Cannabis Use and Sport: A Systematic Review

Abstract

Context: Cannabis use has increased, in large part due to decriminalization. Despite this increase in usage, it remains unclear what proportion of athletes use cannabis and what effect it has on athletic performance and recovery. Objective: To systematically review cannabis use among athletes, including epidemiology, effect on performance and recovery, and regulations for use in sport. Data Sources: PubMed, MEDLINE, and EMBASE databases were queried from database inception through November 15, 2018. A hand search of policies, official documents, and media reports was performed for relevant information. Study Selection: All studies related to cannabis use in athletes, including impact on athletic performance or recovery, were included. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Demographic and descriptive data of included studies relating to epidemiology of cannabis use in athletes were extracted and presented in weighted means or percentages where applicable. Results: Overall, 37 studies were included, of which the majority were cross-sectional studies of elite and university athletes. Among 11 studies reporting use among athletes (n = 46,202), approximately 23.4% of respondents reported using cannabis in the past 12 months. Two studies found a negative impact on performance, while another 2 studies found no impact. There was no literature on the influence of cannabis on athletic recovery. Across athletic organizations and leagues, there is considerable variability in acceptable thresholds for urine tetrahydrocannabinol levels (>15 to 150 ng/mL) and penalties for athletes found to be above these accepted thresholds. Conclusion: Overall, these results suggest that approximately 1 in 4 athletes report using cannabis within the past year. Based on the available evidence, cannabis does not appear to positively affect performance, but the literature surrounding this is generally poor. Given the variability in regulation across different sport types and competition levels, as well as the growing number of states legalizing recreational cannabis use, there is a need to improve our understanding of the effects of cannabis use on the athlete and perhaps adopt a clearer and overarching policy for the use of cannabis by athletes in all sports and at all levels.

Chronic cannabis consumption and physical exercise performance in healthy adults: a systematic review

“…The establishment of the World Anti-Doping Agency (WADA) and subsequent penalisation of athletes for cannabis use has prompted greater scrutiny of the effects of cannabis effects on athletic performance (Hilderbrand 2011). Docter et al (2020) reviewed the epidemiology of cannabis use in student and elite athletes, finding that approximately one in four had used cannabis in the past year and that athletes commonly believed that cannabis would negatively affect their performance, consistent with research findings suggesting that cannabis is nonergogenic and potentially ergolytic.…”

Potential Role of Cannabidiol on Sports Recovery: A Narrative Review

“…Evidence has shown that a third of cyclists, triathletes, and runners are or have been cannabinoids users (mostly ≥ 40 years of age, male, THC + CBD consumers ≤3 times weekly, and exercise 5–7 days per week) ( Zeiger et al, 2019 ). Also, a quarter of university athletes report using cannabis-related products ( Docter et al, 2020 ). Especially in contact sports like rugby, the use rate of CBD is 28%, increasing with age, and reporting pain relief and sleep quality improvements as perceived benefits ( Kasper et al, 2020 ).…”

“…Unlike tetrahydrocannabinol (THC), CBD does not cause psychotomimetic and psychotropic reactions ( WHO, 2017 ) for which there is no evidence of dependence or abuse, but causes mild and infrequent side effects ( Stout and Cimino, 2014 ). On the contrary, CBD use is not only extensive among athletes ( Docter et al, 2020 ), but it has been shown to have specific properties that help to treat chronic pain, spasticity, mood and sleep disorders, immunodepression, inflammation, oxidant effects, and anxiety in clinical patients ( McPartland et al, 2015 ; Whiting et al, 2015 ; Nichols and Kaplan, 2019 ; Pinto et al, 2020 ). These effects could improve and accelerate recovery caused by a prolog or intense physical, physiological, and cognitive efforts as in sports ( Higgins et al, 2017 ).…”

“…Considering that CBD has gained wide acceptance for medicinal and recreational use, its use among athletes is imminent ( Docter et al, 2020 ) even though its the physiological, physical, and cognitive effects are not fully understood ( Nichols and Kaplan, 2019 ), and it seems premature to make specific recommendations and to award all the above mentioned benefits ( Gamelin et al, 2020 ). Consequently and considering the need to clarify these issues, this narrative review aims to present the scientific evidence around the potential benefits of CBD as an ergogenic aid to promote a better and faster recovery between efforts related to physical exercise and sport.…”

Understanding the Medical Chemistry of the Cannabis Plant is Critical to Guiding Real World Clinical Evidence

“…In fact, it is now possible to do a systematic review of systematic reviews [ 3 ]. Whether it be for noncancer [ 4 ] or cancer pain [ 5 ], psychiatric disorders [ 6 ] or athletic performance [ 7 ], the conclusions across these reviews are similar—clinical trial data with cannabinoid products demonstrates mild to no benefit. Evidence-based medicine rubrics typically place systematic reviews on a pedestal as the highest form of evidence.…”