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
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amendments.
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