ANTI-DOPING SEMINAR
MFPA April 2013
David Attard
Summary
• Doping - introduction
• Prohibited list
• Drug testing programme overview
• Positive test results
• Drug testing procedure
• Therapeutic Use Exemptions
• Clubs’ duties & responsibilities
What is Doping?
• Using a prohibited substance
• Possessing a prohibited substance
• Interfering with the testing process
• Refusal to undergo test
• Not providing whereabouts information (Out-of-
Competition). 3 missed tests/18 months for individuals in
RTP
• Encouraging or assisting others to dope (including
trafficking)
• Covering up Doping activities
• Any type of complicity regarding doping activitiy
Introduction
In 1997, Sports Illustrated asked 198 aspiring US
Olympians,
“Would you take a banned performance enhancing
substance if you were guaranteed to win and not get
caught?”
98% said “YES”
Introduction
Then, when asked,
“Would you take the same undetectable substance if
it would contribute to winning every competition for 5
years, then result in death?”
Over 50% still said “YES!!!”
Why do performers take drugs?
Increase
oxygen
transport
Lose weight,
train harder
PHYSIOLOGICAL
REASONS
To build muscle,
increase energy
Mask injury and
reduce
tiredness
Why do performers take drugs?
To increase
motivation
PSYCHOLOGICAL
REASONS
To steady
nerves
To increase
aggression
Why do performers take drugs?
They are
prepared to win
at all costs
Belief that
everyone else
is doing it
SOCIAL REASONS
Pressure to
win from
coaches,
peers and
the media
By winning
they can earn
big money
Fear of not
winning
Why shouldn’t they take drugs?
•Gives an unfair advantage
MORAL
REASONS
•Undermines the true spirit of
sport
•Reflects badly on others
LEGAL
REASONS
•Against the law of the land
•Against the law of sports
Why shouldn’t they take drugs?
HEALTH
REASONS
• Can be addictive
• Lower life expectancy
• Can cause death
• Can lead to liver disorders and heart disease
• Can suppress growth
• Can cause sexual and gynaecological
problems
• Can affect moods and behaviour causing
aggression and depression
Why shouldn’t they take drugs?
ROLE
MODELLING
•Gives a bad example to
others, especially young
people who copy their
heroes and put their lives
at risk
•Gives a bad image to
sport and lowers its
status
Why fight Doping?
• Rules of the Game
• Personal integrity
• Anti-doping rules protect Athletes’ rights
Why is Doping dangerous?
• Studies on substances for therapeutic reasons, not for
doping
• Substances or methods used by athletes have been
developed for people with health problems
• Athletes using Prohibited substances:
• Are not always followed by a doctor
• Often take larger doses
• Might use in combination with other substances
• Are often illegal or counterfeit substances that are not
regulated
How does a substance become
prohibited?
What are the criteria for adding a substance to
the List?
Must meet any 2 of the following 3 criteria:
It has the potential to enhance or enhances sport
performance;
 It represents an actual or potential health risk to
the athlete;
 It violates the Spirit of Sport.
Drugs in Sport
1. Socially acceptable: alcohol, nicotine, - NOT
2.
3.
4.
5.
PROHIBITED
Medications: OTC and prescribed drugs – MAY
BE PROHIBITED
Socially unacceptable: Marijuana, cocaine,
ecstasy, etc.
Performance enhancers
Contaminated supplements
Common medications
• There are some common medications on the Prohibited
List. An athlete or a medical professional should not
make assumptions regarding the status of any
medications.
• It is the responsibility of the athlete to ensure that all
medical professionals are aware of their status as an
athlete who could be tested. All athletes should ask
medical professionals to check the status of medications
during the prescription process and when purchasing
medications over the counter at a pharmacy.
The World Anti-Doping Code
THE 2013
PROHIBITED LIST
INTERNATIONAL
STANDARD
The official text of the Prohibited List shall be
maintained by WADA and shall be
published in English and French. In the event of any
conflict between the English
and French versions, the English version shall prevail.
This List came into effect on 1 January 2013
The Prohibited list is a document which identifies the substances and
methods prohibited in-competition, out-of-competition, and in particular
sports
PROHIBITED SUBSTANCES
S.1. Anabolic agents
1.a. Exogenous AAS (boldenone,
nandrolone, mibolerone, ... and
related substances
1.b. Endogenous AAS
2. Other anabolic agents
(clenbuterol)
S.7. Narcotics(buprenorphine,
levorphanol, meperidine, …)
S.8. Cannabinoids
S.9. Glucocorticoids
releasing factors)
PROHIBITED METHODS
M.1. Enhancement of O2 transfer
M.2. Chemical or Physical
Manipulation
M.3. Gene Doping
S.3. b-2 Agonists
S.4. Agents with anti-estrogenic
activity (aromatase inhibitors, SERMs)
S.5. Diuretics and masking agents
USE LIMITED IN SPECIFIC SPORTS
P.1. Alcohol
P.2. b-blockers (acebutolol, atenolol, sotalol,
S.2. Hormones and related
substances (hCG, hGH, ACTH, EPO, … and
(amilioride, ethacrynic acid, spironolactone, ...
and related compounds)
S.6. Stimulants (amphetamine, cocaine,
mesocarb, strychnine, ... and related
compounds)
... and related compounds)
Anabolic Agents
• Enhance muscle mass gained from strength training
- Anabolic steriods
- Testosterone precursors
Anabolic Steroids
• Testosterone derivatives – modified to increase
anabolic effects while decreasing androgenic effects
• Doses may reach 100X medical replacement dose
• Efficacy in numerous studies since the 1970’s
Anabolic steroid side effects
• Acne
• Adverse lipid profile
• Alopecia
• Hypertension
• Testicular atrophy
• Glucose intolerance
• Masculinization
• Premature epiphyseal
• Gynecomastia
• Infertility
• Mood alterations
closure
Human Growth Hormone
• Manufactured by recombinant technology for
replacement in deficient patients
• Promotes protein anabolism
• Intramuscular delivery
• No virilizing effects – attractive to women
Human Growth Hormone
• Studies suggest increases in muscle size, but not
strength (increased collagen in muscles without an
increase in contractile tissue)
• Excess may lead to SxS of acromegaly
Stimulants
• Promote CNS and muscular excitation
• Caffeine (not prohibited)
• Amphetamines
• Ephedrine (and pseudoephedrine)
Pseudo-ephedrine
• Pseudoephedrine is an ingredient in many cold, flu and
sinus remedies
• Consider using an alternative medication. There are several
products that contain phenylehphrine instead, which is permitted in
sport.
• Never exceed the manufacturers recommended dose.
• Do not use any medications that contain pseudoephedrine with 24
hours (minimum) of competing.
Specified substances
• A specified substance is a substance which allows, under
defined conditions, for a greater reduction of a two-year
sanction when an athlete tests positive for that particular
substance.
• The purpose is to recognize that it is possible for a
substance to enter an athlete’s body inadvertently, and
therefore allow a tribunal more flexibility when making a
sanctioning decision.
• Eg: Ephedrine, Pseudoephedrine, etc.
• Non-specified: Cocaine, Amphetamine, Anabolic Steroids,
HGH, etc.
Herbal products
• Some herbal products contain banned substances. For
example, the plant Ma Huang (Chinese Ephedra) contains
the banned drug ephedrine. Therefore, products
containing Ma Huang are banned. Extreme caution
should be taken when using nutritional supplements
and/or herbal products as they may contain banned
substances not shown in the list of ingredients.
Hair loss products
• Finasteride: a substance contained in particular in a
number of hair loss treatments (Propecia).
• It was added to the List in 2005 (in- and out-of
competition) following compelling research showing that
they could mask steroids in the doping control process.
• Removed from banned list in 2009 due to advances in
steroid profile assays
ED
• Sildenafil, aka: Viagra
• Not banned
• Under study as alleged enhancement of athletic
performance, especially at altitude.
Intravenous infusions (IVI)
• An IV infusion is the supply of fluids or other liquid
substrates through a vein; achieved by inserting a
specialized needle into a vein and infusing fluids at a
predetermined rate from a reservoir.
• Since 2005, intravenous (IV) infusions have been
included in the WADA list of prohibited substances and
methods under Section M2.Prohibited Methods,
• Chemical and Physical Manipulation and are prohibited
both in and out-of-competition.
• The current wording (2009) states that “Intravenous
infusions are prohibited except in the management of
surgical procedures, medical emergencies or clinical
investigations.”
Bottom line
• Check medications!
• Competent personnel, literature, websites.
• www.globaldro.co.uk
• Medications bought in one country may contain
different ingredients in another country
Beware of Supplements!
Supplements
• Supplements can present a high risk for several reasons:
• They do not fall under the same regulations as food and medicines.
This means they do not have to state all their ingredients on the
label, so you may not know what you’re taking
• Advertising of supplements can suggest untested claims about their
benefits
• Production of some supplements has low quality control, which
means that there is a chance of contamination with other products
that may be banned substances.
• Diet, lifestyle and training should all be optimised before
considering supplements.
• Athletes should assess the need for supplements by consulting an
accredited sports dietician, registered nutritionist with expertise in
sports nutrition, or a sports and exercise medicine doctor, before
taking supplements.
Key Concepts
• Performance enhancement is not limited to adding muscle
• Recovery (steroids)
• Euphoric feelings; improved focus and concentration; alteration of the perception of
fatigue (stimulants)
• Improved vision (hGH)
• What is considered a “side-effect” medically may be the desired effect
for performance-enhancement (example - pseudoephedrine)
• It is difficult (or impossible) ethically to conduct research at the doses
and combinations of substances that could be used for performanceenhancement (example – androstenedione in children)
• It is the effect of a substance, not the source, that is important
(example - “natural” dietary supplements)
MFA antidoping - Positive results (to date)
included the following substances:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Pseudoephedrine
Ephedrine
Salbutamol (without TUE, in the previous list)
Methylenedioxymethamphetamine (MDMA – Ecstacy)
Ephedrine
Cocaine
Androstenedione
Nandrolone
Stanozolol
Clenbuterol
Testosterone (physiological causes)
Cannabinoids (marijuana)
Prednisolone (without TUE)
Methylhexanamine
Comments
• Strict liability principle
• More testing….. ?
• Increasing abuse of social drugs
• Misconceptions & misperceptions of doping
control by players / clubs
• Failure to comply with regulations
• Inadequate Medical control of drug consumption
by players
• Supplement contamination
Drug testing procedure
• Urine sample is split into
two collection bottles (A &
B) and these are sealed.
• Players are given an ID no.
and sign respective forms.
• Samples dispatched to
accredited WADA lab to be
analysed
Results
• If negative – no further steps.
• If positive – player/club notified
Next steps
• B test offered.
• If still positive – case examined by Medical Commission
• Report passed on to Executive Committee and relevant
disciplinary board
• Immediate suspension pending investigation (with
exceptions)
Therapeutic Use Exemptions
• Athletes, like all others, may have illnesses or
conditions that require them to take particular
medications.
• If the medication an athlete is required to take to treat
an illness or condition happens to fall under the
Prohibited List, a Therapeutic Use Exemption may
give that athlete the authorization to take the needed
medicine.
Therapeutic Use Exemptions
• STANDARD FORM
What are the criteria for granting a
TUE?
The criteria are:
• The athlete would experience significant health
problems without taking the prohibited substance
or method,
• The therapeutic use of the substance would not
produce significant enhancement of performance,
and
• There is no reasonable therapeutic alternative to
the use of the otherwise prohibited substance or
method.
Standard form
• For any treatment involving a substance or
method on the Prohibited List.
• If approved, athlete can begin treatment only after
receiving the authorization notice from the
relevant organization (except in rare cases of an
acute life threatening condition for which a
retroactive approval may be considered).
Clubs’ duties and responsibilities
• Education of players
• Responsibility for players’ health & safety
• Close liaison with Medical Officer
• To keep up to date with procedures and revised lists
• Proper filling in of the right forms
• TUE forms
• Code of conduct during testing
• Role definition re-doping matters in each club
• ? Club policy/procedure re - Social Drug Abuse by players