Drug Abuse & Sport - The Letter of the Law
In the previous article on this topic, I discussed the World Anti-Doping Agency’s (WADA) list of prohibited substances, focusing on what makes a substance prohibitable. In summary, if a substance unfairly enhances the performance of an athlete, has the potential to cause harm to that athlete, and contravenes the spirit of sport (i.e. the spirit of fair play and improving oneself through training), it will be placed on the prohibited list. So this list encompasses everything from anabolic steroids to stimulants, blood doping to masking agents, and so on. But not all drugs are created equal, and so not all substances are treated equally in the eyes of the WADA.
The prohibited list divides drugs into their abuse classes, either according to the broad therapeutic class of the drug (i.e. a division based on how the drug is used legally), or according to the main effect for which the drug is abused (as is the case with masking agents). These classes are then separated according to: whether they are only a problem during sporting competitions (of no particular sport); whether they are a problem both during competitions and during training (of no particular sport); or whether they are a problem in one particular sport, both in and out of competitions. So things start to get a little more complicated when we have to take all of this into account. Suffice it to say that a good rule of thumb is to avoid putting anything into your body that falls within any category on the prohibited list.
It’s easy enough to say you should avoid putting anything prohibited into your body, but what if you NEED a drug? More specifically, per the Medicines and Related Substances Control Act 101 of 1965, what if you need a medicine? Many of the substances which can be found on the WADA prohibited list have genuine medical uses, and in many cases an athlete’s use of a prohibited substance could be as a result of them needing that medicine while not being properly educated on what is and isn’t allowed. Fortunately for these athletes, there are different ways that such cases are typically handled. The first way is fairly specific to the stimulant drugs we discussed earlier on. Stimulants can boost an athlete’s performance in a pretty obvious way, and for that reason they are consistently prohibited in competition. But the class of stimulants is separated into two sub-sections: the specified stimulants; and the non-specified stimulants.
Non-specified stimulants are those which are very unlikely to be used medicinally, or for any non-doping use, and for that reason an athlete caught with a non-specified stimulant in their system is likely to receive a harsh ban, depending on the context of their situation. A specified stimulant is essentially the opposite in this case. The specified stimulants are those drugs which are likely to have a legitimate, legal use associated with them. So, an athlete caught with a specified stimulant in their system will be able to appeal for a reduced ban on the grounds that they have a reason to be using the substance outside of doping. Specified stimulants include things like ephedrine (often used for nasal congestion), epinephrine (as used for anaphylactic shock), methylphenidate (used for attention deficit disorder), and the like. Interesting to note is that caffeine, everyone’s favourite unscheduled stimulant, is part of the 2017 WADA monitoring programme. So, while it’s not strictly banned, officials are monitoring its use in competition, and if it is found to enhance performance significantly then it could well be banned in future.
All of this is good and well, but what if you are an athlete who needs a medicine which doesn’t fall under the admittedly small bracket of specified stimulants? Or if you need a specified stimulant medicinally, but ‘a reduced ban’ doesn’t sound like your idea of a good time? The good news for you, professional athlete, is that you can apply for something known as a therapeutic use exemption (TUE). A therapeutic use exemption is exactly what the name suggests: you need something for a therapeutic purpose, and you are exempted from the rules surrounding the prohibition of that substance due to your proven need for that substance. Obviously as this is a system which could be open to exploitation, so an athlete applying for a TUE will need to prove that the medication is absolutely necessary, and that it is definitely being used for a therapeutic purpose. In addition, the athlete needs to prove: that there is no non-prohibited alternative; and that the TUE is not to treat a condition caused by the unauthorised use of another prohibited substance. There’s a lot that goes into the awarding of a TUE, which is understandable. If it were easy to fake one’s way to getting a TUE, then the prohibited list would not exist. But there’s no arguing that the introduction and provision for TUEs has made competition at national and international levels viable for athletes suffering from chronic conditions who would otherwise be excluded due to their medicinal needs.
If you as a sport scientist work with athletes who might suffer from an acute or chronic condition that may necessitate the use of a prohibited substance, speak to the official body for the relevant sporting code, or at the very least start with the manager of your club or company. For more information, visit the WADA website at www.wada-ama.org and follow the links to therapeutic use exemptions.