The Regulatory Limits of Hemp and CBD Products for Drug Tested Athletes

Contributed by Guest Blogger Dave Ellis, RD, CSCS

   

Recently, the World Anti-Doping Agency (WADA) pulled cannabidiol (CBD) from the 2018 Prohibited Substance List. Previously, it was illegal for Olympic athletes to use hemp products and isolates from hemp-like CBDs (1).  Literally within 48 hours of WADA releasing the news of CBD’s new permissible status, some of the bigger players in the CBD supplement space began to target drug-tested athletes.  Many of these companies make claims that some of their CBD extracts are 100% THC-free, and in compliance with WADA testing standards for THC. Yet, studies show significant inaccuracies on label claims including the actual amount of CBD found in products, and the presence of THC (2,3).

We have no credible third-party certifying agencies that can currently ensure that every batch of a CBD extract is truly THC-free.  Skip lot testing (as often used for dietary supplements) on THC levels in CBD products is not going to be good enough for drug-tested athletes, and the folks doing the testing will have to be free of any conflicts of interest with the hemp industry. 

There are no federal guidelines that determine label claim qualifications for products promoted as being “THC free.”  One company making THC claims states that they are in compliance with WADA’s “strict testing regulations” for THC by not exceeding 0.3% THC in the product. 

Like caffeine, not everyone metabolizes cannabinoids the same (4).  Even in small amounts, increased frequency of use may well accumulate THC to the point of detection by a drug test. Athletes who are drawn to CBDs as an intervention for pain, concussions, sleep, immune health, etc., must proceed with caution. 

Some professional sports still consider CBD a prohibited substance. While most don’t specifically test for CBD, they do not fund or supply any hemp-based products to athletes, due to the lack of credible assurances or third-party verification that each batch of the product is truly THC-free.

Athletes are advised extreme caution when considering these unregulated and untested CBD products.

1. Summary of Major Modifications and Explanatory Notes – 2018 WADA Prohibited List. 

2. Bonn-Miller, MO, Mallory JE Loflin, Brian F Thomas, et al. “Labeling Accuracy of Cannabidiol Extracts Sold Online.” JAMA. 2017;318(17):1708-1709.

3. U.S. Food and Drug Administration. “Warning Letters and Test Results for Cannabidiol-Related Products.” 2015-2017. https://www.fda.gov/newsevents/publichealthfocus/ucm484109.htm. Updated Nov 2, 2017.

4. Hawks, Richard L. The analysis of cannabinoids in biological fluids. Vol. 42. Department of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute on Drug Abuse, 1982.

Dave Ellis is a Veteran Sports RD who specializes in food and supplement security for drug tested athletes. His full bio and professional work can be found at daveellisbio.com. 

Medical Marijuana, Medical Exception?

State Marijuana Laws in 2016 (Post-Election)

Image Source: governing.com 

Here's what you should know as of the November 8 election:

• There are now eight states that have passed laws permitting recreational use of marijuana: Maine, California, Massachusetts, Nevada, Colorado, Washington, Oregon, and Alaska. 

• Medical marijuana is now legal in 28 states and Washington, D.C. after ballot measures passed in North Dakota, Arkansas, Florida, and Montana. 

• Federally, marijuana is still classified as a Schedule I drug by the Drug Enforcement Administration (DEA). 

• Because of the DEA's imposed status, doctors can only "recommend" marijuana to patients. Federal law prohibits medical professionals from prescribing the drug. 

• Rates of marijuana use in states that have legalized marijuana in some form have increased exponentially compared to those that have not. (Source, page 5)

• The average THC concentrations in cannabis have continued to increase, while the medicinal, non-psychoactive ingredient, cannabidiol (CBD), has not. (Source) 

What this means for athletes:

• Marijuana is still prohibited/banned in sport or considered a drug of abuse. 

• Drug-testing sanctions for marijuana-positive tests, as designated by each sport organization, still apply in states where marijuana has been legalized. 

• Marijuana's cannabinoids are stored in fat. The increasing potency of THC in marijuana means it can take longer for the drug to be metabolized and cleared from the body. (READ: Using marijuana over the holidays, and hoping for clean urine upon returning to practice is probably not the best idea.)

• There are NO medical exceptions (MEs) or therapeutic use exemptions (TUEs) for marijuana in sport. Athletes will not be granted a ME or TUE, even if a doctor has "prescribed" marijuana.

Other athlete-health implications to consider:

• Legalization of marijuana in Colorado has shown an increase in alcohol consumption—separately from the increase in marijuana-infused beers and wines on the market. (Source, page 26)

• Post-legalization of marijuana: DUI cases related to driving while high, and traffic fatalities where the driver tested positive for marijuana have increased in Washington State and Colorado, respectively. (Source, pages 17-18)

Share your thoughts with us on social media (#EducateDrugFreeSport) or request a speaker on marijuana to educate your athletes!

Hydration 411

Water [n]: a transparent, odorless, tasteless liquid, a compound of hydrogen and oxygen, H2O. A need in life— especially when the weather is hot. Now that summer is in full swing and sport camps are gearing up, staying hydrated is extremely important. Proper hydration is crucial to keep your body moving, thinking, and performing to your highest potential.

Do you often find yourself reaching for water during practice or games; it’s probably because you are dehydrated. Read on to find tips and information about the importance of hydration as an athlete.  

*Graphic from U.S. Geological Survey

Water and the Body

The average human body is made up of 60% water. In fact, most of the body's organs are comprised on water.

• The brain and heart are approximately 73% water.
• 83% of the lungs are water.
• The skin is 64% water. 
• Muscles and kidneys are 79% water.
• Bones are even comprised of water, sitting at 31%.

No wonder our bodies cannot function properly when hydration is limited! Water is pivotal for performing at your capabilities.

Hydration

Hydration should not be forgotten when exercise, practice, or games end. Exercising in the heat without adequate fluid replacement is a sure way to cause dehydration and land you on the bench, watching your teammates practice or play.

               

“How much water is needed?”, you ask.

Well, that’s the million-dollar question. There is not a definite answer; in fact, total fluid needs and replacement protocols are quite specific to the individual. Sports dietitian, Nancy Clark, MS, RD, recommends that athletes:

·         Drink 2-3 mL of water per pound of body weight at least 4 hours before exercise, practice, or games.

·         Use your sweat rate to determine necessary water during exercise (see equation below).

·         Drink 50% more fluid than lost in sweat after exercise ends.

Graphic from the American College of Sports Medicine

Calculating your sweat rate is an important step to determine the amount of fluids you need every hour of exercise. Training with your individualized hydration protocol can not only delay fatigue, but also heighten energy and performance against your dehydrated competitors. For best results, work with a sports dietitian or certified athletic trainer familiar with personalized sweat rate calculations and hydration plans.

Hydration and Performance 

Water makes practice and games easier, and helps performance improve. When fluid is taken in the plasma, volume restores near the pre-exercise levels and assists to avoid adverse effects of dehydration on muscle strength, endurance, and coordination. In addition, pre-exercise hydration assists in improving thermoregulation, heat dissipation, and performance.    

Dehydration

Dehydration is shown when the amount of water (sweat) exiting the body exceeds the amount of water (or electrolytes) entering the body. The risk of dehydration greatly increases when practicing in hot, sunny, intense environments. Dehydration can be shown by a number of signs such as:

·         Thirst—first sign of dehydration

·         Headaches

·         Dry skin

·         Bright yellow urine (see urine color chart)

·         Difficulty concentrating

·         Increase in body temperature

·         Muscle cramps

·         Swollen fingers/toes

Dehydration and Performance

Dehydration can be detrimental to your performance, not only during practice and games but in the classroom/film room as well. Physical and mental performance is impaired when you’re dehydrated as little as 2% of your body weight. When dehydration reaches 5%, there is a 30% decline in performance. Endurance is also greatly impaired when severe dehydration sets in. The greatest danger is to the heart; plasma and blood volume fall, increasing blood thickness while lowering central venous pressure. This, in turn, causes difficulty when the body is trying to return blood to the heart. It is vital not only for exercise, but also for life.

Steps to take when dehydrated

1. Go to a cool or shaded area
2. Seek help from your sports medicine team
3. Drink clear fluids: water, electrolytes, pickle juice, etc.
4. Continue to drink these fluids until and after you are re-hydrated

Grab a water bottle and keep it by your side at all times! If drinking water is difficult for you, add flavors such a lemon, lime, or other fruit you enjoy. Athletes with high sweat rates should also consume fluids that replace electrolytes lost in sweat such as sodium and potassium. Challenge yourself and teammates to see who can meet their fluid needs each day. Drink up!

Today's Marijuana Isn't Smoked in Joints, but With the Help of a Blowtorch.

Here’s what we learned about today's marijuana from our speakers at the Sport Exchange Summit last week:

YES, the traditional, herbal cannabis sativa and cannabis indica are botanical plants.

NO, many new users are not smoking herbal cannabis anymore—more on edibles and butane hash oil (BHO) later.

YES, recreational marijuana is legal in four states (Colorado, Washington, Oregon, Alaska), and the District of Columbia.

NO, medical marijuana is not covered through medical exceptions or therapeutic use exemptions (TUE) in sport.

YES, there are some medicinal benefits from the cannabidiol (CBD) components of the flower.

NO, the CBD concentrations of marijuana are not increasing with rising THC potency.

Slide Courtesy of CeDAR speakers Dr. LaTisha Bader and Ben Cort, July 2016. 

Slide Courtesy of CeDAR speakers Dr. LaTisha Bader and Ben Cort, July 2016. 

YES, the THC (psychoactive element) concentration of marijuana is increasing exponentially.

NO, THC-laced edibles and drinks aren’t better or “healthier” forms of consumption.

YES, marijuana is being marketed blatantly to all generations, income levels, and demographics—even to children.

NO, marijuana is not “safer” than alcohol or other illicit drugs.

YES, 1 in 6 adolescents and 1 in 10 adults who try marijuana will become addicted to it.

NO, 420 is not as relevant as 710 in 2016.

Slide Courtesy of CeDAR speakers Dr. LaTisha Bader and Ben Cort, July 2016. 

YES, butane is used to strip the THC from marijuana plant material to create BHO concentrates.

NO, not all of the butane is removed before users light up a blow torch and take a “dab” hit to get high.

Slide Courtesy of CeDAR speakers Dr. LaTisha Bader and Ben Cort, July 2016. 

YES, BHO concentrates are up to 90% THC and deliver the equivalent of smoking 5 joints in just one dab hit. 

NO, marijuana and THC-containing edibles or oils are not regulated to ensure safety, efficacy, or truth in labeling.

Slide Courtesy of CeDAR speakers Dr. LaTisha Bader and Ben Cort, July 2016. 

YES, that means that one “serving” of an edible (10mg = legal dose) could be as small as the ear of a gummy bear—NOT the whole bear, or the full package of six gummy bears sold to the user.

NO, legalization hasn’t made marijuana less of a concern.

OH, and did we mention the significant (and irreversible) decline in IQ points seen in frequent users?

Colorado-based addiction practitioner and licensed psychologist, Dr. LaTisha Bader, and long-term recovered addict, Ben Cort, shocked and awakened attendees at the 2016 Sport Exchange Summit with their straight-forward and relevant presentation on marijuana.  Their message to all members of the “team behind the team”—including parents—was to “know your 2-minute talk.” Understand behavior change, know the perceptions surrounding use, know the consequences of use, and set expectations with athletes. Express your concern and engage in well-informed dialogue on the subject. 

Slide Courtesy of CeDAR speakers Dr. LaTisha Bader and Ben Cort, July 2016. 

For additional help and resources, we’ve provided some links below.

More Education on Marijuana: 

• The Drug Free Sport Speakers Bureau is scheduling education sessions for Fall 2016 and Spring 2017. To invite a speaker to your campus to discuss marijuana or other issues in sport, please contact our Education Program Manager, Anna Filardo, at afilardo@drugfreesport.com or 816-285-1429.

 

• Join Dr. LaTisha Bader and Ben Cort for their webinar "New Trends & Consequences of Marijuana Use Today"  hosted by Drug Free Sport. The live webinar will be on August 23, 2016, from 1-2pm Central Time. Click here to register. Space is limited to the first 100 registrants. 

Resource Links:

CeDAR/University of Colorado Hospital (Ascent Track)

Project SAM (Smart Approaches to Marijuana)

National Institute on Drug Abuse (NIDA)

Substance Abuse and Mental Health Services Administration (SAMSHA)

Peer reviewed, Published Studies and Other Resources on Marijuana:

Hall, W. (2015), What has research over the past two decades revealed about the adverse health effects of recreational cannabis use?. Addiction, 110: 19–35. doi: 10.1111/add.12703

Adverse Health Effects of Marijuana Use, by Nora D. Volkow, M.D., Ruben D. Baler, Ph.D., Wilson M. Compton, M.D., and Susan R.B. Weiss, Ph.D., published online June 4, 2014 in The New England Journal of Medicine

Marta Di Forti, Arianna Marconi, Elena Carra, Sara Fraietta, Antonella Trotta, Matteo Bonomo, et al. Proportion of patients in south London with first-episode psychosis attributable to use of high potency cannabis: a case-control study. The Lancet Psychiatry, Vol. 2, No. 3, p233–238. Published online: February 16, 2015

Rocky Mountain HIDTA Volume 2/August 2014 Report, “The Legalization of Marijuana in Colorado: The Impact.”

Marijuana Legalization in Colorado: Early Findings. March 2016.  Produced by the Colorado Department of Public Safety.