Your Questions Answered
USADA is a signatory to the World Anti-Doping Code, which helps harmonize anti-doping efforts across sports and around the world. The World Anti-Doping Agency (WADA) maintains the Code, as well as the Prohibited List and International Standards.
The WADA Prohibited List identifies marijuana and cannabinoids as substances that are prohibited in-competition. Unless an athlete has an approved Therapeutic Use Exemption (TUE), the use of substances when they are prohibited in sport may lead to an anti-doping rule violation and sanction.
As some states have passed laws decriminalizing the use of marijuana, USADA has received more questions from both athletes and the public about marijuana and anti-doping rules.
Below, you’ll find detailed answers to some of the most commonly asked questions about marijuana, anti-doping rules, and health effects. USADA is always available to help with additional questions you may have about marijuana and cannabinoids via phone at (866) 601-2632 or by email at drugreference@USADA.org.
Answers to Common Questions regarding Marijuana and Cannabinoids
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Cannabinoids exert their action on the body by binding to the receptors that make up the endocannabinoid system. They modulate mood, movement, appetite, pain and sensation, memory, and perception.
When most people think of cannabinoids, they think of marijuana and other substances that come from the Cannabis sativa plant. The two cannabinoids that people are most familiar with are the naturally occurring tetrahydrocannabinol (THC), the psychoactive component of marijuana, and cannabidiol (CBD), which is being explored for a variety of medicinal purposes. Both of these cannabinoids can be extracted from the cannabis plant, or they can be synthesized in a laboratory.
However, there are also many other cannabinoids. The cannabis plant produces 120 different cannabinoids that are unique and not found in any other plant. They can be split into several different types, including THC, cannabidiol (CBD), cannabigerol (CBG), cannabinol (CBN), cannabinodiol (CBND), cannabielsoin (CBE), cannabicyclol (CBL), cannabitrol (CBT), and others.
There are also dozens of entirely synthetic, designer cannabinoids that are not found in nature, such as Spice/K2, JWH compounds, and others. They tend to be more potent and more toxic than naturally occurring cannabinoids, leading most governmental regulatory agencies to consider them illicit, toxic chemicals.
All synthetic and naturally occurring cannabinoids are prohibited in-competition, except for cannabidiol (CBD).
For something to be added to the WADA Prohibited List, it must meet two of the three inclusion criteria: a) it poses a health risk to athletes b) it has the potential to enhance performance and c) it violates the spirit of sport.
In 2011, WADA published a paper in Sports Medicine discussing the reasons marijuana and cannabinoids meet the criteria. Below are excerpts from this publication that address the three criteria:
- “Athletes who smoke cannabis or Spice in-competition potentially endanger themselves and others because of increased risk taking, slower reaction times and poor executive function or decision making.”
- “Based on current animal and human studies as well as on interviews with athletes and information from the field, cannabis can be performance enhancing for some athletes and sports disciplines.”
- “Use of illicit drugs that are harmful to health and that may have performance-enhancing properties is not consistent with the athlete as a role model for young people around the world”.
In 2019, WADA exempted cannabidiol (CBD) from this category. However, all other cannabinoids, whether natural or synthetic, are prohibited in-competition. Even though CBD is permitted at all times, this article explains the legal and anti-doping issues that continue to make these products risky for athletes.
THC is the only cannabinoid for which there is a urinary threshold and it is set at 150 ng/mL. The threshold means there can be some THC in your system in-competition without it causing a positive test, as long as the concentration in the urine is below 150 ng/mL. If the level of THC in your urine goes above the threshold, then the labs report it as a positive test.
There are no threshold limits for any other cannabinoid (natural or synthetic). All other cannabinoids (except cannabidiol) are prohibited in-competition in any amount, including natural cannabinoids (e.g., cannabigerol, cannabichromene, cannabinol, and others) and synthetic cannabinoids (e.g., cannabinoid compounds denoted by the initials “JWH” and a number, HU-210, K2/Spice, AB-PINACA, and many others).
The time it takes for the substance and all of its metabolites to be completely eliminated from the body depends on many factors, including the particular cannabinoid, the dosage used, how often you use it, your weight, your overall metabolism, liver function, general health, and whether you are on other medications. Many cannabinoids accumulate in fat, and for chronic users, they can take weeks or months to clear completely from the body. An athlete using marijuana, or any other cannabinoid, should talk with their doctor about the clearance time for these substances.
Marijuana (cannabis) use can have both short-term and long-term effects. In the short term, marijuana (specifically THC) causes a “high” that may include sedation, altered sense of awareness and time, changes in mood, impaired body movements and thinking, difficulty speaking or remembering, hallucinations, delusion, and psychosis. Long-term, chronic use of marijuana is associated with impaired thinking and memory, and even a loss of IQ among teenage users.
Other negative physical effects of smoking marijuana include dry mouth and throat, an increased resting heart rate, and the expansion of both lung passageways and blood vessels. Cannabis smoking can also produce rapid changes to heart rate, dizziness, and blood pressure.
A 2014 United Nations Office on Drugs and Crime report found that between 2006 and 2010 in the United States, there was a 59 percent increase in cannabis-related emergency room visits and a 14 percent increase in cannabis-related hospital admissions.
Synthetic cannabinoids also pose a great risk to users and athletes. While synthetic cannabinoids may produce effects similar to marijuana, the severity is often greater than those produced by marijuana. When compared to THC, some of the compounds found in synthetic cannabinoids bind more strongly to receptors within the brain. This reaction could lead to potentially more powerful and unpredictable effects.
Since synthetic cannabinoid products may not list all of their ingredients on the packaging label, the effects of the product could also be different than what the user may expect. Consumption of these synthetic cannabinoids has resulted in numerous hospitalizations,  and the drugs have been reported to cause hallucinations, increased heartbeat and blood pressure, aggressive behavior, anxiety, muscle spasms, nausea, and vomiting.
The use and production of synthetic cannabinoid products have increased over the past few years, with products sometimes marketed as herbal mixtures, incense, or potpourri. The packaging labels of these products may list only natural herbs as ingredients, but analysis has revealed that they contain synthetic cannabinoids.
In 2018, the Farm Bill was enacted at the federal level and redefined marijuana and hemp. Accordingly, marijuana is any cannabis plant that contains 0.3 percent or more of THC, and hemp is defined as the cannabis plant that contains less than 0.3 percent of THC.
Marijuana is still a Schedule I substance on the US Controlled Substances Act. Schedule I lists drugs or other substance that have a high potential for abuse, have no accepted medical use in the United States, and do not have accepted safety guidelines for use. Some state governments have passed laws removing restrictions on the use of marijuana for personal or medicinal reasons within the state. At this point, there are ongoing debates between the federal and state governments around whether the federal government can or should interfere with state marijuana laws. Regardless, marijuana is prohibited in-competition by the World Anti-Doping Agency, and this status applies to all athletes regardless of the state laws where they live.
On the other hand, hemp is not a controlled substance and may be cultivated for a variety of purposes. For the most part, hemp-derived products may be sold across state lines as long as the items are otherwise produced according to the law.
There is ongoing debate about the legal status of cannabidiol, which can be derived from marijuana or hemp. The FDA has clarified that cannabidiol is not a legitimate dietary ingredient, and therefore it cannot be marketed or sold in foods or drinks, including candies, gummies, brownies, chews, or beverages of any type, or in dietary supplements. There is one Food and Drug Administration (FDA)-approved drug that contains CBD, called Epidiolex. Read our 6 Things to Know About Cannabidiol article for more information.
USADA will consider a TUE application for medical marijuana for therapeutic use per the WADA TUE Physician Guidelines for Neuropathic Pain. All TUEs for cannabis or other FDA-approved cannabinoid medications (e.g., Marinol, dronabinol) must meet the criteria set forth in the International Standard for TUEs in order to be approved.
White House position on Marijuana: https://www.whitehouse.gov/ondcp/key-issues/marijuana/
Drugs Facts about Marijuana: https://www.drugabuse.gov/publications/drugfacts/marijuana
About Synthetic Cannabinoids: https://www.cdc.gov/nceh/hsb/chemicals/sc/About.html