doping in sports

1. DRUGS AND SPORTS
Presenter- Dr Chimi Handique
PGT
Dept of Pharmacology

2. Introduction
• The issues related to drugs used in sports are varying, complex
and interconnected.
• They include doping, sports ethics, role of the regulatory
bodies and the health hazards to the sports person.
• The reasons why athletes and sportsperson may take drugs are
– As treatment medication for disease
– To enhance performance
– As recreational drugs

3. Doping in
Sports
• It is the use of chemical substances or methods in order to alter
the performance.
• It is unethical and against the spirit of sports as well as poses a
risk to the health of the sportsperson.
• The World Anti Doping Code includes the following
statements in the definition of doping
– Presence of a prohibited substance or its metabolites or
markers
– Refusing to submit to sample collection after being notified

4. – Attempt to use the banned substance or method
– Possession of any prohibited substance or method
– Administering or attempting to administer a prohibited
substance or method to an athlete
– Failure to file athlete whereabouts information and missed
tests
– Tempering with any part of the doping control process
– Trafficking and distribution of any prohibited substance or
method

5. History
• The first recorded incident of doping
was noted by Philostratus and
Galerius in ancient olympic games held
in 3rd century B.C
• The first rule against doping was built by International
Association of Athletes Federation in 1928 by prohibiting the
abuse of drug in sports.
• Various armed forces distributed amphetamines to their
soldiers to stave off fatigue and injury, elevate mood and to
improve the intensity of their fights.

6. • In 1960, during the summer Olympics at Rome, a Danish
cyclist died during 100km team trial race. His autopsy
revealed presence of amphetamines.
• In 1968, International Olympics Committee (IOC) made its
doping controls and ordered the drug testing for the
competitors at the Winter Olympic Games , France.
• The first World conference on doping was held on Feb 2-4,
1999 at Lausanne, Switzerland.
This conference was arranged by IOC and included all the
sports organizations an other parties involved in Doping
control.

7. • In this conference a document named, “Lausane Declaration
on Doping” was produced which suggested the creation of an
independent International Agency against doping.
• With agreement to the terms of this declaration World Anti-
Doping Agency (WADA ) was established.
• WADA is responsible for the World Anti-Doping code in order
to harmonize the Anti-Doping rules and regulations in all
sports and countries.

9. Role of WADA
• Its mission is
– To promote, co-ordinate and monitor the fight against
doping in sports
– To protect the athletes right to compete in a doping free
sports
– To promote the equality among the competitors worldwide
• The main focus lies in promoting education, research and
development of Anti-Doping policies for all countries.
• WADA is responsible for the World Anti-Doping Code in
order to harmonize these rules in all sports and all countries.

10. • The WADA Code is adopted by more than 600 national and
international sports organizations.
• The main purpose of having the international standards is to
harmonize different technical and operational processes of
Anti-Doping programs among different countries.
• It works on basis of 5 International standards
– Testing procedures
– Laboratories
– List of prohibited substances and methods
– Therapeutic use exemptions
– Confidentiality of personal information

11. Doping Testing
• It is to be performed on routine basis for all the sportsperson.
– Those who are participating in the competition
– Those who won the medals in previous sports events
• There is also provision for random drug testing of sportsperson
by their governing body for in competition and out-of-
competition testing
• The samples for testing includes blood and urine.

12. Test methods
• Under established doping control protocols, the participant is
asked to provide a urine sample.
• This urine sample is divided
into two portions and are
preserved within sealed
containers bearing the
same number and
designation as A and B
samples.

13. • An athlete whose A-sample has revealed the presence of a
prohibited substance or method, his/her B sample is requested
for the analysis.
• The B-sample helps confirm that an anti-doping rule violation
has occurred and protects the rights of the athletes
Re-testing of samples
• According to Article 6.5 in the World Anti-Doping Code
samples may be re-tested later.
• Samples from high-profile events, such as the Olympic
Games, are now re-tested up to eight years later to take
advantage of new techniques for detecting banned substances

15. Prohibited Substances
• Prohibited list includes both the drug substances and the
methods which has the potential to enhance performance in
sports.
• Certain substances and methods which have the potential to
mask the other prohibited substances and method are also
included in the prohibited list.
• It includes the following 3 categories substances and methods
– Substances and methods prohibited at all times
– Substances and methods prohibited In-competition
– Substances prohibited in Particular sports

16. Prohibited Substances banned at ALL
times
• Anabolic agents
• Peptide hormones
• Growth factors and related substances
• Beta-2 agonists
• Hormones and metabolic modulators
• Diuretics and other masking agents

17. Prohibited substances in
competition
• Anabolic agents
• Peptide hormones and growth factors
• Beta 2 agonists
• Diuretics and masking agents
• Stimulants
• Narcotics
• Glucocorticoids

18. Prohibited Substances in Particular
Sports
• Beta adrenergic blockers are banned in sports events like
Automobile, Billiards, Golf, Shooting, Skiing/Snowboarding in
ski jumping.
• Alcohol (ethanol) is prohibited (in-competition only) in
particular sports like Air Sports, Archery, Automobile, Karate,
Motorcycling, Power Boating.
• The maximum allowed limit for doping violation of blood
alcohol is equivalent to a concentration of 0.10gm/L

19. Prohibited methods at ALL TIMES
• Manipulation of blood and blood components.
• Chemical and physical manipulation
• Gene Doping

20. Anabolic Steroids
• They are used to enhance body building and to improve the
athletic performance.
• They promote muscle growth and protein synthesis.
• Examples of anabolic steroids listed in WADA prohibited list-
androstenediol, androstenedione, danazol, methyltestosterone,
nandrolone, stanozolol, DHEAS, testosterone and related
isomers and their metabolites.
• The synthetic steroids are easily detected by the conventional
testing methods.

21. • In the earlier days there was lack of methods to detect and
differentiate exogenous testosterone from endogenous
testosterone produced in the body.
• However now there are more accurate methods which can
indirectly detect the exogenously derive steroids by measuring
urine testosterone : epitestosterone ratio
• The ergogenic effects of anabolic steroids are achieved at very
high doses i.e around 50-90 times more than the normal
therapeutic dose.
• At such higher doses there is increased risk of occurrence of
adverse effects of steroids..

23. • Other adverse effects include mania, depression,
neuropychiatric distburances, cardiac arrhythmias, hepatic and
renal dysfunction and fluid retention.
• In males it can cause testicular atrophy, infertility,
gyanecomastia, iincreased risk of prostrate cancer and
baldness.
• In females it causes hirsutism, menstrual disturbances, male
pattern of baldness and clitoral hypertrophy.

24. Peptide Hormones, Growth factors and Related
Substances
• Peptide hormones and Growth factors are being abused in sports
to enhance physical strength.
• Various peptide substances that are prohibited for use are:
– Erythropoietin (EPO)
– Chorionic Gonadotropin (hCG) , Luteinizing Hormone and
their related compounds
– Corticotropins (ACTH )
– Growth Hormone (GH ) and its related factors
– Insulin- like Growth Factor (IGF – 1)

25. Erythropoietin
• It is one of the most well known
substances used for doping.
• It is a peptide hormone which controls the synthesis of
erythrocytes in the body.
• Erythropoietin and its related substances are known as blood
doping agents.
• Erythropoietin stimulating agents are used due to their capacity
to increase the synthesis of RBC’s and so that blood can transport
more oxygen to the muscles.

26. • Adverse effects include increased hematocrit, hypertension,
increased viscosity of blood leading to life threatening
thrombosis, stoke and death due to occlusion of blood vessels .
Gonadotropins
• Parenteral administration of human chorionic gonadotropin
(hCG) or luteinizing hormone (LH) stimulates the production
of testosterone in males and these gonadotropins can therefore
be used by athletes to enhance muscle strength.
• CG, LH and their releasing factors are prohibited in males
only.
• Use of gonadotropins can result in hypertrophy of ovaries and
hormonal imbalance.

27. Growth hormone
• Growth hormone helps in regulation of physical growth in
adoloscents.
• It acts on the body to reduce fat deposits and helps in building
muscle mass.
• It is used in combination with anabolic agents to increase body
building which further doubles the associated risk.
• Adverse effects include acromegaly, gigantism, metabolic and
endocrine disorder

28. Corticotropin
• Corticotropin or ACTH is produced by pituitary gland and acts
on adrenal cortex.
• Corticotropins regulate the synthesis and release of cortisol
which is responsible for producing euphoric effects and creates
a sense of physical well being.
• ACTH is used by athletes in order to increase the amount of
androgens secreted by the adrenal glands as these are converted
to testosterone.
• The deleterious effects include body’s immune system
suppression and increased risk of infection.

29. Stimulants
• They are also referred as psychostimulants.
• Examples – amphetamine, ephedrine, cocaine
• They increase the rate of metabolism and delay fatigue.
• They are used to increase endurance and to reduce the fatigue
during exercise.
• Certain cold remedies contain ephedrine so those remedies are
prohibited to be used in athletes

30. • Adverse effects includes psychiatric disturbances, headache,
anxiety, insomnia, tremor, impaired decision making,
confusion and restlessness.
• Amphetamine and ephedrine may lead to development of
hypertension and tachycardia.
• Prolonged use of amphetamines can cause dependence and
precipitate withdrawal symptoms.
• The potential health risks include hypertension hallucinations,
convulsions and heart attack.

31. Narcotics and Analgesics
• The use of narcotics is prohibited in sports since 1967.
• Narcotics include morphine, buprenorphine,
diamorphine, fentanyl,
methadone, pentazocine,
pethidine.
• These drugs are used In-competition by athletes to increase their
pain threshold.

33. • The major problem associated with their use is the physical and
psychological dependence because of its high addiction potential
• The other adverse effects include loss of coordination, mood
changes, inability to concentrate and other psychological
problems.
• NSAIDS can be used for relieving pain in sportsperson.

34. Beta- 2 Agonists
• These agents are used by the athletes for doping for performance
enhancement due to dilatation of bronchial muscles.
• Most of the beta-2 agonist are banned by WADA.
• They can be used for medical reasons only after the approval of a
therapeutic use exemption.
• All beta-2 agonists are banned except
– inhaled salbutamol (max limit 1600 mg over 24 hours)
– Inhaled formoterol (max limit 54 mg over 24 hours)

37. Diuretics
• Diuretics were first banned in sport (both in competition and out
of competition) in 1988.
• They can be used by athletes for two primary reasons.
– First, their potent ability to remove water from the body can
cause a rapid weight loss that can be required to meet a
weight category in sporting events.
– Second, they can be used to mask the administration of other
doping agents by reducing their concentration in urine
primarily because of an increase in urine volume.
• They are detected by liquid chromatography

39. Blood doping
• Blood doping is the practice of boosting the number of red blood
cells in the bloodstream in order to enhance athletic performance.
• Such blood cells carry oxygen from the lungs to the muscles, a
higher concentration in the blood can improve an athlete’s
aerobic capacity and endurance.
• Types of Blood Doping
– Blood transfusions
– Injections of erythropoietin (EPO)
– Injections of synthetic oxygen carriers

43. • Side-Effects of Blood Doping include Increased blood
viscosity, Heart attack, Stroke, risk of Infections,
hypertension, weight gain and chest pain.
• Blood doping is most commonly used by endurance athletes,
such as distance runners and cyclists.
• It can be detected by flow cytometry and CO rebreathing
technique.

44. Chemical and Physical Manipulation
• Chemical and physical manipulation is the use of substances or
methods in order to alter an urine sample
• It is typically used to tamper or alter the integrity and validity of
samples collected during doping control.
• Chemical and physical manipulation is the last in frequency of
use doping class by 0.1% of all adverse analytical findings
worldwide.
• Urinary Catheterisation
– Drain urine from the bladder, and replace it by a clean urine
substitution (e.g., synthetic urine) to fake the urine test

45. • Urine Substitution
– Use synthetic urine or other people's urine to fake the urine test
• Adulteration
– Injection of chemicals to interfere the results of urine or blood
tests
• Intravenous infusions and/or injections
– Intravenous infusion and/or injection of more than 50 mL per 6
hour period
– According to WADA, the restricted use of this banned method
in sport is excepted for athletes legitimately received in the
course of hospital admissions or clinical investigations

46. Gene Doping
• WADA defines it as "the non-therapeutic use of cells, genes,
genetic elements, or of the modulation of gene expression,
having the capacity to improve athletic performance".
• Example of gene doping could involve applications like
increasing muscle growth, blood production, endurance, oxygen
dispersal and pain resistance.
• In such cases, nothing unusual would enter the bloodstream so
officials would detect nothing in a blood or urine test

47. • The first product to be associated with genetic doping emerged
on the approach to the Turin 2006 Olympic Winter Games,
where Repoxygen was discussed as a possible substance in use
at the Games.
• Targets for gene doping
– Myostatin
– Erythropoietin (EPO)
– Insulin-like growth factor 1
– Vascular endothelial growth factor

48. • Both direct and indirect testing methods are being researched by
the organization.
• Directly detecting the use of gene therapy usually requires the
discovery of recombinant proteins or gene insertion vectors.
• While most indirect methods involve examining the athlete in an
attempt to detect bodily changes or structural differences
between endogenous and recombinant proteins

50. Therapeutic Use
Exemption
• It is an exemption that allows an athlete to use banned substance
for therapeutic purposes only.
• The athlete can obtain a TUE for the use of prohibited substance
or method for the treatment of a legitimate medical condition.
• In such cases, athletes should first check their physician to look if
any alternatives are available.
• If there is no alternative, then athletes should apply for a TUE.

51. • WADA has issued an International Standard for TUEs under
the World Anti-Doping Code.
• TUE applications should be reviewed and managed by TUE
Committee, which is comprised of a group of independent
physicians.
• This committee is responsible for grant or rejection of such
applications.

53. Doping Control in India
• National Anti-Doping Agency (NADA) is responsible for the
doping control in India.
• The main function of this organization is to promote, co-ordinate
and monitor the various doping control program in sport in India.
• India is one of the foundation members of World Anti-Doping
Agency.
• It has accepted the World Anti-Doping Code in march 2008.
• The Anti Doping rules of NADA have been modified in
compliance to WADA code 2009.

54. • The primary functions of NADA are
– Adopting and implementing Anti-doping rules and policies
according to the World Anti Doping Code.
– To work in coordination with other sports organizations and
Anti Doping Organizations
– Promoting anti doping research & education
– Sample collection and testing of sportsperson
– Imposing sanction or ban on athletes who violates the Anti-
Doping Rules

55. • The samples collected from the athletes are tested in National
Dope Testing Laboratory (NDTL), New Delhi.
• NTDL is accredited by WADA for testing of blood and urine
samples.
• NADA also conducts various educational and awareness program
about the Anti Doping rules and regulation.

56. Athlete Biological Passport
(ABP)
• It is an electronic record of an individual athlete’s biological
attributes, developed over time from multiple sample collections.
• Its principle is to monitor the selected biological variable (doping
biomarkers) rather than the doping substance or method itself.
• Thus over a period of time it indirectly reveals the effects of
Doping rather than the substance or the method used.
• The first version of ABP contains the hematological or blood
module.

57. The ABP is currently composed of two modules:
• Hematological Module :
The aim is to identify enhancement of oxygen transport,
including use of erythropoiesis stimulating agents and any form
of blood transfusion or manipulation.
• Steroidal Module :
This is introduced on Jan 1st, 2014. it aims to identify
endogenous anabolic steroids when administered exogenously.
• WADA will continue to develop the ABP by refining the present
modules as well as adding new ones as they are finalized.

58. Conclusion
• With the huge financial incentives and attempts to achieve a
competitive edge especially with the use of performance-
enhancing drugs have only been increasing .
• However, it is not without serious adverse effects on health and
may be potentially fatal at times.
• This gives an unfair advantage, violate the spirit of competition,
and send the wrong message to children as well as unfairly
diminish the historic achievements of clean athletes.
• The efforts to stop it should remain strong.