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Legalization of Marijuana and Implications for Sport and Health Professionals, Part 1

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Marijuana usage is legal in Washington state but players on the Seattle Seahawks could be suspended for using pot while Seattle Mariners players could be fined. Photo: seahawks.com

By M. Brian Wallace, Ph.D., FACSM, and Michael Gunderson, Ed.D. |

Though it remains controversial, use of marijuana for medical and recreational purposes is now changing societies attitude from censure to acceptance. Further contributing to this altered public sentiment is an ever expanding list of documented health benefits.  Sport, both professional and amateur, has further put a powerful spotlight on the debate. Athletes are increasingly turning to marijuana (aka cannabis) to improve recovery time and enhance  performance. In the United States, close to ninety professional sports teams now compete in a state in which medical or recreational marijuana has been legalized. Irrespective of state, federal, or international law however, the World Anti-Doping Agency and all professional sports coalitions apart from the National Hockey League include marijuana on its list of banned substances. In response, there is an increasing conviction in athletes that professional sports should eliminate marijuana from the list of prohibited substances and reduce the severe penalties imposed on players due to a marijuana-related infraction. Because of the timeliness and gravity of this issue, we have developed this two part series to discuss (1) the many facets of marijuana  legalization/implications and (2) its physiologic based role, potential benefits and risks in sports, health and fitness.

Part I: Rapidly changing laws and attitudes related to legalization of recreational marijuana are having, and will continue to have, significant implications for sport and health professionals.  Five additional states voted recently to legalize recreational marijuana for adults 21 years of age or older bringing the number to 15 states, as well as two territories, and the District of Columbia. Recently, the House voted 228-114 to decriminalize marijuana federally highlighting the momentum marijuana legalization is experiencing even at the federal level. All but three states have some form of legalized medicinal marijuana and most have moved to have it decriminalized. There are many aspects of legalization that remain intensely debated, including the long-term impact on brain function and cancer risk. Like alcohol and tobacco, significant money has been invested in marijuana sales, underscoring the critical need for unbiased research. However, unlike alcohol and tobacco, the schedule 1 drug classification of marijuana has limited its study, especially on long term use leaving many questions yet unanswered.

One of the most significant and often misunderstood issues with the legalization of marijuana is the additional legalization of marijuana products and concentrates, gels, gummies, oils, supplements, extracts, candies, oils and more.  The potency of marijuana and marijuana products is much higher than the marijuana of the past. Tetrahydrocannabinol (THC) the active chemical in marijuana has been increasing in concentration dramatically.  Confiscated marijuana in the 1990s tested at an average THC concentration of less than 4%, while marijuana confiscated in 2018 averaged over 15%.  Many states have also legalized the production, sale, and use of marijuana products, and concentrates, some of which have THC concentrations of 90% or higher.  The variations of edible marijuana often come in the form of candy, difficult for children and authorities alike to distinguish from benign sweets. The delivery system of THC in edible marijuana products is significantly different in both timing and duration, when compared to smoking. The slower uptake of edible THC has caused many to overconsume.  Users experiencing a delayed response consume deceptively large quantities of THC leading to the potential for extreme confusion, anxiety, paranoia, panic, delusions, hallucinations, nausea, and an elevated heart rate and blood pressure.  While a fatal overdose is unlikely, marijuana is second to alcohol as the most common substance involved in traffic fatalities.  Numerous additional deaths have been attributed to actions taken after “marijuana intoxication” or through medical conditions exacerbated by high THC levels, especially in connection with high THC marijuana products. The outdated notion that marijuana is not addictive has also been disproven as “marijuana use disorder” impacts up to 30% of users with many experiencing dependency and withdrawal issues often associated with other substances.  Marijuana dependence is brought about by an adaptation to large amounts of the drug in the brain, reducing the production of and sensitivity to the brain’s own endocannabinoid neurotransmitters.

The appealing and nonthreatening delivery method of a brightly colored, candy scented vaping device is an additional issue that must be considered for those working with young people.  Marijuana concentrates in the form of oils can easily be added to vaping devices making highly potent THC easily and quickly consumable, with the taste and smell of something as pleasing as grape, cherry, or passion fruit. Vaping devices continue to be the fastest increasing risk behavior for high school students.  Not only do these devices present an appealing gateway into THC use, they also offer the ability to transport numerous other substances including potentially lethal fentanyl, all while emitting a pleasing and quickly dispersing vapor. Meanwhile, the legalization of recreational and medical marijuana will undoubtedly increase its use. Given it’s potential benefits for athletes this increased use extends to professional sports and possibly even the health and fitness industries. As leaders in these arenas, the legalization of marijuana will be something we all need to address in one way or another over the upcoming months and years.  

In Part II we will discuss the potential benefits and risks of marijuana use in sports, health and fitness.

References provided upon request

Michael Gunderson, Ed.D. (abd) and M. Brian Wallace, Ph.D., FACSM

Dr. Brian Wallace is the chair of sports exercise science at the United States Sports Academy.

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