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\begin{document}

\title{Cannabidiol and its potential use by athletes}



\author[1]{Vinícius Vaz}%
\author[2]{Anderson dos Santos}%
\author[3]{Priscila  Morelhao}%
\author[4]{Sergio Tufik}%
\author[5]{Monica Andersen}%
\author[6]{Cynthia Gobbi}%
\affil[1]{CESUMAR}%
\affil[2]{Unespar}%
\affil[3]{Universidade Federal de São Paulo}%
\affil[4]{UNIFESP}%
\affil[5]{Universidade Federal de Sao Paulo}%
\affil[6]{Universidade Unicesumar}%


\vspace{-1em}



  
  \date{June 13, 2024}


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\textbf{Cannabidiol and its potential use by athletes}

Vinicius S. Vaz\textsuperscript{1} PT, Anderson B. dos
Santos\textsuperscript{1} PT, Priscila K.
Morelh\selectlanguage{ngerman}ão\textsuperscript{2}PhD, Sergio Tufik\textsuperscript{2} MD PhD,
Monica L. Andersen\textsuperscript{2} PhD and Cynthia
Gobbi\textsuperscript{1} PhD

\textsuperscript{1}Universidade Cesumar (UniCesumar), Maringá, Paraná,
Brazil.

\textsuperscript{2}Universidade Federal de São Paulo, Escola Paulista de
Medicina, São Paulo, Brazil.

\textbf{Corresponding author:}

Cynthia Gobbi, PhD

Department of Physical Therapy, Universidade Cesumar (UniCesumar)

Av. Guedner, 1610-Jardim Aclimacao, Maringá-PR, 87050-900

Phone:+55 (44) 99166-8665

E-mail: cynthiagobbi@hotmail.com

\textbf{Acknowledgments/Fundings}

Our studies are supported by grants from the Associação Fundo de
Incentivo à Pesquisa (AFIP). MLA and ST are Conselho Nacional de
Desenvolvimento Científico e Tecnológico CNPq fellowship recipients.

\textbf{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
2018\textsuperscript{1}. CBD seems to have pharmacological properties,
and could be a potential approach to handle different impairments, like
psychological and neurological disorders and pain\textsuperscript{2,4}.
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 authors\textsuperscript{3--5}.

Studies demonstrated that cannabis usage is a common practice among some
athletes\textsuperscript{6,7}, 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 pain\textsuperscript{2}, anxiety and sleep
problems\textsuperscript{8} 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 pain\textsuperscript{3}. Few studies on the
use of cannabinoids by athletes focused on their effects on performance.
The results have been contradictory, reporting both decrement and
improvement\textsuperscript{9}.

One problem that is a frequent concern among athletes is sleep
disturbance and poor sleep quality\textsuperscript{10}, particularly,
but not solely, before competition periods\textsuperscript{11}. Sleep
problems can alter the levels of blood hormones and cytokines that are
related to muscle recovery\textsuperscript{12}. While the potential
mechanisms are not yet fully elucidated, they can affect cognitive
responses\textsuperscript{13}. Some limited data from cannabinoid
studies and athletes' personal reports have suggested that the
administration of CBD may result in better sleep
quality\textsuperscript{8}. 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
cycle\textsuperscript{14}. 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
effect\textsuperscript{15}. Pre-clinical studies with CDB suggested that
it influences sleepiness and sleep time\textsuperscript{16}. 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

1. World Anti-Doping Agency. WORLD ANTI-DOPING CODE 2015 with 2018
amendments.

2. Nutt DJ, Phillips LD, Barnes MP, et al. A Multicriteria Decision
Analysis Comparing Pharmacotherapy for Chronic Neuropathic Pain,
Including Cannabinoids and Cannabis-Based Medical
Products.\emph{Cannabis Cannabinoid Res} . 2021.
doi:10.1089/can.2020.0129

3. Ware MA, Jensen D, Barrette A, Vernec A, Derman W. Cannabis and the
Health and Performance of the Elite Athlete. \emph{Clin J Sport Med} .
2018;28(5):480-484. doi:10.1097/JSM.0000000000000650

4. Nguyen T. Working out with weed. \emph{Nature} .
2019;572(7771):S14-S15. doi:10.1038/d41586-019-02529-0

5. McCartney D, Benson MJ, Desbrow B, Irwin C, Suraev A, McGregor IS.
Cannabidiol and Sports Performance: a Narrative Review of Relevant
Evidence and Recommendations for Future Research. \emph{Sport Med -
Open} . 2020;6(1):27. doi:10.1186/s40798-020-00251-0

6. Brisola-Santos MB, Gallinaro JG de ME, Gil F, et al. Prevalence and
correlates of cannabis use among athletes-A systematic review. \emph{Am
J Addict} . 2016;25(7):518-528. doi:10.1111/ajad.12425

7. Zeiger JS, Silvers WS, Fleegler EM, Zeiger RS. Age related
differences in cannabis use and subjective effects in a large
population-based survey of adult athletes. \emph{J Cannabis Res} .
2019;1(1):7. doi:10.1186/s42238-019-0006-9

8. Babson KA, Sottile J, Morabito D. Cannabis, Cannabinoids, and Sleep:
a Review of the Literature. \emph{Curr Psychiatry Rep} . 2017;19(4):23.
doi:10.1007/s11920-017-0775-9

9. Trinh K V, Diep D, Robson H. Marijuana and Its Effects on Athletic
Performance: A Systematic Review. \emph{Clin J Sport Med} .
2018;28(4):350-357. doi:10.1097/JSM.0000000000000471

10. Bender AM, Samuels CH. Comment on: ``Does Elite Sport Degrade Sleep
Quality? A Systematic Review.'' \emph{Sport Med} . 2017;47(7):1453-1454.
doi:10.1007/s40279-017-0712-4

11. Juliff LE, Halson SL, Peiffer JJ. Understanding sleep disturbance in
athletes prior to important competitions. \emph{J Sci Med Sport} .
2014;14:1-20. doi:10.1016/j.jsams.2014.02.007

12. Dáttilo M, Antunes HKM, Galbes NMN, et al. Effects of Sleep
Deprivation on Acute Skeletal Muscle Recovery after Exercise. \emph{Med
Sci Sport Exerc} . 2020;52(2):507-514. doi:10.1249/MSS.0000000000002137

13. Fullagar HHK, Skorski S, Duffield R, Hammes D, Coutts AJ, Meyer T.
Sleep and Athletic Performance: The Effects of Sleep Loss on Exercise
Performance, and Physiological and Cognitive Responses to
Exercise.\emph{Sport Med} . 2015;45(2):161-186.
doi:10.1007/s40279-014-0260-0

14. Sanford AE, Castillo E, Gannon RL. Cannabinoids and hamster
circadian activity rhythms. \emph{Brain Res} . 2008;1222:141-148.
doi:10.1016/j.brainres.2008.05.048

15. Gamelin F-X, Cuvelier G, Mendes A, et al. Cannabidiol in sport:
Ergogenic or else? \emph{Pharmacol Res} . 2020;156:104764.
doi:10.1016/j.phrs.2020.104764

16. Suraev AS, Marshall NS, Vandrey R, et al. Cannabinoid therapies in
the management of sleep disorders: A systematic review of preclinical
and clinical studies. \emph{Sleep Med Rev} . 2020;53:101339.
doi:10.1016/j.smrv.2020.101339

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