The Athlete

World Anti-Doping Agecy

Drugs Banned From Sports and Olympics

Introduction

Since 2004, the World Anti-Doping Agency (or WADA) has been responsible for creating and maintaining an annual list of prohibited substances and methods for athletes who participate in national and international sports. The list developed by WADA is but one of the five international standards that comprise the World Anti-Doping Code, which a consensus of private and governmental agencies developed to combat doping, banned substances and prohibited methods in sports.  

The other four standards used in the fight against doping include "Testing," "Laboratories," "Therapeutic Use Exemptions (TUEs)" and "Protection of Privacy and Personal Information." However, since the Prohibited List is the standard that determines how the other four are implemented, it is essential to understand the content of the list as well as how categories of banned substances and methods are defined.

The Prohibited List Explained

The Prohibited List is released annually by the World Anti-Doping Agency and outlines all of the substances and methods banned in and out of sports competitions. National and international sports associations use the list and agencies to govern the rules and conduct regarding, banned substances, doping and prohibited methods. Likewise, the list is used to govern banned substances and methods in Olympic sporting events.  The Prohibited List breaks down banned methods and substances in categories (i.e. steroids, stimulants, gene doping and so on.)

Substances Banned at All Times

The WADA Prohibited List sets the standards for substances that athletes must avoid at all times to remain eligible for competition. In the 2014 WADA Prohibited List, there are six categories of substances that are banned at all times (in and out of competition events.) Those categories include:

  1. Non-Approved Substances - The WADA 2014 Prohibited list defines non-approved substance as any not addressed in subsequent sections of the list without approval for human medicinal or therapeutic use from recognized governmental health authorities or regulatory agencies. Non-Approved Substances include drugs under clinical or pre-clinical development or those that have been discontinued. Non-Approved substances also include designer drugs and those approved for veterinary use only. Athletes in all sports are prohibited from taking Non-Approved Substances at all times.

  2. Anabolic Agents - Anabolic agents are referred to commonly as anabolic steroids or just steroids. The WADA 2014 Prohibited List states plainly that Exogenous steroids (steroids with an external origin) are always banned. And, Endogenous  steroids (those produced within the human body) are also banned if taken exogenously (or externally.)

    a.) The 2014 WADA Prohibited List states that banned Exogenous anabolic agents include but are not limited to:

    "Androstenediol , androstenedione , bolandiol , bolasterone, boldenone, boldione, calusterone, clostebol, danazol , dehydrochlormethyltestosterone, desoxymethyltestosterone,  drostanolone, ethylestrenol, fluoxymesterone,  formebolone, furazabol,  gestrinone, hydroxytestosterone, mestanolone, mesterolone, metandienone, metenolone, methandriol, methasterone,  methyldienolone,  methyl-1-testosterone, methylnortestosterone, methyltestosterone, metribolone, mibolerone, nandrolone,  norandrostenedione, norboletone,  norclostebol,  norethandrolone, oxabolone, oxandrolone, oxymesterone, oxymetholone, prostanozol, quinbolone, stanozolol, stenbolone, testosterone, tetrahydrogestrinone, trenbolone. The list also bans other substances with similar chemical structures or similar biological effects.

b.) The 2015 WADA Prohibited List also bans the following Endogenous anabolic agents when administered or taken exogenously:

Androstenediol, androstenedione, dihydrotestosterone, prasterone, DHEA, hydroxyandrostone, testosterone and their metabolites and isomers. Banned metabolites and isomers include but are not limited to:

Androstane, androst, androstenediol, androstenedione, epi-dihydrotestosterone, epitestosterone, etiocholanolone, hydroxy-androstan, hydroxy-DHEA, keto-DHEA, norandrosterone and noretiocholanolone.

c.) Other anabolic agents listed as banned in the 2015 WADA Prohibited List include but are not limited to: clenbuterol, selective androgen receptor modulators (SARMs), tibolone, zeranol and zilpaterol.

  1. Peptide Hormones, Growth Factors and Related Substances - Peptide hormones and growth factors are synthesized proteins that help stimulate grown in living cells. As these types of proteins can provide unfair advantages to athletes, they are listed as banned substances in the 2014 WADA Prohibited List. Particular banned substances in this category include  but are not limited to:

    a.) Erythropoiesis-Stimulating Agents  (i.e.  erythropoietin (EPO), darbepoetin (dEPO), hypoxia-inducible factor (HIF) stabilizers, methoxy polyethylene glycol-epoetin beta (CERA) and peginesatide (Hematide)

    b.) Chorionic Gonadotrophin (CG) and Luteinizing Hormone (LH) and their releasing factors ( in males only.)

    c.) Corticotrophins and their releasing factors.

    d.) Growth Hormone (GH) and Insulin-like Growth Factors.

    e.) In addition to the above hormones and factors, the following are also growth factors are also banned at all times: Fibroblast Growth Factors (FGFs), Hepatocyte Growth Factor (HGF), Mechano Growth Factor (MGF), Platelet-Derived Growth Factor (PDGF), Vascular Endothelial Growth Factor (VEGF).

    Additionally, any other growth factor or substance that affects muscle, tendon or ligament protein synthesis/degradation, vascularisation, energy utilization, regenerative capacity or fibre type switching is also prohibited.

  2. Beta-2 Agonists - Beta-2 Agonists are normally used to smooth muscle relaxation in the bronchial passages. In some cases, the drugs may be used to relax uterine muscle or stimulate the release of insulin. Therefore, WADA prohibits athletes from taking all beta-2 agonists except inhaled salbutamol, inhaled formoterol and salmeterol (but only when taken in accordance with a recommended therapeutic regimen.O

    However, because the drug could be used to increase insulin levels, WADA imposes strict caps on dosages even with the above mentioned beta-2 agonists. The maximum acceptable level for inhaled salbutamol is 1600 micograms within 24 hours. The maximum dosage for inhaled formoterol is 54 micrograms over 24 hours. Inhaled sameterol dosages may vary, but can never surpass manufacturer recommended levels for a 24 hour period. Levels of above the aforementioned amounts are considered Adverse Analytical Findings and may be grounds for disqualification from eligibility for sporting events.

  3. Hormone and Metabolic Modulators - The WADA 2014 Prohibited List states that the following hormone and metabolic modulators are banned at all times for athletes participating in sanctioned events:

    a.) Aromatase inhibitors: aminoglutethimide, anastrozole, androsta, androstatrienedione, androstene, trione, exemestane, formestane, letrozole and testolactone.

    b.) Selective Estrogen Receptor Modulators (SERMs) such as raloxifene, tamoxifen and toremifene.

    c.) Other anti-estrogenic substances including such as clomiphene, cyclofenil and fulvestrant.

    d.) Any agent that modifies myostatin function.

    e.) Metabolic modulators such as Insulin, Peroxisome Proliferator Activated Receptor (PPAR) agonists and PPAR-AMP activated kinase agonists.

  4. Diuretics and Other Masking Agents - In the WADA 2014 Prohibited List, all masking agents are prohibited. Masking agents include diuretics, desmopressing, plasma expanders (such as glycerol, intravenous albumin, dextran, hydroxyethyl starch and mannitol probenecid.) If required for a dental procedure, local administration of felypressin is not prohibited.

    The 2014 WADA Prohibited List states that banned diuretics include Diuretics include: Acetazolamide, amiloride, bumetanide, canrenone, chlortalidone, etacrynic acid, furosemide, indapamide, metolazone, spironolactone, thiazides, triamterene, vaptans,  and other similar substances. Drospirenone, pamabrom , topical dorzolamide and topical brinzolamide are permitted.

  5. It is important to note that if an athlete uses any substance with a threshold limit, he/she must obtain a Therapeutic Use Exemption.

Methods Prohibited at All Times

Just as the WADA 2014 Prohibited List outlines all of the substances that athletes are prohibited from taking, it also defines certain methods that are banned as well. Methods banned by the World Anti-Doping Agency include:

  1. Methods Used to Manipulate Blood and Blood Components - WADA prohibits any method that can be used to manipulate the blood or blood components of an athlete.

    a.) The ban covers methods or processes use to administer or reintroduce any amount or quantity of autologous, allogenic (homologous) or heterologous blood or red blood cells into the body or circulatory system regardless of origin.

    b.) The 2014 Prohibited List also bans any type of delivery, transport or uptake of oxygen. The ban includes but is not limited to perfluorochemicals, efaproxiral and modified hemoglobin products. The list does not prohibit supplemental oxygen.

    c.) The ban also covers any other method or form of intravascular manipulation of the blood or its components by any physical or chemical means.

  2. Chemical and Physical Manipulation - The 2014 WADA Prohibited List also bans methods that can be used to tamper with or alter the integrity and validity of samples collected for the purpose of doping control. The list mentions urine substitution and adulteration specifically, as well as intravenous infusions and/or injections of more than 50mL per six hour period (except as required for legitimate emergencies, clinical investigations or hospital admissions.) However, the ban also covers any other method, procedure or process that might be used to tamper with or alter test or sample integrity and validity.

  3. Gene Doping - The list also prohibits any method or process that could use to enhance sport performance by utilizing the transfer or polymers, nucleic acids or nucleic acid analogues. Additionally, WADA prohibits the use of normal or genetically modified cells to enhance those of an athlete.

Substances Prohibited In-Competition and in Particular Sports

Athletes are allowed to consume legal substances such as alcohol and beta-blockers. However, some sporting types require stricter banning guidelines to ensure the safety of athletes and others during events. To that end, WADA maintains a list of substances prohibited for certain types of sports. In some regards, the "Substances Prohibited in Particular Sports" section is similar to the one for those banned "In-Competition." However, for athletes that participate in certain events, some substances are banned at all times. For other substances such as alcohol and beta-blockers, the bans apply during competitions only.

Sporting events where alcohol is banned during competitions only include Air Sports, Archery, Automobile, Karate, Motorcycling and Powerboating. It is important to note that the violation threshold in the above sports is a blood alcohol concentration of 0.10 g/L. Likewise, beta-blockers are banned during the following events: Automobile, Billiards, Darts, Golf, Skiing and Snowboarding. Beta-blockers are banned at all times for athletes participating in Archery or Shooting events.

During competition, WADA prohibits the use of many substances. The List bans all stimulants except imidazole derivatives for topical use and those on the 2014 Monitoring Program List. The list also prohibits use of any type of narcotic, cannabinoid and glucocorticosteroid.

Summary of Recent Changes

As would be expected, WADA adds and deletes banned substances and methods on the Prohibited List every year. Additionally, though, WADA makes occasional changes to nomenclature, or names, to substances for clarification or ease of understanding. Below is a summary list of changes made in the 2014 Prohibited List.

  1. With help from the World Health Organization, or WHO, the World Anti-Doping Agency made some changes to names of substances for the purposes of clarification and accuracy. To make the names of substances and methods more standardized, WADA changes some nomenclatures so that they follow International Non-Proprietary Names (INN) naming conventions. Where changes were made in the list, WADA included the old name of the banned substance to help avoid confusion.

  2. In the 2014 Prohibited List, WADA also changed the definitions of "exogenous" and "endogenous" with regard to anabolic agents. WADA made changes to the definitions of WADA made the changes for clarification and accuracy purposes.

  3. Because some member agencies and associations expressed concern about the ambiguity of language regarding the prohibition of releasing agents, the World Anti-Doping Agency changed some language to clarify the fact that releasing factor, such as peptide hormones, growth factors and other related substances are indeed on the banned substances list. To help clarify the prohibition of these types of releasing factors, WADA listed many banned growth and releasing factors separately to make the list easier to understand.

  4. To make the banning of diuretics and other masking agents easier to understand, WADA added Vasopresin V2 antagonists, also known as vaptans, as an example of a banned diuretic subclass.

  5. To ensure scientific accuracy when describing the manipulation of blood and blood components, WADA introduced the term "allogenic."

  6. WADA made changes to the "Stimulants" section of the Prohibited List that reclassified drugs that metabolize to amphetamine or methamphetamine. Because recent changes in analytical techniques for these substances offer improved identification the drugs and corresponding matabolites, WADA reclassified MDA and MDMA because they are now less likely to be used as doping agents. Additionally, WADA added cathinone and its derivative analogues, such as mephedrone, methedrone and trimetazidine to reflect new and emerging patterns of drug use.

  7. In the section regarding substances prohibited in particular sports, WADA made changes to the wording describing blood alcohol thresholds to ensure better accuracy.

  8. WADA made changes to names of two of the sports mentioned in the Substances Prohibited in Particular Sports section to reflect updates to international naming conventions. WADA changed "Aeronautic" to "Air Sports" and "FITA to World Archery (WA)" respectively.

  9. WADA added "mitaynine" to the Narcotics Class of the Monitoring Program section to help testers detect potential patterns of abuse for the drug.

    10. Changes to come in effect 1st january 2016

    PROHIBITED SUBSTANCES
    S2: Peptide hormones, Growth Factors, Related Substances and Mimetics
     Leuprorelin replaced triptorelin as a more universal example of a chorionic
    gonadotrophin and luteinizing hormone-releasing factor.
    S4. Hormone and Metabolic Modulators
     Insulin-mimetics were added to the List to include all insulin-receptor
    agonists.
     Meldonium (Mildronate) was added because of evidence of its use by athletes
    with the intention of enhancing performance.
    S5. Diuretics and Masking Agents
     It was clarified that the ophthalmic use of carbonic anhydrase inhibitors is
    permitted.
    SUBSTANCES AND METHODS PROHIBITED IN-COMPETITION
    S6. Stimulants:
     It was clarified that clonidine is permitted.
    SUBSTANCES PROHIBITED IN PARTICULAR SPORTS
    P1: Alcohol:
     After consideration of the Federation International de Motocyclisme (FIM)’s
    request, their Federation was removed from the list of sports prohibiting
    alcohol as a doping agent.
    WADA understands that FIM will address the use of alcohol using their own
    regulations.

    MONITORING PROGRAM
     Meldonium was removed from the Monitoring Program and added to the
    Prohibited List.
     Hydrocodone, morphine/codeine ratio and tapentadol were removed from the
    Monitoring Program.

 

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