BANNED & RESTRICTED SUBTANCES IN SPORTS TEAM PHYSICIAN COURSE Feb 2015: San Antonio SUZANNE HECHT, MD
OBJECTIVES Introduce governing bodies in sports Review ban and restricted substances Discuss therapeutic exemptions List anti-doping resources
DOPING DEFINED Use of any substance or method to increase performance, being harmful to the athlete or against the values of the game If 2 of above are present WADA can ban
ALL ATHLETES ARE RESPONSIBLE FOR KNOWING WHAT IS IN THE FOODS & SUPPLEMENTS THEY INGEST.
DRUGS IN SPORTS: GOVERNING BODIES WADA World Anti-doping Agency Established in 1999 Goal: Harmonize anti-doping policies in all sports and all countries. USADA United States Anti-Doping Agency Established in 2000 National Anti-doping org for US Olympic Sports
USADA Jurisdiction in US sports Olympic Pan American Paralympic www.usada.org
Prohibited: At all times Anabolic Androgenic Steroids Other anabolic agents Clebuterol & Selective androgen receptor modulators Peptide hormones/growth factors & related Epo & HGH Beta-2-agonists Specific amounts & types of inhaled are OK Hormone & metabolic modulators: SERMS Diuretics & other masking agents
Prohibited Methods Manipulation of blood & blood components (? PRP OK) Chemical & physical manipulation Tampering w/ samples IV infusions >50ml over 6 hrs unless hospital admission or clinical investigation Gene doping
Prohibited In-Competition All previous substances & methods Stimulants Pseudoephedrine when urine conc >150 micrograms/ml Narcotics Cannabinoids Glucocorticosteroids Oral, IM, IV, rectal
Prohibited: Specific Sports EtOH (In-competition only) Aeronautic, archery, automobile, karate, motorcycling, powerboating Beta blockers At all times: archery, shooting In-competition: Automobile, billiards, darts, golf, skiing/snowboarding, ski jumping, freestyle aerials, halfpipe & snowboarding halfpipe/big air
Monitoring Program Substances not prohibited but monitored for patterns of misuse Stimulants Bupropion, caffeine, nicotine, phenylephrine, PPA, pipradol, & synephrine Narcotics Hydrocodone, morphine/codeine ratio, tapentadol, tramadol (in-comp only) Glucocorticosteroids Out of comp only
Testing Done in & out of competition Out of comp Automated draw which considers athlete ranking, test hx, risk of doping in that sport File whereabouts form quarterly in order to easily find the athlete
Therapeutic Use Exemption (TUE) Permission to use prohibited substances Therapeutic Treatments related to medical conditions Cases reviewed by a committee Made up of at least 3 physicians
TUE: GRANTED Significant impairment if withheld Would not enhance performance No reasonable alternative Necessity of use cannot be related to previous use of a prohibited substance taken w/o a TUE in place.
TUE No retrospective granting except Emergency Rx or Rx of an acute medical problem Due to exceptional circumstances, insufficient time to submit a TUE
NCAA Testing NCAA year round testing Division 1 & 2 NCAA Championship testing School / Conference testing Not governed by NCAA policies Need own sanctions 90% of D1, 65% D2 & 21% D3 test
NCAA: Banned Stimulants Anabolics EtOH & Beta blockers: Rifle Diuretics & Masking Street drugs Hormones Beta 2-agonists Anti-estrogens
NCAA: Restricted Blood doping Local anesthetics Urine sample manipulation Beta 2 agonists: prescription & inhalation Caffeine: urine > 15 micrograms/ml
OTHER PROGRAMS NFL NBA & WNBA NHL MLB & minors PGA & LPGA MLS
Anti-doping Resources Drug free sport www.drugfreesport.com Partnership for Clean Competition www.cleancompetition.org WADA www.wada-ama.org USADA www.usada.org
CONCLUSIONS WADA & USADA govern all Olympic & US sport athletes NCAA, College conference & individual college testing programs govern most collegiate athletes Pro sports have separate programs Things change frequently! Check appropriate web sites for updates
DON T FORGET! At the end of the day Athletes are responsible for what they put into their bodies!