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Anti-doping: 2010 Guide for Prescribers

Abbreviations
 TUE Therapeutic Use Exemption
 ISTUE International Standard for Therapeutic Use Exemptions

The World Anti-Doping Code, published by the World Anti-Doping Agency (WADA), harmonises anti-doping regulations across all sports and in all countries. This Code includes 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).

TUE forms (and guidelines) are available on www.irishsportscouncil.ie/Anti-Doping. Abbreviated TUEs which existed under a previous system are no longer valid.

Athletes should be advised to declare the use of all medications and supplements taken at the time of a drug test on the doping control form (regardless if they have completed and submitted a TUE).

Not all athletes are bound by the TUE regulations - For details of which athletes need to submit TUE applications, check out www.irishsportscouncil.ie/Anti-Doping.

Summary of the WADA 2010 Prohibited List

Substances and Methods Prohibited In and Out of Competition

Prohibited Substances

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: The following substances, including other substances with similar chemical structure or similar biological effect(s) and their releasing factors are prohibited:
 Erythropoiesis-Stimulating Agents (e.g. erythropoietin (EPO), darbepoietin, CERA).
 Chorionic Gonadotrophin and Luteinizing Hormone are prohibited in men-only.
 Insulins. Insulin-dependent diabetics are required to apply for a TUE to cover their insulin use.
 Corticotrophins, Growth Hormone and certain growth factors e.g. Insulin-like Growth Factor-1 (IGF-1), Mechano Growth Factors (MGFs), Platelet-Derived Growth Factor (PDGF), etc.
 Platelet-derived preparations (e.g. Platelet Rich Plasma, “blood spinning”) are prohibited when administered by intramuscular route; other routes of administration must be declared at the time of testing.

S3 All Beta-2 Agonists are prohibited. As an exception inhaled salbutamol (up to a maximum dose of 1600 micrograms over 24 hours) and inhaled salmeterol are permitted but must be declared by the athlete on the Doping Control Form at the time of testing. To use any other inhaled beta-2 agonist, including formoterol, fenoterol, indacaterol, salbutamol (at doses >1600mcg over 24 hours) or terbutaline, an athlete must have a medical file* in place and may require a TUE.
The presence of salbutamol in urine in excess of 1000ng/mL is presumed not to be an intended therapeutic use of the substance and will be considered as an Adverse Analytical Finding unless the Athlete proves, through a controlled pharmacokinetic study, that the abnormal result was the consequence of the use of a therapeutic dose of inhaled salbutamol.

S4 Hormones Antagonists and Modulators such as aromatase inhibitors (e.g. letrozole, exemestane, formestane), selective estrogen receptor modulators (SERMS, e.g. tamoxifen, raloxifene, toremifene), other anti-estrogenic substances (e.g. clomiphene, fulvestrant) and myostatin modifying agents are prohibited.

S5 Diuretics and other Masking Agents: Diuretics (including substances with a similar chemical or biological effect), probenecid, plasma expanders (e.g. oral and intravenous glycerol, intravenous administration of hydroxyethyl starch, etc.) are prohibited. Drosperinone and topical dorzolamine and brinzolamide are permitted.
A medical approval obtained as part of a TUE is not valid if an athlete’s urine contains a diuretic in association with threshold or sub-threshold levels of another prohibited substance.

Prohibited Methods

M1 Enhancement of oxygen transfer through blood-doping or the use of products that enhance the uptake, transport or delivery of oxygen e.g. modified haemoglobins. Supplemental oxygen is not prohibited.

M2 Tampering or attempting to tamper to alter the integrity and validity of a sample such as catheterisation or urine substitution and/or adulteration (e.g. use of proteases) is prohibited.
Intravenous infusions are prohibited and require a TUE except for those legitimately received in the course of hospital admissions 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 both their optical isomers are prohibited. Examples include modafinil, sibutramine, amphetamine, and pseudoephedrine.
From 1 January 2010 pseudoephedrine is prohibited in-competition at urinary concentrations >150mcg/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 are advised to stop taking any products containing pseudoephedrine at least 24 hrs before competition. Athletes are encouraged to talk to their doctor or pharmacist about the use of alternative permitted medications for therapeutic use during in-competition periods and only if there is no suitable alternative available should the athlete go to their GP to apply for a TUE for the use of pseudoephedrine.

Adrenaline associated with local anaesthetic agents or by local administration (e.g. nasal or ophthalmologic) is not prohibited.
Buproprion, caffeine, phenylephrine and phenylpropanolamine are not prohibited and are instead monitored in-competition by WADA in order to detect patterns of misuse in sport as part of its 2010 Monitoring Program.

S7 Narcotics: Prohibited narcotics include buprenorphine, dextromoramide, hydromorphone, morphine, methadone, oxycodone, pethidine, fentanyl and its derivatives. Codeine, dextromethorphan, dihydro-codeine, diphenoxylate, pholcodine and tramadol are permitted.
The codeine/morphine ratio is monitored by WADA in order to detect patterns of misuse in sport as part of its Monitoring Program.

S8 Cannabinoids are prohibited.

S9 Glucocorticosteroids are prohibited and require a TUE when used orally, rectally, or by intravenous or by intramuscular injection. Glucocorticosteroids administered by non-systemic (e.g. intraarticular, periarticular, perintendinous, epidural, intradermal, inhalation) routes are permitted but must be declared at the time of testing. Topical glucocorticosteroid preparations used for dermatological (including iontophoresis), auricular, nasal, ophthalmic, buccal, gingival and perinal disorders are permitted.

Substances Prohibited in Specific Sports

P1 Alcohol: Prohibited in-competition in certain sports including automobile (FIA) and motorcycling (FIM).

P2 Beta-Blockers: Prohibited in-competition in certain sports such as automobile (FIA), golf (IGF) and gymnastics (FIG). Prohibited both in- and out- of competition in Archery (FITA) and Shooting (ISSF, IPC).
WADA have undertaken to update the Prohibited List regularly.

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 2010 Prohibited List and the ISTUE which are available from the Irish Sports Council or www.wada-ama.org. All information correct at time of going to press.

Only those products with Product Authorisations (PA number) can be classified. Products should only be used in accordance with their PA. To clarify the status of a medical device containing a medicinal substance contact the Irish Sports Council.

Classification

For details on the sport classification and explanation of the symbols, see 'Sport Symbols' at the top of this page, also downloadable at the bottom.

Compiled by Eirpharm.com on behalf of the Irish Sports Council for MIMS Ireland.

More information is available from the Irish Sports Council (Telephone: (01) 8608818 Fax: (01) 8608860. Website: www.irishsportscouncil.ie/Anti-Doping), www.eirpharm.com and National Governing Bodies of Sport.

01 January 2010
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