Athletes and Medical Staff in Elite Contact Sports: a Quantitative Analysis of Use, Knowledge, and Attitudes Regarding Cannabinoids.

Background: Cannabis use among elite contact sport athletes increases with legal reform and commercial availability. Limited education in cannabinoid pharmacology, use, and risk persists among athletes and medical staff, fostering stigma and reducing evidence-based guidance and communication. Hypothesis Athletes use cannabis but perceive stigma and discomfort discussing cannabis with medical staff.

Study design: Quantitative, descriptive cross-sectional surveys. Level of evidence Level 4.

Methods: Two anonymous online surveys were administered to elite and professional contact sport athletes (Canada, United States, Australia) and medical and training staff (February 2023 to July 2024). Descriptive statistics assessed demographics, use patterns, knowledge, education needs, attitudes, stigma, communication, and league policies.

Results: A total of 166 athletes (89.7% male, 35.2% aged 18-23 years) and 64 medical staff (physicians, athletic therapists, strength and conditioning coaches, etc) responded. Knowledge (pharmacology, interactions, dosing) was low. Overall, 56% of athletes currently used cannabinoids (81% having ever used), but only 21.7% knew the endocannabinoid system and 67.4% were unfamiliar with therapeutic dosing. Among medical staff, 59.5% were unfamiliar with mechanisms, only 14% were familiar with dosing protocols, and 71.4% lacked confidence in making treatment plans. Of the athletes, 86.5% believed cannabis had therapeutic value, 72.3% wanted education, and 74.1% favored qualified scientists as instructors. Of the medical staff, 79.5% reported strong educational need, with 100% of staff desiring athlete-specific cannabinoid education. Stigma and communication barriers were substantial: 81.3% of athletes perceived public stigma, 66.1% perceived staff stigma, and only 21.4% felt comfortable discussing cannabis with medical staff. Staff believed athletes would be honest if approached; however,

Conclusion: Athletes and medical staff exhibit parallel knowledge gaps and strong educational needs amid high interest, use, and significant communication barriers. Evidence-informed education and stigma-reducing strategies are urgently needed. Clinical relevance Athletes increasingly use cannabinoids for pain, sleep, and recovery, while medical staff report insufficient training and low confidence. System-level education, communication, and policy updates may improve safety, decision-making, and trust.