1. ANTI-DOPING SEMINAR MFPA April 2013 David Attard

2. Summary Doping - introduction Prohibited list Drug testing programme overview Positive test results Drug testing procedure Therapeutic Use Exemptions Clubs’ duties & responsibilities

3. What is Doping? Using a prohibited substance Possessing a prohibited substance Interfering with the testing process Refusal to undergo test Not providing whereabouts information (Out-of- Competition). 3 missed tests/18 months for individuals in RTP Encouraging or assisting others to dope (including trafficking) Covering up Doping activities Any type of complicity regarding doping activitiy

4. Introduction In 1997, Sports Illustrated asked 198 aspiring US Olympians, “Would you take a banned performance enhancing substance if you were guaranteed to win and not get caught?” 98% said “YES”

5. Introduction Then, when asked, “Would you take the same undetectable substance if it would contribute to winning every competition for 5 years, then result in death?” Over 50% still said “YES!!!”

6. Why do performers take drugs? PHYSIOLOGICAL REASONS Lose weight, train harder Mask injury and reduce tiredness To build muscle, increase energy Increase oxygen transport

7. Why do performers take drugs? PSYCHOLOGICAL REASONS To steady nerves To increase aggression To increase motivation

8. Why do performers take drugs? SOCIAL REASONS Pressure to win from coaches, peers and the media By winning they can earn big money Fear of not winning They are prepared to win at all costs Belief that everyone else is doing it

9. Why shouldn’t they take drugs? MORAL REASONS LEGAL REASONS Gives an unfair advantage Undermines the true spirit of sport Reflects badly on others Against the law of the land Against the law of sports

10. Why shouldn’t they take drugs? Can be addictive Lower life expectancy Can cause death Can lead to liver disorders and heart disease Can suppress growth Can cause sexual and gynaecological problems Can affect moods and behaviour causing aggression and depression HEALTH REASONS

11. Why shouldn’t they take drugs? ROLE MODELLING Gives a bad example to others, especially young people who copy their heroes and put their lives at risk Gives a bad image to sport and lowers its status

12. Why fight Doping? Rules of the Game Personal integrity Anti-doping rules protect Athletes’ rights

13. Why is Doping dangerous? Studies on substances for therapeutic reasons, not for doping Substances or methods used by athletes have been developed for people with health problems Athletes using Prohibited substances: Are not always followed by a doctor Often take larger doses Might use in combination with other substances Are often illegal or counterfeit substances that are not regulated

14. How does a substance become prohibited? What are the criteria for adding a substance to the List? Must meet any 2 of the following 3 criteria:  It has the potential to enhance or enhances sport performance;  It represents an actual or potential health risk to the athlete;  It violates the Spirit of Sport.

15. Drugs in Sport 1. Socially acceptable: alcohol, nicotine, - NOT PROHIBITED 2. Medications: OTC and prescribed drugs – MAY BE PROHIBITED 3. Socially unacceptable: Marijuana, cocaine, ecstasy, etc. 4. Performance enhancers 5. Contaminated supplements

16. Common medications There are some common medications on the Prohibited List. An athlete or a medical professional should not make assumptions regarding the status of any medications. It is the responsibility of the athlete to ensure that all medical professionals are aware of their status as an athlete who could be tested. All athletes should ask medical professionals to check the status of medications during the prescription process and when purchasing medications over the counter at a pharmacy.

17. The World Anti-Doping Code THE 2013 PROHIBITED LIST INTERNATIONAL STANDARD The official text of the Prohibited List shall be maintained by WADA and shall be published in English and French. In the event of any conflict between the English and French versions, the English version shall prevail. This List came into effect on 1 January 2013 The Prohibited list is a document which identifies the substances and methods prohibited in-competition, out-of-competition, and in particular sports

18. PROHIBITED SUBSTANCES S.1. Anabolic agents 1.a.Exogenous AAS (boldenone, nandrolone, mibolerone,... and related substances 1.b.Endogenous AAS 2. Other anabolic agents (clenbuterol) S.2. Hormones and related substances (hCG, hGH, ACTH, EPO, … and releasing factors) S.3. b-2 Agonists S.4. Agents with anti-estrogenic activity (aromatase inhibitors, SERMs) S.5. Diuretics and masking agents (amilioride, ethacrynic acid, spironolactone,... and related compounds) S.6. Stimulants (amphetamine, cocaine, mesocarb, strychnine,... and related compounds) PROHIBITED SUBSTANCES S.1. Anabolic agents 1.a.Exogenous AAS (boldenone, nandrolone, mibolerone,... and related substances 1.b.Endogenous AAS 2. Other anabolic agents (clenbuterol) S.2. Hormones and related substances (hCG, hGH, ACTH, EPO, … and releasing factors) S.3. b-2 Agonists S.4. Agents with anti-estrogenic activity (aromatase inhibitors, SERMs) S.5. Diuretics and masking agents (amilioride, ethacrynic acid, spironolactone,... and related compounds) S.6. Stimulants (amphetamine, cocaine, mesocarb, strychnine,... and related compounds) S.7. Narcotics (buprenorphine, levorphanol, meperidine, …) S.8. Cannabinoids S.9. Glucocorticoids PROHIBITED METHODS M.1. Enhancement of O 2 transfer M.2. Chemical or Physical Manipulation M.3. Gene Doping USE LIMITED IN SPECIFIC SPORTS P.1. Alcohol P.2.  -blockers (acebutolol, atenolol, sotalol,... and related compounds) S.7. Narcotics (buprenorphine, levorphanol, meperidine, …) S.8. Cannabinoids S.9. Glucocorticoids PROHIBITED METHODS M.1. Enhancement of O 2 transfer M.2. Chemical or Physical Manipulation M.3. Gene Doping USE LIMITED IN SPECIFIC SPORTS P.1. Alcohol P.2.  -blockers (acebutolol, atenolol, sotalol,... and related compounds)

19. Anabolic Agents Enhance muscle mass gained from strength training - Anabolic steriods - Testosterone precursors

20. Anabolic Steroids Testosterone derivatives – modified to increase anabolic effects while decreasing androgenic effects Doses may reach 100X medical replacement dose Efficacy in numerous studies since the 1970’s

21. Anabolic steroid side effects Acne Alopecia Testicular atrophy Masculinization Gynecomastia Infertility Mood alterations Adverse lipid profile Hypertension Glucose intolerance Premature epiphyseal closure

22. Human Growth Hormone Manufactured by recombinant technology for replacement in deficient patients Promotes protein anabolism Intramuscular delivery No virilizing effects – attractive to women

23. Human Growth Hormone Studies suggest increases in muscle size, but not strength (increased collagen in muscles without an increase in contractile tissue) Excess may lead to SxS of acromegaly

24. Stimulants Promote CNS and muscular excitation Caffeine (not prohibited) Amphetamines Ephedrine (and pseudoephedrine)

25. Pseudo-ephedrine Pseudoephedrine is an ingredient in many cold, flu and sinus remedies Consider using an alternative medication. There are several products that contain phenylehphrine instead, which is permitted in sport. Never exceed the manufacturers recommended dose. Do not use any medications that contain pseudoephedrine with 24 hours (minimum) of competing.

26. Specified substances A specified substance is a substance which allows, under defined conditions, for a greater reduction of a two-year sanction when an athlete tests positive for that particular substance. The purpose is to recognize that it is possible for a substance to enter an athlete’s body inadvertently, and therefore allow a tribunal more flexibility when making a sanctioning decision. Eg: Ephedrine, Pseudoephedrine, etc. Non-specified: Cocaine, Amphetamine, Anabolic Steroids, HGH, etc.

27. Herbal products Some herbal products contain banned substances. For example, the plant Ma Huang (Chinese Ephedra) contains the banned drug ephedrine. Therefore, products containing Ma Huang are banned. Extreme caution should be taken when using nutritional supplements and/or herbal products as they may contain banned substances not shown in the list of ingredients.

28. Hair loss products Finasteride: a substance contained in particular in a number of hair loss treatments (Propecia). It was added to the List in 2005 (in- and out-of competition) following compelling research showing that they could mask steroids in the doping control process. Removed from banned list in 2009 due to advances in steroid profile assays

29. ED Sildenafil, aka: Viagra Not banned Under study as alleged enhancement of athletic performance, especially at altitude.

30. Intravenous infusions (IVI) An IV infusion is the supply of fluids or other liquid substrates through a vein; achieved by inserting a specialized needle into a vein and infusing fluids at a predetermined rate from a reservoir. Since 2005, intravenous (IV) infusions have been included in the WADA list of prohibited substances and methods under Section M2.Prohibited Methods, Chemical and Physical Manipulation and are prohibited both in and out-of-competition. The current wording (2009) states that “Intravenous infusions are prohibited except in the management of surgical procedures, medical emergencies or clinical investigations.”

31. Bottom line Check medications! Competent personnel, literature, websites. www.globaldro.co.uk Medications bought in one country may contain different ingredients in another country Beware of Supplements!

32. Supplements Supplements can present a high risk for several reasons: They do not fall under the same regulations as food and medicines. This means they do not have to state all their ingredients on the label, so you may not know what you’re taking Advertising of supplements can suggest untested claims about their benefits Production of some supplements has low quality control, which means that there is a chance of contamination with other products that may be banned substances. Diet, lifestyle and training should all be optimised before considering supplements. Athletes should assess the need for supplements by consulting an accredited sports dietician, registered nutritionist with expertise in sports nutrition, or a sports and exercise medicine doctor, before taking supplements.

33. Key Concepts Performance enhancement is not limited to adding muscle Recovery (steroids) Euphoric feelings; improved focus and concentration; alteration of the perception of fatigue (stimulants) Improved vision (hGH) What is considered a “side-effect” medically may be the desired effect for performance-enhancement (example - pseudoephedrine) It is difficult (or impossible) ethically to conduct research at the doses and combinations of substances that could be used for performance- enhancement (example – androstenedione in children) It is the effect of a substance, not the source, that is important (example - “natural” dietary supplements)

34. MFA antidoping - Positive results (to date) included the following substances: Pseudoephedrine Ephedrine Salbutamol (without TUE, in the previous list) Methylenedioxymethamphetamine (MDMA – Ecstacy) Ephedrine Cocaine Androstenedione Nandrolone Stanozolol Clenbuterol Testosterone (physiological causes) Cannabinoids (marijuana) Prednisolone (without TUE) Methylhexanamine

35. Comments Strict liability principle More testing….. ? Increasing abuse of social drugs Misconceptions & misperceptions of doping control by players / clubs Failure to comply with regulations Inadequate Medical control of drug consumption by players Supplement contamination

36. Drug testing procedure Urine sample is split into two collection bottles (A & B) and these are sealed. Players are given an ID no. and sign respective forms. Samples dispatched to accredited WADA lab to be analysed

37. Results If negative – no further steps. If positive – player/club notified

38. Next steps B test offered. If still positive – case examined by Medical Commission Report passed on to Executive Committee and relevant disciplinary board Immediate suspension pending investigation (with exceptions)

39. Therapeutic Use Exemptions Athletes, like all others, may have illnesses or conditions that require them to take particular medications. If the medication an athlete is required to take to treat an illness or condition happens to fall under the Prohibited List, a Therapeutic Use Exemption may give that athlete the authorization to take the needed medicine.

40. Therapeutic Use Exemptions STANDARD FORM

42. What are the criteria for granting a TUE? The criteria are: The athlete would experience significant health problems without taking the prohibited substance or method, The therapeutic use of the substance would not produce significant enhancement of performance, and There is no reasonable therapeutic alternative to the use of the otherwise prohibited substance or method.

43. Standard form For any treatment involving a substance or method on the Prohibited List. If approved, athlete can begin treatment only after receiving the authorization notice from the relevant organization (except in rare cases of an acute life threatening condition for which a retroactive approval may be considered).

44. Clubs’ duties and responsibilities Education of players Responsibility for players’ health & safety Close liaison with Medical Officer To keep up to date with procedures and revised lists Proper filling in of the right forms TUE forms Code of conduct during testing Role definition re-doping matters in each club ? Club policy/procedure re - Social Drug Abuse by players