The suspension of track and field star Sha’Carrie Richardson at this year’s U.S. Track and Field trials brings into question again whether cannabis should be on the banned substance list by anti-doping agencies such as the World Anti-Doping Agency (WADA) and the US Anti-Doping Agency (USADA). Since 1989 the International Olympic Committee (IOC) has also included them on their list of banned substances, since it was considered an illicit substance back then.
But since that time in the U.S., 19 states have legalized recreational cannabis, as well as the District of Columbia and the U.S. territories of Guam and Puerto Rico. There are 37 states in the U.S. that have legalized medical cannabis. And 47 countries around the world have also legalized medical cannabis, with Uruguay and Canada being the 1st and 2nd to fully legalize adult recreational use cannabis, and Mexico is likely soon to follow.
And while cannabis may have medical benefits after injury for pain and inflammation management as well as for concussion, many clinical studies have shown that it is certainly not a performance enhancing drug but can cause the opposite effects and be a detriment to athletic performance.
A study in the journal Sports Medicine show the pharmacologic actions of tetrahydrocannabinol (THC) and cannabis can decrease athletic performance, by increasing blood pressure and heart rate leading to a reduction in cardiac output as well as reducing psychomotor activity and coordination. Another study published in the Clinical Journal of Sports Medicine, specifically looking at cannabis use in elite athletes, they also found no direct evidence of performance enhancement. Additionally, a review article just published this last year in the Journal of Sports Medicine and Physical Fitness, looked at 18 separate studies and they also concluded that cannabis does not enhance exercise performance, but in fact it can decrease athletic performance. This should serve as evidence to address one of the criteria the WADA and USADA have on their banned substances, which is to eliminate performance enhancing substances and drugs. For heaven’s sake, caffeine, which is a stimulant that may actually enhance performance and was once banned, was taken off the list in 2004 now allowing athletes to freely imbibe now even during competition.
Another criterion that WADA looks at for substances on its banned list is safety and health risk to athletes. However, most of the clinical trials that look at safety of cannabis use have looked at recreational use. which is usually higher doses with the intentions of getting intoxicated. There have been studies looking at authorized medical use which have been shown to be safe and well tolerated.
Another somewhat confusing rule is that in 2018, WADA removed Cannabidiol (CBD), a non-psychoactive cannabinoid from its list. But as a cannabis physician, I have seen patients who chronically use full spectrum legal CBD (which has, by law, less than 0.3% THC) to help with pain, inflammation, anxiety, and sleep, and they test positive for THC. And while there are CBD isolate products on the marked touted for athletes, because of the chemical formula similarity of CBD and THC, I have even seen patients using an isolate of pure CBD, without any THC, that still test positive for THC in a urine drug screen, presumably due to cross-reactivity or even perhaps some conversion in the body. Additionally, another problem athletes face is a testing window issue. They are subject to random drop-in drug testing, and with respect to cannabis and its breakdown products we can see positive in urine drug screens for up to 30 days after discontinued use in some cases. Therefore, a positive urine drug screen does not always indicate acute intoxication or use.
It is time for all the anti-doping agencies to follow the emerging medical cannabis science that the world is presenting and update their lists again. Kudos to Sha’Carrie Richardson for owning up and taking responsibility for her actions while facing this seemingly senseless punishment. But I have no doubt that a talent like hers will shine in the next world trials and hopefully the next Olympics representing our country.
Dr. Leigh Vinocur is a board-certified emergency physician who also has a cannabis consulting practice for patients and industry. She is a member of the Society of Cannabis Clinicians and a graduate of the inaugural class, with the first Master of Science in the country in Medical Cannabis Science and Therapeutics from the University of Maryland School of Pharmacy.
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