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BACKGROUND AND OBJECTIVES: Despite scientific evidence that marijuana impairs performance and mental health, there is evidence that some athletes are at higher risk for use. This review aims to identify possible risk factors associated with marijuana use in athletes. METHODS: A search was conducted in the PubMed database with the keywords: (marijuana OR cannabis OR tetrahydrocannabinol OR delta-9-tetrahydrocannabinol OR THC) AND (sports OR sport OR athlete OR athletes). We retrieved 186 studies. After applying the inclusion/exclusion criteria, 15 studies remained for review. RESULTS: The review revealed a number of potential risk factors for marijuana use among adult athletes, including being male, Caucasian, using sport performance-enhancing drugs, using marijuana to enhance recreation or non-sport performance, and practicing specific types of sports including skeleton, bobsleding, and ice hockey. Contrary to use patterns in the general population, among athletes marijuana appears to take the place of tobacco as the second most widely used drug, after alcohol. Many elite athletes denied the use of marijuana, which suggests that toxicological testing is an important tool for identifying users, because it is more accurate than self-report. Geography appears important, as in areas of high consumption, prevalence among athletes appears to be greater as well. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Contrary to the image that athletes do not use psychoactive drugs, this review suggests that a number of athletic subgroups are at increased risk for marijuana use. Surprisingly, a common rationale for use appears to be to enhance sports performance. As in the general population, experimentation starts early-in pre-adolescence-at an age that prevention and guidance programs could have positive influences. (Am J Addict 2016;25:518-528).

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Between 1950 and 1969, on a serendipitous basis, psychiatric drug development flourished. However, there has been a steep decline in the development of new medication classes. Instead of new molecular entities, slight molecular modifications producing “me-too” drugs attempted to garner market share. With failing profitability, industry is now withdrawing from psychiatric medication development. Managed care drastically shortened contact between patients and clinicians, so the possible observation of unexpected benefits has been nullified. The randomized, parallel-groups design met FDA requirements for specific pharmacological efficacy. However, it does not determine whether a patient who improved while drug-treated required the drug or would have gotten better on his own. Further, pathophysiology benefit remains obscure. The major psychotropic drugs have no benefits for normal subjects. Their remarkable benefits must stem from a necessary interaction with a pathophysiological state. Therefore, understanding therapeutic benefit by treating normal subjects becomes unlikely. The claim that therapeutic knowledge in psychiatry proceeds from bench to bedside has proven vacuous, primarily because of our limited understanding of brain pathophysiology. The utility of the alternative intensive design for understanding diagnosis, therapeutic benefit, and pathophysiology is emphasized.

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Between 1950 and 1969, on a serendipitous basis, psychiatric drug development flourished. However, there has been a steep decline in the development of new medication classes. Instead of new molecular entities, slight molecular modifications producing "me-too" drugs attempted to garner market share. With failing profitability, industry is now withdrawing from psychiatric medication development. Managed care drastically shortened contact between patients and clinicians, so the possible observation of unexpected benefits has been nullified. The randomized, parallel-groups design met FDA requirements for specific pharmacological efficacy. However, it does not determine whether a patient who improved while drug-treated required the drug or would have gotten better on his own. Further, pathophysiology benefit remains obscure. The major psychotropic drugs have no benefits for normal subjects. Their remarkable benefits must stem from a necessary interaction with a pathophysiological state. Therefore, understanding therapeutic benefit by treating normal subjects becomes unlikely. The claim that therapeutic knowledge in psychiatry proceeds from bench to bedside has proven vacuous, primarily because of our limited understanding of brain pathophysiology. The utility of the alternative intensive design for understanding diagnosis, therapeutic benefit, and pathophysiology is emphasized.

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