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Marijuana FAQ

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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

Click on the question to drop down the answer.

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:

  1. “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.”
  2. “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.”
  3. “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.[3]

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, [2] 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.[2] 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.

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CANNABIDIOL AND ANTI-DOPING VIDEO TRANSCRIPT

Dr. Amy Eichner:             

Welcome to Cannabidiol and Anti-Doping. In this webinar, we will answer the following questions. What is CBD? What is the legal status of CBD in the US? And what are the anti-doping issues associated with CBD? Then we will talk through a few frequently asked questions, and lastly, we will point you to some good resources for more information.

Our first question is what is CBD? The short answer is that it is one of several hundred compounds made naturally by the cannabis plant. The most recent estimates are that cannabis sativa produces 565 distinct compounds that can be bundled into the classes based on chemical structure, such as cannabinoids, amino acids, alcohols, fatty acids, and many others. Among all of these compounds are about 120 different cannabinoids. More specifically phytocannabinoids with phyto, meaning plant. These cannabinoids all derive from the cannabis plant and they all share a similar chemical structure.

You may have also heard of Endocannabinoids, which are compounds produced naturally in the body that bind to receptors in your body’s endocannabinoid system. And you may have also heard of synthetic cannabinoids like K2 and Spice, but I will not be talking about these compounds today. I will only talk about phytocannabinoids that come from the cannabis plant.

In the next slide, we will focus in on these cannabinoids. The cannabinoids themselves can further be subdivided into several subclasses. And then within each subclass are minor variations and isomers. Basically these compounds can have multiple three-dimensional structures. For example, CBD has been observed to exist in at least 10 different forms.

We know that minor variations in chemical structure can have a profound effect on the action of the body, in the body. For example, you can see here, the structure of THC, which is the psychoactive chemical in cannabis, compared to CBD, which is not reported to have psychoactive effects.

Chemical structures are almost identical except for the circled area. Yet this tiny difference causes the compounds to have very different effects on the body and consciousness. It is thought that cannabinoids can also have synergistic effects on the body, meaning they can act in consort to exert actions on the body that don’t occur with the use of any one of the purified cannabinoids.

So the take home message for athletes is that, is just to realize that any cannabis or hemp extract will include many different types of cannabinoids and other compounds, all with varying effects on the body. When you buy a CBD product, you are probably buying a mixture of many cannabinoids and a product might claim that it is enriched in CBD or that it is purified CBD. Or you may have also heard the term isolate or CBD isolate, but just keep in mind that if CBD is extracted from the cannabis plant, either hemp or marijuana, then it will frequently have some other cannabinoids present. It is very difficult to [inaudible 00:04:00] only pure CBD.

Let’s transition briefly to the legal definition of marijuana in hemp. In 2018, the US passed the Farm Bill that changed the definition of marijuana and hemp and hemp is now defined as any cannabis plant that produces less than 0.3% THC. Whereas marijuana is any cannabis plant that produces more than 0.3 THC. One of the major outcomes of this bill was the removal of hemp from the Controlled Substances Act. Meanwhile marijuana remains a federally controlled substance. Since hemp is no longer controlled, the cultivation of hemp by farmers has far fewer regulatory [verdins 00:00:05:01].

It’s important to realize that hemp and marijuana are essentially the same plant, cannabis sativa, however, farmers and others have been selectively breeding them for ages in order to customize them with certain desired traits. Many farmers cultivate a cannabis sativa that is low in THC and thus qualifies as hemp and is enriched in CBD. But if those plants, for any reasons, started producing more than 0.3% THC, they legally become marijuana, making them subject to the Controlled Substances Act.

The conclusion here is that there is a thin line between the legal definition of marijuana and hemp. From an anti-doping perspective, CBD from a hemp extract is not necessarily safer than a marijuana extract. A hemp extract should contain a much lower THC concentration, but both would likely contain other cannabinoids, which are all prohibited in-competition.

And as a reminder, the term in-competition is defined by the World Anti-Doping Code as, “The time period, starting 12 hours before a competition in which the athlete is scheduled to participate or compete through the end of the competition and the sample collection process.”

Another important thing to realize is that the constituents of both hemp and marijuana are heavily influenced by growing conditions, how, and when they’re harvested, how they are stored, how the extracts are prepared, how the extracts are stored, et cetera.

So from bottle to bottle, hemp and marijuana extracts can vary. This makes it impossible to test one bottle and then know for sure that all future bottles of the same product will be identical. This is a common issue with any herbal or plant-based product.

So the take home message for athletes here is again, that CBD derived from hemp is not necessarily safer than CBD derived from marijuana. Even though hemp extracts will have less THC than marijuana extracts, hemp will still contain all of the other cannabinoids, which are prohibited in-competition.

Now we will transition to the legal status of CBD. There are no federal laws that make it illegal for an individual to have, or use CBD per se. However, the Food, Drug and Cosmetics Act regulates how people and companies can advertise and sell their products. These laws are in place to prevent companies from profiting off of the sale of ineffective products that are not proven to work.

The FDA has approved one CBD drug called Epidiolex, and it’s used to treat a certain types of epilepsy. But the FDA currently does not consider CBD as appropriate for use in dietary supplements.

So this is based on the fact that there’s already an approved drug for CBD. And the fact that CBD does not have a history of use in the food supply, either as a food or dietary ingredient of any type. Therefore, the current FDA opinion at the recording of this webinar is that it is illegal to market CBD by adding it to a food or a dietary supplement. And this is an example of a product that was listed in an FDA warning letter from the FDA, because this product advertised to be a dietary supplement.

It’s currently illegal as well to market CBD in animal foods or supplements. Again, this is because according to the FDA, CBD does not have a history of use in animal foods. And it has not been established that CBD is safe in animal foods. Therefore, the FDA has found that CBD is considered an unsafe food additive. And this is just an example product that received an FDA warning letter because this is advertised as a livestock pellet.

So the take home message for athletes is basically that companies that market CBD in foods such as in various edibles or gummies and in dietary supplements are doing so in direct conflict with the opinion of the FDA. The anti-doping issues relating to CBD are as follows. All cannabinoids are prohibited in competition, and this includes natural cannabinoids and synthetic cannabinoids. WADA has only exempted CBD. Athletes should always consider that CBD products may be mixtures of CBD along with THC and or other cannabinoids.

The FDA has tested some CBD products and issued warning letters. You saw some examples in previous slides, but here are a few more examples that are available on the FDA website. So this first hemp oil product was found to contain 24% CBD 0.5% THC and was also positive for another isoform or form of CBD and another form of THC as well as CBN, which is another cannabinoid.

This hemp oil care product was found to contain no cannabinoids at all, not even CBD. Well, the final product here on the screen was found to contain 25% CBD 0.8% THC, and also contained CBN. And these test results, again, they’re visible along with many others on the FDA website and the test results just demonstrate that the labels are not always accurate on these products. None of these test results matched the label. And two of these products also contained other cannabinoids that were not listed. All of which are prohibited in-competition.

USADAs recommendation to athletes then is that athletes should not use any CBD product during or close to a competition. USADA cannot predict how much, if any THC or other cannabinoids are in a particular product, just from looking at the label and therefore the use of any CBD product is at your own risk.

Okay, let’s move on to some frequently asked questions. One common question we get is, is there a concentration limit for CBD? In other words, is CBD prohibited above a certain concentration or dosage. And the answer is no. WADA has not issued any restrictions for CBD. Therefore, CBD itself is permitted at all concentrations, both in and out of competition. And remember that is just CBD. That is not CBD products.

What about for the other cannabinoids? All other cannabinoids, such as CBN, CBG are prohibited in-competition at any concentration. THC is the only cannabinoid that has a threshold reporting limit.

Another question we get is, my CBD product is third party certified. Is it okay to use? There are no CBD products that are NSF certified for sport, and that is USADAs recommended risk-reduction step for athletes. And therefore USADA recommends you do not use CBD during or close to a competition.

What if I am using a hemp product, instead of a CBD product? Hemp in commercially prepared food, such as seeds and proteins are approved FDA additives, but for hemp as a source of CBD, all of the same issues apply as to what applies to hemp products.

What about full spectrum products? If the product is referred to as full spread full spectrum, then it probably has THC and other cannabinoids in it. USADA recommends you not use such products close to or during a competition.

What about topical products, like creams, lotions, or oils? The FDA would probably consider such products to be cosmetics or drugs. WADA has not exempted any routes of administration. Cannabinoids are prohibited in competition by all routes of administration, including topical.

Where can I find the list of USADA approved CBD products? USADA does not evaluate or approve any CBD products? The use of any the CBD product is at your own risk.

How long before a competition should I stop using CBD products? Unfortunately, USADA cannot predict how much THC or other cannabinoids a product contains just from looking at the label. And we also can’t predict how long it would take such substances to clear from your body. You should work with your physician or pharmacist.

Where can I send my CBD product to get tested? There are many companies that advertise to test to CBD products. However, they are not approved or endorsed by USADA. So they use of any such companies or relying on any such test reports are at the athletes on risk.

What if my team or coach recommends a CBD product to me? USADA recommends you do not use the product during or close to a competition. And again, always remember the use of any product is at your own risk.

For more information about CBD, marijuana or other anti-doping issues, please visit usada.org. The USADA website. We do have a lot of educational articles about these and other topics. For medications, you can always find out the status of your medication by searching GlobalDRO.com. For any questions that were not addressed in this webinar you can call Athlete Express on 719 785-2000 and press number two to get the drug reference group. And for information on dietary supplements, please visit Supplement411.org. And if you have further questions as well, you can also email DrugReference, all one word. DrugReference@usada.org. Thank you very much for attending this webinar.