In January 2018, rugby player Dom Day was recuperating from a knee operation, and searching online for something that could speed up his recovery. The Saracens player came across an article about cannabidiol (CBD), which had recently been taken off the banned substances list by the World Anti-Doping Organisation.
CBD is an extract of the cannabis plant derived from hemp, which has lower concentrations of the psychoactive substance tetrahydrocannabinol (THC) than marijuana. It has exploded in popularity as a health supplement, with users claiming it helps them dull chronic pain and inflammation, turn down the symptoms of anxiety, and get better sleep. In the US, sales are expected to hit a billion dollars by 2020, and in the UK you can buy CBD on the high street in the form of cannabis oil.
Day recommended CBD to a teammate, George Kruis who first started using it while recovering from an ankle injury, and now the pair are regular users. “I spray it under the tongue for a minute or two and then just go about my business,” explains Kruis, who says he takes CBD in the evenings to help him sleep and calm him down. Day, meanwhile, treats it more like a vitamin supplement – taking it each morning and night.
The problem for athletes is that while CBD is legal, THC is still banned, and a rigorous process is required to fully separate the two chemicals during the process that turns hemp into cannabis oil. This year, American free-skier Devin Logan received a three-month suspension from the US Anti-Doping Agency for failing a drugs test, which she says was down to using a CBD-based product that still had some traces of THC.
“There is always a risk when buying any supplement bought in shops or over the internet, quite simply these products are less well regulated than medicines and you won’t know what is in it,” says Marcus Rattray, a professor of pharmacology at the University of Bradford. “As these oils are extracts from cannabis, which has well over 80 different chemical components, they will all vary in the amounts of CBD and other cannabinoids, and may contain impurities.”
Kruis and Day founded a company, fourfiveCBD, to tackle that problem – and have launched the first cannabis oil product that’s been certified as having no cross-contamination with THC. They run an additional extraction process beyond that done by other companies. Pressurised carbon dioxide is used to separate the chemicals from the hemp plant. “We’ve done that one step further to take out that trace level,” say Day.
In the UK, anything with more than 0.2 per cent THC is classed as medicinal marijuana, and is illegal, but THC can build up in the system over time. FourfiveCBD offer a cannabis oil product, which costs £74.99 for 1000mg, with zero per cent THC by weight, and no contamination with other banned substances.
Because they’re selling CBD as a supplement – akin to a multivitamin tablet – fourfiveCBD is not allowed to make any medical claims about its effectiveness as a painkiller or anti-inflammatory. But it’s clear that CBD is being used for that purpose by athletes across a wide range of sports, including rugby, which has had widespread issues around the use and overuse of opioid-based painkillers and other off-the-shelf drugs.
CBD works on a different system of neurotransmitters within the brain, says Elizabeth Phillips, an independent consultant for fourfiveCBD. “It modulates the endocannabinoid system,” she says – smoothing out the peaks and troughs but without blocking other responses in the body, as some painkillers do.
But does CBD actually work? Anecdotal evidence of the pain relief of smoking cannabis has existed for a long time, and is reflected in recent law changes in some countries around medicinal marijuana for the treatment of conditions such as multiple sclerosis. Clinical trials have found that combinations of CBD and THC are effective, says Rattray, but “there are no clinical trial studies yet on CBD alone (or cannabis oil), and so there is no good evidence that it is a painkiller,” he says.
Andrew Moore, an expert on pain treatment at the University of Oxford, goes further. “The higher the quality of the clinical trials, the less effect is seen,” he says. “This is not unusual, and is what we often see.” He points to the fact there are very few clinical trials of CBD still ongoing, which suggests that pharmaceutical companies don’t have the confidence to spend big taking it through the medical approval process.
For athletes, there’s more at stake than just taking a supplement that doesn’t work – failed drugs tests can jeopardise careers, and CBD could also cause problems when travelling to play in countries where it’s still illegal. The UK Anti Doping Agency says using CBD is “at the athlete’s own risk”.
Unlicensed online retailers may not be as rigorous about cross-contamination as fourfiveCBD. “It is definitely possible to separate CBD from THC and other compounds that may cause a failed drug test in athletes, but it will be really hard to get it absolutely pure, and that would come at a cost,” says Rattray. “If it were me I would stick to anti-inflammatories, which are allowed and proven to be effective.”
There has been lots of hype and anecdotal evidence, but not the large high quality clinical trials required to prove effectiveness. “We have been here before with opioids – and look how that turned out,” says Moore, adding that very few painkillers have been proven to work well in more than a small proportion of people. “There are no silver bullets, so beware silver bullet salesmen.”
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