Athletes: 5 Things to Know About Cannabidiol
Although cannabidiol (CBD) is permitted according to the World Anti-Doping Agency (WADA), all other cannabinoids are still prohibited in-competition. It’s important to realize that CBD products may still contain prohibited cannabinoid components, such as THC. Athletes subject to anti-doping rules are strictly liable for any substance found in their blood or urine. As such, there are still risks for athletes when it comes to CBD products.
Learn more below to better understand the risks of using CBD products.
What is cannabidiol (CBD)?
Cannabidiol is one of the 120 identified cannabinoids produced naturally by the cannabis plant. It is different from THC (the psychoactive compound in cannabis) because it has a different chemical structure.
Most importantly, it’s very difficult to extract ONLY CBD from the cannabis plant, so most CBD oils or extracts actually contain a mixture of compounds, all derived from the cannabis plant.
Is CBD prohibited in sport?
No, the chemical compound cannabidiol is not prohibited. Athletes will not face an anti-doping rule violation (ADRV) for the use of pure CBD at any time (in or out-of-competition).
But remember, it is very difficult, if not impossible, to obtain a pure CBD extract or oil from the cannabis plant. Anyone who buys a CBD oil, extract, or other CBD product should assume that it is a mixture of CBD and other cannabinoids. All other cannabinoids, including THC and the other 118 identified cannabinoids in the cannabis plant, as well as all synthetic cannabinoids, are prohibited in-competition.
They may be used out of competition, but cannabinoids can stay in your body long after you have used them. When choosing to use a substance out-of-competition that is prohibited only in-competition, athletes should be aware that complete washout of those substances and their metabolites cannot be easily predicted. You can read more about the clearance times of medications here.
Is CBD legal?
Marijuana, including the resin and every compound within the plant (including CBD), or preparation of the plant (such as extracts or oils), remains illegal as a Schedule I substance under the U.S. Federal Controlled Substances Act. Some states have legalized medical marijuana in conflict with federal law. They can do this because a law was passed that prevents the justice department from spending money (and therefore time) preventing states from implementing their own laws regarding medical marijuana. CBD for medical use might be considered legal in some states where medical marijuana is permitted, but this will vary from state to state.
The FDA has issued numerous warning letters to companies selling cannabidiol because they market their products to treat diseases and illnesses. It is illegal to do this because only FDA-approved drugs that have been proven to be effective in controlled clinical trials are allowed to make such claims. If you see a cannabidiol product that advertises to treat migraines, cure epilepsy, treat depression, or makes any other claim that it treats or prevents a disease or illness, then the product is most likely an unapproved new drug under the law (although only the FDA can make the final determination).
It is also illegal to market CBD oil as a dietary supplement. This is because cannabidiol is not a food ingredient (dietary ingredient) and it doesn’t have an established safety profile or history of use in the food supply. If you see a CBD product, and it is labelled as a dietary supplement, then the company is either unaware or doesn’t care about the FDA’s current position that CBD is not a legitimate dietary ingredient.
There is currently one FDA-approved prescription CBD product, called Epidiolex, for the treatment of seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome. There is also an oral spray called Sativex, which is a combination of THC and CBD used to treat pain related to multiple sclerosis, but it is not approved in the United States.
Why are CBD products risky for athletes subject to anti-doping rules?
Because it’s nearly impossible to extract only CBD from the cannabis plant, athletes should assume that all CBD products are actually mixtures of CBD and other prohibited cannabinoids, including THC.
A JAMA study published by the American Medical Association in November 2017 documents the mislabeling of some CBD products. The study found that 69 percent of the products examined contained different levels of CBD than what was identified on the label. THC was detected in 21 percent of the products tested, and the THC content in some of those products was enough to produce intoxication or impairment.
In sport, THC has a reporting threshold of 150ng/mL, which means that if the WADA-accredited laboratories detect THC below that level in the urine, it won’t be considered a positive test. Other cannabinoids on the WADA Prohibited List don’t have a reporting threshold, meaning that the detection of even the tiniest amount in your urine will be considered a positive test.
If an athlete happens to get a CBD oil that is very low in THC and other cannabinoids, or if they stop using a product in time to ensure that any THC or other cannabinoids are cleared from their body, then the use of a CBD product will not cause a positive test or cause the athlete to incur an anti-doping rule violation. Unfortunately, it is impossible to know how much THC or other cannabinoids are in a CBD product just from looking at the label, and it is impossible to predict how each athlete will metabolize and excrete THC or other cannabinoids. The use of any CBD product is at the athlete’s own risk.
Are there health risks associated with CBD and other cannabinoids?
So far there isn’t a lot of data on the health risks of CBD. Initial studies suggest is it fairly well tolerated, and that it is not likely to cause dependence or abuse. The adverse events and side effects of CBD that have been reported appear to be related to interactions with prescription medications. Since there is interest in CBD for treating various conditions, there is ongoing research into its safety profile, which may produce more information in the future.
However, there are significant and well-understood health risks from using marijuana. A number of studies have indicated that using marijuana can lead to serious health issues, both physical and mental.
More specifically, cannabis has been implicated in uncontrolled cell growth and the impairment of DNA replication and repair, which are likely indicators of cancer. Respiratory conditions, such as lung cysts, chronic bronchitis, and lung cancer, have all been linked to the inhalation of marijuana smoke.
One population-based case-control study found that in terms of lung cancer risk, smoking one joint of cannabis was similar to smoking 20 tobacco cigarettes. In addition to the negative physical effects, which also include decreased immune function, higher rates of irregular heartbeat, and stroke, cannabis smoking has been linked to mental conditions, including depression, bipolar disorder, and psychosis.
Synthetic cannabinoids also pose a significant risk to users because the effects can be much more severe than those produced by marijuana. Some of the compounds in synthetic cannabinoids bind more strongly to brain receptors, which is why the effects could be more powerful and unpredictable. Moreover, synthetic cannabinoid products don’t always list every ingredient on the packaging label, so the effects of the product could be greater or different than expected.
For questions about CBD, cannabinoids, and other substances, contact USADA’s Drug Reference Line at firstname.lastname@example.org or call (719) 785-2000, option 2.