Current Issues In Doping and Anti Doping in Sport David Mottram Disclaimer: PRESENTING AUTHORS HAVE NO RELATIONSHIPS TO DISCLOSE Course Aim: To revue important aspects of doping and anti doping in sport through the exploration of some of the controversial issues that have emerged in 2016. Issues Arising in 2016 Meldonium use by Maria Sharapova and other athletes Cyber hacking into WADA files by Fancy Bears Ban on Russian athletes at Rio 2016 3 1
Learning Objectives Healthcare Providers (Athlete Support Personnel) Your views are important You have a role to play in preventing doping in sport Review World Anti Doping Agency (WADA) regulations regarding anti doping in sport Outline the World Anti Doping Code International Standards for the Prohibited List, Therapeutic Use exemption and Testing and Investigations Discuss and evaluate key current issues relating to recent cases involving individuals and organisations in sport Formulate and present findings relating to the debate on current issues Provide a minimum of 3 examples that demonstrate how healthcare providers can prevent doping in sport Course Objective: For each issue: Short presentation to provide background information. Group discussion with plenary feedback The four issues will be: Inadvertent doping Therapeutic use Exemption Sanctions by Anti Doping Organisations Prohibition of glucocorticoids Issue 1 : Inadvertent Doping 7 2
Definition of Doping The illicit use of a prohibited substance or method to improve an athlete's performance. Why are drugs misused in sport? Achieve athletic success by improved performance Financial gain Improving recovery Prevention of nutritional deficiencies The idea that others use them (peer pressure) (Morente Sánchez J, Zabala M. Doping in sport: a review of elite athletes attitudes, beliefs and knowledge. Sports Med 2013; 43:395 411) Prohibited Drugs Strict Liability Rule Two Major Issues: Deliberate doping Inadvertent doping Athletes are solely responsible for any prohibited substance found in their system, whether or not there was an intention to cheat. 12 3
International Regulation of Doping in Sport The World Anti Doping Agency was established on 10 th November 1999 Mission: To lead a collaborative worldwide movement for doping free sport. Equally funded by the IOC and by governments. Annual budget around US$ 30 Million 4
World Anti-Doping Code The Code harmonizes antidoping policies, rules and regulations within sport. https://www.wada-ama.org/en/resources/thecode/world-anti-doping-code World Anti-Doping Code The Code works in conjunction with 5 International Standards: Prohibited List Therapeutic Use Exemptions (TUEs) Testing & Investigations Protection of Privacy & Personal Information Laboratories 17 17 The Prohibited List Criteria for Inclusion on the List: 1. Potential to enhance or enhances sports performance 2. Actual or potential health risk to the player https://wada main prod.s3.amazonaws.com/resources/files/wada 2016 prohibited list en.pdf 3. Use violates the spirit of sport 5
WADA Prohibited List January 2016 Prohibited List Annual Review Stakeholders WADA Prohibited List Expert Group Accredited Laboratory statistics Research evidence Prohibited List Review Timetable Prohibited List Annual Review January February March April May June July August September Review process begins Consultation with all WADA Stakeholders Examination of research evidence Review Accredited Laboratory statistics Approval by WADA Executive Committee Monitoring Program Stakeholders WADA Prohibited List Expert Group October November December Publication of new Prohibited List Accredited Laboratory statistics Research evidence January New List comes into effect 6
Monitoring Program Allows WADA to monitor patterns of use of: Substances with the potential to be misused Substances that have been removed from the Prohibited List https://www.wada ama.org/en/resources/science medicine/monitoring program Group Work Case Study Maria Sharapova Group Work Case Study Maria Sharapova Received a 2 year ban from the I.T.F. after testing positive for Meldonium during the Australian Tennis Open in January 2016 Her ban was reduced to 15 months following an appeal to C.A.S. 7
Group Work Case Study Maria Sharapova What is Meldonium and why was Sharapova taking it? Why was Meldonium placed on the WADA Prohibited List in January 2016? Who was at fault for her testing positive and why was her ban reduced to 15 months following an appeal to C.A.S.? Key Lessons: Many athletes use legal drugs to enhance performance Athletes should discuss their drug use with appropriate Healthcare providers World Anti-Doping Code The Code works in conjunction with 5 International Standards: Issue 2 : Therapeutic Use Exemption Prohibited List Therapeutic Use Exemptions (TUEs) Testing & Investigations Protection of Privacy & Personal Information Laboratories 8
International Standard Therapeutic Use Exemption A means by which an athlete can obtain approval to use a prescribed prohibited substance or method for the treatment of a legitimate medical condition https://www.wadaama.org/en/resources/therapeutic useexemption tue/international standard fortherapeutic use exemptions istue Medical Condition Attention Deficit Hyperactivity Disorder (ADHD) Arterial Hypertension Asthma Diabetes Mellitus Post infection Cough Musculoskeletal Conditions Prohibited Substances Methylphenidate; Dextroamphetamine Diuretics; Beta Blockers Terbutaline Insulin Pseudoephedrine; Oral Glucocorticoids Narcotics; Oral, Rectal, i.m or i.v. Glucocorticoids 34 Criteria for granting a TUE 1. Impairment to health if treatment withheld 2. No additional performance enhancement other than to return athletes to a normal state of health 3. No permitted alternatives exist The TUE procedure requires supporting medical evidence which includes: Medical history Evidence of an accurate diagnosis Alternatives have been considered or used Dosage & time period of treatment defined 35 36 9
Who grants TUEs? All Anti Doping Organisations (ADOs) have a panel of independent physicians called a Therapeutic Use Exemption Committee (TUEC) Fancy Bears Cyber Hack In September 2016 WADA confirmed illegal hacking into their Anti Doping Administration and Management System Data relating to the TUEs for many high profile athletes was published Fancy Bears Cyber Hack Particular attention was drawn by the media to Bradley Wiggins (Tour de France winner and Olympic Champion) 10
Bradley Wiggins TUE data Prescribed the Glucocorticoid, Triamcinolone, by injection, to treat asthma and allergies Prescribed shortly before: 2011 Tour de France 2012 Tour de France 2013 Giro d Italia Evaluated by three physicians specialized in sports medicine and/or other relevant specialities Group Work Case Study Bradley Wiggins What are the WADA regulations regarding the prohibited status of glucocorticoids? Did Bradley Wiggins contravene any antidoping regulations? Are TUE regulations appropriate? Key Lessons: Security systems need to be strengthened to avoid cyber attacks TUEs are essential for those athletes with medical conditions that require treatment with prohibited drugs The majority of athletes needing TUEs often remain at a disadvantage because of their illness/condition despite the ability to use medications Issue 3 : Sanctions by Anti Doping Organisations 11
World Anti-Doping Code The Code works in conjunction with 5 International Standards: Prohibited List Therapeutic Use Exemptions (TUEs) Testing & Investigations Protection of Privacy & Personal Information Laboratories The purpose: International Standard Testing and Investigations To plan for and conduct effective testing To promote intelligence and investigations https://www.wada ama.org/en/resources/worldanti doping program/international standard fortesting and investigations isti 0 Testing When are athletes tested? In competition Out of competition [Any time, any place, no prior notification] Registered Testing Pools Athletes who compete at the highest levels Maintained by IFs and NADOs Who is tested? Required to provide Whereabouts information 12
Whereabouts Information Athletes provide details on availability for out of competition testing: Analytical Testing An hour slot each day (between 6am and 11pm) Where they will be for those hours (home address, hotel, training venue etc.) Analytical Testing Sample Provision Key stages: Sample collection Athlete Selection Notification Sample Analysis Samples are analysed at WADA Accredited Laboratories Currently, 34 worldwide Qatar accredited in August 2015 Reporting to DCS Chaperoning Carried out by trained Doping Control Officers (DCOs) and Chaperones 13
Anti Doping Rule Violations (ADRVs) 1 Presence of a prohibited substance or its metabolites or markers in an athlete s sample 2 Use or attempted use by an athlete of a prohibited substance or a prohibited method 3 Refusing or failing without compelling justification to submit to sample collection Results Management 4 Violation of applicable requirements regarding athlete availability for out of competition testing 5 Tampering or attempted tampering with any part of doping control 6 Possession of prohibited substances and prohibited methods 7 Trafficking or attempted trafficking in any prohibited substance or prohibited method 8 Administration or attempted administration to any athlete in competition of any prohibited method or prohibited substance 9 Complicity 10 Prohibited Association Negative results: Results Management The athlete and their IF or NADO is informed Samples may be retained for 10 years for retrospective testing Positive results (1 or more ADRVs): A hearing is set up and sanctions may be applied Sanctions for ADRVs Violations result in one or both of the following: Disqualification Results are invalidated (forfeit of medals, points, prizes) Ineligibility Athlete is barred from participating or funding. Normally: First violation 4 years Second violation Lifetime 56 14
Sanctions for ADRVs Sanctions can be increased if: aggravating circumstances, e.g. trafficking or use of multiple substances and/or methods Sanctions can be reduced if: the athlete admits to the ADRV or offers substantial assistance regarding another athlete(s) the athlete can establish no significant fault or negligence (inadvertent use) Testing alone is not enough to lead the fight against doping in sport John Fahey (WADA President) 57 58 Intelligence based Anti Doping WADA co operates with: Law enforcement agencies Customs and border agencies Pharmaceutical companies Investigative journalists 2014 2016 Russian doping cases Documentary programme on Das Erte television alleges widespread doping by Russian track & field athletes CBS broadcast allegations of doping misconduct at Sochi 2014 Winter Olympics WADA set up an Independent Investigation 59 15
2014 2016 Russian doping cases Mclaren Report 61 Group Work IOC/IPC approaches to sanctions at Rio 2016 Based on the McLaren report, WADA recommended: The IOC and IPC consider to decline entries for Rio 2016 of all Russian athletes Group Work IOC approach: It is up to the IFs only to decide on the technical eligibility of athletes, in particular relating to doping issues. IPC approach: The IPC suspended the Paralympic Committee. Consequently, the RPC could not send athletes to Rio 2016 Paralympic Games Which approach do you think was correct? 16
Key Lessons: Investigative journalism is becoming an increasingly important tool in the fight against doping Any allegations must be reviewed and validated by WADA WADA and ADOs must adopt a more harmonized approach in dealing with validated investigations Issue 4 : Prohibition of Glucocorticoids WADA Prohibited List January 2016 Glucocorticoids Used for a wide range of medical conditions through various routes of administration: Dermatological Intra nasal Oral Inhalation Rectal Intramuscular injection Intravenous injection Intraarticular injection 17
Routes of administration: Dermatological Intra nasal Oral Inhalation Rectal Intramuscular injection Intravenous injection Intra articular injection Glucocorticoids WADA regulations: Permitted at all times Prohibited incompetition only Glucocorticoids WADA prohibits use because of: The potential to enhance endurance through effects on: CNS (suppression of feelings of fatigue) Metabolism (increased use of fat as a fuel resource) Anecdotal evidence of out of competition use to aid weight loss Health risks Group Work WADA review of the Prohibited List for 2017 Group Work WADA review of the Prohibited List for 2017 Excretion studies unable to differentiate between permitted and prohibited injection routes WADA Proposed Prohibit all glucocorticoid injection routes incompetition Therefore local injections can be administered no later than 72 hours before the in competition period without a TUE What are your views on this? 18
Summary After consideration of stakeholders comments, no changes were made to the WADA regulations regarding the prohibition of glucocorticoids. Conclusion Thank you for participating Thank you to colleagues at Qatar University Any further comments to: d.r.mottram@ljmu.ac.uk 19