Is Cannabis a Performance-Enhancing Drug?
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Dr. Lewis JasseyMedical Director - Pediatric Medicine
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The World Anti-Doping Agency includes cannabis on its list of banned substances due to concerns that it may have performance-enhancing effects.
But while cannabis appears to offer indirect benefits for athletes, such as helping with muscle recovery and relieving pain and inflammation, does it actually enhance performance? Despite the World Anti-Doping Agency’s stance, research doesn’t support the conclusion that cannabis boosts athletic performance.
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Cannabinoids and the World Anti-Doping Code
The World Anti-Doping Code is a globally recognized document that outlines performance-enhancing drug regulations for all sports and countries. It’s compiled and managed by the World Anti-Doping Agency (WADA). Many major sports organizations comply with its guidelines, including the U.S. Olympic & Paralympic Committees, the U.S. Anti-Doping Agency, and Olympic and Paralympic federations worldwide.
WADA created the International Standard Prohibited Substances List in 2004. The list bans athletes from using natural and synthetic cannabinoids (except CBD) during organized sports competitions.
The ban on cannabinoids received significant attention in 2021 when track-and-field sprinter Sha’Carri Richardson was disqualified from competing at the Olympics after testing positive for marijuana. The decision was controversial, but WADA stood firm that cannabis belongs in the category of prohibited drugs.
WADA uses three criteria to determine whether a substance should be on the Prohibited List. Any substance that meets two of the three reasons may be banned:
- The substance enhances sport performance or may enhance performance.
- It poses an actual or potential health risk.
- It goes against the spirit of sport.
A joint paper with the National Institute of Health summarized the organization’s three main justifications:
- Concern that athletes under the influence of cannabinoids can potentially endanger themselves due to slower reaction times, increased risk-taking, and poor decision-making.
- Concern that using cannabis makes athletes poor role models for young people.
- The possibility that cannabinoids can enhance athletic performance.
Even if the mounting evidence ultimately discredits the third reason, WADA’s ban can persist.
Is Medical Cannabis Also Banned?
WADA allows Therapeutic Use Exemptions (TUE) under certain circumstances. Athletes with a medical need for marijuana may be exempt from the ban. In the United States, athletes can apply to the United States Anti-Doping Agency (USADA) for a TUE if they meet the criteria for a legitimate medical condition or illness. A TUE committee must review and approve the request based on several factors:
- The prohibited substance is needed to treat a diagnosed medical condition.
- The goal is a return to normal health, not a performance enhancement.
- There is no reasonable non-prohibited alternative treatment.
Athletes may also access CBD for any reason since WADA removed it from the banned list in 2019. However, the USADA cautions athletes to be aware that CBD products can potentially cause failed drug tests due to their potential THC content.
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Does Cannabis Enhance Sport Performance?
Performance enhancement is one of WADA’s chief concerns with cannabis use. The agency believes “cannabis can enhance performance for some athletes and sports disciplines.” In a 2011 paper, WADA gave the reasoning behind this stance, noting that cannabis may be able to:
- Help with relaxation and provide anxiety relief
- Help with concentration and focus
- Increase oxygenation to the lungs and heart
- Provide pain relief
- Improve sleep
Cannabis indeed provides many people with anxiety relief, pain relief, and sleep support. However, WADA does not ban many other medications that provide similar effects.
WADA admitted that it referred to anecdotal evidence, not research, regarding marijuana’s potential concentration and focus benefits. And the increased oxygenation assertion came from one study from 1986, which ultimately concluded that cannabis had a net negative impact on exercise capacity.
Overall, there’s much more robust evidence that cannabinoids do not have performance-enhancing effects.
In 2020, the Journal of Cannabis Research published a literature review of four studies on cannabis use and athletic performance. The authors concluded that “chronic cannabis consumption had no significant effect on athletic performance.” However, they did note the potential that cannabinoids could have indirect benefits not examined in the studies.
A more extensive literature review published in 2021 found no data to support the view that marijuana use has performance-enhancing effects. In fact, the authors concluded that most studies found evidence that using cannabis before a competition could hurt performance.
According to this review, cannabis use might negatively affect athletic performance by:
- Reducing stamina
- Increasing heart and breathing rate
- Increasing oxygen demands for optimal heart function
- Causing impaired balance
Based on the current research, it’s safe to say that cannabis before intense exercise isn’t likely to give athletes a boost. In fact, athletes aiming for peak performance should save their edibles until after game time.
Benefits of Using Cannabis in Sport
Cannabis may not be a performance-enhancing drug, but it can be beneficial. Cannabis may be able to benefit athletes before and after strenuous physical activity in several ways, such as:
- Aiding with muscle recovery
- Soothing chronic aches and pains caused by sports injuries
- Reducing inflammation and swelling
- Improving sleep
A 2021 literature review took a closer look at the potential benefits of whole cannabis and isolated THC and CBD on athletic performance.
Based on limited studies, the authors concluded that CBD is more relevant to athletes than THC. According to the review, CBD, a WADA-accepted cannabinoid, can improve athlete recovery before and after training by mitigating pain and supporting better sleep. On the other hand, THC investigations show either “null or detrimental effects on exercise performance in strength and aerobic-type activities.”
Still, studies on general populations show that all cannabinoids, including THC, could be helpful for post-exercise recovery, primarily because of their well-documented pain-relieving and anti-inflammatory effects.
These effects appear significant enough that the National Football League (NFL) is funding a study into the use of THC and CBD to help elite athletes with pain management and traumatic brain injuries (TBIs), which are common in contact sports like American football, pro wrestling, and mixed martial arts (MMA). Although the study is still in the planning stages, the researchers suspect that THC or a combination of THC and CBD will be more effective for post-game pain relief than CBD alone.
It’s also possible that cannabinoids can mitigate some of the health risks of high-impact sports like football and rugby. Professional sports athletes already self-report using cannabis for pain relief and potential benefits related to relieving concussion-related symptoms.
So far, no human studies have examined using cannabis to help with concussion recovery, but it’s a theory that’s starting to receive more attention in the medical world. A 2019 study in mice found evidence that CBD can help animals recover from mild traumatic brain injury, possibly because of its anti-inflammatory effects. CBD’s therapeutic potential could be life-changing for athletes in sports where TBI is a serious risk.
The Bottom Line
Some people may enjoy marijuana’s intoxicating effects during sports activities. However, research does not support the conclusion that cannabinoids have performance-enhancing results. Using high-THC cannabis during an athletic event may even have undesirable effects, like slower reaction times, increased heart and breathing rates, and reduced stamina. The majority of beneficial evidence focuses on CBD, a compound that the World Anti-Doping Agency allows.
Based on the data, WADA’s cannabinoid ban is grounded in marijuana stigma rather than objective truth surrounding the plant’s performance-enhancing potential.
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