E76 - Mark Ware and Elite Athletes

Ross Rebagliati, Michael Phelps, and Sha'Carri Richardson. Different athletes, different sports, and different eras. Tremendous athletic ability and years of arduous training aren't all they have in common. Their sporting careers have all been touched by cannabis. Dr. Mark Ware and his colleagues examined cannabis and elite athletes. What they found was captivating and thought provoking. Join Kirk and Trevor in the discussion.

https://media.blubrry.com/reefer_medness_podcast/content.blubrry.com/reefer_medness_podcast/E76_Mark_Ware_Ver2.mp3
Tuesday, 05 October 2021 15:07

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Episode Transcript

Trevor: Kirk, we're back. 

Kirk: Hey, Trevor, how's it going? 

Trevor: Good. So, we we know that you've been traveling around seeing relatives. I went on a bit of a tour around Manitoba. I got to Winnipeg, saw Doris's mom, sister and my niece. I had my, you know, everyone's had these by now, I feel, but I had my wholely-danna-I'm-doing-everything-wrong in pandemic world moments. You know, we we stayed in a hotel and that was fine. It did that during the pandemic previously that you could go down to the front desk and sort of grab a breakfast and bring it up to your room. You know, a year ago when we were taking my daughter to school. But this time it was everyone went down to the the breakfast buffet room. Together. I was in a room with people, lots of them. Together. Eating. Kind of freaked me out a little bit. And then we then we, my wife, my daughter, picked it and was a bit of a rainy day. We went to the art gallery that wasn't So, bad. There's lots of people but big space, So, I felt a little less claustrophobic. But then the next day we went to the Forks downtown Winnipeg. Again, when I was outside. Not So, bad, but then it started pouring rain. So, we all went inside and there's lots of people inside. Anyway. I think I'm getting over this whole, being in large crowds thing, but it was exciting. So, yeah, then we went out to Pinawa, saw my parents first time in two years. So, yeah, I'm hoping this is really the beginning of the end of the pandemic, not just the calm before the next wave, but I guess we'll see. 

Kirk: Yeah, I'm I'm the same as you. You know, we're we're traveling in vanHoot. We're going, you know, we're in Flin Flon. We're traveling around. When do you wear your mask? When don't you wear your mask? It's all. It's all So, confusing. And again, crowds of people, it's going to be a long time till I go to a mosh pit. 

Trevor: You know, I bet you we could do a Kickstarter campaign or something. You know what? We will donate money to some charity? You know, if you raise X number of dollars, we'll put Kirk in the mosh pit and film it. I think people will pay to see that. 

Kirk: Well, why don't we have it? Why don't we... why don't we help finance us and fundraise for us? Put me in a mosh pit. And yeah, for Reefer Medness, you can help support Reefer Medness and sponsor me in the mosh pit. Yeah, that should be fun. So, mosh pit? Athletics? Obviously, you know the average mosh piter. 

Trevor: It's a it's a Segway. It's a Segway. 

Kirk: What do you call someone in a mosh pit, a mosh pitter or a dancer? 

Trevor: George.

Kirk: George. George the dancer is in the mosh pit. Last time I saw him dance man, he was burning calories. So, yes, I think there's a Segway in there for athleticism. So, you read, you read a paper. I really enjoyed it. I also, read it a couple of days ago. Interesting paper. 

Trevor: Yeah, So, So, let's go back before the Tokyo 2020 Olympics that were really in 2021, there was a sprinter who made the news Kirk. She was American. She was fast. She had exciting hair. But that's not why she made the news. Why did she make the news? 

Kirk: I Oh gee, didn't she consume cannabis legal cannabis recreationally? 

Trevor: Yes, So, Shikari Richardson. Obviously a fantastic athlete, probably would have been a medalist if she had been at the Tokyo Olympics, was not allowed to go by the US Olympic Committee because there was cannabis in her system. And suddenly everybody's talking about cannabis and and athleticism again. You know, it's just like back in Ross Rebagliati days and 

Kirk: Phelps or Michael Phelps days or, you know, and 

Trevor: and that he actually comes up in the interview. Yeah, but the part I liked is I was listening to an interview on CBC with Perdita Felician, a famous hurdler of Canada's, as she was saying how she had heard, I'm going to get his name right. Allan Vernic who apparently is a Canadian who is the medical lead of WADA, the World Anti-Doping Agency, and he, she said that he said, cannabis and athletics "No big deal." I said, wow, you know, maybe we could. Maybe we could interview him and with a little bit of dig digging. He was on this paper, but the guy we got instead, nothing against Dr. Vernic. We got Dr. Mark Ware now I ain't going to actually pull out his biography because it is stupid long. And we'll just we'll do the quick official biography of Dr. Mark Ware. So, he's been with Canopy Growth since 2018.  He is the chief medical officer of Global Reef Research Division. He has been with McGill University, perhaps one of the preeminent universities in the country. Associate tenured associate professor at Faculty of Medicine. He got his university, his medical degree at the University of the West Indies, trained in internal medicine. Master's degree in epidemiology then he became evaluating the role of cannabis in pain management at McGill in 1999. Way pre-legalization. Director of Clinical Research and Pain Management Unit at McGill University Health Center for over 10 years. One of my favorite parts of his resume is he was one of the co-founders of the not for profit Canadian Consortium for the Investigation of Cannabinoids. So, yeah, he's in the in the "been there done that bought the T-shirt" category of everything. One of these other, I can't believe he agreed to talk to us. And he, you know, he throws out little things during the interview like, Well, you know, when I was in Lausanne, Switzerland, sitting around the table with the IOC. All right he was in was in Lausanne with the IOC chatting about cannabis. I think he's the right person to to chat to. 

Kirk: But the paper, the paper is interesting because it's a paper that basically is asking the IOC to say, What is it? What is it that bothers you about cannabis? Is it a performance enhancing drug? You know, we don't know. We don't think so. But I mean, certain drugs. I know I know that when I used to run marathons, I would train high. I would get high and then train, and some of my training runs were as long as twenty to twenty-five miles. So, you know, what they're finding is that there seems to be athletes that use cannabis. Some, it depends on the sport, some of the extreme sports. I guess more extreme sports tend to have cannabis users. But I found I found it's a nuanced study. He's not necessarily saying that cannabis is good. He's saying that we need to understand more how cannabis is being used by athletes. That's how I got the got it. 

Trevor: Oh, absolutely. And there's lots to listen to, So, listen hard to this. But two of the and we'll talk about the more as we come out. But one of the things I really like that he wants us to focus on, and I don't think he's really has an answer. And you know, that's a good researcher for you is "why." Why are there So, many athletes using cannabis? So, So, listen for what he has to say about that. And then I promise we will drop a few more. John Montgomery and references because, you know, Russell Manitoba's John Montgomery Skeleton Racer, the Vancouver Winter Olympics. Yeah, but yeah, listen to the "spirit of sport" "against the spirit of sport" and how close and how close that comes to what we talk about with stigma. But anyway, he can do a better job and does a better job than us. So, let's listen to Dr. Mark Ware and athletes in the Olympics, and we'll come back out and then throw throw a few of our thoughts in there. 

Trevor: Dr. Ware thank you very much for joining us. 

Dr. Ware: Thank you, Trevor, it's a pleasure to be with you. 

Trevor: So, it was in the news recently, Shikari Richardson, a U.S. sprinter, didn't make it to the Tokyo Olympics because some cannabis was found in her system. The interview I heard from her afterwards said, you know, she had a death in the family and was basically using the cannabis several weeks outside of competition, kind of as a coping mechanism. And she didn't really feel it was performance enhancing and wasn't a big fan of doing all that training that not making it to Tokyo. But we thought that gives us an excellent time to talk to you and see what your your group thought about the literature around cannabis and elite athletes and you know where where the science stands right now. So, let's start with what were you when you guys look through the literature, what what were you looking for when you first started looking for cannabis and elite athlete literature? What was what were you looking for? What was the idea behind it? 

Dr. Ware: Yeah. So, maybe some context behind the whole project because it actually began when I was doing some communication back and forth with the medical director of the World Anti-Doping Agency, WADA, Dr. Alan Vernec and I were back and forth about a couple of patients that he had, and he was looking after athletes who were suffering with pain management issues. And he was contacting me because of my experience in my work in the pain unit at the time at McGill University, interested to know what the evidence base behind cannabis and pain was. And So, we got talking. And in around 2016 2017, the International Olympic Committee, the IOC convened a meeting to look at ways that athletes were managing pain. And cannabis was one of the topics which was brought in to be discussed. And I was brought into the IOC as pain expert and somebody who knew a few things about cannabis to talk to them about this. And that began a series of very, very interesting meetings about the way that the IOC looks at sport, about the way they look at doping, about the way WADA regulates cannabis, in particular the cannabinoids, THC and CBD. And it led to a series of papers, one of which was a review of the literature looking at whether we could actually find any evidence that THC was a performance enhancing drug, as that's one of the criteria that the World Anti-Doping Agency and the IOC use to determine whether drugs should be prohibited or not. Long story short, we reviewed the literature extensively, published a paper finding that based on the evidence at that time, we could not find any proof that THC was a performance-enhancing substance. And therefore, on those grounds, we felt that we determined and concluded that THC wasn't performance enhancing. 

Trevor: No, thank you. And actually, that that goes nicely as I am flipping through my papers a lot.  So, two things, well, lots of things surprised me about the paper, but it wasn't until 2004. So, it's been relatively recent that that cannabis was a banned substance. You know, given my age or whatever I remember in 1998, with Ross Rebagliati winning, losing and getting back his gold medal and the Nagano Olympics because he had in his system. But I think one of the big things at the time is it wasn't actually on the list for it to be made illegal. So, I guess that happened shortly after that, but probably more germane to what we've got now. So, the three WADA criteria So, potential to enhance sport performance, which you just talked about actual or potential risk to health and against the spirit of sport. So, you guys found that wasn't actually performance enhancing, which may or may not be of interest to, you know, the general public. But I think the whole does it cause any harm? It's definitely of interest to everybody else. What did you guys look at and find out about whether or not cannabis is harming athletes who use it either recreationally or as a therapeutic. 

Dr. Ware: For that kind of question, you. It's not just about athletes, it really refers to the safety of cannabinoids in general. And I think it's really important that when we speak about cannabis in this context that we try to be really specific. Are we talking about THC or are we talking about CBD or both? And are we talking about oral formulations, inhaled formulations? All of these things have a role to play in assessing the risk of using a substance THC. Obviously, the psychoactive compound found in the sort of more recreationally used and increasingly medically relevant cannabinoids with CBD is undergoing a huge surge of interest right now. So, we have to be careful when we say Cannabis. This is what we have to really be focused on, are we talking about THC or CBD? And CBD has been taken off the list from WADA for some time now, So, it's really not a drug of interest from a performance. So, we're talking about specifically THC. And for that, what are the safety with those safety risks that we know, there's acute risks from the acute intoxication of THC longer term risk if you use it a lot, for the most part, it's a remarkably safe compound. The exception being, you know, young people using it when they're teenagers and early adolescents using early, often and heavily. So, it's actually a remarkably safe compound. And for most of these athletes who are extremely, extremely healthy, it doesn't appear and if it's used in an an oral form, particularly, it doesn't appear to pose a tremendous potential risk to the health of the athlete. So, on the grounds of performance enhancement, THC really isn't isn't performance enhancing and on the grounds of safety, this is a relatively safe compound, especially considering a lot of the other drugs that are used to treat pain in particular, but also, other substances that people use to manage symptoms, especially in elite athletes. So, good safety profile. 

Trevor: Excellent. And the last one against the spirit of sport, that was just interesting wording. So, is that is that really talking to stigma or what does against the spirit of sport mean? And how did cannabis fall into that? 

Dr. Ware: Yeah, that is a very, very it was one of the most interesting things that I found about the discussions that were taking place in Lausanne when we were sitting around the IOC table with the federation heads of all these athletic programs, international federations and talking about the spirit of sport was a real eye opener. I found it philosophically interesting, medically interesting and to try and distill it down, essentially it is what it sounds like. The ideal Olympic athlete is somebody who is seen to be at the peak of their performance at the peak of their health. They represent a role model for young people, for all of us, So, that we just coming out from an Olympic season. I mean, these are incredible people with incredible talents. And So, the spirit of sport really speaks to that, that ideal that we hold of human performance. And of course, it's shaped tremendously by our context. So, what was considered, you know, not an ideal athlete or athletic behavior for our athletes 50 years ago has changed dramatically. And as we watch cannabis undergo tremendous shifts in perception around its safety, around its regulation legality, we're seeing people recognize that cannabis now is no longer required to be prohibitive. Canada's embarked on on this legalization program from 2018. We're beginning to see cannabis much more as a normal regular part of life. Some people use it, some people don't. But we're really working hard to destigmatize that use and take away the criminal prohibition from it. So, the idea that an athlete uses cannabis as somehow diminishing their status as an athlete really deserves to be reconsidered. And I think here specifically a couple of things. One is, you may remember back in the Whistler Winter Olympics, John Montgomery won gold in the skeleton 

Trevor: and is just walking around with a jug of beer 

Dr. Ware: down this high street of Whistler, chugging pitchers of beer. And everyone was like, Yeah, go Jon, you're the man. I'm Michael Phelps wins. I don't even remember how many. Don't quote me on this seven Olympic gold medals in Rio or the event before that Sydney. And then a few months later is captured on a YouTube video, hitting a bong and doing this enormous bong hit. And of course, sponsorships are dropped. He's in trouble. He's called in like a massive thing. And I think, you know, Phelps/Montgomery cannabis/beer like we somehow we're OK with this guy chugging pitchers of beer. And yet we're really not down with Michael Phelps superhuman taking a hit on a bong like this tells us that there's a challenge with the way we approach these substances and the way we interpret that with these athletic performances. And I would ask all of your audience, think carefully about what you think it means for Shikari Richardson just because she used cannabis and it was legal for her to do So, in her state. Does that make her less of a human? Does that diminish your view of her as an athlete in the spirit of sport? I think that's a really key question that we need to keep asking ourselves. 

Trevor: Well, I'm glad you brought that up because we we talk about and deal with stigma a lot on this program and also, gives me the chance to mention John Montgomery grew up in Russell, Manitoba, which is only an hour and a half from me. So, you know, just just another plug for the local area is fantastic. No, the spirit of sport in the stigma, I'm glad you brought that up because, yeah, that even outside of sport, we we deal with that all the time. You know, in the pharmacy, I'm a practicing pharmacist and I have people come in and ask about, should should I be using cannabis? And you know, they are 78 year old lady who you know, has for her entire life had pot is bad, marijuana's bad. But you know, her friend of her friend said it might be good, but she's she's whispering it to me, you know? Do you think this might be OK for me? And yeah, stigma. Stigma around cannabis use is despite legalization in Canada is still a big issue. 

Dr. Ware: And it's the paradox, Trevor, because you know, what's the first thing? What was the first thing that drivers that the Formula One race do when they won the event? They pop up in champagne and start spraying it around. Like alcohol is OK. And yet we know the harms of alcohol far outweigh the harms of cannabis. And yet Shikari tested positive for cannabis use. It's really it's really critical. I think another thing that I want to make sure that we address here is the issue is use of cannabis and specifically THC in competition. OK. These are not prohibited, and we're seeing this actually transforming in a lot of other professional sports the NFL, the NBA, the NHL. They're changing their approaches to drug testing in general, but specifically around THC testing. In some major professional leagues are actually stopping testing or not, not not prosecuting or punishing athletes for testing positive. So, it's really now in in the world of elite sports, the use of THC in competition. So, I think it's important to also, recognize that it does not have an outright ban on using the substance. If you're if you're not actually showing up at events but showing up at to an event and then testing positive is is still considered prohibited. 

Trevor: Yeah. And I just got So, many other questions. Get it in the next little bit. But just to remind our audience, one of the problems about testing, especially with cannabinoids, is they're being fat, they're fat soluble and they hang around the system forever. And you guys even mentioned in your your paper that the metabolite that they test for they raised the level from 15 nanograms per mil in 2011, up to raise it by 10 times up to 150. Because, like you said, if someone's using it recreationally, you know that's outside of competition, but the metabolite could be in their system for a long time after that. And you know, we're assuming having no effect on them during the competition, 

Dr. Ware: To that point. And maybe it's something that your listeners may not be fully aware of, but are testing a urine level of THC. THC, the metabolite that they're testing for, to test positive at over a 150 nanograms per ml in the urine. You have to be pretty actively using cannabis. For most drug tests, if you're going for a urine test for an insurance company, they're looking at levels of 25 or maybe 50 as a cut off, So, they're much lower. But to set a urine level of one hundred and fifty nanograms, you almost have to be using cannabis while you're taking the urine test to get levels of that high. So, this is testing for fairly active current use of cannabis, So, it's important to put that number in the context of what it takes to hit that level. You have to be a pretty recent user to test positive at that level. 

Trevor: No, that's that's great. Now, I'm sure we're going to get a little bit of pushback about is cannabis really or THC really performance enhancing? And you guys do touch on it a little bit. The fact that it might help with things like anxiety and in we'll call them high risk or extremes for you. You guys specifically mentioned high risk or extreme sports like skiing and surfing, and the fact you might not be as anxious as doing crazy things with your snowboard off of a big jump might be performance enhancing, but I want to. You did mention that in the paper that there's some will call it around the edges maybe possibly performance enhancing. But one of the ones I wanted to touch on because it wasn't mentioned here, and maybe you guys didn't specifically look at it was the shooting sports where some again as a nerdy pharmacies, some some drugs that are illegal in shooting you wouldn't even think about using in other sports like beta blockers are not allowed in shooting because it it sort of calms you down. So, if you're trying to keep your bead on the target, you are more able to wear. It's, you know, you certainly wouldn't want to be taking a whole bunch of beta blockers before a combat sport or a 100 meter dash did. You was at maybe there just isn't evidence on this, but. besides the possible anxiety reducing thing in what called extreme sports, did you see anything about whether or not things like THC might possibly be in performance enhancing and things like shooting sports? 

Dr. Ware: So, we didn't specifically look at shooting and we did comb the literature. So, one of the findings was that there wasn't a great deal of good quality data out there to talk about, So, we could only really refer to what was already published. I don't recall seeing anything looking at whether an athlete in a shooting competition would be in any way enhanced if they were using cannabis and then and then trying to take their shot. But So, it's probably just a lack of evidence, rather than saying there's evidence for or against it's performance enhancement. But it does raise an important issue about what do we mean by performance enhancement as as a as a drug? And for some drugs like, you know, Erythropoietin in which raises your blood red blood cell count So, you can pump more oxygen in, that's clearly been shown to enhance performance. Cannabis use and I think this is probably the major takeaway for me, given what happened with Shikari Richardson, given the conversations that are happening around this is why are athletes using cannabis or for whatever purpose? We don't really understand this yet. And I think the changing stigma and the reducing stigma, the changing policies around cannabis possession and planned distribution allow us to start having conversations with athletes, whether they're shooters or snowboarders or long distance cyclists. Why are you using cannabis in your training program? Is it really just at the end of the hard day of training that you use it to relax? Or does it help you focus in your training? And we're aware of some people who actually use it as part of their training program because it helps them focus in on what is an enduring and arduous task of training. We need to understand this. We need to know why professional sports athletes use cannabis to better understand whether there's actually self-medication going on. Are they treating anxiety? Are they helping themselves sleep? I have friends who've been to the Olympics and it's sort of been in the Olympic Village with the athletes, and they will tell you that cannabis is not foreign to the Olympic Village. You will find it there. And why? What is this substance doing for these athletes? And if we can understand that better, we can understand what it is they're trying to achieve. And perhaps that helps us understand whether it's really about performance or whether it's somehow enabling them to do what is a highly stressful. But you think of an Olympic athlete who's showing up at the Games after years of preparation, it's all on the line for that athlete. The pressure, the anxiety, the loss of sleep, the pain from training must be enormous, the nausea and, you know, as well as anyone. Trevor, how much antiemetic properties is it? Is it that? We don't know? But I think we have an opportunity now to take the lid off this issue, explore it, examine it, talk to these athletes, take away the judgment and the stigma, and just better understand what's going on. 

Trevor: And before, but at the time, I knew I would be able to sneak this in. So, you guys did specifically look at cannabis and Paralympians. And I think that goes into the broader picture of what could you find about what athletes were actually if they were using cannabis or THC therapeutically? You know, in the paraolympians, I think one of the quotes was, you know, if they had some quote unquote phantom limb pain or other types of neurologists that, you know, this is a legitimate use of of cannabinoids. What were you finding about the Paralympians and the the non-Paraolympians? What if they were using therapeutically what they were using it for? And if they did, are they allowed to get exceptions to, you know, this is my medicine, I need it for X. 

Dr. Ware: So, yes, there is something called a therapeutic use exemption and this So, any Olympic or professional athlete going into competition can apply for a TUE, which is a therapeutic use exemption, and they have to provide some documentation. As part of the work that I did with the IOC back in in 2016-17 was reviewing the literature on cannabinoids and pain, in particular neuropathic pain, which was what I was studying at the time. That one of the targets for cannabinoid therapy. And they concluded that, you know, for athletes who had neuropathic pain and if they had spinal cord injury, amputations and a lot of Paralympians suffer from these kinds of injuries that have led to them being in the condition that they're in are using cannabinoids when other things have not held for their neuropathic pain, and we actually published in for for WADA as an example of how that therapeutic use exemption for cannabis use can be justified based on pain management principles and then a broader paper on on the, you know, just overall pain management in every sport. So, a number of papers came out of those workshops. But back to the TUE, it is possible and a number of Paralympians, So, I don't know how many. It's hard to get data, but they have applied for and can show up to a professional event or an athletic event. With the use exemption, they're encouraged to use Dronabinol or Nabilone, in which is synthetic or isolated THC compounds but if those have been tried and not work, they can have possession of cannabis for the for the treatment of their pain. Neuropathic pain is on the list, but if it's justifiable, they're allowed to possess and use the substance as part of their strategy for managing their condition in competition, if need be. So, Paralympians, a really good example of where these elite athletes are using a soft drug like cannabis and the cannabinoids to help them manage their pain So, that they can perform. 

Trevor: That was great, and I know you're a busy guy and we really appreciate the time that you've given us on this fascinating who doesn't like talking about the Olympics? Was there anything else that I missed anything else you were hoping that I talk about that you really want to get out to to the audience about cannabis and elite athletes, 

Dr. Ware: Other than just to reinforce the idea that the discussions that we're having around, you know, changing regulations about cannabis. Clearly, the U.S. is a huge part of this conversation. It's still federally illegal in the U.S. until that changes these kinds of issues, like Shikari and the U.S. Drug Association's coming down hard on athletes. Using those conversations are going to continue to happen until that U.S. regulatory approach changes. So, very much looking forward to seeing some improving and more rational drug policy coming from the US. Also, regarding products for people who are using CBD, which is perfectly allowable now. And there's no, you know, prohibition against that. But a number of products are made use for CBD products that still contain THC that haven't been regulated. They haven't been properly tested and checked. And we know that a number of CBD products contain THC. Until those products are properly regulated and properly monarch, there's always that risk that somebody does take THC who's actually not even intending to. So, I think good policy, good regulation that all of this speaks to the importance of that. It affects all of us. It also, affects the athletes that we enjoy watching and that we, some of us aspire to be like. So, I'm really grateful for you to open up the conversation, and I think it's one that we need to keep having. 

Trevor: Dr. Mark Ware this was fantastic. Thank you very much. I'm sure the audience will enjoy this interview as much as I have discovered. 

Dr. Ware: Thanks very much and appreciate your invitation, 

Trevor: Kirk, what do you think of Dr. Ware 

Kirk: I enjoyed this conversation. I was reading an article in Time magazine and the article comes from June. So, it's before. It's before the Olympics. It's an article that was written. These are the athletes you want to watch out for American athletes you want to watch out for. Of course, I started reading it. The reason why I started reading it is that it related to this story because one of the athletes discussed her mental health as an athlete and what happened in the gymnastics part of the Olympics this year. The the the best, the ultimate gymnast, you know, the 

Trevor: The GOT Greatest of all Time.

Kirk: The greatest of all time. Simone Biles. 

Trevor: Biles. 

Kirk: Long "i". sorry Biles. She didn't perform many of her events due to stress, and I'm thinking to myself, Yeah, 

Trevor: there was at a famous Japanese tennis player had issues as well.

Kirk: I'm thinking to myself, there's not a lot of anti-stress drugs that are good for a gymnast, right? So, how does a gymnast use pharmaceuticals to calm her down? Well, we know that cannabis does soothes the soul for many, many people with anxiety. So, I was thinking to myself when I heard this article, when I heard your interview was in the sense that we need to understand why athletes use cannabis and how they use cannabis and if they do use cannabis. Is it performance, is it a performance enhancer for their sport? There's So, much we don't know, but what we do know is that cannabis isn't going to make a sprinter sprint faster. We know that, and we know it doesn't make a swimmer swim faster. You're just a phenomenal athlete who went out and had a couple of bong hits and loses millions of dollars of endorsements because of stigma. Yeah, So, crazy, crazy, crazy. 

Trevor: And this is nothing against Russell Manitoba's John Montgomery. But yeah, to think about John Montgomery and we love the guy. He's from Manitoba. He did great things. He still does great things. Love the guy. But everybody celebrated him walking around the Olympic Village with literal pitches of beer. Yeah. And Dr. Ware mentions the two what the Formula One racer do? They spray champagne around. Now, as as I've said before, I am a pro-alcohol guy. I quite enjoy it. But Dr. Ware mentioned it again, So, it's worth mentioning again as pro-alcohol as I am, you don't have to do very much research to find that marijuana, cannabis, whatever you want to call it, is better for you as a whole, just recreational as as a recreation. It is better for the body than alcohol. Just hands-down. Yeah, do any amount of reading you're going to find, hands down. It's a it's better for you

Kirk: I guess, I guess

Trevor: In this case, and it's been this way for a long time, is the alcohol is definitely more socially acceptable. 

Kirk: Well, and that's the thing, and I don't want to use the word better than as a public health nurse. I'm going to say, let's 

Trevor: less harmful

Kirk: From a point of risk management, but going back to stigma, we've talked about this often in this in this podcast, and I rant about it often, you know, go to the Dauphin Countryfest and people are people are wandering around with children, with fanny packs, you know, advertising Bombay. So, they're prepared to give children fanny packs advertising alcohol. But in our province, we can't grow cannabis because they want to protect the children. We can't advertise cannabis because we protect the children and we want to keep cannabis away from schools. It is all such stigma, and even in high elite level sport, cannabis is being put upon. Well, my friends, Reefer Medness - The Podcast is here to stop that. Everyone should listen to this episode. 

Trevor: How about we don't have to stop anything? We just want to get the conversation going. 

Kirk: Conversations? No, no, no. No.  The conversation is well started. I think it's time we start coming up with, you know, the the the the reasons why still stigmatize. However, in in a couple of minutes, we're going to Segway and do another episode and I'll talk more about my experiences visiting cannabis shops across Canada. But when it comes to elite sports, I love the conclusion that they made. The conclusion of the paper says medical and non-medical cannabis can use among athletes reflects changing social and cultural norms and experiences. Although cannabis is a more prevalent in, some athletes engage in high risk sports, there is no direct evidence of performance enhancing effects in the athletes. So, the potential benefits affect cannabis. As part of pain management protocol, including reducing concussion related symptoms, deserve further attention. It's a good paper. Trevor's timely paper. Yeah, one more reason we need to study cannabis and work on the stigma. I'm Kirk. I'm the nurse. 

Trevor: I'm Trevor Shewfeld. I'm the pharmacist. 

Kirk: Well, it's a good. That was a good one and another good one, Trevor. I enjoyed that. I enjoyed that. That paper in that discussion. 

Trevor: Yeah, hopefully that's not the last time we get to talk to Dr. Ware. Have a good day, everybody. That was a good one. 

Rene: So, I guess that means it's my turn. It's Rene back here in the studio, and I'm going to play the song at the end of the show that was requested by Mark Ware, and that song is Coming in from the Cold by Bob Marley.  

Trevor: Any other last minute questions? 

Dr. Ware: No, that's all good. Trevor, thank you. Thank you for raising, and I really appreciate you bringing the Paralympians into this because I was going to try and squeeze it in somehow, I wasn't going to be an easy Segway, but I was trying to tuck it in and you just lobbed it right up there and let me get it. So, thanks for that. I was great. 

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