Multiple incidence of the prescription diuretic hydrochlorothiazide in compounded nutritional supplements / Donata Favretto, Sindi Visentin Salvatore Scrivano, Emanuele Roselli, Fabio Mattiazzi, Roberto Pertile, Susanna Vogliardi, Marianna Tucci, Massimo Montisci. - (Drug Testing and Analysis 11(2018) 3 (March) ; 512-522)

• PMID: 30194914.
• DOI: 10.1002/dta.2499

Abstract

Diuretic agents are prohibited in sports in- and out-of-competition according to the regulations of the World Anti-Doping Agency (WADA) because of their possible masking effects on other doping agents in urine samples, and their ability to produce fast acute weight losses. Despite previous studies reported adverse analytical findings (AAFs) resulting from contaminations at ppm level (μg/g) of medicinal products, and recommended to introduce reporting limits for diuretics in doping controls, these are not adopted in analyses performed by WADA-accredited laboratories. We report the case of an athlete with two AAFs for hydrochlorothiazide (HCTZ) at low urinary concentrations (<10 ng/mL), who declared the use of nutritional supplements prepared in a compounding pharmacy. His nutritional supplements were analyzed revealing HCTZ presence in different concentrations, at the ppm level (μg/g and ng/mL). With the aim of testing the plausibility of the observed urinary HCTZ concentrations with the nutritional supplement ingestion, a urinary excretion study with three healthy volunteers was performed. HCTZ-contaminated powder (6.4 μg/g of HCTZ) was administered to each subject in different dosages, reproducing the possible ingestion pattern occurred. Urine specimens were collected before and after ingestion of the powder, up to 24 hours, and underwent liquid-liquid extraction and liquid chromatography-tandem mass spectrometry determination. Post-administration specimens were found to contain HCTZ at concentrations of 5-230 ng/mL, which supported the accidental inadvertent intake of the prohibited substance by the athlete. This study makes the argument that the introduction of reporting limits for diuretics are warranted in doping control samples, in order to protect against inadvertent AAFs due to contaminated products.

In December 2017 the India National Anti-Doping Agency (INADA) has reported an anti-doping rule violation against the wrestler Shri Bhagwan after his sample tested positive for the prohibited substances 19-norandrosterone (Nandrolone) and Meldonium.

After notification a provisional suspension was ordered. The Athlete filed a statement in his defence and he was heard for the Anti-Doping Disciplinary Panel of India (ADDPI).

The Athlete stated that he had used prescribed medication as treatment for his injury. Here he failed to apply for a TUE nor did he mention his medication on the Doping Control Form.

The Panel did not accept the Athlete’s statement and evidence as it does not explain the presence of Meldonium in his sample. The Panel deems that the Athlete failed to establish that the violation was not intentional nor how the substance entered his system.

Therefore the ADDPI decides on 15 October 2018 to impose a 4 year period of ineligibility on the Athlete starting on de date of the provisional suspension, i.e. on 12 December 2018.

In February 2018 the India National Anti-Doping Agency (INADA) has reported an anti-doping rule violation against the Athlete Simarjit Kaur after her sample tested positive for the prohibited substance Meldonium.
After notification a provisional suspension was ordered. The Athlete filed a statement in her defence and she was heard for the Anti-Doping Disciplinary Panel of India (ADDPI).

The Athlete stated that she had used supplements during training and prescribed medication as treatment for her injury. She could not explain how the substance entered her system and when requested she could not produce the supplements in question because they were not available anymore.

The Panel finds that the Athlete had used supplements without any research or consultation of any expert before using. The Panel deems that she failed to establish how the substance entered her system nor that the violation was not intentional.

Therefore the ADDPI decides on 3 October 2018 to impose a 4 year period of ineligibility on the Athlete starting on de date of the provisional suspension, i.e. on 6 February 2018.

Prohibited List January 2019 : The World Anti-Doping Code International Standard / World Anti-Doping Agency (WADA). - Montreal : WADA, 2018.

- The official text of the Prohibited List shall be maintained by WADA and shall be published in English and French. In the event of any conflict between the English and French versions, the English version shall prevail.
- This List shall come into effect on 1 January 2019

2017 Anti-Doping Testing Figures / World Anti-Doping Agency (WADA). - Montreal : WADA, 2018

Contents:

- Executive Summary - pp. 2-9 (7 pages)
- Laboratory Report -– pp. 10-36 (26 pages)
- Sport Report - pp. 37-158 (121 pages)
- Testing Authority Report - pp. 159-298 (139 pages)
- ABP Report-Blood Analysis - pp. 299-336 (37 pages)

Annual Report 2017 / Spanish Agency for the Protection of Health in Sport (AEPSAD). - Madrid : Agencia Española de Protección de la Salud en el Deporte, 2018

CAS 2017/A/5209 Clara Victoria Patrugan v. Romanian National Anti-Doping Agency

• Canoe
• Doping (prohibited method; meldonium)
• Arbitration agreement
• Arbitration agreement conferring jurisdiction to CAS based on a private act incorporating normative statutory act
• Athlete Support Personnel

1. An arbitration agreement conferring jurisdiction to the CAS must be based on a private act between the relevant parties. Such act can either derive from a specific contract or express agreement, or otherwise from membership or other affiliation with a (private) sports organization or sports governing body and reference to an arbitration clause provided in the statutes or regulations of that sports federation. By contrast, a judicial body whose competence is based on a statutory provision enacted by the legislator (only) does not qualify as a court of arbitration under Swiss law, but rather as a special court established by statutory law.

2. In case a sports federation, in its statutes or regulations, expresses its commitment to respect and follow the national anti-doping provisions, the respective national provisions are to be understood as incorporated into, or to be applied under the statutes and regulations of the sports federation. If furthermore the respective national anti-doping provisions recognize the CAS as the highest adjudicatory body, an individual affiliated to the sports federation and therefore bound by the latter’s rules and regulations may be considered to have concluded, with the respective federation, an arbitration agreement conferring jurisdiction to the CAS. Specifically, the arbitration agreement conferring jurisdiction to the CAS is based on a private act attributable to the parties (i.e. the statutes or regulations of the sports federation) which incorporates the normative statutory act (i.e. the national anti-doping rules recognizing the CAS as the highest adjudicatory body).

3. A medical doctor who, in official correspondence denotes himself “Medical doctor Kayak – Canoe Olympic Pool” and who furthermore renders himself to training camps of athletes affiliated with a national federation in order to perform treatments to the athletes falls into the category of “Athlete Support Personnel” under Appendix 1 to the World Anti-Doping Code (and the respective identic national anti-doping rules), given that he treated and assisted athletes participating in, or preparing for, sports competitions pursuant to said rule. In order to qualify as Athlete Support Personnel it is irrelevant whether the individual in question holds a specific degree (e.g. sports medicine) or similar. Furthermore, by participating in the activities of the national federation and those of its athletes, the medical doctor consented to the statutes and regulations of the national federation; provided those statutes and regulations foresee the possibility of arbitration of anti-doping rule violations, the consent expressed by means of participation also includes that possibility of arbitration.

On 27 July 2016 the Hearing Commission of the Romanian National Anti-Doping Commission (ANAD) decided to impose a lifetime period of ineligibility on the medical doctor Clara Victoria Patrugan for the treatment of athletes with ozone-therapy. Also ANAD prosecuted the doctor for her failure to report the use of Meldonium when she became aware that some athletes were using this prohibited substance.

Hereafter the doctor appealed, yet the ANAD Appeal Commission confirmed on 3 April 2017 the sanction whereas on 27 November 2017 the Bucharest Court of Appeal concluded that it had no competence to hear the appeal.

Meanwhile in June 2017 the doctor had also appealed the ANAD Appeal Decision of 3 April 2017 with the Court of Arbitration for Sport (CAS). The Athlete questioned the jurisdiction of CAS, but alternatively, she requested the Panel to annul the Appealed Decision.

The doctor denied she committed anti-doping rule violations because she does not qualify as Athlete Support Personnel under the Rules. She admitted that she applied ozone-therapy to athletes and withheld certain information regarding the use of Meldonium by athletes.

She argued that she applied the ozone-therapy only as physician specialized in family medicine and that she was unaware that this was forbidden for athletes. Further she argued that in December 2015 the use of the substance Meldonium by the athletes was still allowed.

The Sole Arbitrator establishes that Ms Petrugan worked as medical doctor for the Olympic kayak-canoe team and the Romanian Kayak and Canoe Federation (RKCF). This undoubtedly qualifies her as Athlete Support Personnel and that she has standing to be sued by ANAD.

The Arbitrator holds that it is undisputed that the doctor applied ozone-therapy to athletes and as a medical doctor supporting athletes she should have known that this treatment offered by her was a prohibited method under the Rules.

The Arbitrator establishes that at the relevant time the doctor had conducted research and that she was aware that athletes could still be tested positive for Meldonium once its ban had come into force. Conversely the doctor failed in her duty to inform the RKCF and ANAD in order to act properly thereafter.

With this information RKCF and ANAD could submitt the athletes for target testing and warn athletes that the use of Meldonium was prohibited as from 1 January 2016. This could have possibly have prevented the athletes from any furher use of the substance whereas later in spring 2016 a number of kayak athletes tested positive for the use of Meldonium.

The Sole Arbitrator deems that the doctor committed a considerable offence and regards that only 9 athletes had received 10 ozone-therapy treatments. There was also no evidence that the doctor was involved into a large anti-doping conspiracy or scheme that justifies the imposition of a lifetime ban.

Therefore the Court of Arbitration for Sport decides on 28 June 2018 that:

1.) The appeal filed by Ms Clara Victoria Patrugan against the decision rendered on 3 April 2017 by the Appeal Commission of the Romanian National Anti-Doping Agency is partially upheld.

2.) The decision rendered on 3 April 2017 by the Appeal Commission of the Romanian National Anti-Doping Agency is amended as follows as far as the period of ineligibility is concerned:

Ms Clara Victoria Patrugan shall be ineligible for a period of 6 (six) years to participate in any competition or activity authorized or organized by a signatory of the WADC, to act in any capacity within a sport body of a signatory of the WADC, to enter any contract relationship with or to act as volunteer for a signatory of the WADC. The period of ineligibility shall be deemed to have started on 3 April 2017.

(…)

5. All other motions or prayers for relief are dismissed.

Perceptions of legitimacy, attitudes and buy-in among athlete groups : a cross-national qualitative investigation providing practical solutions / April Henning, Paul Dimeo. - University of Stirling, 2018

• Report compiled for the World Anti-Doping Agency Social Science Research Scheme

Abstract

First paragraph: In order to achieve its stated purpose, anti-doping relies on athlete buy-in to its overall goals and methods and their compliance with anti-doping policies. Previous research on athlete behavior focused on ways to induce athletes into compliance. However, the authors of the Sport Drug Control Model hypothesized that athletes views of anti-doping and their resultant behaviors resulted from their first hand experiences with anti-doping (Donovan et al, 2002). These and similar findings supported the hypothesis that the greater the levels of perceived legitimacy of antidoping organizations among athletes, the greater the likelihood athletes would comply with anti-doping policies. A better understanding of which experiences at the policy, agency, and individual levels are viewed positively or negatively can provide a path for improving perceptions of legitimacy among athletes. The purpose of this study is to investigate perceived legitimacy, athletes' attitudes, and buy-in towards anti-doping policies in a selection of national contexts and sports. The overall objective is to provide clear, practical guidance as to how to improve the athlete experience to increase levels of perceived legitimacy of anti-doping organizations and regulations among athletes.