Over-the-counter drug use amongst athletes and non-athletes

1 Jan 2003

Chester N, Reilly T, Mottram DR.
J Sports Med Phys Fitness. 2003 Mar;43(1):111-8.
School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.

Many over-the-counter (OTC) drugs used in the symptomatic relief of upper respiratory tract (URT) conditions are banned by sports governing bodies. It would appear therefore that athletes are being penalised for practising conventional pharmacological methods in the management of common ailments. The aim was to identify any differences between athletes and non-athletes and amongst athletic groups, with respect to the prevalence of URT
conditions and the use of OTC drugs to treat such conditions.

Questionnaires were distributed at domestic and international athletics meetings and at university lectures and tutorials. Respondents (n=401) represented both track and field athletes (n=199) and non-athletes (n=202).

No differences were found between athletes and non-athletes and between elite and non-elite athletes in terms of the frequency of episodes of URT conditions reported in the previous year. A higher proportion of elite, as opposed to non-elite athletes did not take OTC medicines (p=0.028) and of those that did take OTC medicines a higher proportion of elite athletes (68%) as opposed to non-elite (32%) took those not containing sympathomimetics, banned by the International Olympic Committee (IOC). Athletes were found to have greater knowledge of IOC banned OTC drugs (p=0.002) and within this group, elite athletes were most knowledgeable (p=0.0003). Although most respondents (81%) believed that OTC drugs should not be prohibited in sport, athletes made up the greatest proportion in support of prohibition (23.5% as opposed to 14.4% of non-athletes) with elite as opposed to non-elite most in favour (p=0.0181).

These results suggest that URT conditions are no more prevalent between athletes and nonathletes or between endurance and power athletes. Athletes competing at the highest level tended to avoid OTC medicines or those containing IOC banned drugs and were most knowledgeable in terms of banned OTC drugs and most in favour of their prohibition suggesting that the control mechanisms in place are only reaching elite athletes.

[PubMed - indexed for MEDLINE]

Ephedrine, pseudoephedrine, and amphetamine prevalence in college hockey players: most report performance-enhancing use

1 Jan 2004

Bents RT, Tokish JM, Goldberg L.
Phys Sportsmed. 2004 Sep;32(9):30-4.
Ashland Orthopedic Associates, Ashland, OR, 97520, USA. Bentsrdd@yahoo.com.

Performance-enhancing drugs are used by some athletes, even though the substances may be potentially dangerous and some are banned.

To assess the use of metabolic stimulants among collegiate hockey players.

Surveys were administered to college hockey players on five teams. Participation was voluntary, and respondents remained anonymous. The survey included questions regarding use of specific stimulants (eg, ephedrine, amphetamines, pseudoephedrine), awareness of potential side effects, and knowledge of National Collegiate Athletic Association (NCAA) rules.

More than half (58%) of the 122 college hockey players who completed the survey reported past or present use of the specific stimulants. Almost half (46%) reported pseudoephedrine use to enhance performance, including 24% who indicated current use, and 38% reported ephedrine use, including 11% who admitted current use. Stimulant users had good knowledge about the potential side effects of ephedrine, including sudden death, hypertension, and insomnia. Nearly all (92%) stimulant users were aware of the current NCAA ban of ephedrine. Over 33% stated they would use a banned substance if it would help them get to the National Hockey League.

A large number of collegiate hockey players admit to using metabolic stimulants despite knowledge of side effects and the NCAA ban on two of these substances. More effective educational interventions, perhaps coupled with a stronger testing policy, may be necessary to curb this potentially dangerous practice. Performance-enhancing drugs are used by some athletes, even though the substances may be potentially dangerous and some are banned.

[PubMed - in process]

Examining athletes' attitudes toward using anabolic steroids and their knowledge of the possible effects

1 Jan 1997

Anshel MH, Russell KG.
J Drug Educ. 1997;27(2):121-45.
Department of Psychology, University at Wollongong, New South Wales, Australia.

One goal of contemporary sports leaders is to eradicate the use of banned drugs in competitive sport. A common approach to achieving this outcome is to provide athletes with adequate
education about the effects of drug use. Ostensibly, educational programs about the deleterious effects of using anabolic steroids are thought to discourage their intake. Thus, the purpose of this study was to examine the relationships between the athletes' knowledge about the long-term effects of anabolic steroids and their attitudes toward this type of drug.

Multiple regression analyses indicated relatively low R2's and correlations between the various components of subjects' knowledge and their attitude toward steroid ingestion. This suggests that educational programs for athletes about taking anabolic steroids may have limited value in terms of creating appropriate, responsible attitudes toward this illegal, unethical, and medically questionable practice.

[PubMed - indexed for MEDLINE]

Football and doping: study of African amateur footballers

14 Feb 2002

P F M Ama, B Betnga, V J Ama Moor, J P Kamga
Br J Sports Med 2003;37:307–310
Professor Ama, BP 2787, Yaounde, Cameroon; Pierre.ama@prc.cm or pierreama@yahoo.fr

Objective: To investigate use and awareness of lawful and unlawful substances by amateur footballers in Yaounde, Cameroon.

Methods: A total of 1116 amateur footballers (1037 male and 79 female) out of 1500 contacted participated in this study. They were divided into three groups: elite players (n = 314); local players (n =
723); female players (n = 79). They answered a questionnaire of 30 items grouped under six main topics: identification of players; use of lawful substances subject to certain restrictions on the International Olympic Committee (IOC) list; use of IOC banned substances; doping behaviour; awareness of doping; food supplements. The results of the questionnaire were scrutinised using Microstat software, and the level of significance was p<0.05.

Results: (a) Use by our footballers of a banned substance (cocaine) and substances subject to certain restrictions (alcoholic drinks, methylated spirits, and banga (marijuana)). (b) Doping behaviour: use by our footballers of substances with similar effects to some IOC banned substances but not listed as such: tobacco, liboga, wie-wie (narcotic), bilibili (locally made alcohol drink). (c) A large intake of vitamin C (food supplements) in all three groups. In contrast, the footballers’ knowledge of doping was vague.

Conclusion: Preventive actions and an epidemiological study of doping among footballers are urgently required.

NCAA institutionally based drug testing: do our athletes know the rules of this game?

1 Jan 1992

Albrecht RR, Anderson WA, McGrew CA, McKeag DB, Hough DO.
Med Sci Sports Exerc. 1992 Feb;24(2):242-6.
Office of Medical Education Research and Development, College of Human Medicine, Michigan State University, East Lansing 48824.

One aspect of the current drug-testing controversy that has gone relatively unexamined concerns the extent to which student-athletes are fully informed of the testing procedures employed by their institution.

College athletes (N = 2,282) participating at 11 NCAAaffiliated institutions nationwide were surveyed as to their awareness of their school's drugtesting program.

Results indicate athletes have numerous misconceptions regarding the drug testing to which they may be subjected. Over one-third of the athletes attending "testing" institutions were oblivious to the fact their school was engaged in drug-testing, and more than 70% were unable to correctly identify their school's drug-testing protocol.

Implications of such ignorance are discussed.

PMID: 1549014 [PubMed - indexed for MEDLINE]

Self-reported attitudes of elite athletes towards doping: differences between type of sport.

1 Feb 2006

Alaranta A, Alaranta H, Holmila J, Palmu P, Pietilä K, Helenius I.
Int J Sports Med. 2006 Oct;27(10):842-6. Epub 2006 Feb 1.
Division of Social Pharmacy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland. anti.alaranta@helsinki.fi

Although athletes' beliefs and values are known to influence whether or not an athlete will use banned drugs, little is known about the athletes' beliefs and attitudes in different sports. The
aim of this study was to clarify the beliefs and attitudes of elite athletes towards banned substances and methods in sports.

A total of 446 athletes (response rate 90.3 %; 446/494) financially supported by the National Finnish Olympic Committee completed a structured questionnaire during their national team camps in 2002. More than 90 % of the athletes reported to believe that banned substances and methods have performance enhancing effects,
and 30 % reported that they personally know an athlete who uses banned substances. Of the male athletes 35 %, and 23 % of females reported they personally know an athlete using banned substances. A total of 15 % of the athletes reported that they had been offered banned substances: 21 % of the speed and power athletes, 14 % of the team sport athletes and of the athletes in motor skills demanding events, and 10 % of the endurance athletes. Stimulants were the most often offered substance group (to 7 % of all the athletes) followed by anabolic steroids (4 %).

Subjects who regarded doping as a minor health risk seemed to be more often associated with doping users than those regarding doping as a significant health risk. Athletes in different sports have a different approach to doping. Risk of doping appears to be highest in speed and power sports and lowest in motor skills demanding sports. Males are at higher risk than females. Controlling doping only by tests is not sufficient. A profound change in the attitudes is needed, which should be monitored repeatedly.

PMID: 16586338 [PubMed - indexed for MEDLINE]

Doping control video (Dutch) Dopingautoriteit

1 Jan 2009

Dopingcontrole procedure (Dutch)

This is an education video of the dopingcontrol procedure in the Netherlands, performed according to the standards of the Anti-Doping Authority the Netherlands.

The video is made in 2009.

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CAS 2011_A_2671 UCI vs Alex Rasmussen & The National Olympic Committee and Sports Confederation of Denmark

4 Jul 2012

CAS 2011/A/2671 Union Cycliste Internationale (UCI) v. Alex Rasmussen & The National Olympic Committee and Sports Confederation of Denmark (Dansk Idraetsforbund)

Related cases:
- CAS 2008_A_1612 Michael Rasmussen vs UCI & FMC
January 22, 2009
- Dutch District Court 2008 Michael Rasmussen vs RABO Wielerploegen
July 2, 2008
- Dutch Court of Appeal 2012 Michael Rasmussen vs RABO Wielerploegen
June 19, 2012
- Dutch Court of Appeal 2013 Michael Rasmussen vs RABO Wielerploegen
June 25, 2013

5. The circumstances stated below are a summary of the main relevant facts, as submitted by the parties in their written pleadings or in the evidence offered in the course of the
proceedings. Additional facts may be set out, where relevant, in connection with the legal discussion which follows.
6. According to the rules governing the doping control program of UCI (the UCI Anti- Doping Rules: hereinafter referred to as the "UCI ADR") and of DIF (the Danish National Anti-Doping Rules: hereinafter referred to as the "NADR"), Rasmussen has
been included since 2009 in the Registered Testing Pool of athletes (hereinafter referred to as the "RTP") both of DIF (hereinafter referred to as the "DIF RTP") and UCI (hereinafter referred to as the "UCI RTP").
7. The World Anti-Doping Code (hereinafter referred to as the "WADC") of the World Anti-Doping Agency (hereinafter also referred to as the "WADA"), in fact, requires the signatories, which include UCI and DIF, to define a group of athletes as their RTP.
Each athlete included in the RTP has the obligation to provide regular and updated whereabouts information, i.e. a three month schedule containing information, before the commencement of each quarterly period, about where he or she can be met for unannounced out-of-competition testing. In order to avoid unnecessary burden on athletes obliged to provide such information both to their National Anti-Doping Organisations and to the International Federation they belong to, WADA has developed
a web-based application, called ADAMS – Anti-Doping Administration and Management System (hereinafter referred to as "ADAMS") to enable athletes to enter their whereabouts into a single system. International Federations are then provided
access by the relevant National Anti-Doping Organisation to the information entered into ADAMS by each athlete.
8. As a result of the above, Rasmussen had the obligation to enter, and keep updated, his CAS 2011/A/2671 UCI v. Rasmussen & DIF - page 3 whereabouts into ADAMS. UCI was allowed to access such information.
9. On 1 February 2010, officers of the Danish National Anti-Doping Organisation (Anti-Doping Denmark, hereinafter referred to as "ADD") unsuccessfully tried to locate Rasmussen for an out-of-competition doping control at the place he had indicated on
ADAMS for that day: instead of being in Denmark, he was in Germany competing in the Berlin Six Days (from 28 January to 2 February 2011). A whereabouts failure was therefore recorded pursuant to Article 5.4.5 NADR and notified to Rasmussen on 16
February 2010, as the explanations he had provided were considered to be insufficient by ADD.
10. On 4 October 2010, ADD notified Rasmussen of a potential failure to file his whereabouts information for the fourth quarter of 2011 by the deadline of 30 September 2010: at the same time, ADD indicated to Rasmussen that it had remarked "that you did
not state your participation in the World Championships in Australia that has just taken place". Following said notification, Rasmussen filed the missing information on 5 October 2010, without providing any explanations. Therefore, on 26 October 2010, ADD recorded and notified to Rasmussen a filing failure for the purposes of Article
5.4.5 NADR.
11. On 28 April 2011, officers of the UCI unsuccessfully tried to locate Rasmussen for an out-of-competition doping control at the place in Spain he had indicated in ADAMS for that day: the UCI officers could only get in touch with Rasmussen on the phone, to
discover that he was in Denmark, for his sister's confirmation. On 14 July 2011, UCI
notified Rasmussen of such potential missed test, which was recorded on 18 August 2011.
12. On 13 September 2011, UCI informed ADD of the recording of the missed test of 28 April 2011, being "the 3rd whereabouts failure of … Rasmussen", to indicate that according to Article 110 of the UCI ADR, ADD was "responsible to bring proceedings against Rasmussen under art. 21.4 [UCI] ADR as his previous whereabouts failures were recorded by your organization". On the same day, ADD referred the case to the Anti-Doping Committee (Dopingudvalg) of DIF for further proceedings.
13. On 14 September 2011, the Anti-Doping Committee of DIF imposed on Rasmussen a provisional suspension pursuant to Article 7.6.2 NADR.
14. On 12 October 2011, the Anti-Doping Committee sent to WADA an email as follows: "… the Doping Commission of the NOC and Sports Confederation of Denmark urgently needs WADA's advice in an unusual case we are currently reviewing. Your last response was most helpful, so we kindly ask for your help once again.
This is the first case in Denmark about an infringement of the whereabouts rules (3 infringements in an 18 months' period). In the current case, two infringements were recorded by the NADO (ADD) and one by the IF and thus the case will be heard before the NOC's Doping Tribunal.
While reviewing the case, we have noticed a slight, but probably important difference between the whereabouts regulations of WADA's International Standard for Testing and the whereabouts regulations of the IF. A difference in the procedural rules that is to the CAS 2011/A/2671 UCI v. Rasmussen & DIF - page 4
disadvantage of the athlete. Although it is not mentioned in the World Anti Doping Code article 23.2 as an area that
must be implemented by Signatories without substantial change, it is stated in art. 5.2 that Anti-Doping Organizations with testing jurisdiction shall conduct such testing in conformity with the International Standard for Testing. The Preamble to the International Standard for Testing states that International
Standard for Testing is a mandatory International Standard (Level 2) developed as part of the World Anti-Doping Program. In addition, it is stated in art. 10 that Section 11.0 of the International Standard for Testing sets out mandatory standards to be implemented by IFs and NADOs (as well as recognized and applied by other Anti-Doping Organizations) as the whereabouts requirements applicable to Athletes in their respective Registered Testing Pools.
Our question is therefore if WADA can confirm that the International Standard for Testing is indeed considered mandatory for IFs and NADOs and, consequently, that no changes from the Standard should be made when drafting the principles and procedural guidelines in the regulations of the IFs and the NADOs ?".

CAS 2011_A_2398 WADA vs WTC & Timothy Marr - Final Award

20 Feb 2012

CAS 2011/A/2398 World Anti-Doping Agency (WADA) v. World Triathlon Corporation (WTC) & Timothy Marr, award of 20 February 2012

Related case:
CAS 2011_A_2398 WADA vs WTC & Timothy Marr - Partial Award
August 19, 2011

Doping (amphetamine)
Assessment of the ineligibility period

In assessing the period of ineligibility to impose, a panel must have regard to the particular circumstances of each case. In a particular case where the facts are agreed to between the parties that the athlete had no intention to take the prohibited substance thus no intent to enhance sports performance, he was consuming a beverage he thought to be his, he was travelling with a friend, he was not in a hostile environment when he consumed the beverage, he was not aware that his friend suffered from Attention Deficit Disorder, nor was he aware that his friend was prescribed medication for the disorder, the degree of fault or negligence by the athlete is very limited.

On 22 February 2011 the AAA Panel decided to impose a 6 month period of ineligibility on the Athlete Timothy Marr after his A and B samples tested positive for the prohibited substance Amphetamine.

Hereafter in April 2011 the World Anti-Doping Agency (WADA) appealed the AAA decision with the Court of Arbitration for Sport (CAS). WADA requested the Panel to set aside the AAA decision of 22 February 2011 and to impose a period of ineligibility on the Athlete between 12 and 14 months.

The Athlete denied the intentional use of the substance and explained that he ingested the substance when he consumed his friend's drink that contained prescribed Adderall while he was not present when the medication was poured by his friend into his drink.

The Panel accepts that the violation was not intentional and finds that the Athlete's degree of fault or negligence is very limited for imposing a reduced sanction.

Therefore the Court of Arbitration for Sport decides on 20 February 2012:

1.) The appeal filed by the World Anti-Doping Agency against the decision issued by the American Arbitration Association on 22 February 2011 is upheld.
2.) The Award rendered on 22 February 2011 by the American Arbitration Association in the matter of World Triathlon Corporation v. Mr. Timothy Marr is set aside.
3.) Mr. Timothy Marr shall serve a twelve months period of ineligibility, beginning 13 August 2010 and ending 12 August 2011. All competitive results obtained by Mr. Marr between 23 February 2011 and 12 August 2011 shall be disqualified, with all of the resulting consequences including forfeiture of any medals, points and prizes.
4.) This award is pronounced without costs, except for the Court Office fee of CHF 1,000 paid by WADA which shall be retained by the CAS.
5.) All other or further prayers for relief are dismissed.

CAS 2011_A_2582 WADA vs Karhan Akay & Turkish Swimming Federation

29 May 2012

CAS 2011/A/2582 World Anti-Doping Agency (WADA) v. Turkish Swimming Federation (TSF) and Karhan Akay

2.1 The Athlete was bom on 20 June 1995. On 21 October 2010 having competed in the Em'e Vardar National Team Election Contest in Istanbul he was selected to provide a urine sample.
2.2 The A sample was tested by the Turkish Doping Control Centre and proved positive to metabolites of methandienone (ie 6b-OH-methandienone and 17-methandienone). The Athlete did not request an analysis of the B sample.
2.3 Methandienone is an anabolic steroid which appears on the WADA 2010 Prohibited Lists underclass Sl.1 anabolic androgenic steroids. ït is prohibited in and out of competition, as indicated in the Prohibited List. It is not defmed as a "Specified' Substance" in the WADA 2010 Prohibited List. By article 4.1 of the FINA Doping
Contcol Rules (FINA DC) those anti-doping rules incorporate the Prohibited List which is published and revised by WADA.
2.4 Proceedings were brought before the TSF Disciplinary Committee a committee constituted under the rules of TSFj at which the Athlete explained that he had to follow medical treatment in order to stimulate gi'owth and to prevent a gtowth slowdown. The evidence was that under this treatment, supervised by Dr Atilla
Boyukkbegiz, a specialist in paediatric endocrinology at the Florence Nightingale Hospital, Istanbul, the Athlete took 1.25mg of oxandrolone per day.

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