Regulation of muscle mass by growth hormone and IGF-I / C.P. Velloso. - (British Journal of Pharmacology 154 (2008) 3 (June); p. 557-568). - Special Issue: Themed Section: Drugs in Sport: Guest Editors: Professor J.C. McGrath and Professor D.A. Cowan

• PMID: 18500379
• PMCID: PMC2439518
• DOI: 10.1038/bjp.2008.153

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Abstract

Growth hormone (GH) is widely used as a performance-enhancing drug. One of its best-characterized effects is increasing levels of circulating insulin-like growth factor I (IGF-I), which is primarily of hepatic origin. It also induces synthesis of IGF-I in most non-hepatic tissues. The effects of GH in promoting postnatal body growth are IGF-I dependent, but IGF-I-independent functions are beginning to be elucidated. Although benefits of GH administration have been reported for those who suffer from GH deficiency, there is currently very little evidence to support an anabolic role for supraphysiological levels of systemic GH or IGF-I in skeletal muscle of healthy individuals. There may be other performance-enhancing effects of GH. In contrast, the hypertrophic effects of muscle-specific IGF-I infusion are well documented in animal models and muscle cell culture systems. Studies examining the molecular responses to hypertrophic stimuli in animals and humans frequently cite upregulation of IGF-I messenger RNA or immunoreactivity. The circulatory/systemic (endocrine) and local (autocrine/paracrine) effects of GH and IGF-I may have distinct effects on muscle mass regulation.

Urinary excretion of exogenous glycerol administration at rest / Karsten Koehler, Hans Braun, Markus de Marees, Hans Geyer, Mario Thevis, Joachim Mester, Wilhelm Schaenzer. - (Drug Testing and Analysis 3 (2011) 11-12 (November-December); p. 877-882). - Special Issue: 29th Cologne Workshop: Advances in Sports Drug Testing

• PMID: 22012747
• DOI: 10.1002/dta.355

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Abstract

Since 2010, glycerol has been ruled a masking agent by the World Anti-Doping Agency and consequently its administration is prohibited in sports. A detection method is available but little is known about the urinary excretion following administration. Fourteen well-trained cyclists (27.0 ± 5.4 years; VO(2max): 63.9 ± 8.5 ml/kg/min) were administered glycerol (1 g/kg body mass + 25 ml water/kg body mass) and placebo (25 ml water/kg) in a cross-over study. Blood and urine samples were collected before administration and after 2.5, 4, and 6.5 h. Urine samples were further collected up to 24 h post-administration. Following glycerol administration, urinary glycerol increased from 10.9 ± 15.5 to 50581 ± 23821 µg/ml within 2.5 h. In the placebo group, urinary glycerol did not exceed 26.8 ± 31.3 µg/ml. Urinary concentrations in the glycerol group were significantly higher than in the placebo group for 16.9 ± 1.0 h. In comparison to placebo, glycerol caused a larger increase in body weight (0.69 ± 0.42 vs. 0.27 ± 0.44 kg; p < 0.05) and a reduced urine output (972 ± 379 vs. 1271 ± 387 ml; p < 0.05). Reductions in haemoglobin and haematocrit were significantly greater after glycerol (-0.60 ± 0.28 g/dl; -1.7 ± 0.7%) than after placebo administration (-0.29 ± 0.39 g/dl; -0.9 ± 1.1%). The study shows that glycerol administration was detectable in urine for several hours. Even though there were significant reductions in haemoglobin and haematocrit after 2.5 h, the plasma expansion by glycerol appeared rather marginal in comparison to placebo.

Guidelines for glycerol use in hyperhydration and rehydration associated with exercise / Simon Piet van Rosendal, Mark Andrew Osborne, Robert Gordon Fassett, Jeff Scott Coombes. - (Sports Medicine 40 (2010) 2 (1 February); p. 113-129)

• PMID: 20092365
• DOI: 10.2165/11530760-000000000-00000

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Abstract

Dehydration in athletes alters cardiovascular and thermoregulatory function and may inhibit endurance exercise capacity if fluid loss exceeds 2% of bodyweight (BW). If this level of dehydration cannot be prevented when starting from a state of euhydration, then athletes may create a state of hyperhydration by consuming extra fluid prior to exercise. From this hyperhydrated situation, individuals have a greater capacity to tolerate fluid loss before becoming dehydrated. Furthermore, excess pre-exercise fluid intake enhances thermoregulatory ability, as well as increasing plasma volume to maintain cardiac output. However, hyperhydrating before exercise is difficult, because a large fluid intake is typically accompanied by diuresis. Glycerol-containing beverages create an osmotic gradient in the circulation favouring fluid retention, thereby facilitating hyperhydration and protecting against dehydration. Many studies have shown that increases in body water by 1 L or more are achievable through glycerol hyperhydration. This article analyses the evidence for glycerol use in facilitating hyperhydration and rehydration, and provides guidelines for athletes wishing to use this compound. An analysis of the studies in this area indicates that endurance athletes intending to hyperhydrate with glycerol should ingest glycerol 1.2 g/kg BW in 26 mL/kg BW of fluid over a period of 60 minutes, 30 minutes prior to exercise. The effects of glycerol on total body water when used during rehydration are less well defined, due to the limited studies conducted. However, ingesting glycerol 0.125 g/kg BW in a volume equal to 5 mL/kg BW during exercise will delay dehydration, while adding glycerol 1.0 g/kg BW to each 1.5 L of fluid consumed following exercise will accelerate the restoration of plasma volume. Side effects from glycerol ingestion are rare, but include nausea, gastrointestinal discomfort and light-headedness. In summary, glycerol ingestion before, during or following exercise is likely to improve the hydration state of the endurance athlete.

• CAS 2009/A/1926 International Tennis Federation (ITF) v. Richard Gasquet
• CAS 2009/A/1930 World Anti-Doping Agency (WADA) v. ITF & Richard Gasquet
• CAS 2009/A/1926 International Tennis Federation (ITF) v. Richard Gasquet & CAS 2009/A/1930 World Anti-Doping Agency (WADA) v. ITF & Richard Gasquet

Related cases:

• ITF 2009 ITF vs Richard Gasquet
  July 15, 2009
• SDRCC 2016 CCES vs Shawnacy Barber
  August 11, 2016
  
  

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• Tennis
• Doping (Cocaine)
• Choice of law by the parties and ordre public
• CAS full power of review “in order to do justice”
• Meaning of the balance of probability test
• No fault or negligence and principle of ne ultra petita

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1. The application of the (rules of) law chosen by the parties has its confines in the ordre public. Usually, the term ordre public is thereby divested of its purely Swiss character and is understood in the sense of a universal, international or transnational sense. The ordre public proviso is meant to prevent a decision conflicting with basic legal or moral principles that apply supranationally. This, in turn, is to be assumed if the application of the rules of law agreed by the parties were to breach fundamental legal doctrines or were simply incompatible with the system of law and values

2. The concept of “in order to do justice” means that the Panel is a fortiori allowed to review the appealed decision if it is arbitrary, i.e. if it severely fails to consider fixed rules, a clear and undisputed legal principle or breaches a fundamental principle. A decision may be considered arbitrary also if it harms in a deplorable way a feeling of justice or of fairness or if it is based on improper considerations or lacks a plausible explanation of the connection between the facts found and the decision issued. In order to exercise such a review, the CAS must be able to examine the formal aspects of the appealed decisions but also, above all, to evaluate – sometimes even de novo – all facts and legal issues involved in the dispute.

3. In case the Panel is offered several alternative explanations for the ingestion of the prohibited substance but it is satisfied that one of them is more likely than not to have occurred, the Athlete is deemed to have met the required standard of proof regarding the means of ingestion of the prohibited substance. It remains irrelevant that there may also be other possibilities of ingestion, as long as they are considered by the Panel to be less likely to have occurred. In other words, for the Panel to be satisfied that a means of ingestion is demonstrated on a balance of probability simply means, in percentage terms, that it is satisfied that there is a 51% chance of it having occurred. The Athlete thus only needs to show that one specific way of ingestion is marginally more likely than not to have occurred.

4. Upon the finding that the Athlete acted with no fault or negligence, the Panel normally has to overrule the decision of the Tribunal imposing a period of ineligibility and to replace the challenged decision with the decision that no period of ineligibility should be imposed on the Athlete for his doping offence. However, the Panel is bound by the principle ne eat iudex ultra petita partium and is thus not in a position to grant the Athlete more than what he asked for, if the Athlete only asked for the appeals to be dismissed and did not express a request for the decision of the Tribunal to be overruled and set aside.

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In April 2009 the International Tennis Federation (ITF) has reported an anti-doping rule violation against the Athlete Richard Gasquet after his A and B samples tested positive for the prohibited substance Cocaine in a low concentration.

After notification a provisional suspension was ordered. The Athlete filed a statement in his defence and he was heard for the ITF Independent Anti-Doping Tribunal.

The Athlete denied the intentional use and asserted that he tested positive for Cocaine after he had kissed a woman in a club who had been ingesting Cocaine prior to their rendezvous.
the Athlete argued that if there was a doping offence, the Athlete could establish “No Fault or Negligence” or alternatively “No Significant Fault or Negligence”.

Further, he argued that there should be no period of ineligibility because of the circumstances of the offence – accidental contamination in a social setting after the Athlete had decided to withdraw from the competition through injury - were such that any ban would be grossly disproportionate to the offence and therefore unlawful.

Also in June 2009 the Athlete filed a complaint with the French prosecuting authority, alleging against the woman that a harmful substance had been administered to him, contrary to the French penal code. A criminal complaint was, at some point in time, also filed by the woman against the athlete for defamation.

The French newspaper, Aujourd’hui, published an interview with the woman that reportedly took place the afternoon before, and in which she denied having either taken or been offered any Cocaine during the evening of the rendezvous. However, she admitted having taken Cocaine on previous occasions in her life. Furthermore, she asserted that she had kissed the Athlete only briefly and not mouth to mouth, and that she was willing to give evidence and undergo a hair test herself.

On September 2009, the public prosecutor’s department of Paris issued a communiqué stating that the proceedings initiated by the Athlete on 4 June 2009 against the woman for administration of a harmful substance to him had been closed, as no criminal offence had been revealed.

The communiqué furthermore noted that the toxicological examination carried out on “a young lady heard during this procedure” revealed that she regularly consumed Cocaine, and that she would be subject to a therapeutic order from the public prosecutor’s department.

The ITF Tribunal Panel accepted that the Athlete has discharged the onus on him of establishing, on the balance of probability, how Cocaine entered his system. The Panel noted that the most likely explanation is that advanced by the Athlete, namely that Cocaine was transferred to the Athlete from mouth to mouth kissing with the woman.

The Panel ruled that this explanation is more likely than not to be the correct one. The Panel holded that in this case, the Athlete’s inadvertent ingestion of Cocaine occurred in circumstances in which the degree of his fault was very small, as small as the miniscule quantity consumed.

On 15 July 2009 the ITF Tribunal decided to impose a 2 months and 15 days period of ineligibility on the Athlete for the time already served, starting on the date of the provisional suspension until the date of the decision.

Also Athlete’s results in competitions in Barcelona and Rome during April 2009, should remain undisturbed and the prize money and ranking points obtained by the Athlete in those competitions should not be forfeited.

Hereafter in August 2009 the ITF and WADA appealed the decision of the ITF Independent Anti-Doping Tribunal of 15 July 2009 with the Court of Aribitration of Sport (CAS).

The ITF and WADA requested the Panel to annul the Appealed Decision and to impose a period of ineligibility of not more than 2 years and not less than 1 year.

Following assessment of the evidence the Panel, on a balance of probability, concludes that it is more likely than not that the Athlete’s contamination with Cocaine resulted from kissing the woman. Any other source is either less likely than the kissing to have resulted in the contamination, or is even entirely impossible.

The Panel thus concludes that the Athete has met the required standard of proof, such as stipulated in Art. K.6.2 of the Programme and Art. 3.1 of the WADA Code, with regard to the way of ingestion.

Futher the Panel states that under the given circumstances, even if the Athlete exercised the utmost caution, he could not have been aware of the consequences of kissing a girl who he had met in a totally unsuspicious environment. It was simply impossible for the Athlete, even when exercising the utmost caution, to know that in kissing the woman, he could be contaminated with Cocaine. The Athlete therefore acted without fault or negligence.

Therefore the Court of Arbitration for Sport decides on 17 december 2009:

1.) The appeal of the International Tennis Federation (ITF) against the decision of the Anti-Doping Tribunal convened under the ITF regulations dated 15 July 2009 regarding the tennis Athlete Richard Gasquet is dismissed.

2.) The appeal of the World Anti-Doping Agency (WADA) against the decision of the Anti-Doping Tribunal convened under the ITF regulations dated 15 July 2009 regarding the tennis Athlete Richard Gasquet is dismissed.

(…)

6.) All other motions or petitions for relief are dismissed.

Doping in de ongeorganiseerde sport (Dutch title)
/ Gezondheidsraad (Health Council of the Netherlands). - The Hague : Gezondheidsraad, 2010. - 150 p. . - (Advies Gezondheidsraad: 2010/03)
Met lit.opg.
ISBN 978-90-5549-797-3

Health Council of the Netherlands. Doping in unorganised sports.

In recent years, reports from the former Netherlands Centre for Doping Issues (NeCeDo) and the subsequently founded Doping Authority showed that doping in sports is likely a growing problem in our country. Use of doping in sports is largely associated with professional sports. However, in addition to organised sports (at both professional and amateur levels), doping is supposed to be widespread in unorganised sports. The minister of Health, Welfare and Sport has asked the Health Council of the Netherlands to investigate the nature and severity of doping use in unorganised
sports, particularly with regard to the harmful effects on health, both short and long-term, the implications of high-risk drugs in terms of health risk, disease burden and care consumption, and to make recommendations regarding these topics. Additionally, the Council is asked to provide a vision statement on improving prevention of health damage based on current scientific insights.The request for advice defines doping in unorganised sports as improper use of authorised or unauthorised medicinal products with the objective of obtaining a muscular or slim physique. It indicates that the use of anabolic steroids and
stimulants by gyms and fitness centre attendees in particular is worrying.

Klanttevredenheidsonderzoek Doping Infolijn : een enquête onder bellers en e-mailers plus trends van 2000-2007 / A. Palsma. - Capelle aan den IJssel : Dopingautoriteit, 2008

In 2000, a telephone information line for questions concerning doping was started: the Doping Informatielijn, abbreviated as DIL. In the first place this telephone service was intended for athletes in gyms, but in the course of the time other target groups within the sport were more and more reached. Since 2006 also the question and answers and context data of e-mailers have been registered. Because the DIL is ISO certified substantive appointments have been fixed about the quality of the settlement of guarantees for the information requests, the recording of the context data of the users of the telephone information line and mailers and intervision of question and answers by the DIL-operators. One of the quality requirements is that the information seekers appreciate the DIL with a report figure of at least seven (on a scale of ten). Until now it had never been examined if this quality requirement was obtained. Therefore a customer satisfaction investigation has been conducted in the period of 1 August 2007 up to and including 1 February 2008 under all information seekers (by phone and e-mail) who have approached the DIL during this period. The recent developments over the period of 2000 up to and including 2007 were also examined. It was also investigated if and which data are available of other doping information lines. The DIL is telephonically contactable on working days from 13.00 till 16.00 by phone 0900-200 1000 or by mail: dopingvragen@dopingautoriteit.nl.

For the customer satisfaction research under users of the telephone line and e-mailers, questionnaires have been placed on internet which could be filled in online. 222 of the 305 users of the telephone line were asked to participate and 65 have eventually filled in the questionnaire. Also 222 of 278 e-mailers have been asked to participate in the study and 68 persons have filled in the questionnaire. The recent developments have been examined using the statistic data of the previous years which have been stored in the access files of the automated recording system. Comparison of data of the participants to the customer satisfaction research with those of mailers and users of the telephone line over the year 2007 learns that the customer satisfactory research is representative for the information seekers which used the e-mail and the telephone service of the DIL.

The users of the telephone line are very satisfied and give an average report figure of 8.1 (spacing 6 - 10). However, 22% of the users of the telephone line noticed that extension of the visiting hours is needed. The users of the telephone line noticed that the mail service must be mentioned more prominent at the websites. The mailers are also very satisfied concerning the DIL and give to an average mark of 8.2 (spacing 7.5 - 10). However, 9% of them find the answer unclear.

From the recent developments it becomes clear that the number of female information seekers increases. The most questions are asked by people in the age categories of 21 up to 25 years, followed by 16 up to 20 years, 26 up to 30 years and 31 to 35 years. Parents do ask more often questions at the DIL, what can explain the increase of the number of information seekers in the age category of 41 up to 50 years. At other information lines it is also noticed that the number of mailers seems to increase.

The age of the users of the Anti-Doping Hotline in Sweden is lower than that of the information seekers of the DIL. As well as in the Netherlands the use of anabolic steroids here too is the most important conversation topic.

Information seekers of the DIL can also contact employees direct outside the opening hours of the DIL telephone and by mail. These question and answers generally are not registered. As a result of this research it is inventoried or and how the quality assurance of the questions which are settled outside the DIL can be realised. Extending opening hours of the DIL runs up against practical objections. For this reason the e-mail service is promoted more, so that information seekers know more about this possibility to get their question answered rapidly. Answering the e-mails will be improved by establishing a guide for this. Current quality is further maintained.

CAS 2008/A/1511 O'Hara v/WADA & UEFA

Mr. Jamie O'Hara is a British football player and at the time under contract to Tottenham Hotspur. He suffered from severe acne and Urticaria pigmentosa whereas he used prescribed medication with a valid TUE.

In December 2007 the Athlete's condition deteriorated and he underwent medical treatment in a hospital. He received an  intravenous injection of hydrocortisone and used prescribed Prednisolone.

Thereupon the Athlete applied for a retroactive TUE. However in January 2008 the UEFA TUE Committee refused to grant the retroactive TUE and in February 2008 the WADA TUE Committee confirmed this decision.

Hereafter in March 2008 the Athlete appealed the UEFA and WADA TUE Committee's decisions with the Court of Arbitration for Sport. The Athlete requested the Panel to set aside the decisions of the UEFA and WADA TUE Committee and to grant a retroactive TUE for Hydrocortisone and Prednisolone.

In this case the Panel assessed and addressed the following issues:

• emergency treatment or treatment of an actute medical condition;
• significant impairment to healt;
• reasonable therapeutic alternative.

The Panel concludes that in view of the Athlete's acute condition the prescription for Prednisone was necessary. The Athlete has also met his burden of proving on the balance of probabilities that, in the circumstances of the case, there were no reasonable therapeutic alternatives to Prednisolone. The Panel deems that in accordance with the International Standards he could apply for a retroactive TUE.

Therefore the Court of Arbitration for Sport decides on 21 October 2008:

1.) The decision issued on 8 January 2008 by the UEFA TUE Committee and the decision issued on 29 February 2008 by the WADA TUE Committee are set aside.

2.) Mr Jamie O'Hara is granted a retroactive TUE for the use of Prednisolone between 29 December 2007 and 1 January 2008.

3.) The costs of the arbitration, to be determined and served on the parties by the CAS Court Office, shall be borne by UEFA.

4.) UEFA shall pay to Mr Jamie O'Hara an amount of CHF 3,000.00 (Three Thousand Swiss Francs) as contribution to costs incurred in connection with this arbitiatlon.

5.) Each party shall otherwise bear lts own legal costs and all other expenses incurred in connection with this arbitratdon.

6.) All other prayers for relief are dismissed.

Prestatiebevorderende middelen bij fitnessbeoefenaars / Eindred. Olivier de Hon; J.H. Stubbe, A.M.J. Chorus, L.E. Frank, P. Schermers, P.G.M. van der Heijden. - TNO Kwaliteit van Leven; Universiteit Utrecht; i.o.v.: Dopingautoriteit. - Capelle a/d IJssel : Dopingautoriteit, 2009

In sports, the use of various performance-enhancing drugs is prohibited. These are often called ‘doping’ substances. It is not clear how many people use performance-enhancing drugs in the Netherlands. No recent studies have been conducted on the prevalence of performance-enhancing drugs in unorganized sports.
Therefore, the Anti-Doping Authority of the Netherlands commissioned TNO Quality of Life to investigate the prevalence and determinants of use of performance-enhancing drugs by athletes visiting Dutch fitness centres. In the current study, the concept of ‘doping’ was not strictly defined as substances on the Prohibited List of the World Anti-Doping Agency (WADA). Firstly, not all substances on this list are of primary interest to the commissioners of this study, nor to fitness athletes looking for performance enhancement (for example corticosteroids and cannabinoids). Secondly, some relevant substances are not on the Prohibited List, for example thyroid hormones and oral anti-diabetic medication. Therefore, these substances were included in the current study. Furthermore, use of performance-enhancing drugs was defined as using doping substances at least once in the preceding year.

The research questions of the study were:
1. What is the prevalence of use of performance-enhancing drugs by athletes (15 years and older) visiting Dutch fitness centres?
2. Which determinants are related to the use of performance-enhancing drugs by athletes (15 years and older) in Dutch fitness centres?
3. Are there trends in the determinants of use of performance-enhancing drugs?
4. How can the prevalence be assessed in a reliable and relatively simple manner in future studies?

Questionnaires were conducted among owners and athletes of fitness centres. A total of 500 centres were randomly selected from the trade register of the Dutch Chambers of Commerce (which listed a total of 1839 of such centres). At least three attempts were made to contact the owners of fitness centres by telephone. A total of 188 owners were reached of which 92 agreed to participate in this study (response rate = 49%). Characteristics of fitness centres participating in the current study were compared with characteristics of centres participating in the Dutch National Fitness Monitor. The findings showed that centres participating in the current study were a representative sample of the Dutch fitnessbranch. Participating in research about performance-enhancing drugs can be threatening to athletes visiting Dutch fitness centres. Respondents may be reluctant to reveal sensitive information. To tackle the problem of response errors, two web-based surveys were conducted. The first survey was conducted to compare the prevalence and determinants with earlier studies. This is the classical method. The second survey was conducted to investigate whether there was an underestimation of the true prevalence caused by response errors due to social desirability. This is the randomized response method. This second method will result in a more reliable and valid estimation of the prevalence of use of performance-enhancing drugs, if respondents experience the questions about performance-enhancing drugs as threatening.

A total of 718 athletes from 92 fitness centres completed the questionnaire; 246 respondents completed the first survey (i.e. classical method) and 447 respondents the second survey (i.e. randomized response method). 8.8% of owners of fitness centres answered there was a good chance that athletes visiting their centre used performance-enhancing drugs. One out of ten athletes knew at least one person who used performance enhancing drugs. These drugs were classified into the following categories: anabolic steroids, prohormones, substances to counteract side-effects, growth hormone and/or insulin, stimulants (to reduce weight), and miscellaneous substances. The classical method resulted in prevalences varying between 0.0% and 0.4% for the different types of performance-enhancing drugs with an overall prevalence of 0.4%. The randomized response method resulted in prevalences varying between 0.8% and 4.8% for the different types of performance enhancing drugs with an overall prevalence of 8.2%. The overall prevalence of the two survey methods differed significantly.

Therefore, it can be concluded that the randomized response method resulted in a more reliable and valid estimation of the prevalence of use of performance-enhancing drugs. The overall prevalence of performance-enhancing drugs was low and therefore it was not possible to carry out an analysis of determinants. As a result, the third question about trends in determinants of performance enhancing drugs could not be answered. A literature research was carried out to investigate which determinants were related to use of performance-enhancing drugs in earlier European studies. The literature search showed that the following determinants were related to performance-enhancing drugs use: gender, educational level, use of various substances (legally prohibited drugs, tobacco, alcohol, coffee, dietary supplements, intention to use performance-enhancing drugs), exercise behaviour (participating in exercise, number of training hours per week, participating in body building), body image (desire to lose weight, self esteem, mental health, and trait anxiety) and social network (knowing people who use performance-enhancing drugs, having a friend who uses doping, and choice of education). The last research question addressed the question how this prevalence can be assessed in a reliable and relatively simple manner in future studies. The current study showed that the classical method led to an underestimation of the prevalence. Therefore, the randomized response method is more suitable for estimating the prevalence of use of performance-enhancing drugs in the future. Studies on the determinants of performance-enhancing drugs should be separately conducted from studies on the prevalence. To enable an analysis of determinants of performance-enhancing drugs, it is important to have a lot of respondents using performance-enhancing drugs. This can be accomplished by including fitness centres that are suspected to have many athletes using performance-enhancing drugs. However, for prevalence studies a representative sample of respondents is essential. Therefore, selecting centres with a high prevalence of performance-enhancing drugs is not the correct strategy, because the results of this selected group of athletes cannot be generalized to the population at large.

De Nederlandse topsporter en het antidopingbeleid / Irene Eijs, Aarno Havenga, Olivier de Hon. - Dopingautoriteit; NL Sporter; Vereniging van Contractspelers (VVCS); AtletenCommissie NOC*NSF. - Capelle aan den IJssel : Dopingautoriteit, 2010

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Background and research methods
Doping use is a real threat to sports. It undermines the spirit of fair play and poses health risks to the athletes. Athletes have no choice but to follow existing doping procedures. The Anti-Doping Authority the Netherlands (‘Dopingautoriteit’) periodically assesses the opinions of Dutch (elite) athletes on several aspects of doping policies in order to evaluate these policies, and possibly to adjust them. In 2009/2010 this study was performed in cooperation with NL Sporter (the Dutch independent interest group for elite athletes), the ‘Vereniging van Contractspelers’ (VVCS, the Dutch representative organisation for professional football/soccer players), and the Athlete Committee of the National Olympic Committee NOC*NSF. The study was financed by the Ministry of Health, Welfare, and Sports. In cooperation with certified research company Intomart GfK a digital questionnaire was sent to 888 elite athletes with an official ‘elite status’, as determined by NOC*NSF. In addition, 453 professional football/soccer players (all members of the VVCS) were approached via email. A representative group of 38% of all ‘status athletes’ responded. The response amongst football players was 21% and can be considered to be indicative of this particular group of athletes. The study was performed in the first few months of 2010.

Whereabouts , dopingcontrols en Therapeutic Use Exemptions (TUEs)
One of the most recent changes in the doping regulations, the introduction of a whereabouts administration, is the most controversial antidoping rule. Less than 20% of all status athletes think this rule is necessary for their own sport, with 61% having experience in fulfilling this requirement. A group of 38% of these athletes regularly experiences problems in filing whereabouts information. This percentage is somewhat lower in younger athletes and in females. The two most important antidoping organisations that collect whereabouts information from Dutch athletes receive similar complaints, but WADA’s ‘ADAMS system’ experiences technical and software related problems more often than Dopingautoriteit’s ‘Sportergegevens’. Athletes perceive whereabouts regulations as a major impact on their personal lives. The software used to collect whereabouts information is considered unnecessary laborious and filing whereabouts information, and keeping them updated, costs a lot of time. The combination of not knowing where one will be at a certain point of time in the future, and the knowledge that administrative mistakes may lead to ‘missed tests’ and possible sanctions leads to a high level of uncertainty. This uncertainty is increased by the fear that a doping control officer might not be able to find an athlete, even when the athlete is present at the specified location. This leads to the situation that of all athletes that have to fulfil whereabouts requirements, 47% feels that the influence of doping regulations on their personal lives is too big. Amongst those athletes who do not have this requirement, this percentage is much lower: 19%. There are strong clues that irritation about the whereabouts requirements seriously lowers the support of antidoping regulations in general.

Submitting to the practice of doping controls receives far more support. Problems are encountered less frequently and more than half of the ‘status athletes’ find it important that out of competition controls are performed to discourage doping use. 79% Of these athletes have been tested themselves in the previous year; in the last survey (in 2003) this was 57%. Football/ soccer players are tested less frequently (32% has been tested in the previous year). One in every twenty athletes (of those who have been tested) has one or more registered ‘missed tests’ in its name. These were most often caused by filing the wrong whereabouts information, or sudden changes in schedule due to traffic jams, changed weather, or other unforeseen circumstances. It is of more concern that two cases of registered ‘missed tests’ have been caused by the inability to find the particular athlete, who actually was present at the filed location.

Athletes are well-informed on the possibility to ask for a therapeutic exemption to use prohibited substances or methods (TUE procedure). Knowledge about, and experiences with, this procedure is somewhat scarcer amongst football/soccer players. Approximately 20% of all athletes with TUE-experience has encountered a problem of some sort, like the return of an (incomplete) request or a lack of clarity related to the duration and/or region of validity of the acquired exemption.

Attitudes ,policy, and knowledge
The attitude of Dutch athletes towards doping in general is very dismissive. No less than 91% would feel guilty if doping would be used and 95% states that they only want to win if this can be achieved on their own strength. Athletes prefer that antidoping efforts are predominantly focussed on internationally harmonised policies, increased education in general, and especially targeted at coaches and support personnel. Relatively speaking, older athletes expect more often that tougher sanctions and the availability of alternative methods to improve performance (better training facilities, better nutrition, innovations) will be efficient deterrents of doping use. When compared to other athletes, football/soccer players favour more out of competition controls. Knowledge on the Prohibited List is reasonable; on the procedures surrounding doping controls it is even better. In the past seven years, knowledge on doping related issues has improved.

Education
Of all educational materials that are offered by ‘Dopingautoriteit’, the fan booklet and the website are best known, and are used most often. Status athletes seek doping related information at the Dopingautoriteit, or consult a specialised sports physician. Football/ soccer players seek this sort of information in their direct (club) environment; they have not yet found the way to Dopingautoriteit. Over the last decade, the general practitioners are increasingly less often consulted on doping matters. Consultation of specialised physicians, internet, and NOC*NSF is on the rise.
Existing educational materials receive great satisfaction. One noticeable result is that satisfaction about educational meetings has dropped somewhat over the last seven years (from 95% to 84%). These meetings could be personalised and targeted at specific questions and requests of the athletes that are present. An email service ranked highest for athletes when asked in what way they would like to receive future updates on doping related issues.

The ‘100% Dope Free’ campaign’, started in 2007 at the initiative of the Athlete Committee of NOC*NSF and Dopingautoriteit, is not yet known amongst all elite athletes. About two thirds of all status athletes are familiar with the campaign; for football/soccer players this percentage is just 8%. The different aspects of the campaign are judged in a positive manner by 50-66% of all athletes.

Based on the results, a number of actionable recommendations have been made. These are listed in the last paragraph of this report (page 23).

Gezondheidsrisico's illegale doping via internet / Hans Wassink, Bart Coumans, Olivier de Hon. - Capelle a/d IJssel : Dopingautoriteit, 2010

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Abstract:

Health Risks of Illegal Doping Trade over the Internet. In the Netherlands it is estimated that there are 160,000 doping users who take these substances particularly for cosmetic purposes, i.e. more muscle and less body fat. It is suspected that a significant proportion of these users purchase doping over the internet. The purpose of this research is to better understand the doping trade over the internet and the associated (additional) health and other risks.

An overview of research in the Netherlands on illegal doping trade over the internet was done. In addition, during the period November 2009 to February 2010 sites were reviewed in particular those selling anabolic steroids and human growth hormone. A selection of these websites was made followed by a qualitative analysis of the (additional) health risks based on the information and advices on these websites. Based on the research overview it can be concluded that it seems that the trade of illicit doping over the internet increases. There are some indications that these substances are more often counterfeited than the 'regular' doping trade. The most recent estimate indicates that approximately 30% of the doping buyers buy the substances over the internet. Internet plays a distinct role in information even when only looking for buying opportunities. Besides health risks, there are also financial and legal risks of buying these products over the internet.

The analysis of websites offering illegal doping brings various risks to the fore. Besides the fact that the use of doping already gives substantial health risks and that 50-60% of illegal doping is counterfeited, users run additional risks following the advices given. Large doses are almost standard advice to beginners, and on websites the tone of voice about doping use is frivolous and the information given is very unbalanced (risks are minimized; risk groups like minors and women are seldom specifically warned).

The findings from this research will be used in the prevention and education activities of the Anti-Doping Authority of the Netherlands mainly focused on athletes and fitness instructors in gyms. To better map trends, future prevalence studies should include doping trade over the internet. It is known that ordinary drug sales over the internet can vary considerably in quality. It is recommended that the quality and risks of the illicit doping trade over the internet should be monitored. Finally, cooperation and exchange with the national Health Campaign "The dangers of internet medication’ and the Trimbos Institute (centre on mental health and drug addiction) are recommended.