Treatments for People Who Use Anabolic Androgenic Steroids : A Scoping Review / Geoff Bates , Marie-Claire Van Hout, Joseph Tay Wee Teck, Jim McVeigh. - (Harm Reduction Journal 16 (2019) 75 (30 December); p. 1-15). - PMID: 31888665. - PMCID: PMC6937954. - DOI: 10.1186/s12954-019-0343-1 ___________________________________________________ Abstract Background: A growing body of evidence suggests that anabolic androgenic steroids (AAS) are used globally by a diverse population with varying motivations. Evidence has increased greatly in recent years to support understanding of this form of substance use and the associated health harms, but there remains little evidence regarding interventions to support cessation and treat the consequences of use. In this scoping review, we identify and describe what is known about interventions that aim to support and achieve cessation of AAS, and treat and prevent associated health problems. Methods: A comprehensive search strategy was developed in four bibliographic databases, supported by an iterative citation searching process to identify eligible studies. Studies of any psychological or medical treatment interventions delivered in response to non-prescribed use of AAS or an associated harm in any setting were eligible. Results: In total, 109 eligible studies were identified, which included case reports representing a diverse range of disciplines and sources. Studies predominantly focussed on treatments for harms associated with AAS use, with scant evidence on interventions to support cessation of AAS use or responding to dependence. The types of conditions requiring treatment included psychiatric, neuroendocrine, hepatic, kidney, cardiovascular, musculoskeletal and infectious. There was limited evidence of engagement with users or delivery of psychosocial interventions as part of treatment for any condition, and of harm reduction interventions initiated alongside, or following, treatment. Findings were limited throughout by the case report study designs and limited information was provided. Conclusion: This scoping review indicates that while a range of case reports describe treatments provided to AAS users, there is scarce evidence on treating dependence, managing withdrawal, or initiating behaviour change in users in any settings. Evidence is urgently required to support the development of effective services for users and of evidence-based guidance and interventions to respond to users in a range of healthcare settings. More consistent reporting in articles of whether engagement or assessment relating to AAS was initiated, and publication within broader health- or drug-related journals, will support development of the evidence base.
Welcome to Doping.nl, the
Anti-Doping Knowledge Center.
This site has been established to host information about doping in the broadest sense of the word, and about doping prevention.
The Anti-Doping Authority Netherlands (the Dutch Doping Authority for short) established this site and maintains it. The Doping Authority was founded in 1989 and it is one of the oldest NADOs in the world. Doping.nl was developed with financial support from the Dutch Ministry for Health, Welfare and Sport.
This website was established because of the importance that the Doping Authority and the Ministry attach to the dissemination of information relevant to doping prevention. Disclosing and supplying relevant information is one of the cornerstones in the fight against doping in sport. However, in practice, a significant amount of information is still not available, or only available to a limited group of users. We therefore decided to bring together all the relevant information in a single site: Doping.nl.
The Doping Authority aims to supply as much information through this website as possible on an ongoing basis. The information will be varied but will focus primarily on: WADA documents like the World Anti-Doping Code, the International Standards like the Prohibited List, Doping Regulations, scientific articles and abstracts, decisions by disciplinary bodies (mainly CAS decisions).As well as making documents available, the Doping Authority aims to supply searchable documents when possible, and to add relevant keywords to ensure easy access.
In the future, Doping.nl will also become a digital archive containing older information that is no longer available elsewhere.
This site has been designed for use by anti-doping professionals such as National Anti-Doping Organisations and International Federations but also for students, journalists and other people interested in the subject.
Recently added documents More »
Enjoy the Sport - Schools Against Doping and Drug Dependence : A Health Education Intervention in Secondary Schools
"Enjoy the Sport - Schools Against Doping and Drug Dependence" : A Health Education Intervention in Secondary Schools / Daniele Masala, Valeria D'Egidio, Teresa Iona, Giuseppe La Torre. - (Igiene e sanita pubblica 75 (2019) 4 (July-August); p. 271-282). - PMID: 31887733 ___________________________________________________ Abstract INTRODUCTION The use of doping substances is growing not only in young athletes performing competitive and non-competitive sports, but also in amateur sports, thereby representing a social and public health problem. The aim of this study was to measure knowledge, attitudes and opinions on doping and drugs and their effects, among students of secondary schools, and to assess the effectiveness of a health education intervention. "Enjoy the Sport- the school against doping and addiction 2.0" is a program developed to discourage the use of drugs, in particular doping drugs, by introducing information on the origins, on the effects of drugs and examples of appropriate lifestyles. This project was conceived by C.I.S.C.O.D. (Comitato Italiano Sport Contro Droga), an association of the C.O.N.I. and carried out with its support. MATERIALS AND METHODS The "Enjoy" project was a study with a one-arm experimental design and with a pre-post evaluation. A multiple-choice questionnaire was used to measure adolescents' knowledge, attitudes and opinions on doping and its effects. A descriptive analysis and post-pre intervention comparison was performed with the McNemar test. RESULTS There was a significant increase in participants' knowledge of doping substances indicated by the WADA (World Anti-Doping Agency) (p<0.001) and a better understanding of the meaning of the term "doping". A decrease in the number of adolescents who would use doping substances (pre = 0.06%; post = 0.0%) was observed, as well as an increase in the number of adolescents who do not consider fair that athletes of any level should use substances that alter their performance (pre = 83.7%; post = 85%). A significant increase was observed in the proportion of participants who believe that athletes should not use doping substances because they are harmful to the human organism (pre = 38.6%; post = 51.7%) (p<0.001). CONCLUSIONS The project "Enjoy the Sport" contributed to increasing the health literacy of secondary school students about doping (and consequent awareness of the negative aspects of drug use). Schools, therefore, are an appropriate setting for implementing educational interventions for the prevention of doping. However, it is fundamental to integrate knowledge and action, especially in the context of family, sport and sports associations.
A Novel Mixed Living High Training Low Intervention and the Hematological Module of the Athlete Biological Passport
A Novel Mixed Living High Training Low Intervention and the Hematological Module of the Athlete Biological Passport / Sven Christian Voss, Khalifa Al‐Hamad, Waseem Samsam, Anissa Cherif, Costas Georgakopoulos, Mohammed Al Maadheed, George Balanos, Sam Lucas, Pierre‐Edouard Sottas, Mathew Wilson, Nathan Townsend. - (Drug Testing and Analysis (2019) 30 December; p. 1-8). - PMID: 31889433. - DOI: 10.1002/dta.2723 _________________________________________________ Abstract Exposure to either natural or simulated hypoxia induces hematological adaptations that may affect the parameters of the Athlete Biological Passport (ABP). The aim of the present study was to examine the effect of a novel, mixed hypoxic dose protocol on the likelihood of producing an atypical ABP finding. Ten well‐trained middle‐distance runners participated in a “live high, train low and high” (LHTLH) altitude training camp for 14 days. The participants spent ˜6 hr.d‐1 at 3000–5400 m during waking hours and ˜10 h.d‐1 overnight at 2400–3000 m simulated altitude. Venous blood samples were collected before (B0), and after 1 (D1), 4 (D4), 7 (D7), and 14 (D14) days of hypoxic exposure, and again 14 days post exposure (P14). Samples were analyzed for key parameters of the ABP including reticulocyte percentage (Ret%), hemoglobin concentration ([Hb]), and the OFF‐score. The ABP adaptive model was administered at a specificity of 99% to test for atypical findings. We found significant changes in [Hb] and Ret% during the hypoxic intervention. Consequently, this led to ABP threshold deviations at 99% specificity in three participants. Only one of these was flagged as an “atypical passport finding” (ATPF) due to deviation of the OFF‐score. When this sample was evaluated by ABP experts it was considered “normal”. In conclusion, it is highly unlikely that the present hypoxic exposure protocol would have led to a citation for a doping violation according to WADA guidelines.
Induction of Erythroferrone in Healthy Humans by Micro-Dose Recombinant Erythropoietin or High-Altitude Exposure
Induction of Erythroferrone in Healthy Humans by Micro-Dose Recombinant Erythropoietin or High-Altitude Exposure / Paul Robach, Elena Gammella, Stefania Recalcati, Domenico Girelli, Annalisa Castagna, Matthieu Roustit, Carsten Lundby, Anne-Kristine Lundby, Pierre Bouzat, Samuel Vergès, Guillaume Séchaud, Pierluigi Banco, Mario Uhr, Catherine Cornu, Pierre Sallet, Gaetano Cairo. - (Haematologica (2020) 1 (9 January); p. 1-20). - PMID: 31919080. - DOI: 10.3324/haematol.2019.233874 ___________________________________________________ Abstract The erythropoietin (Epo)-erythroferrone (ERFE)-hepcidin axis coordinates erythropoiesis and iron homeostasis. While mouse studies have established that Epo-induced ERFE production represses hepcidin synthesis by inhibiting hepatic BMP/SMAD signaling, evidence for the role of ERFE in humans is limited. To investigate the role of ERFE as a physiological erythroid regulator in humans, we conducted two studies: first, 24 males received six injections of saline (placebo), recombinant Epo (rhEpo) 20 UI kg-1 (micro-dose) or 50 UI kg-1 (low-dose). Second, we quantified ERFE in 22 subjects exposed to high altitude (3800 m) for 15 hours. In the first study, total hemoglobin mass (Hbmass) increased after low- but not after micro-dose injections, when compared to placebo. Serum ERFE levels were enhanced by rhEpo, remaining higher than after placebo for 48 (micro-dose) or 72 hours (low-dose) post-injections. Conversely, hepcidin levels decreased when Epo and ERFE arose, before any changes in serum iron parameters occurred. In the second study, serum Epo and ERFE increased at high altitude. The present results demonstrate that in healthy humans ERFE responds to slightly increased Epo levels not associated with Hbmass expansion and down-regulates hepcidin in an apparently iron-independent way. Notably, ERFE flags micro-dose Epo, thus holding promise as novel anti-doping biomarker.
A novel approach to the quantification of urinary aryl-propionamide-derived SARMs by UHPLC-MS/MS / Azamat Temerdashev, Ekaterina Dmitrieva, Alice Azaryan, Elina Gashimova. - (Biomedical Chromatography 34 (2020) 1 (January) ; p. 1-9). - PMID: 31734960. - DOI: 10.1002/bmc.4700 _________________________________________________ Abstract A simple and sensitive procedure for the quantification of two commonly abused aryl‐propionamide‐derived selective androgen receptor modulators (SARMs), namely S‐4 (GTx‐007, andarine) and S‐22 (GTx‐024, MK‐2866, ostarine, enobosarm), has been described. Urine samples were prepared for analysis by means of a dispersive liquid–liquid microextraction using methanol and chloroform as dispersive and extracting solvents, respectively. Factors that might influence the extraction process as well as their optimum conditions were evaluated by Box–Benken and central composite designs. After extraction, the analytes were quantified by UHPLC–MS/MS. The proposed procedure was validated on human urine samples. As a result, for both SARMs the detection limits were observed at 0.05 ng/mL and calibration curves were linear in the concentration range of 0.25–50 ng/mL with the coefficient of determination of 0.998.
The Epidemiology of Androgen Toxicity: A Six-year Retrospective Cohort Study of the Risk of Primary Health Outcomes among Inpatients with Androgen Toxicity in the United States
The Epidemiology of Androgen Toxicity: A Six-year Retrospective Cohort Study of the Risk of Primary Health Outcomes among Inpatients with Androgen Toxicity in the United States / Scottie L. Howell. - Ann Arbor : ProQuest, 2019. - (ProQuest 27543963). - Dissertation Manuscript presented to the Faculty of the College of Health Sciences of Trident University International). 17 October, 2019) _________________________________________________ Abstract Background: Androgen prescriptions have increased substantially from 2000 to 2010. In response to the rise in prescriptions and a questionably credible cardiovascular risk study in 2013, the FDA issued mandates on testosterone labeling requirements to include consumer risk warnings. Despite the FDA mandates and well-established side effects, the reported risk estimates of health outcomes associated with androgen therapies remain equivocal across study populations with little evidence to characterize risk in an inpatient population. The epidemiological research detailed herein addressed this knowledge gap by identifying androgen toxicity types and classifying androgen-induced disease states from the literature into testable primary outcomes. As of 2019, no large-scale nationally representative studies have examined the risk of primary health outcomes with androgen toxicity among inpatients. Objective: The objective of this study was to characterize the epidemiology of androgen toxicity by examining the risk of primary health outcomes, incidence of inpatient variables, and mean healthcare costs in a nationally representative population of inpatients with and without androgen toxicity exposure. Design: A quantitative population-based retrospective cohort design was employed using National Inpatient Sample data spanning a period of six years (2010-2015) to identify an index cohort of 488 androgen toxicity exposures and a reference cohort of nearly 34 million nonexposures for the analysis. Results: In log-binomial GLM regression analysis adjusting for demographic characteristics, androgen toxicity exposure was associated with an increased risk of polycythemia (RR = 152.49, 95% CI [120.97, 192.22], p < .001), hypercoagulability (RR = 6.28, 95% CI [3.59, 10.98], p < .001), drug-induced liver injury (RR = 47.27, 95% CI [27.65, 80.81], p < .001), and venous thromboembolism (RR = 6.42, 95% CI [4.77, 8.63], p < .001), but not mortality (RR = 0.50, 95% CI [0.20, 1.19], p = .119). In negative binomial GLM regression analysis adjusting for demographic characteristics, exposure was associated with an increased incidence of chronic conditions (IRR = 1.20, 95% CI [1.14, 1.27], p < .001), diagnoses (IRR = 1.18, 95% CI [1.12, 1.23], p < .001), external causes of injury (IRR = 4.88, 95% CI [4.08, 5.83], p < .001), but not length of stay (IRR = 1.03, 95% CI [0.96, 1.12], p = .324). Exposure was also associated with a decreased incidence of procedures (IRR = 0.86, 95% CI [0.77, 0.96], p = .009). In log-gamma GLM regression analysis adjusting for demographic characteristics, exposure increased mean healthcare costs (Δ = 4,178.53, p = .206), although the effect was not statistically significant. An odds weighted, inverse probability of treatment weighted, and propensity score weighted analysis replicated that exposure increased the risk of polycythemia, hypercoagulability, druginduced liver injury, and venous thromboembolism, but not mortality. The weighted analysis also replicated that exposure increased the incidence of chronic conditions, diagnoses, and external causes of injury, but not length of stay. The decreased incidence of procedures found in the main adjusted negative binomial GLM analysis failed replication in the weighted analysis. Graphical trend analysis showed consistent year-to-year trends in relative risk estimates of mortality, hypercoagulability, drug-induced liver injury, and venous thromboembolism but not polycythemia. The incidence rate ratio estimates of length of stay, diagnoses, chronic conditions, external causes of injury, and procedures trended consistently from year-to-year. Mean healthcare costs dropped 14.24% from 2010 to 2011, trended upwards 52.55% from 2011 to 2014, and dropped 24.01% from 2014 to 2015. Conclusion: Androgen toxicity increased the risk of several primary health outcomes including polycythemia, hypercoagulability, drug-induced liver injury, and venous thromboembolism in this epidemiologic study. Given the importance of reducing inpatient risk factors and adverse health outcomes in U.S. hospital admissions, further exploration of androgen toxicity has extensive clinical and public health relevance.
The Prevalence of Legal Performance-Enhancing Substance Use and Potential Cognitive and or Physical Doping in German Recreational Triathletes, Assessed via the Randomised Response Technique
The Prevalence of Legal Performance-Enhancing Substance Use and Potential Cognitive and or Physical Doping in German Recreational Triathletes, Assessed via the Randomised Response Technique / Sebastian Seifarth, Pavel Dietz, Alexander C. Disch, Martin Engelhardt, Stefan Zwingenberger. - (Sports 7 (2019) 12 (26 November); p. 1-11). - PMID: 31779150. - DOI: 10.3390/sports7120241 _________________________________________________ Abstract This study investigated the use of performance-enhancing substances in recreational triathletes who were competing in German races at distances ranging from super-sprint to long-distance, as per the International Triathlon Union. The use of legal drugs and over-the-counter supplements over the previous year, painkillers over the previous 3 months, and the potential three-month prevalence of physical doping and or cognitive doping in this group were assessed via an anonymous questionnaire. The Randomised Response Technique (RRT) was implemented for sensitive questions regarding "prescription drugs […] for the purpose of performance enhancement […] only available at a pharmacy or on the black market". The survey did not directly state the word "doping," but included examples of substances that could later be classed as physical and or cognitive doping. The subjects were not required to detail what they were taking. Overall, 1953 completed questionnaires were received from 3134 registered starters at six regional events-themselves involving 17 separate races-in 2017. Of the respondents, 31.8% and 11.3% admitted to the use of dietary supplements, and of painkillers during the previous three months, respectively. Potential physical doping and cognitive doping over the preceding year were reported by 7.0% (Confidence Interval CI: 4.2-9.8) and 9.4% (CI: 6.6-12.3) of triathletes. Gender, age, experience in endurance sports, and number of weekly triathlon training hours were linked to potential physical or cognitive doping. Given the potentially relevant side effects of painkiller use and physical and or cognitive doping, we recommend that educational and preventative measures for them be implemented within amateur triathlons.
Early Warning of Suspected Doping from Biological Passport Based on Multivariate Trends / António Júlio Nunes, Paulo Paixão, Jorge Proença, Ricardo J.N. Bettencourt da Silva. - (International Journal of Sports Medicine 41 (2020) 1 (January); p. 44-53). - PMID: 31810403. - DOI: 10.1080/02640414.2019.1700669 _________________________________________________ Abstract The indirect identification of doping in sports can be performed by assessing athletes' hematological perturbations from the analysis of blood collected on different occasions. Because prosecution for doping based on this information requires expensive and time-consuming interpretation of blood analysis results by various expert hematologists, mathematical data screening is performed to decide which cases should be forwarded to hematologists. The current Bayesian and univariate screening of data does not process the multivariate trends of blood parameters or take the time interval between samplings into account. This work presents a computational tool that overcomes these limitations by calculating a single score, the hematological perturbation index (HPIx), for which a threshold is defined above which hematologists should be asked to assess the athlete's biological passport. The doping detection from this index, normalized for days difference between samplings based on 3, 4 or 5 consecutive samplings, is associated with true positive result rates (TP) not below 98% and false positive result rates (FP) less than 0.9%. Therefore, this tool can be useful as an early warning system of hematological perturbations to decide which athletes should be more closely monitored and which biological passports should be forwarded to hematologists for medical interpretation of data.
Basic Values Predict Doping Likelihood / Christopher Ring, Maria Kavussanu, Bahri Gürpinar. - (Journal of Sports Sciences (2019) 6 December; p. 1-9). - PMID: 31810403. - DOI: 10.1080/02640414.2019.1700669 _________________________________________________ Abstract Basic values, defined as trans-situational goals that vary in importance and act as guiding principles in life, have been linked with unethical cognitions, emotions and actions. Their roles in doping, a form of cheating in sport, have yet to established. College athletes reported doping likelihood in hypothetical scenario-based situations and completed measures of basic values, moral disengagement, and anticipated guilt. Correlation analysis showed that doping likelihood was positively associated with self-enhancement values but negatively associated with self-transcendence values and conservation values. Moral disengagement correlated positively with self-enhancement values and negatively with self-transcendence values, whereas guilt correlated positively conservation values and negatively with self-enhancement values and openness to change values. Regression analyses showed that self-enhancement values positively predicted doping likelihood directly, self-transcendence values negatively predicted doping likelihood indirectly via moral disengagement and guilt, and conservation values negatively predicted doping likelihood indirectly via guilt. In line with theory and evidence concerning the relationship between basic value systems and moral thought and action, we found that the values of athletes are directly (self-enhancement) and indirectly (self-transcendence, conservation) linked with likely use of banned performance enhancing substances, an expression of cheating in sport.
In April 2019 World Athletics (WA) has reported an anti-doping rule violation against the Kenyan Athlete Sammy Kitwara after his sample tested positive for the prohibited substance Terbutaline. After notification the Athlete gave a prompt admission, waived his right to be heard and accepted the sanction proposed by WA. In his submissions the Athlete explained with medical information that in March 2019 he underwent medical treatment for his pneumonia in a clinic in Kenya and he had used prescribed Broxol syrup that contained the prohibited substance as ingredient. WA finds that the Athlete had provided sufficient evidence, accepts that the violation was not intentional and that the Athlete demonstrated how the prohibited substance entered his system through the ingestion of his prescribed Broxol syrup medication. Further WA holds that the Athlete failed to read or to check the ingredients on the label of his medication before using although he was suffering from a serious medical condition and he consulted a qualified docktor. Considering the Athlete’s conduct in this case WA deems that the Athlete’s subjective fault to be at the ‘high’ end of the ‘normal’ category. Therefore WA decides on 20 December 2019 to impose a 16 month period of ineligibility on the Athlete starting on the date of the sample collection, i.e. on 17 March 2019.