With the Summer Olympics in Rio coming up and the media coverage on specific athletes banned from participation, I start to wonder about doping in sport – exactly what drugs are banned. To my amazement, it is more than just the anabolic steroids and related modulators. There is a whole list of drugs, many of them I am unaware of and surprised to see on the list.

According to the World Anti-Doping Code – International Standard Prohibited List that was released in Jan 2016, there are substances that are prohibited at all times and substances that are prohibited during competition.

Substances Prohibited at all times

S1 – Anabolic Agents: These include mainly testosterones and similar derivatives – I expect to see these substances to be banned.

S2 – Peptide Hormones, Growth Factors and Related Substance & Mimetics: It makes sense but I am surprised to see drugs such as erthropoiesis stimulating agents as these are used mainly in end stage renal diseases and dialysis patients to treat anemia.

S3 – Beta 2 Agonists: Again, it makes sense. These are bronchodilators used in asthma and COPD but when used in healthy individuals, it probably can enhance performance by optimizing the intake of oxygen and increasing the heart rate a little. It is recognized some people may need beta2 agonist for therapeutic use so it does set a daily dose limit. For example, inhaled salbutmaol can be used up to 1600mcg over 24 hours and inhaled formoterol can be used up to 52mcg over 24 hours.

S4 – Hormones and Metabolic Modifer: This category includes drugs such as letrozole and tamoxifen usually used in breast cancer patients as well as raloxifene indicated for osteporosis. Insulins are also included here but I haven’t figured out why.   Meldonium is also listed here. It is not available in Canada. This drug was detected by Maria Sharapova, the Russian tennis player who was subsequently banned from competing in Rio. It is thought to improve blood flow.

S5 – Diuretics and Masking Agents: Again, I am surprised to see desmopressin, probenicid, plasma expanders, acetazolamide, amiloride listed here. But I can see how they can potentially alter the urine test results by expediting the urine excertion with diuretics or diluting the effect with plasma expander. Note that opthalmic use of some diuretics are exempted here.

Prohibited Substances In Competition

S6 – Stimulants: This category includes agents such as the usual amphetamine, epinephrine, ephedrine. Clonidine is excluded here. Again I am surprised to see selegiline on the list as it is usually used to treat Parkinson’s disease and I don’t normally connect it with the concept of doping. But it is a selective inhibitor of MAO-B which is responsible for metabolizing dopamine and phenylethylamine. So theoretically, it can enhance performance.

S7 – Narcotics: This category includes the usual opioids such as morphine and hydromorphone. I see why they are banned for use during competition but what if the athetes have chronic pain and do require opioids for pain management?

S8 – Cannabinoids: This category includes both natural and synthetic compounds of cannabinoids. So no smoking weed during competition!

S9 – Glucocorticoids: All routes of intake such as oral, rectal, intravenous are prohibited with all glucocorticoids.

Substances Prohibited in Particular Sports

P1 – Alcohol: I find it intriguing to know that alcohol is not universally prohibited. It is only prohibited in competition only in air sports, automobile, archery and powerboating. It may not enhance performance but likely can take the edge off for someone who is anxious.

So after reviewing this Prohibited list, I have a better appreciation of what doping entails in competitive sport. But next time when I work as a retail pharmacist in the community, I may question why someone is needing his or her Ventolin (salbutamol) puffer so frequently – is it for exercise induced bronchospasm or to enhance performance?

 

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