DRUGS IN SPORT WHAT YOU NEED TO KNOW IN 2017 AND WHAT S REALLY HAPPENING AT THE POINTY END OF ANTI-DOPING

DRUGS IN SPORT WHAT YOU NEED TO KNOW IN 2017 AND WHAT S REALLY HAPPENING AT THE POINTY END OF ANTI-DOPING

WHAT YOU NEED TO KNOW IN 2017

WADA 2017 PROHIBITED LIST -NOT MUCH CHANGE Additions S1 Deta 2 added as an example of DHEA (found in supplements), S2 ESAs sotatercept, S4 Aromatase inhibitors arimistane added as an example Reconfirmed - Higenamine as a prohibited B2agonist found in supplements Changed salbutamol dosing to 800mcg in 12 hrs (remains confusing!!) Monitoring List 2017: Codeine, Concurrent use of B2agonists* (Royal Commission in Scandinavia)

WHAT COULD HAVE HAPPENED!! April 2016: 2017 Draft List All Glucocorticoids prohibited when administered by injection, oral or rectal routes Explanatory notes said local injections can be administered no later than 72 hours before the start of an in-competition period (i.e. <72 hrs = TUE) - Strongly supported by Europeans on List Committee - Overwhelming objections from stakeholders so it was rejected BUT they (Europeans) are planning on trying again for 2018

ASDMAC S POSITION (AND MANY OTHERS) DO NOT prohibit local injections of glucocorticoids within 72 hours of competition, because.. Rationale is not clear -? performance enhancing - no evidence -? Poor medical practice - potential harm to health better managed by rule changes -? concern about masking oral or IM use in competition - not on testing results Logistics of results management/tues etc would be a nightmare. Anti-doping time, money and energy could be far better spent

WADA PROHIBITED LIST- HAVE YOUR SAY CLINICAL INPUT IS GENERALLY LACKING (2017 THE WADA LIST COMMITTEE HAS 4 PHYSICIANS, INCLUDING PETER HARCOURT) STAKE HOLDER COMMENTS ARE CONSIDERED NATIONAL SPORTS, ACESP, ASDMAC IT IS IMPORTANT TO PROVIDE A CLINICAL PERSPECTIVE WE ARE ALL RESPONSIBLE IF YOU HAVE AN OPPORTUNITY.. RESPOND (? ACSEP/ASDMAC GROUP PROVIDE GUIDANCE?...GCS INJECTIONS, ASTHMA MEDICATION DOSING

ASDMAC- CURRENT ISSUES/QUERIES/REQUESTS 1) IV fluids defining in-hospital easy in Australia, hard for the World IV clinics vitamins/hangovers (*social media) Fe infusions does the Fe need to be justified to grant TUE?? (*WADA is looking at this) 2) Rh PDGF TUE requests for delayed bone union, off label use??? 3) Phone/Urgent approvals ASDMAC provides this service but this reassurance Is being abused by some. Not giving the complete circumstances, not producing paperwork in a reasonable time Blacklist/reject

POSITIVE TESTS (IN AUSTRALIA) IN 2016 Majority methylhexanamine, oxilofrine, higenamine (B2-agonist).. likely to be due to tainted supplements Anabolic Agents cycling, lifting/bodybuilding sports Ostarine SARM motorcycling, weightlifting Therapeutic drugs without TUEs terbutaline, prednisolone, probenecid, ADHD meds

TUES- WHO NEEDS THEM? DEPENDS ON LEVEL OF ATHLETE AND SPORT PLAYED 1. International athletes- apply to International Federation TUE Committee 2. National Level athlete in advance TUE apply to ASDMAC 3. Below National Level ( see classification for each sport and competition in TUE section of the ASADA website) only need a TUE if drug tested and return a positive test = Planned Retroactive TUE* * still needs to meet the WADA TUE criteria ( not an automatic right)

TUES WHAT YOU NEED TO DO - Check athletes medications particularly after hospital admissionsprobenicid, oral narcotics - Check international players- baseball, cricket, soccer -? TUE,? Valid duration, - Send a clinical letter, investigations, 2 nd opinions - Check level of athlete in advance means IN ADVANCE ( if no TUE when tested, can apply for a retroactive TUE but must meet the criteria of- emergency or exceptional circumstances I forgot or didn t know is NOT a criteria )

ANTI-DOPING IN 2016 WHAT S REALLY HAPPENING AT THE POINTY END??

Fancy Bears / Dancing Bears/ Fuzzy Balls a Russian distraction tactic Release of TUE information- including medical documents and TUE certificates Accessed from ADAMs WADA s apparently secure data storage system WADA s response - Multiple cyber experts - Email password access Rio Olympic Athletes all current and past TUEs - No access to whereabouts - Reassured stakeholders could continue to use safely?!

FANCY BEARS ASADA/ASDMAC response - Stopped using ADAMS for TUEs and results management in September - Contacted affected athletes and offered advice/counselling As of December 2016 - Australian Government Cyber experts satisfied ADAMs now secure ASADA/ASDMAC started using ADAMs again

FANCY BEARS- MAY HAVE HELPED Not all TUE Committees are competent Not all TUE committees are composed according to the WADA Code ie 3 physicians Not all TUEs are scrutinised by WADA (lack of resources) WADA TUE Expert Group have advised - Audit TUE Committees compositions and TUE processes - WADA increase surveillance of submitted TUEs

ARE WE CATCHING THE CHEATS

WE CAN CATCH CHEATS:- 2016 A RECORD!! Retesting of stored samples as detection techniques improve IOC reanalysis of Beijing and London samples (new steroid metabolite detection) Haematological Passport Whistle-blowers from Russia McLaren reports indicate systematic, government sanctioned doping evidence to proceed on up to 100 athletes and support staff

IOC RE-ANALYSIS PROGRAMME- BETTER LATE THAN NEVER 1 st re-analysis Beijing 2009 and London -2015.6 athletes sanctioned In 2016, reanalysis of samples 95 Adverse Analytical Findings Beijing retesting finished (8 year time frame exceeded) but more AAFs from London likely No. tests No. reanalysed No. of sanctions Beijing 4,800 1,053 61 London 5,000 492 40

IOC RE-ANALYSIS by country. Beijing 09 Beijing 16 London 15 London 16 Armenia 0 2 (25) 0 2 (24) Belarus 0 9 (175) 0 7 (161) Russia 0 17 (454) 0 13 (430) Ukraine 0 4 (241) 1 5 (230) Kazakhstan 0 7 (130) 0 5 (115) others 5 17 0 7 TOTAL 5 56 1 39

IOC RE-ANALYSIS by sport SPORT BEIJING LONDON TOTAL Athletics 29 14 43 Boxing 0 1 1 Cycling 2 1 3 Swimming 0 1 1 Weightlifting 25 22 47 Wrestling 5 1 6 TOTAL 61 40 101

HAEMATOLOGICAL PASSPORT (ABP)

ABP - background First articulated as potential counter to all forms of blood doping in 2001 by AIS scientists (WADA research grant application successful never proceeded due to Australian government ban) First entered lexicon by haematologist in 2003 (Dr Mario Cazzola then Editor of Haematologica) First sold by Dr Mike Ashenden AIS (throughout 2004-2008) First implemented in 2008 by cycling, 2009 by athletics First challenged/appealed in 2011 by Italian cyclists (Caucchioli and Pellizotti) ADAMS system implemented by WADA in 2012

What does it look like? Suspicious OFF Score Probability Males 1:1000 128.6 Females 1:1000 112.6 Classified as: normal, suspicious, likely doping or possible medical condition

How effective is the ABP? Initially used for intelligence only Fully fledged sanctioning test now for 7 years All appeals to the CAS have been dismissed SINCE 2000 ~300 blood doping cases More than 100 cases of ADRV due to ABP Profiling

Effect on Cycling 2003 Introduction of Urine test cyclists started taking smaller EPO doses slightly increasing retics only with less chance of detection of re-epo in urine ; also reflects a return to blood transfusions where Post-Tx retic levels are significantly reduced 2008 Introduction of ABP Cyclists not only had to watch what they may be excreting in urine but also how their blood parameters were behaving micro-doping now pervades: what benefits however!

The Sunday Times Leaked Database of IAAF bloods 2015/6 Blood data had been collected since 2001 ABP was officially introduced by IAAF in 2009 Leaked IAAF Database : 12364 results on over 5000 athletes Reviewed by 2 well respected Australian scientists Almost 900 athletes had suspicious results These 900 athletes - won a third of all medals since 2001

Leaked Database Noteworthy observations Males Females Highest Hb (M:140-180 F:120-160) 220 201 Greatest variance 55 85 Highest OFF-score 168 170 n= >1:10000 males:128.6 females:112.6 78 198

But few progressed to ADRVs with sanctions Possibly due to distractions of bribery and corruption by IAAF President????? IAAF website says they are working on integrity issues..,

MORE DODGY DEALINGS.

THE RUSSIANS Dec 14- German documentary Nov 15 and Jan 16 Independent WADA Commission reports July 16 1 st Independent Person (McLaren) Report Dec 16 2 nd McLaren report Institutional conspiracy- Ministry of Sport, RUSADA, Moscow Lab, CSP (aka KGB) London 2012, University Games 2013, IAAF Worlds 2013, Sochi 2014, and Anabolic cocktails prescribed by Dr Rodchenkov Swapping and tampering with samples DNA and salt testing, B bottle scratches Disappearing positive tests not logged in ADAMs Pre departure urine screening

2 ND MCLAREN REPORT FINDINGS >1000 Russian athletes (summer, winter and paralympic) benefitted from these manipulations Examples of evidence gained 15 medal winners from London 2012 identified 10 have had medals stripped IAAF 2013 4 samples swapped Sochi 2014 2 female ice hockey samples had male DNA Sochi- 12 medal winning athletes had B samples with evidence of tampering (including a physiologically impossible salt reading) 6 athletes (21 Paralympic medals) samples tampered BUT WADA cannot sanction. Evidence passed onto IFs, IOC

AND FINALLY

RIO FROM A FINA PERSPECTIVE July 2016 1 st McLaren Independent Report released.. evidence of widespread, state-sanctioned doping by the Russians Widespread calls for IOC to ban entire Russian team for Rio IOC handballs decision of eligibility for Rio to the IFs. IAAF complete ban, FISA some crews banned Some IFs immediately confirmed all Russian athletes eligible to compete ( these sports were noted to have almost no OOC of athletes) FINA s Doping Control Review Board (DCRB) asked to assess eligibility of Russian swimmers by FINA Executive (given 24 hours) Late night phone hook up 2 days before Opening Ceremony

RIO, THE RUSSIANS AND FINA DCRB determined criteria to be reasonably satisfied an athlete had not doped (i.e. no previous suspicious ABP, testing outside Russia in previous 18 months etc) DCRB advised FINA Executive that approx. 40% swimmers and all water polo players did not meet the criteria FINA Executive.. Silence DCRB were able to infer the FINA Executive decision to allow the Russians to compete by watching the TV

RIO, THE RUSSIANS AND FINA DCRB requested a response from FINA Executive towards the end of Rio Games and were told.. decision not to act was difficult and was made by the IOC (the FINA President later denied/retracted this, saying FINA decided) 3 members of DCRB (including Chair) resigned over lack of transparency Worth noting a lavish World Cup was hosted in Russian just after Rio and the Russian President was awarded the highest FINA honour during 2014, just prior to World Champs in Kazan

THE BIGGEST CURRENT CHALLENGE IN ANTI- DOPING Not science/detection but GOVERNANCE Self regulation is not working in many International Federations and some Anti-doping Organisations and possibly IOC What are the solutions? Independent governance WADA? Other bodies? Involvement of international governments, external scrutiny of governance of IFs and ethical scientists/doctors/administrators

ASDMAC MEMBERS SUSAN WHITE GRACE BRYANT ANIK SHAWDON CAROLYN BRODERICK CHARLES HOWSE GEOFF THOMPSON LARISSA TREASE REVIEW PANEL- PETER HARCOURT, ANDREW POTTER, MARK YOUNG