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Doping in Sport - part 2



Therapeutic Use

Some athletes require the use of drugs for the treatment of a medical condition. Athletes, just like the normal population, are not immune to illnesses or conditions where drugs are often needed for treatment purposes. For example, lets look at some reasons why athletes may need a drug that is banned by WADA.

  1. The drug Raloxifene is used to help treat the thinning of bones (osteoporosis) in postmenopausal women. Raloxifene is a selective estrogen receptor modulator (SERM) and is on the prohibited list. 
  2. Calusterone is an orally active androgenic steroid used in the treatment of breast cancer. Calusterone is on the prohibited list. 
  3. Pseudoephedrine is a common ingredient in Mucinex and Sudafed, which is used to provide relief to sinus issues, breathing issues or the cold or flu.  According to WADA, Pseudoephedrine is a specified stimulant prohibited In-Competition at a urinary threshold of 150 µg/mL. The threshold level of 150 µg/mL has been established based on the intake of therapeutic doses of pseudoephedrine, defined as a maximum daily dose of 240 mg pseudoephedrine taken either as four daily oral administrations (one every 4-6 hours) of a 60 mg (or 2 x 30 mg) immediate release preparation (i.e. tablet, capsule or liquid), or two daily administrations (one every 12 hours) of a 120 mg extended release preparation or one daily administration of a 240 mg extended release preparation. 
  4.  IV nutrient therapies, like B vitamins, are common in the holistic wellness industry. All IV (intravenous) infusions and/or injections of more than 100mL (~6.8 tablespoons) per 12 hour period are prohibited.
  5. When a male athlete presents with symptoms consistent with low testosterone, a doctor may be willing to provide a prescription. However, USADA (United States Anti-Doping Agency) will not process a TUE for the use of testosterone unless specific criteria are met by providing all required documents.
When an athlete seeks medication that is on the prohibited list, a Therapeutic Use Exemption (TUE) may give that athlete the authorization to take the needed medicine. Because some drugs can be purchased over-the-counter or online, it's important to ensure that the consumed drug does not contain other banned substances.

Drugs taken by athletes that may require a TUE include (not limited to):
  • Insulin
  • Diuretics
  • Beta-blockers
  • Beta-2-agonists
  • Glucocorticosteroids
  • Decongestant stimulants
  • Narcotics
The broad criteria for granting a TUE are:
  1. The athlete would experience a significant impairment to health if the prohibited substance or prohibited method were to be withheld in the course of treating an acute or chronic medical condition.
  2. The therapeutic use of the prohibited substance or prohibited method would produce no additional enhancement of performance other than that which might be anticipated by a return to a state of normal health following the treatment of a legitimate medical condition.
  3. There is no reasonable therapeutic alternative to the use of the otherwise prohibited substance or prohibited method.
  4. The necessity for the use of the otherwise prohibited substance or prohibited method cannot be a consequence, wholly or in part, of the prior use, without a TUE, of a substance or method which was prohibited at the time of use.
For more information on TUE - click HERE.

Social and recreational use

Did you know that up until 2004, caffeine was on the banned substance list? Whether for social purposes or for other reasons, athletes may follow their peers (or trends) and use social or recreational drugs. Although not every athlete using a recreational drug does so with the intent to enhance performance, some drugs have performance-enhancing properties. Additionally, being under the influence of these substances can pose a threat or danger to other competitors or yourself. 

Drugs on this list include (but are not limited to):
  • Alcohol
  • Cocaine
  • Cannabinoids
  • Stimulants

Performance Enhancers

Why do athletes take performance enhancing drugs? There are many factors which influence why an athlete will intentionally resort to using performance-enhancing drugs;
  • To level the playing field,
  • To win at any cost
  • To improve
  • Pressure from training partners/coach/organization/federation/country
  • To please sponsors
  • To change body composition
  • To change physiology
  • To manage depression self-worth
  • To boost self-esteem
  • To earn money
  • For recognition
  • To qualify for an event
  • To set a personal best. 
However, no reason is a good enough reason to use a banned substance. Substances on the WADA list used to enhance performance is cheating. It threatens the integrity of sport and may compromise health. Performance enhancing drugs are shortcuts (cheating) to success and are not worth it. 

SUPPLEMENTS

Although most athletes are well aware that anabolic androgenic steroids or EPO (erythropoietin) are banned by WADA, you may not be aware that there are 835 dietary supplements considered high risk due to containing a banned substance. Supplements are not well-regulated and many supplements contain undeclared substances that are prohibited under anti-doping regulations. Be mindful that any supplement used to improve performance, improve recovery, change body composition, prevent or treat nutritional deficiencies or to enhance energy, may contain banned substances.

For example, on the Supplement High Risk List

Brand Name: MetaSalt
Manufacturer: CarboPro
Could Contain: Anabolic agents
Notes: Testing of an open container of an illegible lot number revealed the presence of ostarine. A sealed container of the same lot or formulation was not available for testing. For more information about SARMs see the USADA webpage on SARMS.
What the label says: The Supplement Facts panel lists "a variety of vitamins, minerals and extracts."

Another example is Vital Nutrients DHEA. DHEA may be recommended to you from your doctor or a friend as it's believed to improve sex drive, fight the effects of aging, build muscle, seek relief from menopausal symptoms, help with depression and adrenal insufficiency and treat osteoporosis. While DHEA is allowed in medications and supplements, it's considered a prohibited anabolic agent in sport.

As an athlete, it's your responsibility to stay updated with the current rules, guidelines and prohibited substances set forth by WADA. Even if your doctor makes a medical or supplment recommendation, most doctors are not aware of the anti-doping rules in your sport. A lack of knowledge by you and your doctor about performance enhancing drugs may lead you to fail an anti-doping test, even when it's not your intention to cheat. Whether you take a supplement to improve your performance or take a medication to improve your health, it's your responsibility to know what you are about to put into your body and to comply with all rules set forth by the World Anti-Doping Code. 

Bottom line: Do your research and make sure your supplements are NSF safe.

Resources such as USADA can and the World Anti Doping Agency can help you identify products that are safe and effective or that violate a doping code. Check your sport doping code every year to recognize what substances are prohibited in and out of competition.

2023 Prohibited List
Recognize the Red Flags
High Risk Supplement List
TUE process

And lastly, even if you aren't a front pack athlete, you are not trying to qualify for the World Championship or you are just participating in sport for fun, you do not get an exemption from WADA. When you register for an event, you must comply with anti-doping rules - no matter your fitness level. These rules are not just for performance but for your health and wellbeing.

In Part 3 I'll discuss one of the most commonly used banned substance by athletes.....you may be surprised that you took a banned substance and never realized it.