F. DRUGS IN SPORT Flashcards
what are the 8 anti-doping rule violations
- prohibited substance/metabolites/markers in athlete’s sample
- use or attempted use or a prohibited substance or prohibited method
- refusing or failing to submit sample
- violation of availability for out-of-competition testing
- tampering or attempted tampering with any part of doping control
- possession of prohibited substances and prohibited methods
- trafficking or attempted trafficking in any prohibited substance or prohibited method
- administration or attempted administration to any athlete in-competition of any prohibited method or prohibited substance (medical staff)
what is doping
- occurrence of 1 or more anti-doping rule violations
what can cause a ban and stripping of medals
- committing one of the ADRVs
what are the 3 sections of the WADA prohibited list
- substances and methods prohibited at all times
- substances and methods prohibited in competition (ie Olympic Games, World Cup)
- substances prohibited in particular sports
how often is the WADA prohibited list updated
annually
- 2024 list released 1/10/2023
- 2024 list in effect from 1/1/2024
categories for substances and methods prohibited at all times
S0 - Non-approved substances
S1 - Anabolic agents
S2 - Peptide hormones, growth factors, related substances and mimetics
S3 - Beta-2 agonists
S4 - Hormone and metabolic modulators
S5 - Diuretics and other masking agents
M1 - Manipulation of blood and blood components
M2 - Chemical and physical manipulation
M3 - Gene and cell doping
examples of S0 - Non-approved substances
- shouldn’t be seen anyways
- no approval by any governmental regulatory health authority for human therapeutic use (ie MHRA)
- drugs under pre-clinical/clinical development
- designer drugs
- discontinued drugs
- substances approved only for veterinary use
examples of S1 - Anabolic agents
- testosterone
- stanozolol
examples of S2 - Peptide hormones, growth factors, related substances and mimetics
EPO, goserelin
examples of S3 - Beta-2 agonists
- salbutamol
- formoterol
- salmeterol
exemptions to S3 list for asthma
- inhaled salbutamol: max 1600 micrograms over 24 hours in divided doses. Can’t exceed 600 micrograms over 8 hours starting from any dose
- inhaled formoterol: max delivered dose of 54 micrograms over 24 hours
- inhaled salmeterol: max 200 micrograms over 24 hours
- inhaled vilanterol: max 25 micrograms over 24 hours
examples of S4 - hormone and metabolic mimetics
- letrezole
- anastrezole
- exemestane
- clomifene
- tamoxifen
- insulins
examples of S5 - diuretics and other masking agents
- furosemide
- spironolactone
- amiloride
*gets prohibited drugs out of body quicker
example of M1 - Manipulation of blood and blood components
- taking own blood out then inserting before competition to boost RBCs
- administrationor reintroduction of any quantity of autologous, allogenic (homologous) or heterologous blood, orredblood cell products of any origin into the circulatory system
- artificially enhancing the uptake, transport or delivery of oxygen. Including, but not limited to:Perfluorochemicals; efaproxiral (RSR13) and modified haemoglobin products, e.g. haemoglobin-based blood substitutes and microencapsulated haemoglobin products, excluding supplemental oxygen by inhalation
- any form of intravascular manipulation of the blood or blood components by physical orchemical means
example of M2 - Chemical and physical manipulation
- artificially enhancing uptake of oxygen using modified haemoglobin
- tampering, orattempting totamper,to alter the integrity and validity ofsamplescollected duringdoping control.Including, but not limited to:Samplesubstitution and/or adulteration, e.g. addition of proteases tosample
- intravenous infusions and/or injections of more than a total of 100 mL per 12-hour periodexceptfor those legitimately received in the course of hospital treatments, surgical procedures or clinical diagnostic investigations
example of M3 - Gene and cell doping
- using medicines to alter gene expression
- ie: over-expression of genes that produce fast muscle twitch fibres for a runner
- use of nucleic acids or nucleic acid analogues that may alter genome sequences and/ or alter gene expression by any mechanism. This includes but is not limited to gene editing, gene silencing and gene transfer technologies
- the use of normal or genetically modified cells
categories for substances and methods prohibited in competition
S6 – Stimulants
S7 – Narcotics
S8 – Cannabinoids
S9 – Glucocorticoids
(all glucocorticoids prohibited when administered by oral, IV, IM, rectal route)
examples of S6 - stimulants
- ecstasy
- cocaine
- adrenaline
- ephedrine
- pseudoephedrine (only if concentration in urine is >150 micrograms per mL, different for each patient due to different PKs)
- methylphenidate
what S6 substances are in the 2024 monitoring program
- bupropion
- caffeine
- nicotine
- phenylephrine
- phenylpropanolamine
- pipradrol
- synephrine
when is caffeine prohibited
when its concentration in urine is greater than 5 micrograms per millilitre
when is ephedrine and methylephedrine prohibited
when the concentration of either in urine is greater than 10 micrograms per millilitre
when is epinephrine (adrenaline) not prohibited
in local administration, e.g. nasal, ophthalmologic, or co-administration with local anaesthetic agents
when is pseudoephedrine prohibited
when its concentration in urine is greater than 150 micrograms per millilitre
examples of S7 - Narcotics
- tramadol
examples of S8 - Cannabinoids
- produced from cannabis plants
examples of S9 - glucocorticoids
- beclometasone
- prednisolone
what is the 2024 update to S7 - Narcotics
Tramadol has been moved from the WADA Monitoring Programme to the Prohibited List
why has tramadol been moved to prohibited list
- misuse of concern due to risks of physical dependence, opiate addiction and overdose
- side effects: nausea, dizziness, vomiting and it can affect motor control
- hence dangerous for athletes and competitors (cycling and rugby)
- it masks the pain from an actual injury so there’s a risk of making injury worse
- studies show average of 1.3% faster than placebo in a cycling time trial over 25 miles
substances and methods prohibited in particular sports
P1 - Beta-blockers eg - propanolol
(darts, snooker - removes mild tremor, used in things associated with nerves as they lower heart rate and anxiety)
what used to be in substances and methods prohibited in particular sports
- alcohol
- intent of this change is not to compromise the integrity or safety of any sport where alcohol use is a concern, but rather to endorse a different means of enforcing bans on alcohol use in these sports
- ie banned through sport not a doping ban
what is a TUE
therapeutic use exemption
how is a TUE gained
- must apply for TUE before medicine (prohibited) is used
- physician completes TUE and submits
- reviewed by a panel of experts
when is a TUE granted
- your health will be significantly impaired if you do not take medicine
- the substance does not enhance your performance beyond what brings you back to normal health
- there are no alternatives available
testing of athletes
- all testing is carried out WITHOUT advance notice
targeted testing
- there has been rumours that someone is doping
- a sudden withdrawal from a competition?
- sudden unexpected improvements in performance
- athlete makes new association with a coach/doctor with a doping history
out of competition testing
- athletes must submit a quarterly “Whereabouts filing”
- includes info on where living, training and a 60 minute slot each day where they will be available for testing
in competition testing
- top placements
- random selection
what are the 2 main sanctions for doping
- disqualification
- ineligibility
disqualification
- result of event invalidated
- forfeit medals, points and/or prize
ineligibility
- athlete is prevented from competing or receiving funding
- normally two years
- can be up to four year in cases of “aggravating circumstances” ie - dangerous to other/yourself
- can be less if athlete offers “substantial assistance” to anti-doping organisation ie - admit to it and work with them
what is required to work in sports pharmacy
- prioritise patient health, safety, wellbeing, longevity
- keep current on codes of conduct, antidoping rules, legal regulations (CPD!)
- evaluate drugs for safety and efficacy when used by an athlete
- recognise misuse or abuse of prescription, non-prescription drugs or substances
- respect patient confidentiality
- provide professional patient counselling on appropriate use of drugs
- communicate effectively with other athlete support personnel
- disclose financial interests that may influence recommendation
