According to a recent survey of 333 medical professionals in sports medicine, there is generally a positive attitude toward CBD and cannabis. The majority of respondents believe that marijuana should no longer be considered a prohibited substance by the World Anti-Doping Agency (WADA). The study, published this month, also reveals widespread support among sports medicine physicians for the legalization of marijuana, both for recreational and medical purposes.
However, the survey identifies diverse perspectives on cannabis within the field, with age, practice type, and gender significantly influencing these views. Women, older doctors, and individuals in rural settings were found to be less inclined to support the recreational use of marijuana, as well as more likely to oppose WADA's removal of cannabis from the list of prohibited substances and the NCAA permitting CBD use among collegiate athletes.
Conversely, men and younger physicians were less prone to view marijuana as having performance-enhancing properties. These findings underscore the nuanced and varied opinions within the sports medicine community regarding CBD, cannabis, and their regulatory status in sports.
CBD Removed, Marijuana's Status Unchanged"
In 2018, the World Anti-Doping Agency (WADA) removed CBD from its list of prohibited substances, but marijuana continues to be banned in competition by WADA and numerous other professional and international sports organizations.
The recent study indicates that 72% of sports medicine physicians support WADA's decision regarding cannabidiol, with 59 percent advocating for the removal of cannabis itself from the list of prohibited substances. In September, an NCAA panel recommended eliminating marijuana from the banned substances list for college athletes.
A separate study, published this month, reveals that states that legalized marijuana experienced improved recruitment for college basketball but faced adverse outcomes for football teams.
Regarding the recommendation of CBD to patients, the new study found that pediatricians, rural doctors, and academic physicians were less inclined to suggest the use of the cannabinoid compared to their counterparts in the field. Despite this, the study concludes that many sports medicine providers are endorsing CBD and cannabis products, primarily for chronic musculoskeletal and neuropathic pain. Notably, the study claims to be the first to uncover that some providers, although in a minority, recommend these products for sport-related concussions and sports performance anxiety.
CBD Gains Favor, Influenced by Safety and Cultural Shifts"
The evolving cultural shift towards CBD and cannabis in sports motivates continuous research and education for sports medicine providers. Addressing athletes' inquiries about the safety, dosing, and potential effects of these substances remains a priority.
Among surveyed physician members of the American Medical Society for Sports Medicine, more recommended CBD (40.8%) compared to marijuana (24.8%). The study suggests that the preference for CBD may be influenced by its overall safety profile, lack of intoxicating effects, and its widespread incorporation into mainstream consumer products, making it seem a safer option compared to cannabis and THC-containing products.
Differences in doctors' perspectives on the potential drawbacks of CBD versus THC in terms of physical performance were observed, with the authors attributing these distinctions more to marketing and cultural shifts than scientific evidence. A small percentage (9.9%) of respondents believed CBD is detrimental to performance, while a larger percentage (39%) held similar views about cannabis.
The study emphasizes the unknown aspects of the ergogenic versus ergolytic effects of CBD compared to cannabis and suggests that perceptual differences may be largely attributed to marketing and advertising. The ubiquitous addition of CBD to numerous consumer products is also acknowledged as a contributing factor to the evolving distinction.
It's important to note that the study's relatively small sample size (about 7% of the American Medical Society for Sports Medicine membership) and its single-point-in-time nature limit the ability to describe changing opinions.
While WADA has maintained its ban on marijuana after a review in 2022, an opinion piece from members of the association’s Prohibited List Expert Advisory Group in August highlighted other cannabis reforms, such as raising the allowable THC levels in an athlete's urine to accommodate consumption outside of competitions. The group emphasized that athletes requiring medicinal cannabis should seek a therapeutic use exemption due to these higher thresholds.
Push for Change Following Athlete Suspension
Advocates strongly pressed for WADA to undergo reforms following the suspension of U.S. runner Sha’Carri Richardson from participating in Olympic events due to a positive THC test in 2021.
In response to this suspension, the U.S. Anti-Doping Agency (USADA) declared that international marijuana rules "must change." Both the White House and President Joe Biden indicated their support for new policies, with congressional lawmakers echoing this sentiment.
While USADA initially expressed sympathy for Richardson and suggested a potential reevaluation of marijuana prohibition, the organization later issued a statement explicitly calling for a policy change. The organization highlighted President Joe Biden's acknowledgment that while "rules are rules," there may be a need for a reassessment of the regulations.
As more states have moved to legalize cannabis, various sports organizations have taken steps to implement reform. The National Basketball Association (NBA) and its players union recently signed a collective bargaining agreement that removes marijuana from the league’s list of banned substances, allowing players to invest in and promote cannabis brands, with certain exceptions.
In Nevada, sports regulators voted to send a proposed regulatory amendment to the governor, aiming to formally protect athletes from penalties for using or possessing marijuana in compliance with state law.
UFC announced in 2021 that fighters would no longer be penalized for positive marijuana tests. The National Football League (NFL) revised its drug testing policy significantly in 2020 as part of a collective bargaining agreement. In June, the NFL and its players union jointly announced funding for independent research on the therapeutic benefits of CBD as an alternative pain treatment for players with concussions.
The New York Media Softball League (NYMSL), featuring teams from The Wall Street Journal, High Times, and BuzzFeed, revealed a sponsorship deal with a Kentucky-based CBD company in July. This collaboration was inspired by similar moves in Major League Baseball (MLB), where certain teams, like the Kansas City Royals and Chicago Cubs, partnered with CBD businesses. MLB itself announced a league-wide partnership with a popular CBD brand last year, with Charlotte’s Web Holdings becoming the "Official CBD of MLB."
Bottom Line
The evolving landscape of attitudes toward marijuana and CBD in sports medicine reflects a nuanced interplay of regulatory shifts, cultural influences, and diverse perspectives within the medical community. As the discourse unfolds, the push for reform gains momentum, spurred by both athlete experiences and changing societal norms, paving the way for potential transformations in sports medicine practices and regulations.
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