Elise, a 20-year-old elite skier, returns home from a recent series of competitions. The travel schedule wreaked havoc on her diet, and she subsequently is blocked up, that is to say, constipated. Elise wanders through a large pharmacy looking to purchase something to help her. She begins to sweat. Perhaps because she is overdressed or overly fatigued but mostly because she is nervous. Nervous to take a product that could result in a positive doping test. As she exits the store with only a bottle of prune juice, she wonders, “How did we get here?”

How did we get here indeed!

A LITTLE BIT OF ANTI-DOPING HISTORY

Doping and Anti-doping are increasingly important issues for athletes around the world. Early in the last century, concerns grew that athletes were endangering both themselves and the competition by taking performance-enhancing drugs (PEDs). At the time, these were mostly stimulants or opioids. Slowly, sports federations joined the fight against what we know today as doping.

It would not surprise that the nascent sport of long-distance road cycling was at the forefront of cheating. In the 1960s, two deaths occurred in cycling, one in 1960 at the Rome Olympics and another one in 1967 during the Tour de France. Both were attributed to PEDs. This led the IOC to become a leader in the world of Anti-Doping and create the first IOC Prohibited List (List). In 1999, the World Anti-Doping Agency (WADA) came into being. It became the primary authority on anti-doping matters. The List is now updated and published annually by WADA.

AVOID INADVERTENT DOPING: KNOW THE LIST

This List applies to most sports in the world (other than a few professional leagues). All athletes who undergo doping control are bound by this List. If you are not sure if the List applies to you, check with your National Anti-Doping Organization (NADO) as they are the ones that define levels of athletes in their countries.

Over the years, the List has expanded considerably and is now harmonized across all sports. In other words, with the exception of Beta-blockers, anything on the List is prohibited across all sports. This expansion also increased the risk of inadvertent doping—the unintentional consumption of prohibited substances.

Adanna, a 21-year-old basketball player, is playing in an important tournament. The competition is intense, and she feels drained. At half-time, one of her teammates suggests that she takes a caffeine tablet to help get her energy back. “Are you sure that is allowed?” Adanna asks nervously. “Don’t worry. Caffeine is ok. Besides, I was drug tested twice and was fine,” says her friend. Nervously, Adanna takes two tablets of MegaBurn and feels energized for the rest of the game. She was riding a good buzz—until she was tested after that game. She tested positive for a prohibited stimulant and was sanctioned for six months.

ALWAYS CHECK YOUR MEDICATION

If you are an athlete who gets drug tested, you should be aware of what is on the List. Furthermore, always check that your medications are not prohibited. The List contains substances such as anabolic agents that would be used almost exclusively for doping, but it also has many common medications such as glucocorticoids, Beta-2 agonists (for asthma), insulin (diabetes), tamoxifen (breast cancer) etc. These latter agents may be used for legitimate medical reasons. However, as an athlete, you need to apply and abide by the Therapeutic Use Exemption (TUE) process which would allow, in some circumstances, retroactive applications. Go to your NADO or the WADA website to learn more about TUEs to avoid inadvertent doping.

For List databases, check the WADA Prohibited List or consider national drug databases, such as GlobalDRO: https://www.globaldro.com. Make sure you are familiar with the terms and any limitations with any database you use. Importantly, supplements are not mentioned in any drug database as their quality cannot generally be vouched for.

DON’T RELY ON YOUR DOCTOR TO PREVENT INADVERTENT DOPING

Aiko, a 28-year-old runner, goes to a local clinic because of a cough, mild fever, and aching muscles. She is very anxious as there is an upcoming important qualifying race. After a short consultation, the doctor tells her to rest and drink fluids. Three days later, she returns to the clinic, unchanged except that her cough is worse. Consequently, the doctor gives her a short course of antibiotics plus vilanterol, a medication usually used for the treatment of asthma.

Aiko tells the doctor that she is a competitive athlete and asks if the medications are banned. He looks at her quizzically and then says, as he dismisses her, “Of course they are perfectly legal.” One week later, during an unannounced doping test, Aiko writes on the Doping Control Form all her recent medications. Consequently, the testing organization starts proceedings against her: She used vilanterol, a substance prohibited at all times, without a TUE.

MY COMMENTS TO THE ATHLETES

Elise, you were right to be cautious! Whenever possible, healthy food choices should be your first option. Your mama was right, too–eat your vegetables!! However, asking the pharmacist for some fibre or a simple medicinal product from a reputable company would be reasonable and extremely low risk. As a precaution, check the ingredients against one of the databases of the List. Supplements themselves are not on the List but do your best to mitigate the risk.

Adanna, the investigation in your case acknowledged that you were fully cooperative and never intended to cheat. Nonetheless, the Strict Liability principle means that you are responsible for whatever prohibited substance is found in your body. It is possible that you actually had an unfair advantage, even if that was not your intent.

The fact that the prohibited stimulant (MHAA) was not on the label of the package gave you a lesser sanction. It could have been much worse… The dubious name, MegaBurn, should have been a red flag. It was a hard lesson, no doubt. Still, as an athlete, you need to be extremely cautious about what you take. You have to be diligent and document everything you do. Orange slices at half-time would have been a safer bet!

Aiko, remember that athletes are always responsible for what they take. Always double-check with your NADO, the WADA List or a reliable national anti-doping database. Do not assume that all doctors understand the anti-doping world. But, even if you saw an experienced sports doctor, it would be wise to double-check. Besides, there were other permitted options that would not have needed a TUE. They would not have resulted in an anti-doping rule violation.

TAKE-HOME MESSAGES AGAINST INADVERTENT DOPING

• Performance-enhancing drugs are prohibited for a good reason. They may have short- and/or long-term effects on your health. In addition, they damage the integrity of sport. Respect yourself as well as your competitors. Cheating is not the road to personal empowerment.
• Remember: there is a process that allows you to take prohibited medications but there are rules to follow. Don’t get caught out through ignorance or sloppiness. Contact your NADO, sports organization, or WADA to learn more about Therapeutic Use Exemptions. You have to avoid inadvertent doping when you need treatment.
• Dietary supplements are less regulated and may contain Prohibited Substances. Importantly, these may not even be on the label but could result in a sanction anyway. The concept of Strict Liability rules in sports, meaning that you are responsible for what you take. There are new rules in place that may reduce the sanctions for contaminated products. However, you should make sure that you know how to mitigate the risk (Making Decisions About Supplement Use. R. Maughan et al. 2018).
• The world of anti-doping can be complex. I have included only a few messages on Prohibited Substances here. Make sure that you check out the WADA website, your NADO’s or your International Federation’s anti-doping sites to learn more. No need to panic but be sensible and know the rules of the game. Knowledge is power.

Note that the stories are variations of real stories I learned from athletes. I have modified them to maintain anonymity.