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. 

What's the deal with CBD Oils and Creams? Do they contain THC?

Contributed by Anna Filardo, Education Program Manager

Cannabis|noun|can•na•bis|\’ka-nә-bәs\: any of the preparations (as marijuana or hashish) or chemicals (as THC) that are derived from the hemp plant and are psychoactive.¹

Essentially, marijuana is a species of cannabis, specifically named Cannabis Indica or Cannabis Sativa. There are more than 100 different cannabinoids that make up the marijuana plant; the most widely known are Δ9-tetrahydrocannabinol (or THC) and cannabidiol (or CBD). THC is commonly attributable to the psychoactive or euphoric side effects, while CBD is known for its more medicinal effects. Marijuana (specifically THC) is banned by a majority of sports organizations and is not eligible for medical exceptions or therapeutic use exemptions (TUEs). So what about CBD?

Recently, CBD oils and creams available for purchase in stores or on the internet have been growing in popularity, as seen in an increase of Drug Free Sport AXIS™ inquiries for these products. CBD has been cited for having some medicinal benefits, and homeopathic doctors are prescribing CBD oils and creams for treatment. The Drug Enforcement Administration (DEA) classifies CBD extract as a Schedule I Controlled Substance, which means it is illegal in states that have not passed medical marijuana laws.²

Manufacturers may claim their products are “pure CBD” and do not contain THC. However, there is no way to be certain the products do not also contain THC. The DEA asserts that it is “not aware of any industrially-utilized methods that have achieved this result [of 100% CBD].” ²  In February of 2016, the US Food and Drug Administration (FDA) tested the composition of 22 CBD tinctures, oils, and creams. A majority of the products were marketed to be “100% Pure CBD.” Upon testing, the FDA found that almost all of the products tested did not have the amount of CBD claimed; some products did not contain any CBD, while others contained far less. THC was also present in measurable amounts in most of the products.³

CBD products are not approved by the FDA for marketing or distribution as safety and effectiveness have not been proven, and the federal government classifies marijuana as an illegal substance. Therefore, the FDA does not test these products before they are available to consumers. Since the FDA does not test CBD products before becoming available to consumers, there is no way to tell the amount of CBD (or THC) in each product. Therefore, AXIS classifies CBD oils and creams as high risk products. 

Dr. David Kuntz, Ph.D., Executive Director of Analytical Toxicology for Clinical Reference Laboratories, affirms 

“Plants are being specifically developed to have high concentrations of CBD to maximize the compound in the bud.  It is my understanding that there are no 100% pure CBD products on the market, and these products will contain minor to significant amounts of THC in the oil depending on their purification steps.”

Bottom line: The use of CBD oils, creams or tinctures may cause adverse health effects and/or a positive drug test.

To learn more about the difference between THC and CBD, view this short video and check out the new Marijuana tab on Drug Free Sport AXIS™. 

Sources:

      Definition of Cannabis, Merriam-Webster

      Establishment of a New Drug Code for Marihuana Extract

      2016 Warning Letters and Test Results for Cannabidiol-Related Products

 

Other Resources:

• Committee on the Health Effects of Marijuana. (2017). The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. National Academies of Sciences, Engineering, Medicine.
• Video: CBD is Schedule I and always has been

Drug Free Sport Staff Weigh-in on Industry Trends Leading Into 2017

Contributed by Lara Gray, Director of Education

For this week’s blog, we interviewed a few of the staff at Drug Free Sport. We asked them to share insights from drug testing in 2016, and potential new (or repeating) trends in 2017.

LG: What, if anything, is changing in sport drug testing and analysis?

Staff: More and more, we are seeing professional sport leagues test blood samples as well as urine to ensure fair play. Amateur and institutional clients are beginning to look into oral fluid testing and other matrices as complementary features of their current drug testing program.

LG: Specific to the blood testing, what’s changing?

Staff: The World Anti-Doping Association (WADA) has validated Human Growth Hormone (hGH) biomarker analysis to compliement isoform testing for hGH. Essentially, they’re able to test for a greater detection window with the biomarker analysis that can show hGH up to two weeks after administration. Comparatively, isoform testing can detect hGH only within 24 – 48 hours of administration.

LG:  Is WADA validation important with new testing methods?

Staff: Of course. Many sport leagues look to the WADA Code and Prohibited Substances List as a gold standard. However, full implementation of WADA protocols can be difficult for clients that must also negotiate terms with their players unions through Collective Bargaining Agreements.

LG: What are sport organizations doing to work with the players unions and still provide effective drug testing programming?

Staff: “Smart” testing is becoming a new trend where we are seeing a shift to testing methodologies that efficiently and effectively use appropriate funds for deterrence testing. We are seeing this across the board for professional, amateur, and collegiate/institutional clients. Essentially, everyone is learning how to make the most of their drug-testing dollars and amplify the impact on deterrence.

LG: Are there any changes being made to the substances tested for in sport?

Staff: Nothing is changing dramatically in terms of the substances screened, even with marijuana which gets a lot of attention. We don’t anticipate any significant changes in marijuana testing as a result of the legislation efforts in several states across the country. Until there is a change from the Federal government, there likely won’t be a change in marijuana as a banned substance in sport. What has changed, however, is the conversation around marijuana—again, because of legalization in certain states.

LG: Can you elaborate? What has changed in the conversation?

Staff: There is a discussion targeting the social acceptability of marijuana—especially in the states where it is now legal for recreational use. We are providing more education on the different forms of marijuana use like edibles and concentrates, or that athletes may be using e-cigarettes or vape pens to mask their use on campus or within the sports facility. The potency of marijuana has changed dramatically over the last few years, which may be leading to higher dosages, longer lasting effects in the body, even addiction. For institutional collegiate clients, marijuana remains the largest concern on campuses.

LG: Are there other substances of concern looking ahead into 2017?

Staff: It’s hard to say what will be new in 2017, but there is growing concern over growth hormone releasing peptides (GHRPs) in professional sports, and the reemergence of anabolic steroids that were popular in the Eighties. SARMs, such as ostarine and LGD-4033, are also a concern as they are appearing in more supplement items and marketed as “legal”, which is absolutely false. Collegiately, there have been increasing requests for testing panels to include prescription narcotics and opiates. Prescription stimulants being used and abused without a prescription are also concerns on college campuses—we’ve even heard stories specific to athletes snorting amphetamines like Adderall.

LG: Sounds like there’s a lot going on! Are there any other trends you feel are important to share?

Staff: Probably the technology that surrounds drug-testing and third party administration of programs. For example, there are a number of researchers working on new technology that can detect certain drugs at lower specific gravity (or urine concentrations). Labs are also making strides to update machines that are “greener” in terms of efficiency. This helps decrease the turnaround time for receiving results which positively benefits the clients. We also know that there is a lot of work going into delivering appropriate protocols for testing transgender athletes. In January, we distributed our "Collection Procedures and Guidelines for Transgender Student-Athletes" to all of our collectors nationwide.

LG: Lastly, what impact (if any) do you feel the 2016 Russia doping issue has had on drug testing efforts in the US, or for Drug Free Sport specifically?

Staff: The impact is really just the importance of having independent administrators for drug-testing programs. A complete third-party that conducts athlete selection, administration of the program, conducts testing and works with WADA accredited labs, and provides accurate reports to the sport organization is critical. Their involvement must be completely separate and independently run. The Russia issues also increased the importance of consistency in communicating confidentiality and the code of ethics for drug testing to all of our certified collectors. Cyber security also becomes a larger concern in the wake of 2016.

LG: I think all of this is important to share and continue to discuss as we get further into 2017. Thanks for your time and insights!

For more information on any of the issues or topics discussed here, please email Lara Gray at lgray@drugfreesport.com.

Special thanks to the following staff members for their time and responses that made this blog possible: Ryan Willis, Sarah Ziegelmann, Allison Lathim, Ben Mosier, and Michaela Stemmons. 

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!

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.