As more athletes use cannabis for pain and pain, there is more we need to know

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As a 2000 Olympic triathlete, Joanna Zeiger, SPH ’01 (Ph.D.), never imagined a future cannabis study that was on the US Anti-Doping Agency’s ban list until recently. But it was before Zeiger’s devastating career-ending bike crash at the 2009 Ironman 70.3 World Championship in Clearwater, Florida, followed by chronic pain.

Zeiger suffered clavicle fractures and structural and neurological damage to the rib cage, causing intercostal neuralgia, severe muscle spasms and abdominal and rib pain. She was later diagnosed with a periodic fever syndrome, which doctors suspect was related to the accident.

Living in severe pain, Seiger has tried almost every treatment she has available. When she sought options such as acupuncture, nerve block, and physiotherapy, she found only limited temporary relief. Looking for an alternative, she turned to cannabis, but found that there was little information about cannabis as a cure for pain. What kind of cannabis? What medication? When and how often do you take it? “I had to do a lot of experimentation,” she says, “start with a small amount of food.” After trial and error, she found relief from both pain and nausea and better sleep.

2008 Iron Man 70.3 World Champion Zeiger is not the first professional athlete to explore the use of cannabis to relieve pain. Retired NFL players Eugene Moore and Jake Plummer, former professional cyclist Floyd Landis, and many others have sought out their benefits, especially as an alternative to addictive opioids. In addition, 34 states have legalized marijuana, either for recreational or medical purposes. According to Marijuana Business Daily, cannabis is a large industry, from oils and creams to food, and is expected to reach sales of more than $ 106 billion by 2024. All types of athletes are experimenting with how this substance fits into the regimen for pain and pain training and injury recovery.

Although of interest and need, there is no detailed information on pain medication and it remains an area that requires additional research. Studies on the effects of non-psychoactive CBD on pain, stress, and other conditions are largely inconclusive, but recent studies do not completely reduce pain and inflammation, but do not make pain unpleasant. .. The response to cannabis is also very personal and can be further affected by other drugs, genetics, food, and consumption methods, says Zeiger. There is also a balance between the levels of THC (tetrahydrocannabinol) and CBD (cannabidiol), the active ingredients of the plant, to find the right ratio.

Not only found relief, but also interested in the use of cannabis in the athletic community, Zeiger launched the Canna Research Group in 2018 with his father, allergist and pediatrician Robert Zeiger.

Her academic background, athletic journey, and life in Colorado, an early cannabis legalization state, set the stage. According to her, it was triggered by a cycling accident. “It was a detour from a Hopkins graduate student to starting a non-profit cannabis research organization,” says Zeiger, who holds his PhD. Majored in Genetic Epidemiology at Bloomberg School.

Zeiger describes himself as a former cannabis skeptic. After graduating from Bloomberg School, she conducted two postdoctoral fellowships funded through training grants at the National Institutes of Health. Shortly thereafter, she moved to Boulder, a mecca for athletic training for its altitude, weather, and elite athlete community, but worked part-time at the Institute of Behavioral Genetics at the University of Colorado for a postdoc at NIH. Meet the requirements. It was there that Zeiger first investigated cannabis research.

“I analyzed the use of cannabis in young people and how it could lead to substance abuse in adults,” she explains. “This exposed me to many negative aspects of the drug, which led to my overall negative impression at the time.”

Zeiger, along with Canna, developed the Athlete PEACE (Pain, Exercise, and Cannabis Experience) Survey in 2019 to learn more about the prevalence of cannabis use among athletes and how to use it.Studies published in the journal PLOS OneIncluded investigating cannabis usage patterns, their benefits, and side effects in more than 1,200 athletes of various sports and levels. “At the research level, everything before our work focused on negative consequences,” she says. “I position our job of studying cannabis in a neutral way and also looking for positive effects so that people can minimize the number of side effects and find the right dose. It’s the ultimate goal. “

The study found that 26% of athletes used cannabis for a defined two-week period and 67% used cannabis for life. About 61% of respondents said they used the drug for pain, 68% of whom reported relief.

“When we looked at the positive effects of cannabis on this population, sleep, pain levels, and ability to calm were the most common areas athletes saw improvement,” says Zeiger. “There were only a few side effects such as poor concentration and increased anxiety.”

Since many sports governors have historically had strict rules surrounding this substance, Zeiger’s work stands out as the first to examine both its use and dosage in an athlete population. For example, the US Anti-Doping Agency and the World Anti-Doping Agency have banned cannabinoids altogether until 2018, when they began allowing very low doses containing less than 0.3% THC. This is a small amount in commercial CBD oil. One of the biggest stories of recent Olympic trials in athletics is the shutdown of the 100-meter sprinter Shakeri Richardson following a positive THC test above the allowed threshold. The 21-year-old runner approved the drug after learning that his mother had died, and gained sympathy and support from sports fans. Despite the protests, talented runners will miss the Tokyo Olympics to avoid a four-week penalty.

Similarly, the NFL has traditionally banned the use of marijuana, but relaxed those regulations in 2020 to allow for higher thresholds for THC. Prior to that, Ryan Vandry, a professor of psychiatry and behavioral science at the School of Medicine, who focused on cannabis behavioral pharmacology research, tried to coordinate with the NFL from 2016 and learned more about the number. .. Players were using it, and why. At that time, cannabis was still a banned substance, so the league refused to participate.

However, Vandry has succeeded in publishing a treatise demonstrating that medical cannabis is associated with better health. These include improved sleep, mood, quality of life, and pain relief, and as a result, the use of health care should be reduced.

The problem in the athletic world is the composition of cannabis, which is a combination of CBD, which has no psychotropic effects, and THC, which has euphoric “high” and other psychoactive effects.

The complete separation of the two can prove difficult and labeling remains unregulated. For example, the FDA recently tested 147 cannabis products and found that many contained THC, even though the label did not specify it. Vandrey’s 2017 survey on labeling revealed the need for stricter rules. “We tested various retail products and found a lot of irregularities,” he says.

Therefore, the responsibility lies with the athlete and somehow remains within the rules of use. Zeiger and her partners are now hoping to receive funding to conduct follow-up research on athlete usage patterns.

After their first study Use of cannabis Among athletes, Zeiger and her Canna Research Group joined the non-profit Canna Research Foundation to expand their mission to evidence-based consulting and education for physicians, stakeholders, patients and clinics. The team’s research has the potential to bridge the wide knowledge gap between practitioners and their patients.

In a recent study published in Annual report on allergies, asthma and immunology, Zeiger found that only about 40% of doctors are discussing cannabis as an alternative treatment for their patients. “This makes me uncomfortable with the fact that cannabis isn’t federally funded and doctors are worried about losing their licenses, and that they don’t have enough education and knowledge to talk to patients. I think it’s a combination of the facts that it is. “Seiger says.

Looking at the usage patterns of allergy and asthma respondents, 18% now use cannabis to improve their quality of life. Similar to the athlete survey, respondents in the allergy / asthma group reported positive effects more often than negative effects.

Zeiger continues his research activities, but is also a cannabis user as part of his multimodal approach. Her career in triathlon is out of reach because she can no longer swim or ride a bike, but at this stage she is rarely competitive, but she continues to run.

All cannabis research that Zeiger has done so far confirms her own personal experience. There is little guidance for patients, and doctors lack the tools they need to provide that guidance.

“We know it Cannabis, People can step into the clinic and ask what they want, “says Zeiger. “For patients, this ownership is released, but because they are themselves, they have to experiment as I did.”

Zeiger hopes that the activities of the Canna Research Foundation will ultimately minimize the need for patient experimentation. “We want to at least provide patients with the information they need to have a starting point,” she says. “Cannabis is not a panacea, but our goal is to help patients find the right proportions, doses, and routes of administration to get the most benefit with minimal harm.”

A study of uncontrollable asthma patients found that half-smoked cannabis

For more information:
Joanna S. Zeiger et al, Use of Cannabis in Active Athletes: Behaviors Related to Subjective Effects, PLOS ONE (2019). DOI: 10.1371 / journal.pone.0218998

Dennis J. Sholler et al, Treatment Potential and Safety Considerations for Clinical Use of Synthetic Cannabinoids, Pharmacology Student Chemistry and Behavior (2020). DOI: 10.1016 / j.pbb.2020.173059

Cannabis attitudes and usage patterns among followers of Joanna S. Zeiger et al, Allergy & Asthma Network Annual report on allergies, asthma and immunology (2021). DOI: 10.1016 / j.anai.2021.01.014

Provided by
Johns Hopkins University

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