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Athletes: 6 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 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 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. 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 be aware that it may be a mixture of CBD and other cannabinoids. All other cannabinoids, including THC and the more than 115 other identified cannabinoids in the cannabis plant, as well as all synthetic cannabinoids, are prohibited in-competition.

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 here.

 

Is CBD legal?

If a CBD preparation or extract is derived from hemp and contains less than 0.3 percent THC, then it is not considered a controlled substance at the federal level. However, according to a statement by the U.S. Food and Drug Administration (FDA), it is still unlawful to sell CBD in dietary supplements, and it’s unlawful for companies to market CBD to treat or cure diseases like epilepsy, diabetes, Alzheimer’s, or psychiatric issues like anxiety or depression.

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.

 

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. 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 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% 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. 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.

 

More questions?

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.

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