Cannabidiol (CBD) and the Athlete: Claims, Evidence, Prevalence, and Safety Concerns

Cannabidiol (CBD) has rapidly transitioned from a niche cannabinoid compound into a widely discussed recovery and wellness product within elite sport. Marketed as a natural solution for pain, inflammation, anxiety, and sleep disturbance, CBD is now commonly used across professional environments ranging from football and rugby to endurance sport and combat disciplines.

The growing visibility of CBD reflects a broader trend in elite sport, the search for legal, “natural,” and non-intoxicating recovery aids that may enhance adaptation and reduce adverse symptoms. However, despite widespread adoption and commercial enthusiasm, the scientific evidence base remains incomplete, particularly in athletic populations and there is a very real risk of inadvertantly anti-doping present.

What is Cannabidiol?

Cannabidiol is one of over 100 phytocannabinoids derived from the Cannabis sativa plant. Unlike tetrahydrocannabinol (THC), CBD is non-intoxicating and does not produce euphoric or “high” effects. CBD interacts indirectly with the endocannabinoid system (ECS), a complex regulatory network involved in pain modulation, inflammation, mood regulation, sleep regulation, immune function and stress response. Rather than binding directly to CB1 and CB2 receptors like THC, CBD influences receptor signalling, neurotransmitter release, and enzymatic breakdown of endogenous cannabinoids such as anandamide (Pertwee, 2008).

This broad regulatory role has led to claims that CBD may support recovery and resilience in physically stressed populations such as athletes.

Why Athletes Use CBD

A key driver of CBD adoption in sport is its alignment with recovery-focused narratives. Athletes commonly report using CBD for sleep improvement, muscle soreness reduction, anxiety and stress management, pain relief from training load, post-match recovery support and injury rehabilitation support. In elite environments, CBD is often perceived as a “clean” alternative to NSAIDs, alcohol, or sedative medications. Practitioners have also observed CBD being used as part of broader recovery routines including sleep hygiene protocols, travel recovery strategies, and post-match decompression processes. However, much of this use is driven by anecdote, peer influence, and commercial marketing rather than strong empirical evidence.

Proposed Mechanisms of Action

CBD’s potential effects in athletes are theorised through several physiological pathways. However despite these proposed mechanisms, most evidence is derived from animal studies or clinical populations with chronic pain or neurological disorders as opposed to elite athletes.

Anti-inflammatory effects

CBD may influence cytokine production and immune signalling, potentially reducing inflammation following exercise-induced muscle damage (Nagarkatti et al., 2009).

Analgesic properties

CBD may modulate pain perception through interactions with vanilloid receptors (TRPV1) and serotonin pathways.

Sleep regulation

CBD may reduce anxiety and promote sleep onset through anxiolytic effects, indirectly supporting recovery processes.

Neuromodulation

CBD influences serotonergic and GABAergic systems, which may contribute to reduced stress reactivity.

What Does the Evidence Say?

The scientific evidence for CBD in sport-specific contexts remains limited and inconsistent. Overall, the literature suggests that CBD’s strongest effects may be indirect (e.g. anxiety reduction), rather than direct improvements in physical performance or recovery processes (Iffland & Grotenhermen, 2017).

Pain and inflammation

Some clinical studies suggest CBD may reduce chronic pain symptoms, particularly in neuropathic conditions. However, evidence in exercise-induced muscle damage is sparse. A major limitation is dosage uncertainty. Effective doses in clinical settings often exceed those commonly consumed by athletes in commercial products.

Recovery

There is currently no strong evidence that CBD directly enhances physical recovery markers such as muscle strength restoration, glycogen replenishment, muscle protein synthesis and performance recovery timelines.

Sleep

CBD may have mild anxiolytic and sedative effects at certain doses, but results are mixed. Some studies show improvements in sleep quality, while others report minimal or no effect.

Performance

There is no robust evidence that CBD improves strength, speed, endurance, power output and reaction time. Importantly, CBD is not considered a performance enhancing substance in the traditional physiological sense.

Prevalence of CBD Use in Athletes

Although precise prevalence data is limited, surveys indicate increasing CBD use among athletes. Common findings include higher use in contact sports (rugby, American football, MMA), use primarily for recovery and sleep, increasing normalisation among younger athletes, frequent use alongside other supplements (protein, creatine, caffeine). A key concern is that many athletes source CBD from unregulated commercial markets, where product composition may vary significantly. Studies have shown that CBD products can contain higher THC levels than labelled, no detectable CBD despite claims and contaminants or banned substances. This raises both safety and anti-doping concerns (Citti et al., 2020).

Safety and Health Considerations

Although CBD is generally considered well tolerated, several safety considerations are relevant for athletes. This creates a direct risk for athletes subject to anti-doping testing.

Liver enzyme interaction

CBD may affect cytochrome P450 enzymes, potentially altering the metabolism of medications.

Gastrointestinal effects

Some users report nausea, diarrhoea, or appetite changes.

Sedation and fatigue

At higher doses, CBD may cause drowsiness or reduced alertness, which could negatively impact training quality.

Drug interactions

CBD may interact with common medications including anti-inflammatories, anticoagulants, and antidepressants.

Product purity and contamination

Perhaps the most significant issue in sport is product quality. Studies have shown inconsistencies in labelled CBD content and potential contamination with THC or other cannabinoids.

Anti-Doping Considerations

CBD itself is not prohibited by the World Anti-Doping Agency. However, THC remains a banned substance in competition. Many CBD products contain trace amounts of THC, even when labelled as 'THC-free'. This creates a contamination risk and potential anti-doping rule violation. Athletes using CBD therefore assume personal responsibility for product sourcing, third-party testing verification, batch certification and supplement risk management. Given strict liability rules in elite sport, even unintentional contamination can result in WADA sanctions.

Psychological and Cultural Drivers

Beyond physiology, CBD use in sport is strongly influenced by cultural and psychological factors. Athletes often report a belief in 'natural recovery', desire to avoid pharmaceutical medication, influence from teammates or coaches, marketing claims from wellness industries and social media promotion by elite athletes. CBD has also become associated with a broader wellness identity in sport, often linked to sleep optimisation, mindfulness, and holistic recovery approaches.

Practitioner Challenges

Sports practitioners face several challenges regarding CBD use:

1. Education gap - Athletes often overestimate CBD’s evidence base.

2. Product regulation - Difficulty verifying supplement purity and legality.

3. Communication barriers - Athletes may use CBD without disclosing it to medical staff.

4. Balancing autonomy and risk - Practitioners must respect athlete autonomy while managing health and compliance risks.

Future Research Directions

Key areas requiring further investigation include dose-response relationships in athletes, effects on exercise-induced muscle damage, sleep architecture changes under training load, long-term safety in high-performance populations, interaction with other recovery interventions and psychological expectancy effects. Much of the current evidence is extrapolated from clinical or recreational populations, limiting applicability to elite sport.

Conclusion

CBD has become one of the most widely discussed recovery supplements in elite sport, positioned at the intersection of performance, wellness, and commercial influence. While athletes commonly report benefits related to sleep, anxiety, and recovery perception, the scientific evidence supporting meaningful physiological improvements remains limited. The strongest effects appear to be indirect and subjective rather than direct enhancements in performance or recovery capacity. Meanwhile, concerns surrounding product purity, THC contamination, regulatory risk, and inconsistent dosing remain significant issues for practitioners.

In elite sport, where marginal gains are highly valued, CBD occupies a unique space: widely used, heavily marketed, but not yet strongly supported by performance science. Ultimately, CBD should be viewed not as a recovery solution, but as a supplement with emerging and incomplete evidence, requiring careful contextualisation, robust education, and strict risk management.

References

Citti et al. (2020). Pharmaceuticals, 13, 68.

Iffland et al. (2017). Cannabis and Cannabinoid Research, 2, 139–154.

Nagarkatti et al. (2009). Future Medicinal Chemistry, 1, 1333–1349.

Pertwee, R. G. (2008). British Journal of Pharmacology, 153, 199–215.

World Anti-Doping Agency (WADA). (2024). World Anti-Doping Agency.