hearings on the links between professional sports and prescription drug addiction. If I had to estimate, I would say that no less than 50% of NFL players have at some point used some kind of pain medication. That’s about 650 players. Half the guys you see on the field every Sunday.

We’ve all got some tough questions to face and I’m willing to do anything it takes to answer those questions. Is the NFL? I’ve donated to researchers at Johns Hopkins and Penn through the Realm of Caring, a great organization that I recently partnered with. I’ve also set up a website with the goal of educating athletes — and the broader community — about the benefits of medical cannabis.

The answer can no longer be pills…. and more pills.

Every NFL player rides the T Train at some point in his career. But we need to be able to get off. The NFL should explore every means available to safely treat chronic pain and traumatic head injuries. And that means that the league needs to take a long, hard look at the benefits of medical marijuana.