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.

This study examined the attitude towards doping and behaviour regarding doping amongst Ukrainian students. The sample consists of both Sports students and Polytechnics students. The first part of the study includes material of self-reported data of mass survey amongst students. The second part deals with focus groups’ interview materials in order to deeper investigate driving forces of doping behaviour.

It has been established that the doping prevalence in Ukraine might affect nearly 10 % of university students. Prevalence of doping varies greatly with level of sports’ results, kind of sports activity, and the aims of engaging in sport. Representatives of strength and cyclical kinds of sports are at a higher risk of doping prevalence.

The opinion that using doping can lead to better sport results and development of muscles is widespread among Sports students, while Polytechnics students mostly consider that doping can improve appearance and increase muscles.

In spite of the widespread opinion of doping pernicious effect on health, the opinion of athletes has an essential distinction from common beliefs. Sports-oriented students consider that doping does not impact on health negatively if it is used in a reasonable way. Among athletes the opinion that doping in small doses and in reasonable proportions would be beneficial is widespread.

Our results suggest that doping use has a moral legitimacy among the majority of athletes, and this point determines doping use. The motive of “necessity” looks like a mature explanation – an ideological scheme. One of the main reasons of doping use that athletes indicated was the self-affirmation motive, reaching high sport results, material welfare.

A considerable proportion of students have lack of knowledge, in terms of side-effects, sources of information and testing procedure.

A vast proportion of high performance athletes have admitted positive attitude towards doping. One of the main reasons to take a risk of using doping is an opportunity to have a compensation (tangible, social, ideological) for harm to health.

This indicated that driving forces of doping behaviour among sports students are mainly described by the self-affirmation motive, which in turn resulted in pecuniary component.

The findings highlight a gap between policy and student behaviour regarding doping. The evidence from these results may provide arguments for governing bodies and serve as a platform in creating educational programs for main stakeholders.

Many activities focusing on Dutch elite sport have been transferred to the elite sport campaign, 100% Dope Free. In addition to providing information, this campaign focuses also on changing attitudes and behaviour.

Objectives of this program are:
- Increasing the awareness of athletes that it is their responsibility to keep the sport healthy and clean.
- To show that Dutch athletes actively support clean sport.
- To show a new generation that sport without doping is very well possible.
- To be a source of inspiration for the new generation.

Facts
The French Triathlon Federation (Fédération Française de Triathlon, FFTri) charges respondent M41 for a violation of the Anti-Doping Rules. During a match on January 9, 2005, a sample was taken for doping tests purposes. The analysis of the sample showed the presence a metabolite of cocaine. Cocaine is a prohibited substance according the World Anti-Doping Agency (WADA) prohibited list.

History
The respondent was sanctioned with a period of ineligibility of two years by the disciplinary committee of the FFTri. He didn't appear at the hearing and the contra analysis confirmed the findings. The appeal committee of the FFTri confirmed the same sanction.
The panel extends the sanction to all sport federations.

Decision
1. The sanction is a period of ineligibility of two years, in which respondent can't take part in competition or manifestations organized or authorized by sport federations.
2. The decision starts on the date of notification.
3. The decision will be published and sent to the parties involved.

Fact
The French Cycling Federation (Fédération Française de Cyclisme, FFC) charges respondent M28 for a violation of the Anti-Doping Rules. During a cycling event on July 17, 2011, a sample was taken for doping control purposes. The analysis of the sample showed the presence of parahydroxyamphetamine, L-Amphetamine, D-Amphetamine and Fenetylline which are prohibitred substances according the World Anti-Doping Agency (WADA) prohibited list. Parahydroxyamphetamine is regarded as a specified substance. L-Amphetamine, D-Amphetamine and Fenetylline are regarded as non-specified substances.

History
The respondent had allready received a decision dated November 29, 2007, for the refusal of a doping test (period of ineligibility 2 months).

Decision
1. The sanction is a period of ineligibility of 4 years (second violation) in which the athlete can't take part in competition or manifestations organized by the French sport federations.
2. All the results obtained at the cycling event of July 17, 2011, are canceled with all resulting consequences including forfeiture of
medals , points and prizes.
3. The decision will start on the date of notification.
4. The decision will be published and sent to the parties involved.

The Royal Dutch Athletics Association (KNAU) has reported against this person in connection with a third Whereabouts registered error in the last eighteen months concerned. When a member commits three Whereabouts errors within a period of eighteen months, there is a violation of the Anti-Doping Rules. Person has filed a defence and the case is then treated orally.
Concerned has stated that the DA and / or the Athletics Union of the discovery of the erroneous entry of the whereabouts and the two missed tests not acted carefully and regulations has been exceeded. However, the Disciplinary Committee has not discovered any jurisdiction of the DA or not or not properly comply with the regulations. The defence of person is rejected as being unfounded.
The DA has an erroneous submission of whereabouts information, be awarded. Also, the doping control official twice attempted concerned within the specified one-hour time slot control. Person could not be reached by the official. The defence is concerned at all three times rejected and the Disciplinary Commission considers that insufficient data subject has proved that there is no question of a mistake on his part.
There is a first offense of person. The Disciplinary Committee is a penalty of exclusion for a period of one year is appropriate. The Disciplinary Committee considers it important that the maximum penalty of two years to moderate, now it is an administrative offense concerned and it is established that there is no use of prohibited substances. The case related to these costs are borne by individual charged.

For violating the doping regulations of the ISR, the Dutch Royal Strength Sport Fitness Federation (KNKF) reported against this person. In the A portion of the urine sample of person are prohibited substances 17β-methyl-5β-androst-1-ene-3α, 17α-diol and 17α-methyl-5β-androstane-3α, 17β-diol (metabolites of metandienone) and a testosterone / epitestosterone ratio greater than 4 detected. This result is confirmed by the analysis of the B-portion of the urine sample. The doping is held during the Open Powerlifting Championship North Holland Alkmaar. The case was orally treated with the person appeared in person.
Person relied on the inadmissibility of the KNKF related to exceeding the six-week deadline for reporting the ADRV. The Disciplinary Commission notes, however, that there is no excess of this limit. Person has no further use is made of a defence. During the hearing person said to have been taken by surprise by the doping. Person had just joined the KNKF. In his own words, he was not informed about doping and possible controls. Person states that he purchased the supplements on the Internet. He had no idea that these preparations may contain prohibited substances.
For a first offense of doping, there is a penalty of exclusion for a period of two years. Person has not previously been convicted of a doping offense. The Disciplinary Committee finds that no reasons are given for the reduction / extension of the standard sanction period. Person after suspension has not participated in power lift competitions. This period shall be deducted from the total period of exclusion. Also, 50% of the costs recovered from the person concerned. Not the total cost because the information provided by the KNKF on doping control has left much to be desired.

For violating the doping regulations of the ISR, the Dutch Royal Strength Sport Fitness Federation (KNKF) reported against this person. In the A portion of the urine sample of person are prohibited substances 17β-methyl-5β-androst-1-ene-3α, 17α-diol and 17α-methyl-5β-androstane-3α, 17β-diol (metabolites of metandienone) and a testosterone / epitestosterone ratio greater than 4 detected. This result is confirmed by the analysis of the B-portion of the urine sample. The doping is held during the Open Powerlifting Championship North Holland Alkmaar. The case was orally treated with the person appearing in person.
Person relied on the inadmissibility of the KNKF related to exceeding the six-week deadline for reporting the ADRV. The Disciplinary Commission notes, however, that there is no excess of this limit. Person has no further use is made of a defence. During the hearing person said to have been taken by surprise by the doping. Person had just joined the KNKF. In his own words, he was not informed about doping and possible controls. Person states that he supplements to purchased on the Internet. He had no idea that these preparations may contain prohibited substances.
For a first offense of doping, there is a penalty of exclusion for a period of two years. Person has not previously been convicted of a doping offense. The Disciplinary Committee finds that no reasons are given for the reduction / extension of the standard sanction period. Person after suspension has not participated in power lift competitions. This period shall be deducted from the total period of exclusion. Also, 50% of the costs recovered from the person concerned. Not the total cost because the information provided by the KNKF on doping control has left much to be desired.

The KNKF Appeal committee decides on 22 July 2010 to dismiss the appeal and to uphold the impose a 2 year period of ineligibilty.

Journal of the International Society of Sports Nutrition 2012, 9:28
Paolo Borrione, Marta Rizzo, Federico Quaranta, Emanuela Ciminelli, Federica Fagnani, Attilio Parisi and Fabio Pigozzi

Background: A growing consumption of natural (plant-derived) dietary supplements with ergogenic aims, with particular regard for ecdysteroids, phytoestrogens and vegetal sterols, has been registered over the last years among “recreational” athletes. The present study was carried out in order to evaluate the real knowledge of plant-derived nutritional supplements among physically active people as well as their real consumption. Additional aim was to evaluate the effects of these supplements on the health profile of the users.

Methods: Twenty-three trained subjects who habitually used natural dietary supplements, and 30 matched controls
were analyzed for plasma biochemical markers and hormonal profile.
Results: The laboratory tests revealed the absence of any sign of organ toxicity/damage in both athletes and controls. On the contrary, hormone profiles revealed marked alterations in 15 (65%) out of the 23 of investigated athletes. Specifically, 10 males presented increased plasma levels of progesterone, 15 subjects presented abnormal estrogen levels, including 5 (2 F and 3 M) presenting a “dramatic” increased estrogen values and 2 two males with increased estrogen levels, increased testosterone levels and associated suppression of luteinizing hormone and follicle-stimulating hormone.

Conclusions: The results of the present study highlighted that the habitual consumption of plant-derived nutritional supplements is frequently associated with significant hormonal alterations both in male and female subjects. Although these biochemical alterations were not associated with signs or symptoms of organ toxicity/
damage at the moment of the study, it cannot be excluded that, in the mid/long-term, these subjects would suffer of health problems secondary to chronic exposure to heavily altered hormonal levels. Further large scale studies are needed to confirm the results of this pilot study as well as to investigate the biological mechanisms at the base of the observed hormonal alterations.

J Cachexia Sarcopenia Muscle. 2011 September; 2(3): 153–161.
Dalton JT, Barnette KG, Bohl CE, Hancock ML, Rodriguez D, Dodson ST, Morton RA, Steiner MS.

BACKGROUND:

Cachexia, also known as muscle wasting, is a complex metabolic condition characterized by loss of skeletal muscle and a decline in physical function. Muscle wasting is associated with cancer, sarcopenia, chronic obstructive pulmonary disease, end-stage renal disease, and other chronic conditions and results in significant morbidity and mortality. GTx-024 (enobosarm) is a nonsteroidal selective androgen receptor modulator (SARM) that has tissue-selective anabolic effects in muscle and bone, while sparing other androgenic tissue related to hair growth in women and prostate effects in men. GTx-024 has demonstrated promising pharmacologic effects in preclinical studies and favorable safety and pharmacokinetic profiles in phase I investigation.

METHODS:
A 12-week double-blind, placebo-controlled phase II clinical trial was conducted to evaluate GTx-024 in 120 healthy elderly men (>60 years of age) and postmenopausal women. The primary endpoint was total lean body mass assessed by dual energy X-ray absorptiometry, and secondary endpoints included physical function, body weight, insulin resistance, and safety.

RESULTS:
GTx-024 treatment resulted in dose-dependent increases in total lean body mass that were statistically significant (P < 0.001, 3 mg vs. placebo) and clinically meaningful. There were also significant improvements in physical function (P = 0.013, 3 mg vs. placebo) and insulin resistance (P = 0.013, 3 mg vs. placebo). The incidence of adverse events was similar between treatment groups.

CONCLUSION:
GTx-024 showed a dose-dependent improvement in total lean body mass and physical function and was well tolerated. GTx-024 may be useful in the prevention and/or treatment of muscle wasting associated with cancer and other chronic diseases.