Aim
The broad aim of this project was to explore the use of over-the-counter (OTC) medication, amongst athletes, from four nations and across 10 sports, with specific reference to stimulants on the Monitoring Program and Prohibited List.
Methodology
1. A review of the scientific literature was undertaken to establish current evidence with regards to the physiological and performance enhancing properties of OTC medication and their desirability as drugs of abuse.
2. A questionnaire was developed to assess respondents:
i. demographics;
ii. use of OTC drugs;
iii. knowledge and understanding of OTC medication in reference to anti-doping measures; and
iv. views and opinions regarding changes to the Prohibited List.
It was administered to elite athletes from Australia, Canada, the UK and the USA representing 10 Olympic sports, including: track and field athletics, canoeing, cycling, gymnastics, hockey, rowing, swimming, triathlon, volleyball and weightlifting.
3. Data from WADA-accredited laboratories was obtained to assess current proportions of urine samples testing positive for stimulants on the Monitoring Program and Specified Substance List.
Key findings
The current research has generated several key findings with regards to the use of OTC drugs amongst elite athletes across four major sporting nations:
i. Athletes who had used OTC products containing substances present on the Monitoring Program over the preceding 12 months accounted for 38 percent of all respondents.
ii. A small proportion of athletes used OTC products for their reputed ergogenic properties.
iii. Athletes demonstrated limited knowledge relating to the penalty incurred following a doping violation involving a banned OTC stimulant; the terms Monitoring Program and Specified Substance List; and the status of substances in relation to the Prohibited List.
iv. If unsure of the prohibitive nature (or otherwise) of an OTC product almost all athletes would consult someone for advice.
v. Both WADA and individual NADOs were the choice by many athletes in terms of whom they would consult for advice. A significant proportion of younger athletes stated that they would consult an individual such as their coach, training partner or team doctor.
vi. Athletes representing cycling and triathlon were most likely to be dissatisfied with anti-doping education within their sport.
vii. The development of a list according to ailment, highlighting OTC products that do [not] contain prohibited substances was deemed an appropriate measure to improve the information available to athletes.
viii. Data from the Monitoring Program supports that of the questionnaire with regards to pseudoephedrine use, however data that pertains to phenylephrine is difficult to interpret.
ix. As a whole, athletes were of the opinion that: OTC stimulants were not performance enhancing; they posed a risk to health; their use was against the spirit of sport; and yet should remain off the Prohibited List.
Conclusions
Whilst the balance of scientific evidence would promote the use of caffeine as an ergogenic aid, the evidence for the use of other stimulants found in OTC medication for the treatment of the symptoms associated with upper respiratory tract infection is less convincing.
The use of OTC products amongst elite athletes is significant, however the evidence suggests that use of such preparations is primarily for therapeutic purposes.
An overall limited knowledge and awareness of OTC medication in reference to anti-doping was evident amongst elite athletes, suggesting that ignorance remains an important factor in the use of drugs by athletes. This is only tempered by their willingness to seek advice from reliable sources.
The inability of the Monitoring Program to provide valid evidence to support the misuse of substances contained in OTC medications highlights the need to expand the current programme to all WADA-accredited laboratories and to include continual qualitative assessment of the situation.
