Cannabidiol and Sports Performance: a Narrative Review of Relevant Evidence and Recommendations for Future Research

Abstract

Cannabidiol (CBD) is a non-intoxicating cannabinoid derived from Cannabis sativa. CBD initially drew scientific interest due to its anticonvulsant properties but increasing evidence of other therapeutic effects has attracted the attention of additional clinical and non-clinical populations, including athletes. Unlike the intoxicating cannabinoid, Δ 9-tetrahydrocannabinol (Δ 9-THC), CBD is no longer prohibited by the World Anti-Doping Agency and appears to be safe and well-tolerated in humans. It has also become readily available in many countries with the introduction of over-the-counter "nutraceutical" products. The aim of this narrative review was to explore various physiological and psychological effects of CBD that may be relevant to the sport and/ or exercise context and to identify key areas for future research. As direct studies of CBD and sports performance are is currently lacking, evidence for this narrative review was sourced from preclinical studies and a limited number of clinical trials in non-athlete populations. Preclinical studies have observed robust anti-inflammatory, neuroprotective and analgesic effects of CBD in animal models. Preliminary preclinical evidence also suggests that CBD may protect against gastrointestinal damage associated with inflammation and promote healing of traumatic skeletal injuries. However, further research is required to confirm these observations. Early stage clinical studies suggest that CBD may be anxiolytic in "stress-inducing" situations and in individuals with anxiety disorders. While some case reports indicate that CBD improves sleep, robust evidence is currently lacking. Cognitive function and thermoregulation appear to be unaffected by CBD while effects on food intake, metabolic function, cardiovascular function, and infection require further study. CBD may exert a number of physiological, biochemical, and psychological effects with the potential to benefit athletes. However, well controlled, studies in athlete populations are required before definitive conclusions can be reached regarding the utility of CBD in supporting athletic performance.

Preliminary data on the potential for unintentional antidoping rule violations by permitted cannabidiol (CBD) use

“…One pharmaceutical CBD product (Epidiolex®) is currently approved in Europe for the therapy of a serious form of epilepsy in children (Dravet syndrome) 13 . However, CBD products are frequently sold as nutritional supplements, novel foods, or cosmetics and can be purchased in pharmacies, organic shops, drugstores, supermarkets, and via the Internet, and a growing receptivity amongst elite athletes is conceivable 14–16 …”

Lack of efficacy of cannabidiol for relieving back pain: time to re‐set expectations?

“…CBD has been touted as a special case, widely perceived by non‐clinicians as relatively non‐toxic 5 . However, this is not consistent with clinical experience, particularly noting the potential for CBD‐related drug interactions 6 .…”

Annual banned‐substance review: Analytical approaches in human sports drug testing 2019/2020

“…Although being explicitly excluded from the Prohibited List by WADA, the natural cannabinoid receiving most attention lately in the context of sport and doping is cannabidiol (CBD). It has been considered as non‐intoxicating and potentially (or evidently) beneficial as anti‐inflammatory, analgesic, anxiolytic, and/or neuroprotective compound, and yet the global regulatory status is complex, ranging from classifying CBD as a controlled substance to allowing for CBD products being sold as nutraceuticals 171,172 . Further, the quality of several CBD products has been questioned, especially concerning the substantial presence of other natural cannabinoids (e.g., tetrahydrocannabinol, THC, cannabigerol, and cannabichromene), all of which could cause an AAF if detected at concentrations exceeding established thresholds or reporting levels 173 ; nevertheless, recent prevalence studies demonstrated that a considerable number of study participants from sports characterized by frequent high‐impact collisions have used CBD products for improved recovery, pain, and sleep management, largely without consulting a nutritionist 174 .…”

“…, and yet the global regulatory status is complex, ranging from classifying CBD as a controlled substance to allowing for CBD products being sold as nutraceuticals. 171,172 Further, the quality of several CBD products has been questioned, especially concerning the substantial presence of other natural cannabinoids prevalence studies demonstrated that a considerable number of study participants from sports characterized by frequent high-impact collisions have used CBD products for improved recovery, pain, and sleep management, largely without consulting a nutritionist. 174 In order to avoid inadvertent AAFs, thorough and immediate education of athletes and their entourage is recommended, also with regards to the use of products labeled as, for example, "light cannabis."…”