Health Tips / Anti-Doping: 2017 Guide for Prescribers
MEDICINES AND SPORT – Anti-Doping: 2017 Guide for Prescribers
The World Anti-Doping Code, published by the World Anti-Doping Agency (WADA), harmonises anti-doping regulations across all sports and in all countries. The Prohibited List of Substances and Methods is one of the International Standards that are mandatory for all signatories of the Code. The List is a list of substances and methods which are prohibited in sport. Some of these substances are contained in medicinal products marketed in Ireland. However, in recognition of the fact that some prohibited substances may be necessary for legitimate medical treatment, the Code permits athletes and their physicians to apply for a Therapeutic Use Exemption (TUE).
Sport Ireland Therapeutic Use Exemption (TUE) Policy
If a medication is prohibited and requires a TUE, athletes should first seek to use an alternative permitted treatment. If there is no permitted alternative athletes should adhere to the Sport Ireland TUE Policy which states that athletes on the Sport Ireland Registered Testing Pool must apply for a TUE before using the substance (a Pre-Test TUE); athletes not on the Registered Testing Pool may take the substance, and if required, apply for a Post-Test TUE, but should ensure that a medical file* for use of the medication is in place. Athletes who compete at an International Level or who are on their International Federation Registered Testing Pool should check and comply with the TUE requirements of their International Federation.
*Medical file: See Glossary of MIMS Ireland. Athletes should be advised to declare the use of all medications and supplements taken in the 14 days prior to the drug test on the doping control form (regardless if they have completed and submitted a TUE). Full details, TUE Application Form and guidelines on the TUE Policy are available at www.sportireland.ie/Anti-Doping/Athlete-Zone/Therapeutic-Use-Exemptions-/ Summary of the WADA 2017 Prohibited List Substances and Methods Prohibited In- and Out-of-Competition Prohibited Substances
S0 Non-Approved Substances: Any pharmacological substance which is not addressed by any of the subsequent sections of the List and with no current approval by any governmental regulatory health authority for human therapeutic use (e.g. drugs under pre-clinical or clinical development or discontinued, designer drugs, substances approved for veterinary use only) is prohibited.
S1 Anabolic Agents are prohibited. Examples include danazol, testosterone, stanozolol, tibolone and selective androgen receptor modulators (SARMs).
S2 Peptide Hormones, Growth Factors and Related Substances and Mimetics: The following substances, including other substances with similar chemical structure or similar biological effect(s) and their respective releasing factors are prohibited:
1 Erythropoietin-Receptor agonists;
1.1 Eythropoiesis-Stimulating Agents (ESAs) [e.g. erythropoietin (EPO), darbepoietin (dEPO) CERA, peginesatide];
1.2 Non-erythropoietic EPO-Receptor agonists;
2 Hypoxia-inducible factor (HIF) stabilisers, e.g. cobalt and molidustat; and HIF activators, e.g. argon and xenon; Vitamin B12 is not prohibited;
3 Chorionic Gonadotrophin (CG) and Luteinizing Hormone (LH) and their releasing factors, e.g. buserelin, gonadorelin, leuprorelin and triptorelin, are prohibited in men-only;
4 Corticotrophins and their releasing factors;
5 Growth Hormone (GH) and its releasing factors including Growth Hormone Releasing Hormone (GHRH) and its analogues, e.g. sermorelin; Growth Hormone Secretagogues (GHS), e.g. ghrelin and ghrelin mimetics and GH-Releasing Peptides (GHRPs). Additional prohibited growth factors: Fibroblast Growth Factors (FGFs); Hepatocyte Growth Factor (HGF); Insulin-like Growth Factor-1 (IGF-1) and its analogues; Mechano Growth Factors (MGFs); Platelet-Derived Growth Factor (PDGF); Vascular-Endothelial Growth Factor (VEGF) and any other growth factor affecting muscle, tendon or ligament protein synthesis/degradation, vascularisation, energy utilisation, regenerative capacity or fibre type switching.
S3 All Beta-2 Agonists are prohibited except: • Inhaled salbutamol (up to a maximum dose of 1600μg over 24 hours, not to exceed 800μg every 12 hours); • Inhaled formoterol (up to a maximum delivered dose of 54μg over 24 hours); • Inhaled salmeterol (up to a maximum dose of 200μg over 24 hours). To use any other inhaled beta-2 agonist, including terbutaline, indacaterol, vilanterol, olodaterol, formoterol (at delivered doses >54μg over 24 hours), salmeterol (at doses >200μg over 24 hours) and salbutamol (at doses >1600μg over 24 hours, not to exceed 800μg every 12 hours; such as by nebuliser), an athlete must adhere to the TUE Policy paying particular attention to the requirements of a medical file*. Formoterol is declared in terms of the delivered dose e.g. a Turbohaler device labelled as containing 6μg of formoterol delivers 4.5μg. Check the specific delivered dose of the device when calculating formoterol doses.
S4 Hormones and Metabolic Modulators such as aromatase inhibitors (e.g. exemestane, formestane, letrozole), selective oestrogen receptor modulators (SERMS, e.g. raloxifene, tamoxifen, toremifene), other anti-oestrogenic substances (e.g. clomiphene, fulvestrant), myostatin modifying agents and metabolic modulators including insulins and insulin mimetics and trimetazidine are prohibited.
S5 Diuretics and Masking Agents: Diuretics (including substances with a similar chemical or biological effect), desmopressin, probenecid, plasma expanders (e.g. oral and IV glycerol, IV administration of albumin, dextran, hydroxyethyl starch and mannitol, etc.), vaptans (e.g. tolvaptan) are prohibited. Note: Drosperinone, ophthalmic use of carbonic anhydrase inhibitors (e.g. dorzolamine, brinzolamide) and local administration of felypressin in dental anaesthesia are permitted. Glycerol is prohibited as a plasma expander which requires the ingestion of quantities far beyond that which are commonly found in foodstuffs and toiletries. The detection in an Athlete’s Sample at all times or In-Competition, as applicable, of any quantity of the following substances subject to threshold limits: formoterol, salbutamol, cathine, ephedrine, methylephedrine and pseudoephedrine, in conjunction with a diuretic or masking agent, will be considered as an Adverse Analytical Finding unless the Athlete has an approved TUE for that substance in addition to the one granted for the diuretic or masking agent.
M1 Manipulation of blood and blood components by (1) the administration or reintroduction of any quantity of autologous, allogenic (homologous) or heterologous blood or red blood cell products of any origin into the circulatory system, (2) the use of products that enhance the uptake, transport or delivery of oxygen e.g. modified haemoglobins, or (3) any form of intravascular manipulation of the blood or blood components by physical or chemical means is prohibited. Supplemental oxygen, by inhalation, is not prohibited.
M2 Chemical or physical manipulation such as tampering or attempting to tamper to alter the integrity and validity of a sample such as urine substitution and/or adulteration (e.g. use of proteases) is prohibited. IV infusions and/or injections of more than 50ml per 6 hour period are prohibited and require a TUE except for those legitimately received in the course of hospital admissions, surgical procedures or clinical investigations. Emergency infusions will require a retroactive TUE.
M3 Gene doping. Substances and Methods Prohibited In-Competition Prohibited Substances
S6 Stimulants including their related substances and their optical isomers are prohibited. Examples include amfetamine, lisdexamfetamine, modafinil and pseudoephedrine at urinary concentrations >150μg/ml. Pseudoephedrine is found in many over the counter medicines available in pharmacies including many multi-ingredient products used as cough and cold remedies, hayfever and decongestant treatments. Athletes should stop taking any pseudoephedrine containing products at least 24 hours before competition. For therapeutic applications during the in-competition period, athletes should consider the use of alternative permitted medications after prior consultation with their doctor or pharmacist, or apply for a TUE for the use of pseudoephedrine for therapeutic purpose(s). Local administration (e.g. nasal, ophthalmologic) of adrenaline or co-administration with local anaesthetic agents or the topical/ophthalmic administration of imidazole derivatives such as xylometazoline are not prohibited.
S7 Narcotics: Prohibited narcotics include buprenorphine, dextromoramide, fentanyl and its derivatives, hydromorphone, methadone, morphine, nicomorphine, oxycodone, pethidine. Note: Codeine, dextromethorphan, dihydrocodeine, pholcodine and tramadol are permitted.
S8 Cannabinoids (natural and synthetic) and Cannabimimetics are prohibited.
S9 Glucocorticoids are prohibited and require a TUE when administered by oral, rectal, intravenous or intramuscular routes. Glucocorticoids administered by all other routes do not require a TUE.
Substances Prohibited in Specific Sports
P1 Alcohol: Prohibited in-competition in certain sports including automobile (FIA) and archery (WA).
P2 Beta-Blockers: Prohibited in-competition in certain sports such as automobile (FIA), golf (IGF) and darts (WDF). Prohibited both in- and out- of competition in Archery (WA) and Shooting (ISSF, IPC).
WADA 2017 MONITORING PROGRAMME
In order to detect patterns of misuse in sport, the following are included in the 2017 Monitoring Programme:
1. Stimulants: In-Competition only: Bupropion, caffeine, nicotine, phenylephrine, phenylpropanolamine, pipradrol, synephrine;
2. Narcotics: In-Competition only: Mitragynine; tramadol and codeine;
3. Glucocorticosteroids: In-competition (by routes of administration other than oral, intravenous, intramuscular or rectal) and Out-of-Competition (all routes of administration);
4. Telmisartan: In- and Out-of-Competition;
5. Beta-2-agonists: In- and Out-of-Competition (any combination of beta-2-agonists).
This summary is deliberately concise and is intended to be used as a guide only. For an authoritative reference source consult the complete World Anti-Doping Code, The 2017 Prohibited List and the International Standard for TUE (ISTUE) which are available from Sport Ireland or www.wada-ama. org. WADA have undertaken to update the Prohibited List regularly. All information correct at time of going to press.
Only those products with a marketing authorisation or CE mark can be classified. Products should only be used in accordance with their marketing authorisation. Classification: See list of Sport symbols in the Glossary of MIMS Ireland.
Compiled by Eirpharm.com on behalf of Sport Ireland for MIMS Ireland. More information is available from Sport Ireland (telephone: (01) 8608818; fax: (01) 8608860; website: www. sportireland.ie/anti-doping), www.eirpharm.com and National Governing Bodies of Sport.
Published December 2016.Related health tips:
- Anti-Doping: 2017 Guide for Prescribers
- Athletes Fluid Requirements
- Changes to the Prohibited List 2017
- Drugs abuse in sports
- Ephedra prohibited in the US
- IOC Study on Sports Supplements
- Irish Sports Council's Policy on Treatment of Hayfever
- What is EPO?