What is THC-COOH and why does it matter for athletes?

THC-COOH (11-nor-9-carboxy-Δ⁹-tetrahydrocannabinol) is the inactive urinary metabolite of THC. Standard urine immunoassays measure THC-COOH because it persists for days to weeks after THC exposure. The WADA in-competition threshold is 150 ng/mL with a 180 ng/mL Decision Limit; the NFL post-2024 threshold is 350 ng/mL. THC-COOH does not correlate with current impairment — it is a marker of past use.

What does "in-competition" mean under WADA?

WADA defines the in-competition period as commencing at 11:59 p.m. on the day before a competition in which the athlete is scheduled to participate, through to the end of that competition and the sample collection process (per the 2026 Prohibited List). Out-of-competition cannabis use is not a violation — but THC-COOH persistence means heavy out-of-competition use can still trigger an in-competition Adverse Analytical Finding.

What is a Therapeutic Use Exemption (TUE)?

A TUE is a formal authorization under WADA International Standard for TUE (ISTUE 2026 Article 4.1) permitting an athlete to use a substance otherwise prohibited under the WADA Code, when four criteria are met: significant health impairment without the substance; no performance enhancement beyond return-to-baseline; no reasonable therapeutic alternative; and the necessity is not the result of prior non-therapeutic use. TUEs for cannabis are theoretically possible but rarely granted.

Athlete Cannabis Glossary: AAF, THC-COOH, TUE, NSF & More

Plain-English definitions of the anti-doping and cannabis terms athletes encounter: AAF, THC-COOH, TUE, NSF Certified for Sport, Decision Limit, Substance of Abuse, Specified Substance, in-competition, sample collection.

Plain-English definitions of the anti-doping, pharmacology, and league-policy terms athletes encounter most often. Cross-references in SMALL CAPS-style bold within definitions point to other glossary entries.

Anti-Doping & Testing Terms

AAF (Adverse Analytical Finding): A laboratory result indicating the presence of a prohibited substance, metabolite, or marker at or above the applicable threshold. Triggers a results-management process under the WADA Code.
THC-COOH (11-nor-9-carboxy-Δ&sup9;-THC): The inactive urinary metabolite of THC. Standard urine immunoassays measure THC-COOH because it persists for days to weeks after exposure; confirmatory testing uses GC-MS or LC-MS/MS. THC-COOH does not correlate with current impairment — it is a marker of past use.
TUE (Therapeutic Use Exemption): Formal authorization under ISTUE 2026 Article 4.1 permitting an athlete to use a substance otherwise prohibited. Four criteria: significant health impairment without the substance; no performance enhancement beyond return-to-baseline; no reasonable therapeutic alternative; necessity not the result of prior non-therapeutic use.
NSF Certified for Sport®: Third-party batch-level certification under NSF/ANSI 173 plus the strict NSF 306 THC requirement. The only third-party CBD certification recognized by USADA, MLB, NHL, and the CFL.
Decision Limit: The actual numeric threshold above which a result is reported as an AAF, set higher than the formal threshold to account for measurement uncertainty. WADA's THC-COOH Decision Limit is 180 ng/mL, against the formal threshold of 150 ng/mL.
Substance of Abuse: WADA Article 10.2.4.1 category covering substances frequently abused outside sport. Cannabis qualifies. If the athlete can establish non-performance use, the standard sanction can be reduced to one month of ineligibility with rehabilitation.
Specified Substance: A WADA classification permitting more flexibility in sanctioning when the athlete can establish how the substance entered their body and that intent was not performance-enhancing. All Section S8 cannabinoids are Specified Substances.
In-Competition: Under WADA, the period commencing at 11:59 p.m. on the day before a competition in which the athlete is scheduled to participate, through to the end of that competition and the sample collection process.
Prohibited List: WADA's annually-updated list of substances and methods banned in sport. Section S8 (Cannabinoids) contains natural and synthetic THCs — prohibited in-competition only. The 2026 list took effect January 1, 2026.
ISTUE: International Standard for Therapeutic Use Exemptions. The 2026 ISTUE is the procedural rulebook for TUE applications.
LiEAG: List Expert Advisory Group — the WADA committee that reviews and recommends Prohibited List changes. The LiEAG conducted the cannabis review that culminated in the September 23, 2022 ExCo retention vote.

League & Governance Terms

CBA (Collective Bargaining Agreement): The labor agreement between a professional league and its players' association. Cannabis policy in U.S. pro sports is set by CBA — NBA-NBPA April 26, 2023; NFL-NFLPA March 2020 (modified December 6, 2024); MLB-MLBPA December 12, 2019.
SABH: Substance Abuse and Behavioral Health — the NHL/NHLPA program. Co-medical-directors Dr. Dave Lewis and Dr. Brian Shaw review positives anonymously and offer voluntary, confidential treatment entry.
CSAD: Combat Sports Anti-Doping — the UFC's results-management body since the January 1, 2024 transition from USADA. Sample collection by Drug Free Sport International (DFSI); analysis by SMRTL in Salt Lake City.
CSMAS: NCAA Committee on Competitive Safeguards and Medical Aspects of Sports — raised the THC-COOH threshold to 150 ng/mL in February 2022 and recommended elimination across divisions in September 2023.

Pharmacology & Endocannabinoid Terms

CB1 / CB2: The two principal cannabinoid receptors. CB1 is densely expressed in the central nervous system (basal ganglia, hippocampus, cerebellum). CB2 is predominantly peripheral on immune cells, with smaller central populations.
AEA (Anandamide): An endogenous cannabinoid — one of the body's own ligands for CB1/CB2. Plasma AEA rises with acute aerobic exercise (Sparling 2003; Raichlen 2012); CB1 blockade abolishes runner's-high anxiolysis (Fuss et al., PNAS, 2015).
2-AG (2-Arachidonoylglycerol): The other major endogenous cannabinoid ligand, generally present at higher concentrations than AEA.
FAAH (Fatty Acid Amide Hydrolase): The principal enzyme that breaks down anandamide. Genetic FAAH variation modulates individual endocannabinoid tone.
MAGL (Monoacylglycerol Lipase): The principal enzyme that breaks down 2-AG.
Ergogenic / Ergolytic: Ergogenic = performance-enhancing. Ergolytic = performance-impairing. Cannabis is, on balance, mildly ergolytic at acute doses (raised submaximal HR, reduced time-to-exhaustion); the WADA 2022 review explicitly did not conclude cannabis is ergogenic.
Washout: The period of cessation between last cannabis use and a sample-collection event sufficient to clear THC-COOH below the applicable threshold. Avery Collins's documented 5-week protocol is the most-cited athlete reference.

Performance, Recovery & Health Terms

RPE (Rating of Perceived Exertion): Subjective effort scale (typically 6-20 Borg, or 0-10 modified). The Sahinovic et al. 2025 trial found 300 mg acute CBD reduced mile-1 RPE by approximately 8%.
DOMS (Delayed-Onset Muscle Soreness): Muscle pain peaking 24-72 hours post-exercise. CBD evidence for DOMS is preliminary and mixed (Hatchett 2020, Cochrane 2021, Isenmann 2024); CBD's added value is sleep and anxiety, not DOMS specifically.
CINV (Chemotherapy-Induced Nausea and Vomiting): The clinical indication for which oral cannabinoids (nabilone, dronabinol) have the strongest non-athletic evidence base.
REM (Rapid Eye Movement) Sleep: Sleep stage associated with dreaming and motor-skill consolidation (Stickgold, Nature, 2005). THC suppresses REM at low-to-moderate doses (Schierenbeck 2008); chronic REM suppression risks blunting fine-motor skill learning — a real trade-off for skill-dependent sports.
CTE (Chronic Traumatic Encephalopathy): Neurodegenerative condition associated with repeated head trauma. The Calvin Johnson / Rob Sims / Primitiv-Harvard partnership and the University of Regina (Dr. Patrick Neary) NFL Joint PMC project both target cannabinoids for CTE/concussion neuroprotection.
MAPS (Multidisciplinary Association for Psychedelic Studies): Research nonprofit relevant to athletes through the broader cannabinoid/psychedelic mental-health research landscape, particularly post-career mental-health work.