UPDATED: November 29, 2021
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 more than 115 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, regardless of whether it is extracted from the hemp variety of the cannabis plant or the marijuana variety. Athletes should assume most CBD oils or extracts contain a mixture of cannabinoids, not just CBD.
Is CBD prohibited in sport?
No, the purified chemical compound “cannabidiol” is not prohibited. But remember, it is very difficult, if not impossible, to obtain a pure CBD extract or oil from the cannabis plant. This is true regardless of whether CBD is extracted from the hemp variety or the marijuana variety of the cannabis plant. WADA has only exempted CBD from the Prohibited List; they have not exempted any other cannabinoid. Anyone who buys a CBD oil, extract, or other CBD product should be aware that, like any other supplement or alternative health product, it may be contaminated with prohibited substances, such as other cannabinoids.
Cannabinoids can also 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.
Is CBD legal?
Societal opinions about cannabinoids have changed significantly over the last decade, and the FDA does have plans to review and possibly alter their approval process for cannabinoid-based products. Furthermore, many states have their own laws relating to cannabinoids and more specifically CBD.
However, the current legal status at the federal level is that it is unlawful to sell CBD in dietary supplements and it’s unlawful for companies to market CBD as a medication to treat diseases or illnesses of any type. The FDA has issued numerous warning letters to companies selling such products. Athletes who choose to use CBD products should be aware that those products are not evaluated or approved by the FDA.
Are there any FDA-approved CBD medications?
Yes, 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.
Around the world, there is only one other CBD product approved for medical use. The oral spray, used to treat pain related to multiple sclerosis, is not approved in the United States by the FDA.
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 CBD products are probably mixtures of CBD and other prohibited cannabinoids, including THC, CBN, CBG, etc. Depending on whether the CBD was extracted from a high-THC plant (more than 0.3 percent THC, or marijuana) or a low-THC plant (less than 0.3 percent or hemp), different CBD preparations could have differing levels of 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. All other cannabinoids are prohibited in-competition at any presence level and do not have a reporting threshold. The presence of any amount in your system during the in-competition period is prohibited.
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 help ensure that any THC or other cannabinoids are cleared from their body, then the use of a CBD product will not 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 (for more information, please see USADA’s article on clearance times). The use of any CBD product is at the athlete’s own risk.
Are there third-party certified CBD products?
Yes, there are a number of companies that will certify CBD products for use in sport. It is important to remember that third party certification reduces, but does not eliminate, the possibility that a product contains substances prohibited by WADA. The only way to have zero risk is to not use such products.
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.
For questions about CBD, cannabinoids, and other substances, contact USADA’s Drug Reference Line at drugreference@USADA.org or call (719) 785-2000, option 2.