Recreational and ergogenic substance use and substance use disorders in elite athletes: a narrative review

Abstract

BackgroundSubstances from various classes may be used for recreational purposes, self-treatment or to boost performance. When substance use shifts from occasional to regular, heavy or hazardous use, positive and negative effects can develop that vary by substance class and athlete. Regular use of recreational or performance enhancing substances can lead to misuse, sanctions or use disorders.ObjectiveTo review the prevalence, patterns of use, risk factors, performance effects and types of intervention for all classes of recreational and performance enhancing substances in elite athletes by sport, ethnicity, country and gender.MethodsA comprehensive search was conducted to identify studies that compared the prevalence and patterns of substance use, misuse and use disorders in elite athletes with those of non-athletes and provided detailed demographic and sport variations in reasons for use, risk factors and performance effects for each main substance class.ResultsAlcohol, cannabis, tobacco (nicotine) and prescribed opioids and stimulants are the most commonly used substances in elite athletes, but generally used at lower rates than in non-athletes. In contrast, use/misuse rates for binge alcohol, oral tobacco, non-prescription opioids and anabolic-androgenic steroids are higher among athletes than non-athletes, especially in power and collision sports. Cannabis/cannabinoids seem to have replaced nicotine as the second most commonly used substance.ConclusionsSubstance use in elite athletes varies by country, ethnicity, gender, sport and competitive level. There are no studies on substance use disorder prevalence in elite male and female athletes and few studies with direct comparison groups.

Attitudes about cannabis mediate the relationship between cannabis knowledge and use in active adult athletes

“…Cannabis has the potential to diminish performance due to reducing alertness and reaction time as well as accelerating muscle fatigue (Gil et al 2016). However, studies examining both benefits and adverse effects, as well as knowledge and attitudes, regarding cannabis in adult athletes have been overlooked in favor of studies examining risk (Gil et al 2016;McDuff et al 2019).…”

Use of psychotropic substances among elite athletes – a narrative review

“…Recreational substance use in elite athletes was overshadowed by doping and attracted little scientific attention in the past, but is now researched more intensively. Our review adds to the knowledge of earlier works by including recent studies [7,64]. In our opinion, sports medicine as a cross-sectional subject should integrate knowledge on prevalence rates and treatment options of common mental disorders among elite athletes.…”

Potential Role of Cannabidiol on Sports Recovery: A Narrative Review

“…With the exclusion of CBD from the prohibited substances in 2018, and even before, the use of CBD among athletes has considerably increased and is still accelerating ( Leas et al, 2019 ). Cannabinoids are considered the second most commonly used substance among contact sports athletes replacing nicotine ( McDuff et al, 2019 ). 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 ).…”