Conflicts of interest
The authors report no conflicts of interest.
Dear Editor,
Maintaining a competitive and healthy environment in professional sport is a significant challenge. The World Anti-Doping Agency (WADA) is in charge of deciding what substances are permitted or prohibited in or out of competition. Cannabis use has been prohibited by WADA since 2003, but a phytocannabinoid called cannabidiol (CBD) was removed from the list of non-permitted substances in and out of competition in 20181. CBD seems to have pharmacological properties, and could be a potential approach to handle different impairments, like psychological and neurological disorders and pain2,4. However, CBD is still illegal in many countries and the “taboo” around the substance has resulted in the creation of a barrier to research into CBD and its pharmacological management. The consequent relative lack of good evidence in respect of its properties is an issue that has been cited by different authors3–5.
Studies demonstrated that cannabis usage is a common practice among some athletes6,7, with the majority using it for recreational purposes and some reports of its sport-related use. There is growing evidence about the consumption of cannabinoids for the treatment of pain2, anxiety and sleep problems8 in the general population. Different possibilities are being explored for the use of cannabinoids in health care, and although not yet fully understood, the endogenous cannabinoid system (ECS) has been a target in some approaches. Research showed that the ECS plays an important role in a range of processes, particularly in respect of the control of pain3. Few studies on the use of cannabinoids by athletes focused on their effects on performance. The results have been contradictory, reporting both decrement and improvement9.
One problem that is a frequent concern among athletes is sleep disturbance and poor sleep quality10, particularly, but not solely, before competition periods11. Sleep problems can alter the levels of blood hormones and cytokines that are related to muscle recovery12. While the potential mechanisms are not yet fully elucidated, they can affect cognitive responses13. Some limited data from cannabinoid studies and athletes’ personal reports have suggested that the administration of CBD may result in better sleep quality8. It is possible that cannabinoids could have an indirect effect on athlete’s performance by promoting better sleep quality, rather than by directly enhancing their power or endurance. Data in relation to this latter hypothesis is contradictory and lacking in quality.
Some data suggested that the endocannabinoid system appears to be involved in the regulation of the circadian sleep-wake cycle14. CBD described to have different effects on the sleep-wake cycle at different dosages, with a low dosage having a stimulating effect and a high dosage, a sedating effect15. Pre-clinical studies with CDB suggested that it influences sleepiness and sleep time16. More research is needed to understand if cannabidiol could have the potential to help athletes to manage sleep impairments. However, the absence of clinical trials, the low quality of some studies and the barriers to conduct research into cannabidiol limits decision making. Since the literature is controversial among cannabis intake and sleep quality, pre-clinical studies are needed to investigate, in fact, the effects of CDB into sleep, and establish whether it has any direct effect on performance. In this way, it could be possible to understand if there is any safe dosage that would help sleep quality and recovery in athletes, conducting clinical studies that could show the effects of CDB into these conditions, and it’s potential to be a valid approach to help athletes while not conflicting with the current WADA rules.
References
1. World Anti-Doping Agency. WORLD ANTI-DOPING CODE 2015 with 2018 amendments.
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