Emerald Magazine: Hello, everybody. This is Emerald interviewing Dr. Charles Bush-Joseph, team physician for the Chicago White Sox. Today we’re discussing sports and cannabis. Please tell me about yourself.
Dr. Charles Bush-Joseph: I’m an orthopedic surgeon practicing in Chicago, and I specialize in sports medicine. I’ve been an orthopedic surgeon for almost 30 years now, and I would say I take care of lots of athletes. I come at this from a perspective of the value of medical cannabis or medical marijuana in treating pain and symptoms that people have, and sometimes athletes can have, after they have serious or significant injuries and are even left with disabling symptoms. It’s not unusual for many of these patients to devolve into using narcotics and opioids on a regular basis. I’ve always felt that medical cannabis can provide a great deal of pain relief for patients who’ve got chronic symptoms and still want to participate in recreational or even sometimes competitive activities. Now obviously you don’t use medical marijuana to perform a sport, but in treating the symptoms, the problems or the sequela of that sport. I think that’s where it has value.
EM: What are the benefits of an athlete using cannabis?
CBJ: The benefits are:
– If an athlete is trying to treat symptoms, and they’ve got pain after a knee injury or difficulty with recovery following a shoulder injury or a spinal injury where they’ve had treatment and have had a hard time getting rest and sleep.
– They’re going to rehabilitation, and they can’t find that relief to get rest or sleep. When they choose other stronger medications, like sedatives or muscle relaxants or, as I mentioned earlier, opioids, I think that medical cannabis provides a great alternative.
– It’s a naturally occurring substance that generally is very safe. It’s very, very difficult, if not impossible, for a patient to overdose on medical marijuana, whereas, with opioids, it’s much easier to overdose, because too much affects your brain stem function, which regulates your breathing and your heart function, whereas with medical cannabis there are no receptors in your brain stem affected by cannabis, so that generally just doesn’t happen.
EM: What are some of the cons of athletes using cannabis?
CBJ: Well, I think there are several.
Number one, is cannabis is not a performance-enhancing drug. And certainly, if you’re using marijuana during the performance of your sport or training, you’re not going to do well.
Cannabis dulls your sensations, and it freezes your reaction time.
There are a variety of things that are not beneficial for performance reasons, but useful from a recovery perspective. That should be intuitive to think about what cannabis does for people. It’s a sedative; it’s relaxing, it has some pain-relieving qualities. It can help alleviate or treat symptoms associated with nausea from other medications or other medical problems.
EM: Do you see cannabis treatments in the future that will help athletes recover faster from injury?
CBJ: I honestly can’t say that.
– They’re not using narcotics.
– They can find rest easier without other stronger medications.
– It allows them to get through the trauma of surgery or injury if necessary.
– I think the great value of cannabis with athletes is that they can recover safer.
From a psychiatric or psychological perspective, it allows for restfulness and sedation and decreases anxiety. I’m sure there are other potential benefits for it. I know many athletes who do use cannabis for medical reasons, and some for recreational use, but that’s not an area of my expertise.
EM: Can or should cannabis be used as a neuroprotectant?
CBJ: I wish I could say there is evidence that exists. There are certainly anecdotal reports by patients that feel there is a neuroprotective value to it [a neuroprotectant serves to protect nerve cells against damage, degeneration, or impairment of function], but that hasn’t been borne out well in science.
With the current drug classification as it is by the federal government, it is very hard to study the effect of medical marijuana unless you have a very clear-cut and defined topic.
That’s one of the things that we’re hoping—that the FDA will lower the threshold to declassify medical marijuana, allowing us to get better evidence because we do think it has value, but unfortunately we’re not at the point where we can really prove that.
EM: There are many ways to ingest cannabis. From your experience, do you recommend any particular method of usage?
CBJ: No. How patients ingest or take in cannabis is purely an individual choice. It goes with patient experiences and how they perceive enjoyment. Obviously, if you’re inhaling—vaping or smoking it—you get a much more rapid intake.
The benefit from it is, how quickly cannabis gets into your system and how much of the cannabinoids you get into your system. For example, seizures or other neurologic issues.
One problem for patients is that some don’t know how to smoke or “vape,” and sometimes they use edibles, whether they be candy or gumdrops or things like that. The problem there is the effect is not the same as from inhalation, and patients have to be more patient and regulating in their dose. In my experience, many older patients who have never smoked or had cannabis before generally rely on ingestibles, either candy or cookies, because that’s the way they are most comfortable taking in cannabis.
EM: Do you recommend any specific strain of cannabis for athletes to take?
CBJ: No, I would again tell you that that’s a matter of personal preference for the taste, the smell, the feel, the sensation. From a medical perspective, “cannabis” is beneficial. It comes down to how much THC and what percentage it makes up of the “strains.”
There are different types of cannabinoid compounds within medical marijuana that have beneficial effects. Largely, all the other things that patients perceive about sensation or taste are added benefit for the personal pleasure. That’s why some patients are just happy taking ingestible cookies or candies, or they have no perception of taste. They don’t necessarily want to get high, but they want to get the medicinal benefits.
In the state of Illinois, when you purchase a product, whether it be plant material or an ingestible, every package tells you exactly what percentage of compounds are present within that product that you’re taking. That’s obviously what makes medical marijuana different from people just buying it off the street and why we say it’s a pharmaceutical-grade approach to dosage and ingestion.
EM: Do you see a future where athletes or even everyday people can grow their own to medicate?
CBJ: I see that if individual state regulation allows that. I think if we get to that point of legalization, people are going to know what they’re getting. It’s just like growing tomatoes. There are a thousand different tomato brands available, and that same thing occurs with cannabis.
Consumers will want to know the strain and the potency is going to provide the desired therapeutic effect they’re looking for, for example, relaxation. It’s about much more than just trying to get high.
EM: Do you see major sporting organizations becoming more relaxed in their approach to cannabis?
CBJ: Yes, I take a look at it from a Major League Baseball perspective. They would term two types of drugs as abusive, of which marijuana should be considered one similar to cocaine, where there is no perceived benefit for the player, and the second type would be performance-enhancing drugs.
Nowadays, what we’re finding in Major League Baseball is they’re getting much, much more relaxed, although not entirely, in the use of “perceived drugs of abuse,” because they don’t give a patient or a player an advantage over another player in competition.
Medically speaking, there’s no perceived performance enhancement. What we talked about earlier today was the benefits of recovery and allowing players to avoid other more dangerous methods of treatment. In general, I would expect all the professional leagues in time to discontinue marijuana testing and similar types of things. These things are slow, and they’re based on player union contracts, which are on a five-year cycle. Nonetheless, I would expect that to go away gradually.
EM: Do you believe cannabis can lower health care costs?
CBJ: Yeah, I do. I think we have excessive health care costs because patients find themselves in more expensive ways to manage their symptoms and pain, and they often end up on opioids, which can lead to opioid addiction. The consequences can be disastrous. Sixty-six thousand people in 2016 died of an opiate overdose, intentional and unintentional.
For every person who dies of an opioid overdose, there are probably 35 who end up in an emergency room. I think the likelihood of ending up in an emergency room from cannabis is dramatically less. I think it allows patients a natural option to treat symptoms of chronic pain or chronic nausea, or other symptoms associated with some serious medical conditions. I think it’s got excellent treatment value; it’s safer. I think it has significant economic value to public health as a whole.
EM: What do you think is the future for athletes and cannabis?
CBJ: I would say this: As a scientist and a researcher, my hope is that, with the continued legalization of medical marijuana, we can perform scientific studies to find out specifically where there is greater value, in muscle strain recovery or athlete-endurance recovery.
There’s a variety of areas that we can study where we think that it would have potential benefit. My expectation is that after we go through this legalization cycle we’re in now, we’re going to be able to find more specific target areas where we think cannabis is going to have great benefit to athletes.
I believe it will be in the psychological aspects of training, but more importantly, I think in the medical aspects of recovery from injury, or the effects of overtraining.
*The author of this interview prefers to remain anonymous