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Drugs in Sport

The need for speed

Part One

Part One Part Two

The International Olympic Committee (IOC) Medical Code states "doping contravenes the ethics of both sport and medical science ... doping consists of the administration of substances belonging to prohibited classes of pharmacological agents or the use of various prohibited methods, or both".

Misuse of drugs in sport is not new. Athletes have always expressed a need for speed, but some interpret this pharmacologically. The first documented report was in 1865, in swimming, when an unnamed drug was used to enhance performance in a canal race in Amsterdam. In 1955, 20% of cyclists in a French cycle race tested positive for drugs. Stimulants and anabolic steroids are the most common drugs implicated. In 1967, a British cyclist died under the influence of amphetamine during the 1967 Tour de France.

In a study in West Glamorgan, 38.8% of body builders admitted to taking anabolic steroids to enhance their physique and performance. Similarly, in an American study, 54% of male body builders were abusing anabolic steroids. Of the 671 cases of drug abuse logged by the UK Drug Testing Programme, 273 involved stimulants while anabolic agents were implicated in 169 cases.

Ben Johnston, the Canadian track athlete and former Olympic gold medal winner, was banned for abusing stanozolol; interestingly he now plays American football, a sport not policed for doping.

 

The expulsion of Chinese swimmers from the 1998 World Swimming Championships in Perth also received worldwide media coverage.

Doping is back in the news again this month. A leading UK track athlete, of Lucozade fame, was allegedly reported to be getting more of a fizz from the anabolic steroid, nandrolone, and a top US sprinter, who attributed his astronomically high testosterone levels to "pleasing his wife" the night before the drug test, was banned.

Review of the UK drug testing programme reveals that sports most commonly implicated are athletics, cycling, rugby, football, powerlifting and weightlifting.

One Step Ahead

Methods of doping are becoming more advanced. According to Domhnall MacAuley, editor of the British Journal of Sports Medicine and former international rower, "tesing is becoming even more sophisticated, yet athletes seem to be at least one step ahead". Currently, the greatest concern to sports authorities are the new "sports designer drugs", the peptide hormones, predicted to be the scourge of the 2000 Olympic games in Sydney. These pose a particular problem in that they cannot be detected by currently available testing methods. Similarly, the prohibited method of blood doping is almost impossible to detect.

However, not only is doping in sport against all principles of fair competition, it can also be dangerous to an athlete's health. In July of this year, the Irish Sports Council (ISC) was established to promote sports development in Ireland. Part of the remit of the ISC will be to evolve effective antidoping procedures; education and research into doping in sport will also be part of their agenda.

How do Athletes obtain Drugs?

Athletes may obtain drugs through three main networks: their physician, the black market and the proximity network.

Many GPs prescribe drugs unwittingly, for what they trust is a genuine complaint.

Many drugs, in particular the hightech agents are purchased on the black market. The proximity network is the term used to describe acquisition of drugs from people within a close network e.g. coaches, teammates, and commonly relatives.

The Role of Prescriber and Pharmacist

Control of intentional and non-intentional drug abuse in sport requires the co-operation of athletes and prescribers. Athletes suffer the same cross-section of ailments as other patients and many sportsmen avoid all medicines because of concern about failing doping tests.

A balance is needed to have a range of drugs available to manage a variety of common disorders while maintaining a level playing field. Prescribers should be aware of prohibited medicines and routes of administration compatible with sports. The BNF includes a useful reference section on drugs in sport.

 

Prescribers' knowledge of drugs that are prohibited is generally poor. In a survey of GPs in West Sussex, only one-third were aware of the Sports Council guidelines given in the BNF and general knowledge of banned substances was highly variable. In the same survey, 20% of respondents said that they had been asked by patients to prescribe anabolic steroids for non-medical reasons.

There is a need for provision of up to date information and advice to prescribers on drugs in sport. Different sports may have different regulations and drugs banned by one sports organisation may be allowed by another. Where there is any doubt, as to the compatibility of a drug in sport, athletes should be recommended to check with their governing body .

The community pharmacist also has an important role to play in advising on appropriate use of medicines in sport. In addition to prescribed medicines, many OTC preparations also contain prohibited substances. For example, many cold, cartarrh and hayfever remedies contain sympathomimetics and analgesics may contain opioids and caffeine. It is noteworthy, that because OTC preparations are widely used for minor ailments, their abuse is more difficult to control.

Table 2 lists drugs and doping methods banned by the International Olympic Committee (IOC).

TABLE 2
Prohibited Classes of Substances and Prohibited Methods banned by the IOC


Prohibited classes of substances

Prohibited methods

Classes of drugs subject to certain restrictions
Stimulants Blood doping Alcohol
Narcotics Pharmacological, chemical and physical manipulation Marijuana
Anabolic agents - e.g. steroids, beta-agonists Local anaesthetics
Diuretics Corticosteroids
Peptide and glycoprotein hormones and analogues Beta-blockers

Drugs allowed by the IOC.


Drugs permitted for use in sport by the IOC


Anaesthetics (local, intra-articular*)
Beta-agonists (inhaled salbutamol, terbutaline, salmeterol)*
Analgesics e.g. paracetamol, aspirin, codeine
Corticosteroids (inhalers, topical, intra-articular)*
Antacids (simple)H2 antagonists (cimetidine, ranitidine)
Antibiotics
Oxymetazoline (topical)
Antidiarrhoeals (diphenoxylate, loperamide, electrolyte replacement agents)
Proton pump inhibitors
Anti-emetics (metoclopramide, domperidone)
Sodium cromoglycate Antihistamines
* prior written notification of use required