Drugs in sport

It is important for general practitioners to have a basic understanding of drugs that are banned and those that are permissible for elite sporting use. The guidelines formulated by the International Olympic Committee (IOC) Medical Commission are generally adopted by most major sporting organisations. 7 Tables 18.4 and 18.5 provide useful guidelines. The IOC's list of prohibited drugs is regularly revised. Banned classes of drugs include stimulants, narcotics, anabolic agents, diuretics and various hormones. Banned methods include blood doping (the administration of blood, red blood cells and related blood products) and pharmaceutical, chemical and physical manipulation (substances or methods that alter the integrity and validity of the urine testing).

Restricted drugs include alcohol, marijuana, local anaesthetics, corticosteroids and betablockers. Practitioners can check the guidelines and provide written notification to the relevant authority.

Table 18.4 Prohibited classes of substances with examples International Olympic Committee Medical Commission 1998

Classes Examples

Amiphenazole, amphetamines, caffeine (above 12 •g/mL

. 0.. . . in urine), cocaine, ephedrine, mesocarb, terbutaline,*

A. Stimulants salmeterol,* salbutamol,* pseudoephedrine, phenylpropanolamine

B. Narcotics**

C. Anabolic agents

Diamorphine (heroin), methadone, morphine, pethidine, pentazocine

Methandienone, nandrolone, stanozolol, testosterone, oxandrolone, DHEA

Acetazolamide, frusemide, hydrochlorothiazide, D. Diuretics triamterene, indapamide, spironolactone (and related substances)

E. Peptide and glycoprotein hormones and analogues

Growth hormone, corticotropin, chorionic gonadotrophin, erythropoietin

Note: masking agents such as probenecid are banned

Classes subject to certain restrictions

A. Alcohol Restricted in certain sports (refer to regulations)

B. Marijuana Restricted in certain sports (refer to regulations)

C. Local anaesthetics

D. Corticosteroids

Most agents permissible except cocaine: route restricted to local or intra-articular injection

Route of administration restricted to topical inhalation, local or intra-articular injection

E. Beta-blockers Restricted in certain sports

* permitted by inhaler only but with permission

** codeine, dextromethorphan, dextropropoxyphene, dihydrocodeine, diphenoxylate and pholcodeine are permitted

Table 18.5 Guidelines for treatment of specific conditions International Olympic Committee Medical Code 1996

Asthma Allowed Salbutamol inhaler, salmeterol inhaler, terbutaline inhaler Banned

Sympathomimetic products, e.g. ephedrine, pseudoephedrine, isoprenaline, systemic beta-2 agonists

Cough Allowed

All antibiotics, steam and menthol inhalations, cough mixtures containing antihistamines, pholcodine, dextromethorphan, dihydrocodeine

Banned Sympathomimetic products, e.g. ephedrine, phenylpropanolamine Diarrhoea Allowed Diphenoxylate, loperamide, products containing electrolytes, e.g. Gastrolyte Banned Products containing opioids, e.g. morphine

Hayfever Allowed

Antihistamines, nasal sprays containing a corticosteroid or antihistamine, sodium cromoglycate preparations

Banned Products containing ephedrine, pseudoephedrine

Pain Allowed Aspirin, codeine, dihydrocodeine, ibuprofen, paracetamol, all NSAIDs

Banned Products containing opioids, e.g. morphine, or caffeine

Vomiting Allowed Domperidone, metoclopramide

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