DRUGS IN SPORTS

A.INTRODUCTION

The use of drugs in sports has had a long and well documented history. The IAAF became the first International Sporting Federation to prohibit doping, doing so in 1928 by including the following wordings in its handbook:

“Doping is the use of any stimulant not normally employed to increase the poser of action in athletic competition above the average. Any person knowingly acting or assisting as explained above shall be excluded from any place where these rules are in force or, if he is a competitor, be suspended for a time or otherwise from further participation in amateur athletics under the jurisdiction of this Federation.”

However, soon after World War II it became clear that many athletes in a wide range of sports were using drugs to enhance their performance. This practice was widespread, while measures to resist such use were limited. The death of athletes in cycling events in 1960 and 1967, which was traced to doping, aroused strong reactions and demand was made that sports authorities should intervene.

The council of Europe first defined doping in 1963 as the use of certain substances or the use of methods that could have the effect of unnaturally improving the physical and/or mental condition of a contestant before or during competition and thus enhance his or her sports performance. Although the danger associated with the use of drugs was the initial incentive for doping control, doping is now no less regarded as cheating and unethical.

In general, athletes have used drugs both to speed up development during training and to enhance their performance in the competition itself. The International Olympic Committee (IOC) established a medical commission in 1967 and approved a ban on doping in 1968. The committee defined the list of prohibited substances and the first test for stimulants were performed at the Winter Olympics in 1968. Steroids only became detectable in 1974.

International Sports Federations (IFs) also initiated doping controls at their own events and IAAF became the first IF to perform systematic out-of-competition tests, which are considered the most effective form of testing.

The authorities (such as National Anti-Doping Agencies) of various countries have taken over doping controls within their own borders and in some countries doping has been banned by law, and is therefore also punishable as such.

In 1998, several doping incidents occurred in various parts of the world, and several governments declared their dissatisfaction with the current doping control situation. As a result, the IOC called a conference in Lausanne in early 1999 with the participation of National Olympic Committees (NOCs), Government authorities, IFs, and athletes. More stringent measures were approved and “The Lausanne Declaration” was issued and the decision was made to establish The World Anti-Doping Agency (WADA), with the participation of the IOC, IFs, and governments. The purpose of WADA is to harmonise and strengthen anti-doping actions and rules across all sports and countries.

At a conference in Copenhagen in March 2003 “The World Anti-Doping Code” was formally approved and replaced the IOC anti-doping rules. The “Code” sets stricter anti-doping aims, rules and controls than were previously in effect.

WADA also took over the role of publishing the list of Prohibited Substances, which is continually under review and formally updated on 1 January each year. A substance or method is considered for inclusion on the list of WADA determines it meets any two of the following three criteria: a) it is performance enhancing, b) be dangerous to athlete’s health, c) be contrary to the spirit of sport. A substance or method can also be added to the list if WADA determines it has the capacity to mask the use of other prohibited substances or methods.

The scope of the doping problem continues to shift and expand as new compounds, chemical and pharmacological classes, and methods of doping are embraced by succeeding generations of athletes, coaches, and unscrupulous chemists. As a result, anti-doping analytical laboratories have evolved continuously to face these new challenges.

In order to meet numerous legal challenges to the anti-doping rules and regulations, more-detailed legal definitions and clarifications were devised. Today’s anti-doping regulations testing procedures, and adjudication processes are developed and refined constantly by teams of legal, medical and pharmacological-analytical experts.

Substances may be prohibited either in-competition, or both in-and-out-of-competition, depending upon their short or long term potential to enhance performance or endanger the athlete’s health. The determination as to whether a substance or method is banned, or whether it is to be sought either in-competition or both in-and out-of-competition, or neither, may be updated from year to year, depending on current scientific knowledge and an evaluation of the extent to which a substance is being abused. Hence, it is essential that sports physicians, athletes, coaches and sports administrators regularly apprise themselves of the contents of the WADA Code and List of Prohibited Substances and Methods, which is revised and published at least annually. Each new version comes into effect on 1 January.

The List is now published and revised by WADA and is made available to each member and published on the website (www.wada-ama.org) and also on the IAAF website (www.iaaf.org). WADA determination of the prohibited list and methods is not subject to legal challenge.

B:Prohibited Substances and Methods:A Brief History

Following is a brief history and selection of how the Prohibited List has evolved over the years. The classes of substance are listed by their current WADA Prohibited List titles, however these too have changed often.

The Prohibited List (the List) originally consisted only of: 

·         Psychomotor stimulant drugs

·         Miscellaneous central nervous system stimulants

·         Narcotic analgesics

·         Anabolic steroids 

At first, few individual drugs were specifically named on the list, which remained divided by substance class. The list has subsequently been under constant revision and changed considerably, with more individual substances mentioned within each group and some even deleted. In addition to Classes of Substances, the categories Prohibited Methods, Substances Prohibited in Particular Sports have been added.

1.Anabolic Steroids 

  a)Anabolic steroids initially included on the prohibited list were: methandienone, stanazolol, esters of nortestosterone, and related compounds.

  b)testosterone and its esters were added in 1979 and in 1986 the list was expanded to include any substance that increased the testosterone:epitestosterone (TE) ratio, which was initially set at 6:1 by the IOC, but decreased to 4:1 in 2005. Further investigation may be needed to determine whether the ratio is due to a physiological or pathological condition.

  c)In 1993 Anabolic Agents were divided into two categories:

   i.Androgenic Anabolic Steroids; and

  ii.Other anabolic agents (beta-2 agonists)

  d)Dihydrotestostrone was added to the list in 1995 and deemed to be positive where the concentration in urine exceeds the range of normal values.  A sample is  not regarded positive for dihyhydrotestosterone or testosterone where an athlete proves that the ratio or concentration is attributable to pathological or physiological condition. This principle was also applied in 2002 to any Prohibited Substance that is capable of being produced by the body naturally. In 2000 it was stated that evidence obtained from metabolic profiles and/or isotopic ratio measurement may be used to draw definite conclusions.

 e)Epitestosterone was listed in 1995 under Prohibited Techniques.

2.Hormones and related substances

 a.1990 the Hcg , ACTH and Hcg were includrd in the list

 b.In 1992 Erythropoietin (EPO) was added

 c.In 2000 the following were added as well: Pituitary and Synthetic Gonadotrophins (LH), Insulin-like Growth Factor (IGF-I) and insulin (but permitted to treat insulin –dependent diabetes), all other erythropoiesis-stimulating proteins.

 d.In 2005 Mechano-Growth Factors (MGFs) were added to the prohibited list.

3.Beta-2 Agonists

 a.Beta-2 Agonists first appeared on the list in 1993 as other Anabolic agents with clenbuterol as an example.

 b.Salbutamol and Terbutaline by inhalation were permitted in 1995 as exceptions, when prescribed for therapeutic purposes by properly qualified medical personnel.

 c.Salmeterol was added to the “permissible list” in 1996 and Formoterol in 2000.

 d.In 2004 it was emphasised that all beta-2 agonists are prohibitd except that formoterol, salbutamol,salmeterol and terbutaline are permitted by inhalation only to prevent and/or treat asthma/bronchoconsriction. However, a concentration of Salbutamol greater than 1000ng/ML is considered an adverse finding, despite the granting of a Therapeutic Use Exemption (TUE). In 2004 Beta-2 Agonists were classified as a Specified Substance.

4.Agents with Anti-Oestrogenic Activity

 a.Agents with Anti-Oestrogenic Activity appear on the list in 2002 as Clomifene, Cyclofenil, tamoxifen and aromatase inhibitors(prohibited in males only).

 b.In 2004 Selective Oestrogen Receptor Modulators were added.

5.Diuretics and other masking agents

 a.Masking agents were placed on the list as their own category in 2004, including but not limited to: diuretics, epitestosterone, probenecid and plasma expanders.

 b.In 2005 the name of the group was changed to Diuretics and other Masking agents and Alpha-Reductase inhibitors were added to the list.

 c.Diuretics were classified as Specified substance in 2004, but deleted from that list in 2005.

6.Stimulants

 a.Stimulant substances were initially classified in two groups as indicated previously;

 i.In 1985 they were all grouped together and simply known as stimulants;

ii.In 1990 they were divided into Amphetamines and Stimulants; 

iii.And in 2004 they were again merged into one group as stimulants.

b.Caffeine was placed on the list in 1983 but removed in 2004.

c.Ephedrine was on the original list  and in 2002 a positive finding was stipulated as concentration of more than 10 mcg/ml in urine. In 2004 it became classified as a specific substance.

d.Cocaine was includd in the list in 1990.

7.Narcotic Analgesics

a.Only a few narcotic analgesics were listed initially.

b.In 1979 Codeine was “permitted for therapeutic uses”

c.In 2006 analgesics are prohibited only in competition.

8.Cannabinoids

Cannabinoids were placed on the list in 2004 and classified as a specified substance. They are prohibited in competition only.

9.Glucocorticosteroids

a.Corticosteroids were put on the list in 1992 and prohibited by oral, intramuscular or intravenous application.

b.Rectal administration was added in 2000.

c.In 2006 Glucocorticosteroids are only prohibited in competition, and are classified as a specified substance.

10.Enhancement of oxygen transfer

a.Prohibited techniques were first introduced as such in 1990 and defined as “blood doping and techniques”.

b.Erythropoietin (EPO) was added in 1992; and blood plasma expanding products (eg HES) and artificial oxygen carriers were included in 2000.

c.In 2002 any sort of blood transfusion was prohibited as well as all erythropoiesis-stimulating proteins.

d.The term Blood Doping was changed to Enhancement of Oxygen Transfer in 2004 and defined as the use of autologus, homologous or heterologous or red blood products of any origin, other than for medical treatment.

e.Use of products that enhance the uptake, transport or delivery of oxygen is prohibited.

11.Chemical and Physical Manipulation

a.Originally entitled “Techniques”, these were defined as the use of substances that alter the integrity of the urine samples such as catheterisation, urine substitution and/or tampering or inhibition of renal excretion, eg by probenecid and related compounds.

b.Epitestosterone was added in 1995, diuretics in 1996 and bromantan in 1998.

c.In 2004 the term Prohibited Techniques was changed to Pharmacological, chemical and physical manipulation.

d.In 2005 intravenous infusions were prohibited except as legitimate acute medical treatment.

12.Gene Doping

Gene doping appears on the list for the first time in 2004.

13.Substances prohibited in particular sports

Substances prohibited in particular sports were added to the list in 2005 and consist of Alcohol and Beta-blockers. Each International Sporting Federation is able to choose whether or not they prohibit these substances. Neither of these two substances are currently prohibited by the IAAF.

14.Specified Substances

Specified substances were introduced in 2004 as substances that are susceptible to unintentional anti-doping rule violations because of availability in medicinal products. Athletes who test positive to these substances may receive a reduced sanction if they can prove they were not taken to enhance performance.

Examples of substances included on this list are: Ephidrine, L-methylamphetamine, cannabinoids, Inhaled Beta-2 Agonists(except clenbuterol), Diuretics(deleted 2005), Probenecid and Glucocorticosteroids.