Acute Topics in Anti-Doping

O. Rabin, Y. Pitsiladis

• Publisher: S. Karger
• Year: 2017
• ISBN:
  9783318060447
• Topic: Psychologie
• Subtopic: Histoire et théorie en psychologie

Doping represents the dark side of amateur and professional sports – in order to protect athletes around the globe, anti-doping rules are continuously revised and improved. This publication reviews the current regulatory framework, scientific aspects, future approaches, and social and ethical dimensions of the fight against doping in sport. Prominent experts on the implementation of anti-doping strategies, as well as leading researchers in science and medicine, have contributed to this publication. In keeping with its interdisciplinary origin, the book is intended for athletes, coaches, students, scientists, anti-doping officials, and all others interested in anti-doping and sports. Ranging from legal and educational to scientific and medical issues, this collection emphasizes the need for a multidisciplinary approach and the importance of preventative strategies in the fight against doping in sports.

The Anti-Doping Science

Rabin O, Pitsiladis Y (eds): Acute Topics in Anti-Doping. Med Sport Sci. Basel, Karger, 2017, vol 62, pp 39–54 DOI: 10.1159/000460699

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Structure and Development of the List of Prohibited Substances and Methods

Audrey Kinahan^{a, d, e} · Richard Budgett^{a, b, g} · Irene Mazzoni^{c, d, f}

^aProhibited List Expert Group, ^bWorking Group on World Anti-Doping Agency (WADA) Governance Matters, and ^cScience Department, ^dWADA, Montreal, QC, Canada; ^eEipharm, Ennis, and ^fSport Ireland, Dublin, Ireland; ^gInstitute of Sport Exercise and Health, University College London Hospital, London, UK

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Abstract

The list of prohibited substances and methods (the List) is the international standard that determines what is prohibited in sport both in- and out-of-competition. Since 2004, the official text of the List is produced by the World Anti-Doping Agency (WADA), the international independent organization responsible for promoting, coordinating, and monitoring the fight against doping in sport. Originally based on the prohibited lists established by the International Olympic Committee, the List has evolved to incorporate new doping trends, distinguish permitted from prohibited routes of administration, and adjust to new analytical and pharmacological breakthroughs. In this chapter, the elements that compose the List as well as the updates over the years are presented.

© 2017 S. Karger AG, Basel

Introduction

“Is this drug prohibited?” Every day athletes all over the world ask this question to their doctors, trainers, sports federation, or anti-doping organization. The answer can be found in the list of prohibited substances and methods (the List), yearly published and updated by the World Anti-Doping Agency (WADA). The List is a legal document that defines what drugs or procedures are prohibited for athletes, in which instances they are prohibited and, in some cases, in which sport. Although it is full of scientific and pharmacological terminology and chemical names that may be a good subject for a spelling bee competition, it is, at the same time, the clean athlete’s best friend. This chapter will address how the List has evolved, the processes that make this possible, and look at what new drugs and methods may find their way into future Lists.

Legal Context – The Code

The structure and contents of the List are defined in the 2003, 2009, and 2015 World Anti-Doping Codes (the Code). The Code is the overarching document on which the anti-doping program is based and harmonizes rules and regulations throughout sports. Only those sport organizations and public authorities that are signatories of the Code are bound to it. To date, the vast majority of governments (183 countries out of 195 possible) and sports authorities (e.g., the International Olympic Committee, IOC, International Paralympic Committee, and IOC-recognized and -nonrecognized organizations) have accepted the Code and enforce its rules and policies accordingly.

The Code outlines the principles that constitute the framework of the List, briefly:

• Publication and Revision of the List: the Code establishes the timing and process involved in the preparation of the List.

• Prohibited Substances and Methods Included: the Code outlines what is prohibited in sports and when.

• Criteria for Including Substances and Methods: the 3 criteria used to consider whether a substance or method should be included in the List are defined in the Code.

• Therapeutic Use Exemptions: the Code explains the procedures to follow if an athlete needs to use a prohibited substance for a medical reason.

• Monitoring Program: the Code states the procedures to follow the patterns of use of nonprohibited substances that are suspected to be used in doping.

Publication and Revision of the List

The first List published by WADA came into effect in January 2004. Immediately following the 2nd World Conference on Doping in Sport that took place in Copenhagen in March 2003, the newly formed List Expert Group (LiEG) met and drafted the 2004 List. This List was based on the 2003 IOC prohibited List and was modified and adapted to the requirements of the Code. One of those requirements was the need for consultation with WADA’s stakeholders (governments and sports authorities – signatories of the Code). As stated in the Code, the draft List should be circulated among the stakeholders for comments, making this, for the first time in the history of lists of prohibited drugs in sport, a highly interactive and participative process. Every year, the LiEG meets to discuss the contents of the List and modifies it according to new doping trends and new drugs with doping potential. This draft is sent to WADA’s stakeholders, who have a period of about 3 months to send their comments on the changes made as well as other changes they may consider pertinent. In a subsequent meeting, the LiEG discusses the stakeholders’ comments, modifies the draft List if needed, and makes their recommendations to WADA’s Health, Medical, and Research Committee (HMRC). The HMRC can amend the recommendations made by the LiEG on the List. Finally, the draft List is submitted to WADA’s Executive Committee, who can approve the draft List as presented by the HMRC or make further modifications before its approval. As a matter of principle, modifications introduced after the consultation period with stakeholders are avoided as much as possible, to preserve the spirit of the consultation process.

The Code also has a provision to modify the List at any time of the year if a substance or method in question requires immediate action. This “fast track” mechanism was used for the first time in 2014, when reports during the Winter Olympic Games in Sochi of the abuse of hypoxia-inducible factor (HIF) activators like xenon prompted the LiEG to revise the 2014 List in June. The modified List came into effect on September 1, 2014.

Prohibited Substances and Methods Included

The Code establishes in general terms that there exist substances and methods which are considered as doping both in- and out-of-competition, i.e., at all times, others that are only prohibited in competition, and finally a smaller number that are prohibited in certain sports. The distinction is based on the fact that some substances or methods can have long-term effects and, even if taken during the training period, can impact future competitions so they should be always prohibited, while the effects of others are more restricted in time. It is up to the LiEG to determine the categories of drugs or methods to be included in the List and to determine the periods of time in which they should be prohibited. Examples of substances prohibited at all times include those that can affect the quality and quantity of muscles, like anabolic steroids, growth hormone, and β₂-agonists, as well as substances and methods that affect the number of red blood cells, erythropoietin (EPO), or blood transfusion. Masking agents, as they can conceal the use of doping substances, are also included in this category. On the other hand, drugs that increase arousal, like stimulants, or curtail pain, like narcotics, are examples of substances prohibited in-competition only. To date, only 2 groups of substances are prohibited in particular sports: alcohol and β-blockers. The use of these substances would be detrimental for or incompatible with the practice of most sports but, for example, the use of β-blockers could be an advantage in the practice of sports requiring precision, such as shooting, archery, or darts. In the first List published by WADA in 2004, there were 9 categories of prohibited substances and 3 categories of prohibited methods until 2011, where the category S0 (non-approved substances) was introduced. The other categories have evolved in time and new subcategories added, as will be described later.

Another classification defined by the Code is that of specified substances. Except for all the anabolic agents and hormones, as well as some stimulants and hormone antagonists and modulators, which one can think of as substances more likely to be used for doping, all other substances included in the List are considered “specified.” But what is exactly a “specified substance?” In the original 2003 Code, “specified substances” were those that could be easily accessible as medicinal products, for example, over-the-counter medications, or those that were potentially less likely to be used for doping. When the World Anti-Doping Code was revised in 2009, this distinction was strictly linked to sanctions. However, the definition of “specified substances” in the revised 2015 Code resembles more that of 2003, as they are defined as substances more likely to be consumed for purposes other than performance enhancement [1–3]. In any case, there is a misconception that an athlete doping with a “specified substance” will automatically get a reduced sanction. This is not necessarily the case and if it can be proven that the athlete had the intention to dope with a “specified substance,” a full-term sanction can be applied. Alternatively, an athlete can get a reduced sanction if he/she can prove that there was no intention to dope with a non-specified substance. In brief, “specified substances” are not less important or less dangerous doping substances.

The categories included in the List can be closed or open. In the closed categories, only the drugs or methods listed are prohibited; an example of this is the Narcotics section. In the open categories, only some typical examples are shown on the List, so there are many other substances or methods that are not shown that are part of these categories. One of the reasons to do this is space, as it would take many pages to name all the drugs and methods prohibited. The other reason is that there are new pharmacological and illegal drugs entering the market that are included in these open categories, so if all the prohibited substances must be listed, this would require a constant updating of the List. Therefore, these open categories can be identified in the List by phrases like “including but not limited” or “similar chemical structure and/or biological effect.” Nevertheless, each year, the LiEG adds examples to help the athlete and entourage identify what is prohibited or allowed. In any case, it is always better for an athlete to ask an anti-doping organization or sports federation rather than risk a sanction.

Criteria for Including Substances and Methods

The Code also defines 3 criteria, 2 of which need to be fulfilled before a substance or method can be considered for the inclusion in the List. These criteria are: proven or potential performance-enhancing abilities of the candidate drug or method, actual or proven health risk, and violation of the spirit of sport. The 3 criteria and their equal importance have remained unaltered since the first Code in 2003. During the consultation process of the latest Code revision, some stakeholders suggested that performance enhancement should be made a mandatory criterion. However, since experiments to prove performance enhancement may be difficult to perform in humans, especially for designer and unapproved drugs, in the end it was decided not to introduce any modifications.

Monitoring Program

There are some substances that are not prohibited but which WADA closely monitors to detect patterns of use or abuse in sport that would suggest a perceived competitive advantage. Substances may be monitored because they have a mechanism of action that is not well defined but could attract the attention of cheating athletes. Other substances, like the stimulant caffeine, are in the program because they are consumed by the majority of the population, and it is difficult to distinguish normal use from doping abuse. Medications with mild doping potential, but which are broadly used, can also be placed i...