This past month, the National Collegiate Athletic Association (NCAA) voted to remove cannabinoids from the banned substance list. 

I applaud this decision. Not because I support uncontrolled self-dosing of marijuana but because I have long been a firm believer that our messaging was not effective and that the testing approach did not accomplish the desired effect of overall deterrence. In explaining the decision, the NCAA noted a lack of scientific evidence that marijuana provides a competitive advantage and further acknowledged the ineffectiveness of the existing policy of penalizing athletes after positive tests. Rather, a harm-reduction strategy implemented at the institutional level is the preferred approach. 

Did you ever wonder what a nanogram is? Or why 150 nanograms/milliliter (ng/mL) were set as a threshold for a positive test that sent each athlete toward a required counseling session, suspensions, community service and other forms of punishment? In a world where we practice evidence-based medicine, we have neglected to make a correlation between nanograms and how they specifically can impair one’s cognitive and physical performance. 

Consider the following hypothetical situation: Two teammates meet up on a given night, and they each smoke the exact same amount of marijuana. Let’s assume there are no previous amounts in their system. Two weeks later, they are both called in for a random drug test. The results reveal that one of the individuals tests positive at 155 ng/mL while the other tests negative at 145ng/mL. One enters “the program”; the other is not required to. Merely by genetics, hydration status, ability to excrete, dietary habits and a host of other factors, despite testing so close to one another they are managed very differently. 

Imagine for a second if you will that as compared to zero, 145 ng/mL and 155 ng/mL are essentially the same amount of tetrahydrocannabinol (THC) in one’s system. Would it make more sense to better understand what that amount of THC in the system does to performance rather than impart a penalty to one athlete and not the other? Do we even know that an arbitrary number of 150 ng/mL impairs everyone in the same manner? Think about alcohol. While we know that the blood alcohol content (BAC) of 0.08% represents legal impairment for driving, we do not have similar impairment thresholds for THC. Doesn’t every person react differently to different amounts of alcohol despite an impairment threshold? Wouldn’t it make sense, therefore, that individuals are also affected differently using different amounts of marijuana? Perhaps some individuals demonstrate cognitive deficiencies and reaction-time deficits with just 40 ng/mL of THC in the system. Yet others who yield highly positive tests may develop a tolerance to THC and not necessarily show the same performance deficits. The key here is to understand that in a harm-reduction model, we should focus on individual use and individualized interventions. What works for some does not work for others. Abstinence is not an effective form of messaging. Neither is just telling athletes that marijuana is bad. We have tried and failed for decades using these approaches. The solution is tying the outcomes of individual THC use to the identify of an athlete — being an athlete. 

This is not to say that counseling interventions and mental health are not important. Quite the contrary. Among many other reasons, understanding why individuals partake in marijuana use, and helping with coping mechanisms, justifies such interventions. Counseling, however, should not be viewed as a punishment. These must be meaningful and trustworthy sessions, or the athlete will view them as checking a box in order to keep playing. A team approach to messaging is essential, and mental health professionals are a welcome addition to the support staff. 

So, what is a nanogram? A nanogram is a measure of weight equal to one billionth of a gram. Can something this small in the body be so impactful and deleterious to performance? Is there really a difference between 145 and 155? Is it a one-size-fits-all approach? I suggest that moving forward, we begin to ask more relevant and meaningful questions in an effort to obtain more factual and practical information. We can measure so much now with the technology made available to us. It is time that we apply this technology toward assessing the correlation of THC in the body with metrics that matter and the factors that athletes view to be important to them. 

As our thinking advances, we will also better learn about the many other non-euphoric cannabinoids (e.g., CBD, CBG) and the therapeutic effects that they may provide related to sleep, inflammation, pain, anxiety, recovery and who knows what else. There is a wealth of information yet to be learned once we break down the single word “cannabis” into the various entities that it is comprised of.  

Change is difficult. Change can also be exciting. The change of the cannabis classification by the NCAA will have ripple effects for athletes and those physically active of all ages. 

Read Dr. Konin's recent article "The Cannabis Shift: How We Educate and Message is Key" in the latest issue of Current Sports Medicine Reports.

Jeff G. Konin, PhD, ATC, PT, FACSM, FNATA, FNAP, is a clinical professor and director of the Doctor of Athletic Training program at Florida International University. He is a frequent speaker at conferences on the topic of cannabis and athletic performance and consults with numerous athletic programs at various levels, delivering contemporary cannabis education to coaches, athletes and support staff.