The World Anti-Doping Agency and CBD

Trend of cannabis use in sports

Generally, drugs are strictly regulated in professional sports. Over the years, the talking points on drug use in sports have evolved rapidly from performance-enhancing drugs to the tendency for abuse to medical use as an alternative therapy for athletes. Athletes have experimented with many substances labeled with unverified claims to enhance performance, improve cognition, and quicken recovery time from injury and fatigue. To a large extent, these compounds were of synthetic origin used discreetly as an off-label indication for performance-enhancing in endurance sports. Recently, natural compounds have gained popularity in sports, in large part due to their organic nature and safety profile. Cannabis, used as a full-spectrum product, is a product of interest in sports. 

The Athlete PEACE Survey was conducted in 2019 to investigate trends of cannabis use and subjective effects in a large population of adult athletes. As published in the Journal of Cannabis Research, the methodology was focused on athletes’ cannabis benefits, reported adverse effects and patterns of use including frequency of use, route of administration, duration of use, and total cannabinoid use. Out of a pool of 1161 participants, 301 athletes currently use cannabis, with a history of it being more prominent in younger people who also reported significant positive and adverse subjective effects to cannabis. These results agree with earlier studies initially published by the NCAA suggesting that 30.3% of student athletes consumed cannabis for recreational purposes, with the current cannabis use ranging from 2.7% to 23% in elite athletes (Brisola-Santos et al., 2016).   

Science behind cannabis use in sports

Cannabis sativa contains over 113 cannabinoids, fatty acids, sugars, terpenes, nitrogenous compounds, and hydrocarbons. In sports, cannabis is predominantly consumed as an edible or smoked as a whole. In this form, cannabis users report a diverse range of beneficial effects, which are believed to be derived from the constituent compounds. Years later, the Entourage Effect explained a scientific basis for this observation. Cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) are the principal cannabinoids present in cannabis. THC is the main psychoactive compound; however, CBD possesses no mind-altering effects and is currently used in adjunctive therapies of rare and chronic diseases. 

Cannabinoids exhibit biochemical properties in humans by influencing the activity of the endocannabinoid system—a connected network of receptors, neurons, and enzymes collectively playing important roles in memory formation, pain regulation, emotional behavior, mood regulation, metabolic process control, glucose metabolism, and the brain reward system. The science supporting cannabis use in humans has grown tremendously over the years. The endocannabinoid receptors, endogenous cannabinoids, and transport cell membranes in the endocannabinoid signaling system have been extensively studied. Specifically, cannabis shows promising benefits in athletes. Studies have confirmed that cannabis reduces pain and inflammation, shortens injury recovery time, improves sleep quality, combats anxiety, and improves cognitive performance. 

CBD regulation in sports

Although there are large volumes of research submissions supporting cannabis use in sports, cannabis-derived products are not expressly allowed in professional athletes. Cannabis has generated different debates in the sporting community, with athletes citing researched benefits of cannabis-derived products. However, the movement against cannabis use in sports draws argument points from the unknown adverse effects of cannabis in humans and various research submissions detailing the mechanism of cannabis-induced cognitive impairment. 

In 1999, the International Olympic Committee established the World Anti-Doping Agency (WADA) as a body responsible for monitoring doping activities and ensuring proper implementation of the World Anti-Doping Code. Every year, the Medical and Research Committee of WADA publishes the Prohibited List, a list of prohibited substances and methods in sports. Under WADA’s regulations, a substance is declared prohibited if it masks the presence of prohibited substances, or if it fulfills three different criteria: (1) it is performance-enhancing, (2) it possesses a potential risk to athletes, and (3) it violates the spirit of sport. Substances included in this list are anabolic androgenic steroids, peptide hormones, growth factors, hormone modulators, glucocorticoids, and stimulants. A few drugs and substances in these classes were, however, exempted. 

Until recently, the use of cannabinoids in sport was banned. The detection of cannabis metabolites in athletes at a threshold value equal to or greater than 150 ng/ml is considered a positive result for drug use. Cannabis use in sport is banned in competition. This period is defined to extend beyond cannabis use during the competition. Basically, the time frame includes the time period (before the competition) required for the 11-nor-delta-tetracannabinol carboxylic acid to be completely eliminated from the body. WADA’s threshold for determining a positive test to prohibited substances cuts across all sports; however, sports regulating bodies are allowed to set quantity standards in compliance with the general rule. The Major League Baseball limit is set at 50 nanograms, and the new Collective Bargaining Agreement (CBA) rules set the limit at 150 nanograms for NFL players. 

WADA reviewed its initial stance on cannabinoid regulation in sports, following wide advocacy for approval of cannabis in sports and accumulating research evidence supporting CBD use. In 2020, WADA modified the list of prohibited substances in the sport while noticeable excluding cannabidiol from the list. Under the new regulation, all-natural and synthetic cannabinoids, including natural and synthetic THC and synthetic cannabinoids that mimic the effects of THC, except cannabidiol. Effective January 1, 2020, cannabidiol is legal in sports and excluded from the classes of drugs prohibited in competition. Although the new provisions allowed cannabidiol use in sports, cannabis and other cannabis-derived products remained prohibited.

Prospects of CBD in sports

The current regulation revolutionized the acceptance of cannabidiol in the sporting world and legalized the use of cannabidiol for medical purposes. Most importantly, the new rule is expected to facilitate more medical surveys investigating the drug use patterns in sport. Research studies have confirmed that cannabidiol complements the therapeutic effects of opioids when administered concurrently. In practical use, a low dose of cannabidiol can be combined with clinically effective doses of opioids to manage pain and reduce local inflammation in athletes. This approach to pain management is expected to address the opioid crisis currently ravaging the sporting world. 

REFERENCES

• https://www.wada-ama.org/en/content/what-is-prohibited/prohibited-in-competition/cannabinoids
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717337/#!po=59.7973
• https://jcannabisresearch.biomedcentral.com/articles/10.1186/s42238-019-0006-9
• https://pubmed.ncbi.nlm.nih.gov/27629700/
• https://swimswam.com/wada-releases-2020-prohibited-list/