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Meldonium Use by Athletes at the Baku 2015 European Games

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Meldonium Use by Athletes at the Baku 2015 European Games Downloaded from http://bjsm.bmj.com/ on April 24, 2017 - Published by group.bmj.com Original article Meldonium use by athletes at the Baku 2015 European Games 1 2 3 Editor’s choice Mark Stuart, Christian Schneider, Klaus Steinbach Scan to access more free content 1BMJ Publishing Group, ABSTRACT Mildronate; Trizipin; Vazonat and Vazopro in London, UK 1 2 Background The aim of this report was to estimate Ukraine. Schön Klinik München — Harlaching, Munich, Germany the prevalence of meldonium use in athletes competing Meldonium chemical name: 3-(2,2,2- 3Chair of EOC Medical in the Baku 2015 European Games to contribute to the Trimethyldiazaniumyl) propanoate—is an inhibitor Commission, Hochwald- surveillance of substances on the 2015 World Anti- of carnitine synthesis and is reported to have cardi- Kliniken, Weiskirchen, Germany Doping Agency (WADA) Monitoring Program. Meldonium oprotective and anti-ischaemic effects. It has been is reported to be used by athletes to potentially enhance used in a variety of disorders including for the Correspondence to Mark Stuart, BMA House, personal performance and shorten the recovery period management of ischaemic heart disease and ischae- Tavistock Square, London after physical activity. mic cerebrovascular disturbances. Typical thera- WC1H 9JR, UK; Methods Three sources of data were reviewed to peutic oral and intravenous doses range from [email protected] determine the prevalence of meldonium use during the 500 mg to 1 g of meldonium daily. A course of – Accepted 8 March 2016 Games including: (1) athlete self-reported declarations of 500 mg given four times daily for 7 10 days has Published Online First drug and supplement use; (2) declarations from National been reported to be used clinically in alcohol 25 March 2016 Olympic Committee medical teams of the list of abstinence syndrome.1 medicines that they imported into Azerbaijan as part of The WADA publishes the List of Prohibited their stock of drugs for administration; (3) results from Substances and Methods at least annually. This list the antidoping laboratories reporting the detection of includes any substance or method that has medical meldonium. or scientific evidence, whether alone or in com- Results Meldonium was declared as imported into bination, to enhance performance, to represent Azerbaijan by 2 of 50 National Olympic Committee health risk to the athlete or to violate the spirit of medical teams at the Games, but athletes from 6 sport.2 countries declared the use of meldonium. Only 23 of the In addition, WADA also publishes a list of sub- 662 (3.5%) athletes tested from 8 to 28 June 2015 stances on the WADA Monitoring Program, which declared the personal use of meldonium, which included is composed of substances that are under surveil- 13 competition winners. However, 66 of the total 762 lance by WADA to detect possible patterns of use (8.7%) athlete urine samples analysed during the Games or misuse in sport. The substances specifically and during precompetition tested positive for being monitored by WADA during 2015 were: meldonium. Meldonium use was detected in athletes ▸ Stimulants including: bupropion, caffeine, nico- competing in 15 of the 21 sports during the Games. tine, phenylephrine, phenylpropanolamine, Conclusions This study highlights the widespread and pipradrol and synephrine; inappropriate use and prescribing of this prescription ▸ Narcotics including: hydrocodone, mitragynine, drug in a generally healthy athlete population. morphine/codeine ratio, tapentadol and Subsequent to these findings, WADA has included tramadol; meldonium as a prohibited substance on the 2016 List ▸ Glucocorticoids; of Prohibited Substances. ▸ Telmisartan; ▸ Meldonium. WADA accredited laboratories responsible for testing urine or blood samples from athletes are INTRODUCTION requested to test and report on such substances The aim of this report is to identify the prevalence being monitored. This information is used by of meldonium use in the 5632 athletes competing WADA as evidence to inform future decisions in the Baku 2015 European Games held in about whether to prohibit specific substances or Azerbaijan from 12 to 28 June 2015, with the not. It should be noted that the reported presence purpose of contributing to the surveillance of sub- of a drug on the WADA Monitoring Program in an stances listed on the 2015 World Anti-Doping athlete’s blood or urine sample would not result in Agency (WADA) Monitoring Program. an antidoping rule violation by the athlete. Meldonium was added to the WADA Clinical use of meldonium Monitoring Program in January 2015 in light of Meldonium is registered and prescribed as a drug anecdotal reports of use among the athlete popula- for human therapeutic use in Latvia, Russia, tion during the London 2012 Olympic and Ukraine, Georgia, Kazakhstan, Azerbaijan, Belarus, Paralympic Games. During London 2012, declara- Uzbekistan, Moldova and Kyrgyzstan, and is manu- tions from each team were required for all medi- To cite: Stuart M, factured under a number of brand names. These cines being imported into the UK. Five teams Schneider C, Steinbach K. Br include: Cardionate; Idrinol; Medatern; Melfor; declared the importation and possession of meldo- J Sports Med 2016;50: Midolat; Mildronate; Mildroxyn and Vazomag in nium for legitimate use by their own medical teams – 694 698. Russia; and Metamax; Methyldronat; Metonat; accompanying the athletes. Stuart M, et al. Br J Sports Med 2016;50:694–698. doi:10.1136/bjsports-2015-095906 1of5 Downloaded from http://bjsm.bmj.com/ on April 24, 2017 - Published by group.bmj.com Original article METHODS road cycling, athletics (long distance running and high jump), Three sources of data were reviewed by the EOC Medical and fencing, boxing, gymnastics, volleyball and canoe-sprint. Anti-Doping Commission to determine the prevalence of mel- donium use during the Baku 2015 European Games. Laboratory detection of meldonium A summary of findings from both, the Moscow and Seibersdorf Self-reported meldonium use on doping control forms laboratories, relating to substances on the 2015 WADA At the time of providing a urine or blood sample at a doping Monitoring Program are provided below. Only the data for mel- control station, all athletes were asked to declare any medica- donium are discussed in this report. tions or nutritional supplements taken during the previous 7 days. Athletes were also asked to sign to indicate that the Combined laboratory data ▸ samples could be used anonymously for antidoping research Of 762 urine samples analysed, 66 cases of meldonium were purposes. reported (8.7%). ▸ Members of the European Olympic Committees (EOC) Both laboratories reported meldonium >100 ng/mL; the Medical and Anti-Doping Commission present in Baku during Moscow laboratory provided estimated concentrations in the – m the Games undertook a review of the doping control forms and range of 0.7 273 g/mL; estimated concentrations were not recorded the self-reported declarations made by the athletes. available for the Seibersdorf laboratory. Moscow laboratory data Declaration of meldonium as medical team stock Four hundred and fifty urine samples were analysed and 48 mel- Each country’s National Olympic Committee (NOC) participat- donium cases reported. ing in the Games was required to submit a declaration to the Baku 2015 Games Medical Services of all medicine supplies Seibersdorf laboratory data being imported into Azerbaijan for use by their own medical Three hundred and twelve urine samples were tested and 18 teams during the time of the Games. These declarations were meldonium cases reported. reviewed for self-reported meldonium stock, which the teams were carrying for the purpose of administration to members of Comparison of self-reported versus laboratory-detected their team. meldonium The table below presents the comparison of self-reported Laboratory detection of meldonium in doping control declared use by athletes versus the laboratory detection in indi- samples vidual samples by sport (table 1). Two WADA accredited laboratories were used to analyse urine and blood samples during the Games. These were located in Importation of medicines by NOC teams Moscow, Russia, and in Seibersdorf, Austria. Sample testing was Of the 50 NOCs represented at the Games, the importation of split between the two laboratories, based on a preplanned agree- meldonium into Azerbaijan was declared to the Games Medical fi ment related to speci c sports. Services by 2 NOCs as stock for potential issue or administra- Both WADA accredited laboratories screened all urine tion by their team doctors. fi samples speci cally for the presence of meldonium. These data ▸ One country declared: 20 ampoules of meldonium 500 mg were provided directly to WADA as part of the Monitoring solution for injection Program surveillance. ▸ One country declared: 120 tablets of meldonium 250 mg However, athletes from six different countries declared the RESULTS use of the drug on the doping control forms. There are three Self-declaration of meldonium possible reasons for this: There were a total of 864 tests, which included 762 urine and 1. The athletes had personal supplies of meldonium, which was 102 blood tests from 46 of the 50 participating NOCs, under- not required to be declared at the time of importation; taken by the Baku 2015 Anti-Doping Services. Of these, 662 2. The NOC medical staff members were unaware that one or (297 female/365 male) were undertaken from 8 to 28 June more of their athletes were taking meldonium; 2015, and the rest were undertaken as pregames testing in the 3. The NOC failed to declare this drug as being imported. month prior to the Games. Of all Baku 2015 Doping Control Forms reviewed from 8 to DISCUSSION 28 June 2015, 525 of 662 (80%) had a self-reported declaration Estimate of prevalence of meldonium use by the athlete for either a medication or nutritional supplement. Meldonium use was detected across athletes competing in 15 of A total of 23 of the 662 (3.5%) athletes tested from 8 to 28 the 21 (71.4%) sports staged during the Games.
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