Doping in sport relevant changes in the WADA code. Dr Chris Milne, Sports Physician Hamilton NZ

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1 Doping in sport relevant changes in the WADA code Dr Chris Milne, Sports Physician Hamilton NZ

2 Outline of talk 1-Rationale for anti-doping rules 2-Potted history 3-WADA Code the basics 4-TUEs and how to apply for them in the following groupsa-national level athletes b-international level athletes Other issues Anything else that you were afraid to ask other people

3 Rationale for anti-doping rules Sport should be about fair competition People don t like cheats Some doping agents [eg anabolic steroids, EPO, HGH] have significant health risks

4 Adverse health effects of doping agents

5 Even in the olden days there was doping

6 Potted history Ancient times- many different potions fed to soldiers Early 1900s- strychnine etc taken by cyclists in Tour de France Mid century- Tour de France organisers stopped supplying drugs!!!! Danish cyclist Kurt Jensen died at Rome Olympics from combination of amphetamines and nicotinic acid British cyclist Tommy Simpson dies in Tour de France from combination of amphetamine and alcohol 1960s- widespread use of anabolic steroids so drug testing introduced at 1968 Olympics Ben Johnson stripped of 100m gold medal in Seoul Olympics after testing positive to nandrolone Lance Armstrong finally confesses to doping on Oprah Winfrey show

7 Rogues gallery of dopes

8 They come in all shapes and sizes..

9 What is doping in 2015?- let me count the ways.. 1-Presence- of prohibited substance in sample of urine or blood 2-Use or attempted use of prohibited substance or method 3-Refusing to submit to sample collection after being notified 4-Failure to file athlete whereabouts information and missed tests 5-Tampering with any part of the doping control process

10 What is doping in 2015?- continued 6-Possession of a prohibited substance or method 7-Trafficking a prohibited substance or method 8-Administering a prohibited substance or method to an athlete 9-Complicity in an ADRV- Anti Doping Rule Violation 10-Prohibited association with sanctioned Athlete Support Personnel

11 Roles and responsibilities of Athlete Support Personnel [including doctors]-article Be knowledgeable and comply with anti-doping rules 2.2- Co-operate with the testing programme 2.3- Use your influence to foster anti-doping attitiudes 2.4- Disclose any rule violation within the past 10 years 2.5- Co-operate with anti-doping organisations re antidoping rule violations 2.6-Not use or possess any prohibited substance or method

12 Therapeutic Use Exemption [TUE] Rationale-Allows athletes to use a prohibited medicine for legitimate medical reasons Criteria 1-Impairment to health if medicine withheld 2-No enhancement of performance other than restoration of normal health 3-No reasonable therapeutic alternative exists World Anti-Doping Agency [WADA] website contains useful background information

13 TUEs- how to apply for them eg prednisone for flare of asthma or inflammatory bowel disease Document severity of condition [eg asthma] with clinical information and spirometry Submit application to Drugfree Sport NZ [or International Federation of the athlete s sport] Prescribe medication Administer medication once TUE approval granted Monitor response to therapy In emergency only- treat first, and apply later for retrospective TUE Drugfree Sport NZ hotline 0800DRUGFREE or Drugfree Sport NZ web address drugfreesport.org.nz

14 Other issues Asthma drugs Probenecid and cellulitis Supplements and anti-ageing products Blood testing to monitor health of people taking AAS

15 Asthma drugs B2 agonists- Stick to salbutamol and then your athlete patients will be spared the need to have bronchial provocation testing LABA- Salmeterol Ok Cromoglycate, tilade etc, often under used in athletes and need no notification

16 Probenecid and cellulitis Probenecid blocks renal excretion of drugs Hence its use to keep penicillin levels high in people with significant infections In the protocols of many A+M centres Athletes should know to inform staff that they are subject to testing, but you can imagine the pitfalls, even in otherwise well organised athletes.. Solution- double the dose of penicillin in athletes with significant infections. DON T use probenecid

17 Supplements and anti-ageing products A minefield Explain to the athlete that they [not you] are taking the manufacturer on trust Contamination is a huge issue eg natural herbal ED products contaminated with Viagra Helps sales of the product!!! Can get athletes into BIG trouble

18 Blood testing to monitor health of people taking AAS Why would you bother? Could be accused of aiding/abetting a corrupt practice No duty of care to such individuals- it is their choice to take AAS- they have to accept the risks

19 The future- not if we can help it

20 Thank you