WHELEHANS HEALTH BLOG


Whelehans Health Blog

Thursday, 11 August 2016

Drugs in Sport (Rio Olympics Special)

With the Rio 2016 Olympics now underway, we’re coming into the business end of the event……track and field.  Many of the worlds elite athletes will be competing for gold, chasing personal bests, new world records and the ultimate rewards in their sport……… but not all. In the run up to these Olympic Games, you could hardly switch on the news without another drug / doping related issue making the headlines, with subsequent bans, exclusions (from individuals to whole countries!) before a starting gun had fired in anger. In this article I want to give you an overview of the current rules and regulations governing and working towards “drug / doping free sport”.

Doping in sport is nothing new…… perhaps since ancient times but more particularly in the last 40 years, the spectre of doping and the “clean or not clean” question has been ever present in global sport. In the Olympic context, for many, their first real awareness of doping came with the banning of Ben Johnson following his winning gold in the Olympic flagship event, the mens 100m at Seoul in 1988. Stripped of his medal following a positive test for steroids this led many to start asking questions about all athletics. Over the intervening years since there have been many high profile drugs related issues in many sports with athletics, cycling (Lance Armstrong being the most infamous) and swimming being the most prevalent, but present at some level in many more.
Why to people cheat in sport
Why do sports people and athletes in particular take drugs? There is no simple single answer to this question. However, given the risks, to health, career, lifestyle vs the potential rewards to be gained for success and victory at the highest level: prestige, money, status etc, this is most likely at the root of it.
For some, drugs offer faster recovery, harder training, for others, it’s a way to level the field in the belief that others are using drugs. Perhaps an athlete has been injured and needs to “catch up” or maybe simply a lack of knowledge or education regarding drug use or the mistaken belief that the chances of getting caught are comparatively small. Whatever the reason, where there is competition, there will always be those that are prepared to cheat to be the “winner”
Who tries to prevent drugs in sport?
It follows therefore, that where cheating through doping is present, there must be regulation to try to prevent and ultimately eliminate it. In sport today, this role falls to an organisation called WADA (World Anti-Doping Agency).  Formed in 1999, WADA is an international independent agency funded by sports authorities and governments with the overriding vision of “a world where all athletes can compete in a doping-free sporting environment”. Operating across all competitive sports and geographies, WADA monitor and enforce their World Anti-Doping Code (new 1st Jan 2015) via the various individual countries sports regulatory authorities, which in Ireland is the Irish Sports Council.
The “banned list”
WADA also produce “The List” each year. First produced in 2004, it is the definitive guide to substances or methods which are prohibited. Compiled and reviewed annually by a panel of 13 experts, it is issued each January 1st. It was this review that Maria Sharapova fell foul off in January this year when she tested positive for a substance (Meldonium) which was a new addition since the 2015 list, although advisory notices had been issued in September 2015. This resulted in a two-year ban for the Russian tennis star.
The list is divided into 9 sections across 7 main classes: -

         Stimulants (e.g. caffeine, amphetamines, cocaine)

         Build Muscle / Bone (e.g. anabolic steroids, human growth hormone)

         Relaxants (e.g. Alcohol, Beta-Blockers, Cannabinoids)

         Mask Drug use (e.g. diuretics, epistestosterone)

         Reduce Weight (e.g. diuretics)

         Increase Oxygen Delivery (e.g. EPO, Blood Doping)

         Mask Pain (e.g. Narcotics, Cortisone, local anaesthetics)

The above is purely indicative to show the differing areas covered. The actual list itself is a comprehensive and detailed description of exactly what is prohibited and is available for download or perusal from the WADA website (www.wada-ama.org).
What if an athlete needs a banned substance for a medical condition?
At some point, it may be necessary for an athlete, participating at international level or who is part of a registered testing pool in the Anti-Doping programme, to be treated with a medicinal product contained within the list, for legitimate medical reasons. In this case they may apply to WADA (via the Irish Sports Council) for a TUE (Therapeutic Use Exemption). There are a number of criteria that are used to determine whether a TUE will be granted. Irish Sports Council (ISC) policy regarding TUE’s is that the applicant should first consider any alternative treatment or medication that may be permitted rather than using a prohibited substance. If no suitable alternative is available, then the applicant should be guided by ISC policy to ensure compliance with TUE. Worth noting here that with Asthma being such a common condition, most of the commonly used inhaled medication is now permitted either in full or up to certain levels. The only time a TUE is required would be for Terbutaline (Bricanyl® inhaler), which is better known as a “reliever” or “blue” inhaler to asthmatics. Terbutaline is a similar drug to Salbutamol in Ventolin® inhalers.
The ISC also lay out a TUE policy for lower levels sports, (i.e. GAA Senior, national athletes in cycling, swimming, boxing etc.) that enables them to take the prohibited substance for genuine medicinal purposes and then if necessary, complete a “Post Test TUE”.
As you would expect, all TUE applications must be fully supported with the relevant medical history and information with details of health professionals involved.
Testing
The key to the success of any Global Anti-Doping programme is the gathering, storing and sharing of information. WADA maintains a system known as ADAMS (Anti-Doping Administration & Management System), a web based database management system which securely collects data such as an athlete’s whereabouts information, testing history (blood and / or urine), lab results and TUE management. The Irish Sports Council use a customised version of this called SIMON. All the information gathered then creates the athletes’ biological passport within the WADA infrastructure.
Top level elite athletes, subject to in or out of competition testing, are required to participate in the programme. Athletes have to provide a quarterly report of their “whereabouts” (time and place) to their relevant anti-doping agency, which is the ISC in the case of Irish Athletes. Once the information is within the database, the random testing programme is in place. So, based on the athletes whereabouts report, anti-doping authorities can turn up and test. It is vitally important therefore for any registered athlete to keep their whereabouts information up to date with changes via web, or even text etc as the penalties for a “missed test” can be severe, with whereabouts violations bans of up to 12 months can be enforced. There was a furore over the participation in the Women’s Cycling Road Race event in Rio of the British cyclist Lizzie Armitstead due to the fact that she was allowed to participate, despite 3 “missed test” violations last year.
There is an abundance of mis-information around these days for athletes trying to find out information about or indeed obtain drugs, supplements etc. From magazines to friends or fellow sports people or from gyms to coaches, whilst some might be valid, as a general rule of thumb, it’s always best to check information with the proper authorities.
With nearly every category of prescription drug available for purchase online without a prescription, as well as performance-enhancing drugs, taking this route can be a minefield as it is completely un regulated and you really have no clue what you are buying or any guarantee of quality. In addition, it is a criminal offence to import prescription only drugs into Ireland or indeed to be in possession of prescription only drug without the relevant prescription. Customs and Excise have ramped up their vigilance on illegal drug imports and convictions are increasing also.
Dangers of supplements
In addition to drugs, there are many dietary or nutritional supplements advertised that appear to offer amazing results in terms of performance improvement, again, many recommended by someone in the gym or a fellow competitor. In most cases, there is absolutely no actual evidence to support the claims made.  As they are not medicines, they are not subject to the same rules when it comes to description of ingredients or labelling. There have been incidences where supplements have contained an undeclared prohibited substance, which then show up as an adverse finding in a test.
Allegedly, it was just such an adverse finding that resulted in the boxer Michael O’Reilly being eliminated and sent home from the Rio Olympics following a positive test for a prohibited substance on 4th August. According to him, it was in a supplement he took.
In general, the ISC advise against the use of supplements believing that correct diet and balanced nutrition should provide anything a supplement claims to offer.
Creatine
One substance that often comes up in the “supplement” discussion is Creatine. Widely promoted via health and fitness publications and websites as a muscle, stamina and power builder, (kidney) it is not a prohibited substance. General advice would be to view and assess its use in the same way as supplements. Direct effects of consumption include weight increase and water retention. There is no evidence that long term use would have any adverse effect, there is some slight concern on the possible long term effect on renal function. The Irish Sports Council website offers comprehensive advice and information regarding the anti-doping programme and enforcement in Ireland. (www.irishsportscouncil.ie)
No shortcut to success
If you are engaged in sport, at whatever level, like anything in life, there is no shortcut to success. In general terms, you get out of it what you put in. If you are in any doubt at all about what you can and cannot take, it is always best to consult a health professional, either your GP or your Pharmacist or perhaps a specialist in Sports Nutrition before you take it!!! or indeed check out any of the online resources outlined above.
Updated by Eamonn Brady MPSI in Aug 2016 to coincide with the Rio Olympics.

Whelehans Pharmacy, 38 Pearse St, Mullingar (Opposite the Greville Arms Hotel). Tel 04493 34591. www.whelehans.ie or info@whelehans.ie. Find us on Facebook

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