CAS ad hoc Division (OG Turin) 06/004 Deutscher Skiverband & Evi Sachenbacher-Stehle v. International Ski Federation (FIS)

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• Cross-country skiing
• Haemoglobin (Hb) value exceeding the threshold under the FIS Rules
• Alleged naturally high elevated level of Hb
• Application for a dispensation from the FIS Hb Rule

Since 2003 requests have been made each year to issue a dispensation for a naturally elevated high level of Haemoglobin (Hb) for this Athlete. All requests have been unsuccessful in persuading the FIS that this Athlete has a naturally high elevated level of Hb. FIS does agree that this Athlete does have a modestly elevated level of Hb but it is not sufficient to justify issuing a dispensation pursuant to Rule FIS B.4.8. Far be it for the CAS Panel to substitute its views to those of the experts who have declined to grant the dispensation to this Athlete for a naturally high elevated level of Hb over the past 3 years. The Panel is being asked to make a medical expert’s judgement through the guise of cancelling a Notification of Start Prohibition. It is not for the Panel to perform an evaluation similar to that contemplated by the FIS B.4.8, which would apply for the duration of theOlympic Games.

Ms Evi Sachenbacher-Stehle is a German Athlete selected to compete in the Women's Cross Country Skiing Events at the Turin 2006 Olympic Winter Games.

Following a blood screening/testing on 9 February 2006 that showed a level of haemoglobin above the maximum tolerated values, Ms Sachenbacher-Stehle was obliged by the FIS not to start any competitions for five consecutive days. As a result, the athlete would be forced to miss her first Olympic Games event on 12 February 2006.

Hereafter the German Ski Federation and the German cross-country skier Ms Evi Sachenbacher-Stehle filed an application in order to cancel the “Notification of Start Prohibition” issued by the International Ski Federation (FIS).

The athlete further asked the Panel to declare that the levels of haemoglobin were naturally elevated and had no connection with any haematological disease. The Panel refused to make a medical expert’s judgment and dismissed the application; moreover, it was convinced that the athlete did not have a naturally high level of haemoglobin.

On the basis of the facts and legal aspects, the ad hoc Division of the Court of Arbitration for Sport renders the following decision:

1.) The application filed by Ms Evi Sachenbacher-Stehle and Deutscher Skiverband against the International Ski Federation is denied.

2.) (…).

Risk Factors for Illicit Anabolic-Androgenic Steroid Use in Male Weightlifters: A Cross-Sectional Cohort Study / Harrison G. Pope, Jr., Gen Kanayama, James I. Hudson. - (Biological Psychiatry 71 (2012 3 (February); p. 254–261)

• PMID: 21839424
• PMCID: PMC3218214
• DOI: 10.1016/j.biopsych.2011.06.024

Background

Illicit anabolic-androgenic steroid (AAS) abuse, though an important public health problem, remains inadequately studied. Almost all AAS abusers are male and lift weights, but the risk factors for AAS use among male weightlifters remain poorly understood.

Methods
We recruited 233 experienced male weightlifters, of whom 102 (44%) reported lifetime AAS use, and assessed their childhood and adolescent attributes retrospectively using structured clinical interviews and computerized questionnaires. This “cross-sectional cohort” approach—a design that we have formally presented in the recent methodological literature— utilizes a study cohort, not selected for outcomes of interest, and assesses exposures and outcomes retrospectively. We hypothesized that conduct disorder and body-image concerns would be major risk factors for subsequent AAS use among male weightlifters.

Results
Within our study population, many attributes showed little association with AAS use, but conduct disorder and body-image concerns showed strong associations. For individuals with prior conduct disorder vs. those without, the hazard ratio [95% confidence interval] for subsequent AAS use was 2.2 [1.5, 3.4]. For individuals in the middle vs. lowest tertile of scores on a retrospective adolescent “muscle-dysmorphia” scale, the hazard ratio was 1.5 [0.84, 2.6]; for the highest vs. lowest tertile, the hazard ratio was 3.3 [2.0, 5.3]; and for the linear trend of hazard ratios, P < 0.001.

Conclusions
Conduct disorder and body-image concerns represent important risk factors for AAS use among male weightlifters. Thus, assessment of these attributes may help to identify individuals most likely to require interventions to discourage this form of substance abuse.

Brian P. Brennan, Gen Kanayama, James I. Hudson, and Harrison G. Pope, Jr.
Am J Addict. 2011 Jan-Feb; 20(1): 9–13.

In a study of performance-enhancing substance use among 231 experienced young male weightlifters, we found that 27 (12%) reported illicit use of human growth hormone (HGH) or its bioactive derivative, insulin-like growth factor-1 (IGF-I). All of these 27 men also reported use of anabolic-androgenic steroids (AAS) and 22 (81%) met criteria for current or past AAS dependence. Fifteen (56%) also reported current or past dependence on opioids, cocaine, and/or ecstasy. These findings suggest that among young male weightlifters, illicit HGH use has become a common form of substance abuse, frequently associated with both AAS dependence and classical substance dependence.

Amphetamine-induced psychosis - a separate diagnostic entity or primary psychosis triggered in the vulnerable? / Jørgen G. Bramness, Øystein H. Gundersen, Joar Guterstam, Eline B. Rognli, Maija Konstenius, Else-Marie Løberg, Sigrid Medhus, Lars Tanum, Johan Franck. - (BMC Psychiatry (2012), 12:221

• doi:10.1186/1471-244X-12-221

Use of amphetamine and methamphetamine is widespread in the general population and common among patients with psychiatric disorders. Amphetamines may induce symptoms of psychosis very similar to those of acute schizophrenia spectrum psychosis. This has been an argument for using amphetamine-induced psychosis as a model for primary psychotic disorders. To distinguish the two types of psychosis on the basis of acute symptoms is difficult. However, acute psychosis induced by amphetamines seems to have a faster recovery and appears to resolve more completely compared to schizophrenic psychosis. The increased vulnerability for acute amphetamine induced psychosis seen among those with schizophrenia, schizotypal personality and, to a certain degree other psychiatric disorders, is also shared by non-psychiatric individuals who previously have experienced amphetamine-induced psychosis. Schizophrenia spectrum disorder and amphetamine-induced psychosis are further linked together by the finding of several susceptibility genes common to both conditions. These genes probably lower the threshold for becoming psychotic and increase the risk for a poorer clinical course of the disease.

The complex relationship between amphetamine use and psychosis has received much attention but is still not adequately explored. Our paper reviews the literature in this field and proposes a stress-vulnerability model for understanding the relationship between amphetamine use and psychosis.

Psychiatric and medical effects of anabolic-androgenic steroid use. A controlled study of 160 athletes / Harrison G. Pope Jr, David L. Katz. - (Archives of general psychiatry 51 (1994) 5 (May); p. 375-382)

• PMID: 8179461
• DOI: 10.1001/archpsyc.1994.03950050035004

Abstract

Background: We sought to expand on preliminary findings suggesting that anabolic-androgenic steroids produce psychiatric effects in some athletes who use them.

Methods: We compared 88 athletes who were using steroids with 68 nonusers, using the Structured Clinical Interview for DSM-III-R to diagnose psychiatric syndromes occurring in association with steroid use (if applicable) and in the absence of steroid use. Demographic, medical, and laboratory measures were also performed.

Results: Steroid users displayed more frequent gynecomastia, decreased mean testicular length, and higher cholesterol-high-density lipoprotein ratios than nonusers. Most strikingly, 23% of steroid users reported major mood syndromes--mania, hypomania, or major depression--in association with steroid use. Steroid users displayed mood disorders during steroid exposure significantly more frequently than in the absence of steroid exposure (P < .001) and significantly more frequently than nonusers (P < .01). Users rarely abused other drugs simultaneously with steroids.

Conclusion: Major mood disturbances associated with anabolic-androgenic steroids may represent an important public health problem for athletes using steroids and sometimes for the victims of their irritability and aggression.

Clenbuterol residues in pig muscle after repeat administration in a growth-promoting dose / Pleadin J, Vulić A, Persi N, Vahcić N. Meat Sci. 2010 Nov;86(3):733-7.

• doi: 10.1016/j.meatsci.2010.06.013. Epub 2010 Jun 20

Laboratory for Analytical Chemistry, Croatian Veterinary Institute, Savska 143, HR-10 000 Zagreb, Croatia.

The aim of this study was to determine the level of clenbuterol residues in muscle tissue of pigs after repeat administration in a growth-promoting dose. An anabolic dose of clenbuterol (20 μg/kg body mass per day) was administered orally to experimental group (n=12) for 28 days, whereas control animals (n=3) were left untreated. Clenbuterol treated pigs were randomly sacrificed (n=3) on days 0, 3, 7 and 14 of treatment discontinuation and clenbuterol residues determined in muscle tissue. Determination of residual clenbuterol was by enzyme-linked immunosorbent assay (ELISA) as a screening method and liquid chromatography tandem mass spectrometry (LC-MS/MS) as a confirmation method. The highest clenbuterol content in the muscle of treated animals was recorded on day 0 of treatment cessation (4.40±0.37 ng/g) and significantly (p<0.05) exceeded the maximum residue limit (MRL) of 0.1 ng/g. On day 3 of withdrawal, it was 0.49±0.22 ng/g and on day 7 0.10±0.02 ng/g (at MRL); on day 14 of treatment discontinuation, clenbuterol content was below the limit of detection (<0.1 ng/g) in all samples. Administration of clenbuterol as a growth promoter in pig production could lead to residues in meat for human consumption up to 7 days after treatment discontinuation.

Stephany RW. Handb Exp Pharmacol. 2010;(195):355-67. doi: 10.1007/978-3-540-79088-4_16.

In contrast to the use of hormonal doping agents in sports to enhance the performance of athletes, in the livestock industry hormonal growth promoters ("anabolics") are used to increase the production of muscle meat. This leads to international disputes about the safety of meat originating from animals treated with such anabolics.As a consequence of the total ban in the EU of all hormonal active growth promoters ("hormones") in livestock production, in contrast to their legal use [e.g. of five such hormones (17beta-estradiol, testosterone, progesterone, trenbolone and zeranol) as small solid ear implants and two hormones as feed additives for feedlot heifers (melengestrol acetate) and for swine (ractopamine) in the USA], the regulatory controls also differ sharply between the EU and the USA.In the EU the treatment of slaughter animals is the regulatory offence that has to be controlled in inspection programs. In the USA testing for compliance of a regulatory maximum residue level in the edible product (muscle, fat, liver or kidney) is the purpose of the inspection program (if any).The EU inspection programs focus on sample materials that are more suitable for testing for banned substances, especially if the animals are still on the farm, such as urine and feces or hair. In the case of slaughtered animals, the more favored sample materials are bile, blood, eyes and sometimes liver. Only in rare occasions is muscle meat sampled. This happens only in the case of import controls or in monitoring programs of meat sampled in butcher shops or supermarkets.As a result, data on hormone concentrations in muscle meat samples from the EU market are very rare and are obtained in most cases from small programs on an ad hoc basis. EU data for natural hormones in meat are even rarer because of the absence of "legal natural levels" for these hormones in compliance testing. With the exception of samples from the application sites - in the EU the site of injection of liquid hormone preparations or the site of application of "pour on" preparations - the hormone concentrations observed in meat samples of illegally treated animals are typically in the range of a few micrograms per kilogram (ppb) down to a few tenths of a microgram per kilogram. In the EU dozens of illegal hormones are used and the number of active compounds is still expanding. Besides estrogenic, androgenic and progestagenic compounds also thyreostatic, corticosteroidal and beta-adrenergic compounds are used alone or in "smart" combinations.An overview is given of the compounds identified on the EU black market. An estimate is also given of the probability of consumption in the EU of "highly" contaminated meat from the application sites in cattle. Finally some data are presented on the concentration of estradiol in bovine meat from animals treated and not treated with hormone implants. These data are compared with the recent findings for estradiol concentrations in hen's eggs. From this comparison, the preliminary conclusion is that hen's eggs are the major source of 17alpha- and 17beta-estradiol in the consumer's daily "normal" diet.

Determination of 76 pharmaceutical drugs by liquid chromatography-tandem mass spectrometry in slaughterhouse wastewater / Shao B, Chen D, Zhang J, Wu Y, Sun C. J. - (Chromatogr A. 2009 Nov 20;1216(47):8312-8318

• doi: 10.1016/j.chroma.2009.08.038. Epub 2009 Aug 21.

Central Laboratory, Beijing Center for Disease Control and Prevention, Beijing 100013, China

A multi-residue method for the analysis of 76 pharmaceutical agents of nine classes of drugs (tetracyclines, macrolides, fluoroquinolones, beta-agonists, beta-blockers, diuretics, sedatives, sulfonamides and chloramphenicol) in slaughterhouse wastewater and a receiving river is presented. After simultaneous extraction with an Oasis HLB solid-phase extraction (SPE) cartridge and further purification using an amino SPE cartridge, analytes were detected by liquid chromatography-electrospray ionization-tandem mass spectrometry in positive or negative ion mode. Standard addition was used for quantification to overcome unavoidable matrix effects during ESI-MS analysis. Recoveries for most analytes based on matrix-matched calibration in different test matrices were >60%. The method quantification limits of 76 pharmaceuticals were in the range 0.2-30 ng/L. Nineteen compounds of 76 drugs were found in raw and treated slaughterhouse wastewater from four main slaughterhouses in Beijing. Sulfanamides (sulfanilamide, sulfameter), fluoroquenones (ofloxacin, pefloxacin, norfloxacin, ciprofloxacin, enrofloxacin), tetracyclines (tetracycline, oxytetracycline) and macrolides (kitasamycin, tylosin, erythromycin) were most frequently detected, with the highest levels up to approximately 3 microg/L in slaughterhouse wastewater and approximately 1 microg/L in treated wastewater. Illicit drugs for animal feeding such as clenbuterol and diazepam were commonly detected in slaughterhouse wastewater. These analytes were also observed in a river receiving slaughterhouse wastewater, with a highest level of up to 0.2 microg/L.

Meat products as potential doping traps? / Hans Braun, Hans Geyer, Karsten Koehler. - (International Journal of Sport Nutrition and Exercise Metabolism 18 (2009) 5 (October); p. 539-542).
- PMID: 19051433.
- DOI: https://doi.org/10.1123/ijsnem.18.5.539

Abstract:

Recently published news regarding food safety in China caused some worldwide disturbance and uncertainty among top athletes and their supporting staff. According to an article in The New York Times, a member of the U.S. Olympic team discovered oversized chicken breast when visiting a supermarket in Beijing, China. More interesting, the chicken contained considerable amounts of anabolic steroids, which were reported to be large enough to cause a failed doping test after ingesting the meat (Shpigel, 2008). Based on this case report it appears necessary to assess the danger posed to our (Olympic) athletes by foods and especially meat products on a more general basis. More important, our athletes are involved in worldwide travel during the competitive season. Therefore we must consider not only our athletes’ local food choices but also the wide variety of foods and regional delicacies our athletes might be confronted with in foreign countries.

Barbosa J, Cruz C, Martins J, Silva JM, Neves C, Alves C, Ramos F, Da Silveira MI. Food Addit Contam. 2005 Jun;22(6):563-6.
Laboratório Nacional de Investigação Veterinária, Lisboa, Portugal.
Abstract

This paper describes the occurrence of four cases of acute food poisoning, involving a total of 50 people, due to the ingestion of lamb and bovine meat containing residues of clenbuterol. Symptoms shown by the intoxicated people may be generally described as gross tremors of the extremities, tachycardia, nausea, headaches and dizziness. Analytical methodology developed for the determination of clenbuterol in meat, liver and blood samples is described. Procedures are described which should be followed when the described symptoms are evident in a group of people who have ingested contaminated meat, and particularly liver of ruminants.