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Diana Heiman, MD
Associate Professor, Family Medicine
Residency Director
East Tennessee State University
Objectives
Introduce governing bodies in sport
Review banned and restricted
substances
Discuss therapeutic exemptions
List Anti-doping resources
Doping Definition
Use of any substance or method to increase performance, being harmful to the health of the athlete or being against the values of the game
When at least two of the above conditions are present, a substance can be banned by WADA
All athletes are responsible for knowing what is in the foods and supplements they ingest!
Governing Bodies in Sport
World Anti-Doping Agency (WADA)
Established in 1999 to “harmonize anti-
doping policies in all sports and all
countries”
United States Anti-Doping Agency
(USADA)
Created in 2000
The national anti-doping organization for the
Olympic movement in the US
USADA Covered Organizations
Covers all Olympic, Pan American and
Paralympic sport in the US
www.TeamUSA.org
Banned and Restricted
Substances Prohibited at all times
Anabolic Androgenic Steroids (AAS)
Other anabolic agents ○ Clebuterol
○ Selective androgen receptor modulators
Peptide hormones, growth factors and related substances ○ EPO
○ HGH
Beta-2 agonists
Hormone and metabolic modulators ○ Aromatase inhibitors
○ Selective Estrogen Receptor Modulators
Diuretics and other masking agents
Banned and Restricted
Substances
Prohibited methods
Manipulation of blood and blood
components (?PRP OK)
Chemical and physical manipulation
○ Tampering with samples collected during
Doping Control
○ IV infusions of over 50 mL during a 6 hour
period unless related to hospital admission or
clinical investigation
Gene doping
Banned and Restricted
Substances
Prohibited In-Competition
All of the prior substances and methods
Stimulants
○ Bupropion, caffeine, nicotine, phenylephrine, PPA, pipradol and synephrine are not banned (Monitoring Program)
○ Pseudoephedrine banned only when urine concentration > 150 micrograms/mL
Narcotics
Cannabinoids
Glucocorticosteroids (oral, IV, IM, rectal)
Banned and Restricted
Substances
Prohibited in specific sports
Alcohol (In-Competition only)
○ Aeronautic, archery, automobile, karate, motorcycling, powerboating
Beta blockers (In-Competition only unless listed)
○ Archery – also Out-of-Competition, automobile, billiards, darts, golf, shooting – also Out-of-Competition, skiing/snowboarding in ski jumping, freestyle aerials/halfpipe and snowboarding halfpipe/big air
Banned and Restricted
Substances
Monitoring Program
Substances that are not on the prohibited
list, but are monitored for patterns of misuse
in sport
○ Stimulants as previously noted In-Competition
only
○ Narcotics – hydrocodone, morphine/codeine
ratio, tapentadol, tramadol In-Competition only
○ Glucocorticosteroids – Out-of-Competition
only
Testing
Performed In-Competition and Out-of-
Competition
Out-of-Competition testing performed
based upon automated draw taking into
consideration athlete ranking, risk of
doping in the sport, test history
File “whereabouts” forms quarterly so
the athlete can be found for testing
Therapeutic Use Exemption (TUE)
“Permission to use, for therapeutic purposes, substances or methods contained in the List of Prohibited Substances or Methods where Use would otherwise be prohibited.”
Therapeutic - Of or relating to the treatment of a medical condition by remedial agents or methods; or providing or assisting in a cure.
Cases reviewed by TUE Committee made up of at least 3 physicians
TUE
Granted when: Athlete would experience a significant impairment to
health if the substance or method was withheld in treatment of an acute of chronic medical condition.
The Therapeutic use of the substance or method would not enhance performance other than returning the athlete to a normal state of health following treatment of a medical condition. Treatment to increase “low-normal” levels of an endogenous hormone are not acceptable.
There is no reasonable Therapeutic alternative to the use of the substance or method.
The necessity of the use of the substance or method cannot be a consequence of the prior use, without a TUE, of a substance or method which was prohibited at the time of use.
TUE
Cannot be approved retrospectively
except
Emergency treatment or treatment of an
acute medical condition was necessary
Due to exceptional circumstances, there
was insufficient time or opportunity for an
applicant to submit, or a TUE committee to
consider, an application prior to Doping
Control.
NCAA
Drug Testing Policy (WADA-certified labs)
Started in 1986 Started in 1990 90% DI, 65% DII, 21% DIII
NCAA
Banned drugs Stimulants
Anabolic agents
Alcohol and beta blockers (rifle only)
Diuretics and other masking agents
Street drugs
Peptide hormones and analogues
Anti-estrogens
Beta-2 agonists
Restricted drugs and procedures Blood doping
Local anesthetics (under some conditions)
Manipulation of urine samples
Beta-2 agonists allowed with prescription and by inhalation only
Caffeine – if concentrations in urine exceed 15 micrograms/mL
NFL
Policy and Program for Substances of Abuse (part of CBA) AAS
Hormones (and all related substances to agents below) ○ HGH and animal GH’s
○ HCG
○ IGF
○ EPO
Bets-2 Agonists
Anti-Estrogenic Agents
Masking agents ○ Diuretics
○ Epitestosterone
○ Probenecid
○ Finasteride
Certain stimulants (including pseudoephedrine unless prescribed by Club medical personnel)
NBA
Anti-Drug Program (part of CBA) Drugs of Abuse
○ Amphetamine and its analogs
○ LSD
○ Opiates
○ Heroin
○ PCP
○ Marijuana and its by-products
Steroids, Performance Enhancing Drugs, and Masking Agents (SPEDs) – includes stimulants
Diuretics
MLB
Joint Drug Prevention and Treatment Program (part of CBA) Any and all drugs on Schedules I and II of the Code of
Federal Regulations’ Schedule of Controlled Substances (= drugs of abuse), plus below ○ Natural and synthetic cannibinoids
○ Cocaine
○ LSD
○ Opiates
○ MDMA (Ecstacy)
○ GHB
○ PCP
Performance Enhancing Substances – all AAS on Schedule III, hormones and all “designer steroids”
Stimulants (not including PPA or pseudoephedrine)
NHL
Performance Enhancing Substances
Program (part of CBA, may be modified
given current negotiations)
Substances “relevant to the sport of hockey”
modified from the WADA banned substance
list
No list published online…
Antidoping Resources
Partnership for Clean Competition (www.cleancompetition.org)
MISSION: To protect the integrity of sport and public health by engaging and supporting the world's top scientists and innovators in high quality anti-doping research and development.
FOUNDING PARTNERS:
CONTRIBUTORS:
CORPORATE DONORS:Amgen Inc. (2011)
Antidoping Resources
Drug Free Sport (www.drugfreesport.com) The National Center for Drug Free Sport (Drug Free
Sport™) is a company devoted to preventing drug abuse in athletics. As the premier provider of drug-use prevention services for athletic organizations, Drug Free Sport provides strategic alternatives to traditional drug-use prevention programs. More importantly, Drug Free Sport is a SPORT drug-use prevention company. Unlike traditional third-party drug-testing administration companies that conduct primarily workplace and insurance testing, Drug Free Sport works exclusively with sports organizations and their athletes.
Drug testing, drug policy development, education for athletes, resource for athletic trainers and physicians
Antidoping Resources
World Anti-Doping Agency (www.wada-
ama.org)
United States Anti-Doping Agency
(www.usada.org)
Conclusions
WADA and USADA govern all Olympic
and USA sport athletes
NCAA guidelines apply to most
collegiate athletes
All professional sports have their own
testing programs and banned
substances that are linked to the CBA
for that sport
Recommended