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Sports Medicine’s Changing Attitude on Cannabis

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Attitudes regarding cannabis use are changing in professional sports and with good reason. Recent scientific evidence as well as an overwhelming amount of anecdotal evidence from athletes themselves points to the therapeutic benefits of cannabis for common athletic ailments.

The World Anti-Doping Agency (WADA) establishes standards for athletes globally in various disciplines regarding the use of performance-enhancing substances during competition.  Cannabis has been on the “Prohibited List” since the list’s inception in 2004. This year, however, WADA specifically removed cannabidiol (CBD) from the list in response to current scientific knowledge citing CBD’s benefits for pain and anxiety and the input of various stakeholders.

To understand the old and new attitudes of sports medicine towards cannabis, we need to examine the following:  

Why do athletes use cannabis?

Not surprisingly, competitive athletes are some of the most high-profile advocates and consistent users of cannabis for health and wellness. Professional competition creates a state of heightened anxiety, which is difficult to release at the end of the day. Cannabis can support relaxation and healthy sleep. Sleep, in particular, is necessary to prevent physical injury and support mental focus prior to extreme activity.  

We also know that the road to the podium is lonely. Cannabis is a social enabler, creating connection and a sense of community, especially for athletes who are often isolated due to long hours of daily training.  

Most importantly, an athlete’s greatest asset is his or her body. Sports is a billion-dollar industry because we enjoy watching the incredible physical feats of those who literally put their lives and bodies in harm’s way for our entertainment. We know about the extensive injuries involved in almost all professional sports. Cannabis gives athletes relief from chronic and acute pain without subjecting them to the liver toxicity of anti-inflammatory meds or addiction of opiate pain relievers. The NFL has publicly stated that cannabis for pain management deserves further research because it works so well anecdotally.

What about cannabis and Traumatic Brain Injury (aka concussions)?

In addition to the positive effects of cannabis on pain, anxiety and sleep, cannabis is neuroprotective. Government-sponsored research demonstrates that cannabis preserves and can even help regenerate and create new nerve and brain cells.

There has been increased focus on the risk of sustaining concussions in many popular sports and the long-term detriment of recurrent brain injury on cognitive function. Recently, former Baltimore Ravens player Eugene Monroe donated $10,000 to research on cannabis and TBI, and challenged other athletes to do the same. Many studies support the claim that TBI responds to cannabis. Given what is at stake, it’s no wonder that sports medicine has revised its stance on CBD and supports further research of whole plant medicine.

Should cannabis remain on the Prohibited List?

The Prohibited List is based on three criteria:

  1. Is the substance performance enhancing?
  2. Is it dangerous to the health of the athlete?
  3. Does it violate the spirit of the sport?

In terms of physical performance enhancement, cannabis does not directly appear to have an effect on athletic performance. In fact, it would seem to be detrimental. Tetrahydrocannabinol (THC) increases heart rates and decreases the amount of blood the heart pumps to muscles and other vital organs. This causes slower movements, slower reaction time, decreased coordination and potential spatial perception alteration.

While cannabis can enhance focus and awareness, especially in creative endeavors, it can also have a negative effect on judgement and strategic thinking. Some have argued that this can enhance performance in extreme sports by mitigating risk perception, allowing these athletes to perform superhuman, incredibly dangerous stunts by overriding their internal fear factors. Though there is a known and well-studied correlation between cannabis use and extreme sport athletes, cannabis is not considered performance enhancing in this regard.   

As noted previously, cannabis is known to decrease performance anxiety and support a good night’s sleep. In this regard, it is performance enhancing in its ability to help athletes maintain a sense of normalcy around competition. This is considered a secondary effect.

Cannabis does not present a health risk to athletes, except possibly when smoked. Inhaling combustion products is known to be carcinogenic. Research has demonstrated that vaping is less so. Since cannabis can be consumed in many effective forms, there does not appear to be an increased health risk for athletes.

Regarding the spirit of the sport, this is a tricky one to answer. WADA specifically states that prohibited substances are not to be used during competition. Since cannabis is stored in fat cells, trace metabolites remain in the body long after cannabis is consumed. To date, there is no reliable way to measure an individual’s level of cannabis intoxication in the moment. Athletes undergoing urine tests prior to competition may test positive for cannabis use weeks prior. It is also possible that athletes who consume only CBD on a regular basis may build up THC in their systems. This would be from the trace amounts of THC commonly found in CBD derived from whole plant oils, even though they may never experience any psychoactivity.


Remembering that the role of the endocannabinoid system is to achieve homeostasis and balance, cannabis appears to be a natural health and wellness tool, which athletes have capitalized on.  NBA players have publicly stated that more than 80 percent of current players use cannabis for relief. NFL players have quoted stats around 89 percent. Retired players speak out, while those who are currently active are forced to remain silent or potentially face “early retirement.”  Some athletes have begun taking cannabis brand sponsorships. For example: Boulder marathon runner Flavie Dokken endorses Wana Brands, Tanner Hall worked with Black Rock Originals designing grinders and rolling papers, and former NBA star Al Harrington has taken his belief to another level by starting his own cannabis company.

Although CBD has been removed from the “Prohibited List,” there is still a long way to go for cannabis normalcy and being recognized by WADA for athletes. However, it’s still great to see athletes — our cultural icons — starting to pave the way.


As a Certified Nurse-Midwife, Sheri Matteo is passionate about women’s health with over 20yrs experience in clinical care. She believes in an integrated approach to wellness that includes the four pillars of education, nutrition, exercise and meditation.  Cannabis can play an important role in establishing and maintaining physiological balance, supporting the above. As a member of both the American College of Nurse-Midwives and the American Cannabis Nurses Association, Sheri is dedicated to providing women the most up to date information about cannabis for health and access to quality products.

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