Research: Cannabis Use Among Athletes and Exercise Participants

Liquid Life Cannabis Use Among Athletes

Introductions and image by @SuperFunker.

1) Ware et al (2018) explored the state of Cannabis use among athletes and elucidated possible benefits. Although there is no evidence that Cannabis enhances physical performance, athletes who engage in such sports as skeleton, bobsledding, snowboarding, skiing and ice hockey, feel that they experience a Cannabis-induced benefit. In these examples, it’s speculated that Cannabis may facilitate relaxation, improve concentration and reduce anxiety which may then enhance athletic execution. Outside of physical sporting activities, Cannabis may provide tangible benefits for athletes and athletic conditions. Specifically, Cannabis may improve pain tolerance, reduce inflammation, mitigate spasticity, enhance sleep/recovery, prevent/manage traumatic brain injury and reduce the reliance on opioid pain medication. These therapeutic benefits underscore a safety/health-based rationale to allow Cannabis use among athletes.

Cannabis and the Health and Performance of the Elite Athlete.

Cannabis (marijuana) is undergoing extensive regulatory review in many global jurisdictions for medical and nonmedical access. Cannabis has potential impact on the health of athletes as well as on performance in both training and in competition. The aim of this general review is to identify and highlight the challenges in interpreting information with respect to elite athletic performance, and to point to important research areas that need to be addressed.

Data Sources
A nonsystematic literature review was conducted using Medline and PubMed for articles related to cannabis/marijuana use and sports/athletic performance; abstracts were reviewed by lead author and key themes identified and explored.

Main Results
Cannabis may be primarily inhaled or ingested orally for a range of medical and nonmedical reasons; evidence for efficacy is limited but promising for chronic pain management. Although evidence for serious harms from cannabis use on health of athletes is limited, one should be cognizant of the potential for abuse and mental health issues. Although the prevalence of cannabis use among elite athletes is not well-known, use is associated with certain high-risk sports. There is no evidence for cannabis use as a performance-enhancing drug.

Medical and nonmedical cannabis use among athletes reflects changing societal and cultural norms and experiences. Although cannabis use is more prevalent in some athletes engaged in high-risk sports, there is no direct evidence of performance-enhancing effects in athletes. The potential beneficial effects of cannabis as part of a pain management protocol, including reducing concussion-related symptoms, deserve further attention.

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2) YorkWilliams et al (2019) conducted a series of clinical surveys to assess Cannabis use and opinions among adult exercise participants in states that allow recreational Cannabis consumption. A combined 605 respondents provided answers to a Cannabis-exercise questionnaire. 494 (81.7%) affirmed that they use Cannabis before and/or after exercise. The researchers found that participants who combined Cannabis with exercise – before and/or after engagement – were more likely to be male and younger. Dominant reasons for Cannabis use in relation with exercise was an increase in enjoyment, enhanced recovery and improved motivation.

The New Runner's High? Examining Relationships Between Cannabis Use and Exercise Behavior in States With Legalized Cannabis.

Scientific literature examining cannabis use in the context of health behaviors, such as exercise engagement, is extremely sparse and has yielded inconsistent findings. This issue is becoming increasingly relevant as cannabis legalization continues, a situation that has been associated with increased initiation of use among adults, and increased potency of available products in legalized states. Physical activity is among the most important health behaviors, but many Americans do not meet minimum exercise recommendations for healthy living. Common issues surrounding low exercise rates include inadequate enjoyment of and motivation to exercise, and poor recovery from exercise. It is unclear whether cannabis use shortly before and/or after exercise impacts these issues, and whether this co-use affects exercise performance. The present online survey study examines attitudes and behaviors regarding cannabis use with exercise among adult cannabis users living in states with full legal access (N = 605). Results indicated that the majority (81.7%) of participants endorsed using cannabis concurrently with exercise, and those who did tended to be younger and more likely to be males (p < 0.0005 for both). Even after controlling for these differences, co-users reported engaging in more minutes of aerobic and anaerobic exercise per week (p < 0.01 and p < 0.05, respectively). In addition, the majority of participants who endorsed using cannabis shortly before/after exercise reported that doing so enhances their enjoyment of and recovery from exercise, and approximately half reported that it increases their motivation to exercise. This study represents an important step in clarifying cannabis use with exercise among adult users in states with legal cannabis markets, and provides guidance for future research directions.

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3) Zeiger et al (2019) conducted a cross-sectional quantitative survey among adult self-declared athletes in an effort to understand Cannabis use patterns and therapeutic benefits.

Of 1,161 participants:

  • 399 (34.4%) were triathletes.
  • 299 (25.8%) were runners.
  • 258 (22.2%) were cyclists.
  • 895 (77.1%) had been athletes for 11 years or greater.
  • 722 (62.2%) were male.
  • 439 (37.8%) were female.
  • 787 (67.8%) were 40 years of age or older.
  • 302 (26.0%) were current Cannabis users, however due to a statistical issue, 301 (25.9%) were considered for analysis.
  • 483 (41.6%) had tried Cannabis in the past, but were not current users.
  • 376 (32.4%) had never used Cannabis.

Although researchers detailed a variety of Cannabis usage patterns and identified different Cannabis types, they found that the combination of THC and CBD provided greater pain and anxiety relief than CBD alone.

Cannabis use in active athletes: Behaviors related to subjective effects.

Cannabis use has not been well characterized in athletes. Studies primarily examine problematic use or its categorization by anti-doping bodies as a banned substance. Patterns of use, reasons for use, and responses to cannabis consumption have not been studied in a community-based sample of adult athletes. The Athlete PEACE Survey examined cannabis use patterns and subjective effects to cannabis in a community-based cohort of adult athletes. We used mainly social media and email blasts to recruit and SurveyGizmo to collect data. 1,161 (91.1%) of the 1,274 athletes taking the survey completed it. Current cannabis use was evaluated by asking “In the past two weeks, have you used marijuana (including THC and/or CBD)?” and cannabis type used was assessed by asking “What do you primarily use THC, CBD, or both?”. Cannabis benefits and adverse effects (i.e. subjective effects) and patterns of use were reported. 302 athletes (26%) currently use cannabis of whom 301 had complete data for cluster analysis. Cluster analysis was used to determine cannabis user phenotypes and exploratory factor analysis (EFA) was used to create subjective effects factors. Associations between cannabis user phenotype clusters and the subjective effects factors were explored using multivariate analysis. Cluster analysis identified three statistically distinct cannabis user phenotypes: (1) older athletes who primarily use medical CBD, (2) mixed age athletes who use cannabis mainly recreationally with both THC and CBD use, and (3) mixed age athletes who used cannabis the longest with primary THC and CBD use. EFA showed three subjective effects factors: (1) Well-being, (2) Calm, and (3) Adverse. Mean positive subjective were higher than mean adverse subjective effects (p<0.001). The cluster using THC and CBD showed the highest mean scores for all three subjective effects factors (p<0.001). Athletes who use a combination of THC and CBD exhibited the most benefit to well-being and calm with minimal adverse effects. Our methodology can be used to develop real-world evidence to inform future use of medical cannabis products.

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