A Warning against the Negligent Use of Cannabidiol in Professional and Amateur Athletes

Abstract

Cannabidiol (CBD) is a non-psychoactive cannabinoid, widely marketed to athletes for claimed effects such as decreased anxiety, fear memory extinction, anti-inflammatory properties, relief of pain and for post-exercise recovery. The World Anti-Doping Agency (WADA) has excluded CBD from its list of prohibited substances. Nevertheless, caution is currently advised for athletes intending to use the compound—except CBD, all other cannabinoids are still on the prohibited list. CBD products, specifically non-medicinal, so-called full-spectrum cannabis extracts, may contain significant levels of these substances, but also contaminations of tetrahydrocannabinol (THC) (>2.5 mg/day in >30% of products on the German market) potentially leading to positive doping tests. Labelled claims about CBD content and absence of THC are often false and misleading. Contaminations with the psychoactive THC can result in adverse effects on cognition and, in general, the safety profile of CBD with respect to its toxicity is a controversial topic of discussion. For these reasons, we would currently advise against the use of over-the-counter CBD products, especially those from dubious internet sources without quality control.

Are side effects of cannabidiol (CBD) products caused by tetrahydrocannabinol (THC) contamination?

“…The risk also includes positive cannabis urine tests for several days, which may be expected from daily oral doses of more than 1 mg Δ 9 -THC 1,2,43 . Therefore, more than 1/4 of products in our study would probably lead to false-positive urine tests, which could have grave consequences for persons occupationally or otherwise required to prove absence of drug use or of doping in professional sports 44,45 .…”

Cannabidiol: A case presentation on the shortcomings in clinical application

“…[10] Furthermore, the lack of compliance with quality control production standards amplifies the risk of THC contamination, posing greater risks for positive drug tests. [8] Products include many formulations involving administration through inhalation, oral, buccal, and topical routes. As such, CBD is being commonly marketed and sold through items such as dietary supplements, food products, e-liquids for vaping, and cosmetics.…”

“…[4] This results in a marketplace replete with CBD products available for purchase by varied consumers, including athletes. [8] All of this imparts grave concern that ADEs and DDIs propagate negative health consequences for consumers who may be unaware that inaccurate labeling and dose variability across the product backdrop is present. Consequences can be both profound and exponential when considering today's consumers are markedly more proactive in self-medicating through OTC purchases.…”

“…Consequences can be both profound and exponential when considering today's consumers are markedly more proactive in self-medicating through OTC purchases. [3] Advisement against the use of OTC CBD products may very well be a reasonable or even preferable clinical strategy [8] based on the augmented risks for ADEs, DDIs, and positive drug screen for THC.…”

“…With this in mind, Maria and her parents were advised to discontinue CBD products, as this is the most appropriate risk-mitigation strategy. [8] Moreover, the symptoms of diarrhea, headache, and paranoia should subside over time with CBD cessation.…”