2011 PROHIBITED DRUG CLASSES AND METHODS. Dr Nicolas Theron Loch Logan Waterfront Sport and Travel Medicine Centre Tel :

Transcription

1 2011 PROHIBITED DRUG CLASSES AND METHODS Dr Nicolas Theron Loch Logan Waterfront Sport and Travel Medicine Centre Tel :

2 Doping is defined as the administration of substances belonging to prohibited classes of pharmacological agents and/or the use of various prohibited methods. Introduction

3 How are drugs placed on the list? Evidence of performance enhancement Harmful to health Against the spirit of sport The use of any drug should be limited to medically justified indications

4 Ergogenic substances The list of prohibited substances is extensive but only a few substances have been shown to be ergogenic in controlled studies. Not only used by elite athletes. Consuming a substance in abnormal quantities with the intent of artificially and unfairly enhancing sports performance is per definition illegal.

5 Doping Classes In and Out of Competition S0. Any pharmacological substance not addressed below or not approved for human use S1. Anabolic agents S2. Hormones and related substances S3. Beta-2 Agonists S4. Hormone antagonists and modulators S5. Diuretics and other masking agents M1. Enhancement of oxygen transfer M2. Chemical and physical manipulation M3. Gene doping In Competition Only S6. Stimulants S7. Narcotics S8. Cannabinoids S9. Glucocorticosteroids Classes of drugs with certain restrictions P1. Alcohol P2. Beta-blockers

6 S1. Anabolic agents 1. Anabolic Androgenic Steroids a. Exogenous b. Endogenous Anabolic androgenic steroids and the B 2 stimulants(clenbuterol and salbutamol) Testosterone, nandrolone and their precursors 19-norandrostendione, dehydroepiandrosterone (DHEA), androstenedione and related substances 19-norandrostenedione, a precursor is sold freely as a supplement Testosterone:Epitestosterone (>4:1)

7 Result will be positive if values are outside of the expected normal physiological ranges or ratios, as found in normal healthy individuals. Anabolic agents

8 Anabolic agents Used to increase muscle strength, muscle bulk and aggressiveness. Athletes also take epitestosterone to maintain a normal ratio or hcg to reduce the ratio.

9 S1. Anabolic agents 2. Other Anabolic Agents Clenbuterol Selective androgen receptor modulators (SARM s)

10 S2. Hormones and Related Substances 1. Erythropoiesis-stimulating agents (erythropoeitin (EPO), Darbepoeitin (depo), Hematide) 2. Chorionic gonadotrophin (CG) and Luteinizing hormone in males 3. Insulins 4. Corticotrophins 5. Growth Hormone (GH), Insulin-like growth factors (IGF-1), Mechano growth factors (MGF s) And other substances with similar effects

11 CERA Continous Erythropoiesis Receptor Activator EPO with polyethylene glycol Prolonged activity No renal excretion

12 S3. Beta-2 agonists Inhaled Salbutamol and Salmeterol are permitted do not require a declaration of use or TUE anymore Classified as stimulants and anabolic agents Prevalence of EIA from 10% in 1984 to 60% in 1994 in American Olympic teams Oral and injectable forms are totally prohibited Terbutaline and Formoterol remain prohibited Urine Salbutamol must be less than 1000ng/ml

13 S4. Hormone Antagonists and Modulators 1. Aromatase inhibitors 2. Selective estrogen receptor modulators (SERMs) such as tamoxifen 3. Anti-estrogenic substances such as Clomiphene 4. Agents modifying myostatin functions

14 S5. Diuretics and other masking Therapeutic use exemption is not valid if threshold values of prohibited substances are found with diuretics Used by; Body builders (cutting up) For weight categories As an anti-androgen (spironolactone) agents

15 Masking agents Diuretics, epitestosterone, probenecid and plasma expanders (hydroxyethyl starch, mannitol, glycerol, dextran and albumin)

16 Doping Classes In and Out of Competition S1. Anabolic agents S2. Hormones and related substances S3. Beta-2 Agonists S4. Hormone antagonists and modulators S5. Diuretics and other masking agents M1. Enhancement of oxygen transfere M2. Chemical and physical manipulation M3. Gene doping In Competition Only S6. Stimulants S7. Narcotics S8. Cannabinoids S9. Glucocorticosteroids Classes of drugs with certain restrictions P1. Alcohol P2. Beta-blockers

17 S6. Stimulants Pseudoephedrine re-introduced Greater than 150µg/ml = adverse analytical finding All stimulants except imidazole derivatives for topical use and those on the 2010 monitoring program Used to increase performance by effects on the central nervous system, metabolism and muscle contractile function Increase alertness and reduce fatigue Amphetamines, sympathomimetic amines (cold and flu medications), beta-2 agonists and cocaine Positive effect has been documented Exercise increases [urinary] of stimulants

18 Caffeine Improves a large number of exercise parameters but there is a large individual variation Urine concentrations were not to exceed 12μg/ml

19 Caffeine Caffeine use is common due to the possible benefits gained, there is little stigma attached to it s use, it is relatively safe and the cut off for disqualification was high enough to take the risk. An athlete would need to ingest more than (6mg/kg) i.e. about 1200mg daily or 500mg of caffeine over a short period of time to return a positive test. 9mg/kg of caffeine results in concentrations as high as 14μg/ml

20 Caffeine Chocolate 100g Coffee Espresso 60ml Large Espresso Cola Tea Red Bull Bioplus 30ml Regmakers Lert Caffeine tablets 16mg mg/250ml 100mg 350mg 30-50mg/250ml 35mg-90mg 80mg/250ml 270mg 150mg 180mg 50mg

21 Be cautious Herbal products Plant sterols similar to anabolic steroids Ginseng, Ginkgo biloba, Guarana, Ma Huang and others Breakdown products similar to ephedrine or caffeine

22 Morphine and related substance Banned due to side effects Used to relieve pain Codeine, propoxyphene, tramadol and others are currently permitted S7. Narcotics

23 S8. Cannabiniods Marijuana - Prohibited

24 S9. Glucocorticosteroids All are prohibited when administered orally, intravenously, intramuscularly or rectally A declaration of use must be provided for intra-articular or other infiltrations, not for inhalation therapy Topical preparations are not prohibited

25 Doping Classes In and Out of Competition Stimulants Narcotics Anabolic agents Diuretics Peptide hormones and analogues Agents with anti-oestogenic activity Masking agents Doping methods M1. Enhancement of oxygen transfer Blood doping Artificial oxygen carriers or plasma expanders M2. Chemical and physical manipulation M3. Gene doping Classes of drugs with certain restrictions Alcohol Cannabinoids Local anaesthetics Cotricosteroids Beta-blockers

26 M1. Enhancement of Oxygen transfer 1. Blood doping in any form Not performed much anymore, due EPO use. 2. The administration of products that enhance the uptake, transport or delivery of oxygen e.g. modified haemoglobins, perfluorochemicals and plasma expanders.

27 M2. Chemical and Physical manipulation 1. Catheterization, urine substitution or tampering Masking agents Tampering (adulteration proteases) Uricosurics (probenecid) Carbonic acid anhydrase inhibitors (asetazolamide) Diuretics Bromantan Bicarbonate Alpha reductase inhibitors (finasteride, used for prostrate problems and hair loss) are now permitted

28 Other manipulations 2. Intravenous infusion for non-medical purposes is explicitly banned Sequential withdrawal, manipulation and reinfusion of whole blood

29 M3. Gene doping The use of genetic elements (nucleic acids) that have the capacity to enhance athletic performance Modified cells Peroxisome Proliferator Activated Receptor Agonists

30 Doping Classes In and Out of Competition S1. Anabolic agents S2. Hormones and related substances S3. Beta-2 Agonists S4. Hormone antagonists and modulators S5. Diuretics and other masking agents M1. Enhancement of oxygen transfere M2. Chemical and physical manipulation M3. Gene doping Out of Competition S6. Stimulants S7. Narcotics S8. Cannabinoids S9. Glucocorticosteroids Classes of drugs with certain restrictions P1. Alcohol P2. Beta-blockers

31 P1. Alcohol Blood alcohol of >0.1g/l In specific sporting codes only

32 P2. Beta-blockers In specific sporting codes only and mostly only during competition Golf was added in 2009

33 Multiple micro dosages Supplemental oxygen is permitted Platelet injection New developments No declaration of use needed for routes other than intra-muscular Intra-muscular route prohibited Personal biological passport Urine and blood testing baseline

34 Designer drugs

35 THE PROCEDURE In and out of competition Should an athlete fail to cooperate with a test the sample or lack thereof will be deemed to contain a prohibited substance

36 Supplement Contamination Results from a study by the medical commission of the IOC showed that in 634 non-hormonal nutritional supplements gathered from around the world, 94 products tested for anabolic steroids contained non-labelled substances that can produce positive doping tests. A further 66 of the products returned borderline results for various other unlabelled substances. Other research has also found that many of the OTC products are contaminated with androgenic anabolic steroids and other substances or that the concentrations of the listed contents differ substantially from that given. (Geyer etal 2000; Kamber et al 2001)

37 Conclusion The Olympic rules state that an athlete is responsible for whatever substance is found in his or her body.

38 The South African Institute for Drug Free Sport or World Anti-Doping Agency

39 THANK YOU