The Case for Cannabis in Sports Medicine

On last count, over half a million student athletes compete in 24 sports at the collegiate level according to the NCAA website. Should they make the jump to pro sports, they’ll join 16,700 other athletes, according to the US Bureau of Labor Statistics. Regardless of age or professional stature, these players will all face extraordinary challenges to their physical and mental health throughout their careers that will follow them on and off the field of play. On January 23rd, the Association for Cannabis Health Equity and Medicine hosted its second annual Global Health Summit to address these challenges and to discuss how athletes, doctors and advocates can work together to educate sports programs and professional leagues on the benefits of medical cannabis. Considering the rapid expansion of cannabis legalization throughout the country and the liberalization of employment policies in legal states, speakers at the Global Health Summit agreed that it was time the sports world caught up to where their states, fans and players already were.

In her keynote, “Cannabis Science: A Primer for Sports Medicine and Policy,” Dr. Jessica Knox, a board certified preventative medicine physician who works with the Association for Cannabis Health Equity and Medicine ( a/k/a “ACHEM”), explained the ongoing plight of athletes from their initial point of entry to their possible career in pro sports and their eventual retirement. From the data she discussed, it’s clear that most athletes are not using cannabis for the same reasons the fans are. In high school, for instance, 90% of players will suffer an injury; 54% will play through them. Their mental health struggles are also significant: 20-45% of these players report levels of anxiety and depression higher than their peers, which might be tied to elevated pressures to perform and succeed. Out of their peers in the college and university level, 33% report pressures on their mental health; only 10% seek out help. On the pro level, athletes often experience such things as stress, burnout, depression and anxiety that can be associated with burdens coming from fans expectation, coaches demands and a sizeable entourage of friends and family that may depend on their earnings. That’s piled atop high levels of perfectionism drilled into athletes, alongside bullying and overtraining.

So when it’s time to seek an intervention, where do they turn? Often, it’s to antidepressants, anticonvulsants, corticosteroids, or any other number of pharmaceuticals. While non-pharmaceutical interventions such as psychotherapy or wellness techniques are available, they are often underutilized and carry a strong stigma. Bianca Reed, a former Division One track & field athlete, mentioned in a breakout session that she was on seven different pain medications that wreaked havoc on her stomach lining. When she first discovered CBD topicals, she was initially reluctant to try them, but soon found them effective. Later on, medical cannabis helped correct the dysbiosis which accounted for her stomach problems. She shared that this experience taught her that “student athletes should advocate for [their] own health. The NCAA often forgets that you will have a life after college sports, and it’s only now that we’re seeing athletes gain NIL (name, image and likeness) rights. So I urge [athletes] to do that because your program may not have your best interests at heart.”

The specter of the World Anti-Doping Agency (WADA) banned substances list hovered over many of the Summit’s sessions. Formed in 1999 after Ross Reglibiati’s was allowed to keep his gold medals after testing positive for cannabis metabolites, WADA lists cannabis as a “drug of abuse”. And while it removed CBD from its list in 2017, ACHEM believes there is more progress to be made. In her keynote, Dr. Knox advocated for use of full and broad-spectrum cannabis products over simple isolates. Isolates, she argued, have a smaller therapeutic window (meaning that you are more likely to harm yourself if you go above or beyond a certain dosage range), require higher dosing to get the proper effect and reduced tolerability. She suggested the whole plant, or as close to it as you can get, carries greater benefits, yet most veterans of pro and college sports who spoke at the Summit, including NFL players Marvin Washington (New York Jets, San Francisco ‘49s) and Lofa Tatupu (Seattle Seahawks), reported that most sports programs shy away from even CBD, as they worry about possible THC “contamination” within the product that may run afoul of WADA rules. And it’s distressingly easy to run afoul of WADA rules. WADA restricts the “in-competition” use of THC; and defines “in-competition” to include “11:59 p.m. on the day before a competition in which the athlete is scheduled to participate” to the end of the competition. However, according to Knox, no drug test can pinpoint precisely when the cannabis was consumed, and considering how long cannabis metabolites can linger in one’s system, this can severely disrupt an athlete’s career. Not surprisingly, ACHEM considers WADA’s position on cannabis unscientific and believes it is an unnecessary moralistic imposition on players.

Should WADA and the US Anti-Doping Agency revisit their policies regarding cannabis, as they have pledged to do this year, it may remove a major barrier for certain athletes, particularly Olympians. However, the panelists all acknowledged that for bodies such as the NCAA, which conducts its own doping programs independently of WADA and USADA, to change their policies, federal reforms are necessary. But progress has been made in several sports leagues, such as Major League Baseball, which removed CBD and THC from its list of drugs of abuse, and the NBA, which suspended drug testing for cannabis at the beginning of the pandemic. And as more athletes come forward, according to Washington, it will force change, especially if one of them is a once-in-a-lifetime great. “The athlete who will bring change is a child right now. He isn’t playing yet,” he asserts. “But if he can carry a team to victory, he will force the league to come along with him.”