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WHATCOMMUNICATION EVERY PHYSICIAN SHOULD KNOW ABOUT DOPING AND DOPING CONTROL What every physician should know about doping and doping control O QUE TODO MÉDICO DEVERIA CONHECER SOBRE DOPING E CONTROLE ANTIDOPING JOSÉ KAWAZOE LAZZOLI1 1Adjunct Professor, Instituto Biomédico, Universidade Federal Fluminense. Specialist in Sports Medicine from Sociedade Brasileira de Medicina do Exercício e do Esporte (SBMEE) and Cardiology from Sociedade Brasileira de Cardiologia (SBC). Former President of the Brazilian Society of Sports Medicine (2009/2011). Secretary General of the Panamerican Confederation of Sports Medicine (Copamede). Treasurer of the International Federation of Sports Medicine (FIMS), Rio de Janeiro, RJ, Brazil http://dx.doi.org/10.1590/1806-9282.62.02.101 Probably the medical professional who is closer to the teria are present in a substance or a method, the theoret- daily life of an athlete, who participates regularly in com- ical possibility of listing occurs. petitions, whether or not high-performance, is the expert Examples of artificial performance enhancement in- in exercise and sports medicine. However, occasionally clude anabolic steroids, which also cause serious risks to the athlete may need to resort to other medical profes- the health of the athlete. This group of substances in- sionals, for various reasons, such as a general practitio- cludes two of the three basic principles of the concept of ner, a dermatologist, a cardiologist, an orthopedist or a doping, and therefore makes the list. gastroenterologist. Therefore, every physician is subject The concept of “violating the spirit of sport” can give to come across a patient who is an intermediate level or rise to subjective interpretations, but these values are ex- high-performance athlete, and will need to go through plained in WADA World Anti-Doping Code as follows: eth- doping controls throughout his sporting life. The pur- ics, fair play and honesty; health; excellence in performance; pose of this article is to provide concepts and informa- character and education; fun and joy; team spirit; dedica- tion to medical professionals so that they can properly tion and commitment; respect for rules and laws; self-re- treat their “athlete patients”, avoiding the use of substanc- spect and respect for the other athletes; courage; solidarity. es that may harm them in a doping control situation. Cannabinoids, such as hashish and marijuana, are examples of substances considered doping because they HISTORY are harmful to the health of the athlete and contrary to In the past, the list of banned substances was drawn up the fundamental values of sport, although they not en- by the Medical Commission of the International Olym- hance athletic performance. pic Committee (IOC) and usually revised in the year pre- vious to an Olympic game. The IOC list was used by in- DEFINITION OF DOPING ternational federations of different sports, in many By resolution of the World Anti-Doping Code, doping is countries. However, over time, alternative lists slightly characterized when there is/are one or more anti-doping different from each other were created. This would com- rule violations, which are as follows: pel the experts in exercise and sports medicine to know which authority was responsible for a given competition, 1. Presence of a prohibited substance or its metabolites and what the list of banned substances adopted would or markers in the sample collected from an athlete; be. The problem was finally resolved with the creation in 2. Use or attempted use by an athlete of a prohibited subs- 1999 of the World Anti-Doping Agency, also known as tance or prohibited method; WADA. 3. Refusing or failing without compelling justification WADA annually updates the list of prohibited sub- to submit to sample collection after notification, or stances and methods. The list is valid from January 1 of otherwise evading doping control; each year and is usually updated and approved by WADA 4. Violation of the requirements regarding athlete avai- Executive Committee in the last quarter of the preceding lability for out-of-competition testing; year, then published on WADA’s website: www.wada-ama. 5. Tampering or attempted tampering with any part of org. doping control; 6. Possession of prohibited substances and prohibited CONCEPT OF DOPING methods; The concept of doping by WADA is based on three crite- 7. Trafficking or attempted trafficking of prohibited subs- ria: enhancement of sports performance; risk to the health tances and prohibited methods; of the athlete; and that use of the substance or method 8. Administration or attempted administration to any ath- violates the spirit of sport. When two of these three cri- lete in-competition of a prohibited substance or a prohi- REV ASSOC MED BRAS 2016; 62(2):101-105 101 LAZZOLI JK bited method; or administration or attempted adminis- a. That the prohibited substance is necessary to treat an tration to any athlete out-of-competition of a substance acute or chronic medical condition, so that the sus- or method that is prohibited out-of-competition; pension or non-use of the substance significantly wor- 9. Assisting, encouraging, aiding, abetting, conspiring, sens the symptoms; covering up or any other type of intentional compli- b. The prohibited substance being claimed for use can- city involving an anti-doping rule violation; not enhance the physical performance beyond what would be expected with the simple treatment and rees- TYPES OF DOPING CONTROL tablishment of the normal state of the athlete’s health; In-competition control is performed in a specific compe- c. There are no other evidence-based alternatives to the tition, such as a soccer game or a swimming competition. use of the prohibited substance, or – in other words – In this type of control, all WADA-prohibited substances that the prohibited substance is considered irreplacea- and methods are considered doping. ble in the treatment of the athlete’s medical condition; The out-of-competition control can be performed at d. That the need for the use of the prohibited substance the discretion of International Federations, National does not result from previous non-therapeutic use of Olympic Committees or National Anti-doping Agencies, any substance or method banned by WADA. which have a database on the location of athletes, updat- ed periodically. An athlete may receive a visit from an an- World-class athletes and athletes who participate in an ti-doping control officer at any time, at home, at the train- international competition should apply for TUE direct- ing facilities, at the workplace or during holidays. In ly from the international federation for their sport. Ath- principle, this type of control can be performed up to 48 letes who participate in national competitions, in turn, hours before a sporting competition. must request a TUE directly from the ABCD, as soon as possible and within a period not less than 30 days before WADA LIST OF PROHIBITED SUBSTANCES AND the competition. In Brazil, applications should be com- METHODS pleted by the athlete and his/her assisting physician (form As mentioned above, the list of prohibited substances available on the ABCD website). Assessment is made by and methods is annually updated by WADA, always in the ABCD TUE Commission (CAUT-ABCD); if the CAUT- the last quarter of the year, coming into force on Janu- -ABCD considers that the use of the substance meets the ary 1 of the following year and being valid until Decem- criteria defined by the International Standard for Thera- ber 31 of that year. peutic Use Exemptions, the TUE is granted. Evidently, The following tables show the prohibited substanc- the form must be accompanied by appropriate documen- es and methods, as updated by WADA for the year of tation confirming the diagnosis, including results and 2016. Table 1 shows the list of prohibited substances and expert opinion reports of the relevant complementary methods in any in- and out-of-competition testing. Ta- tests. ble 2 shows the list of prohibited substances and meth- If due to a medical emergency a medical doctor has ods for in-competition testing only. Table 3 shows the to administer a prohibited substance, the case must be list of prohibited substances in particular sports. The reported as soon as possible to the ABCD using the TUE Tables display the most common substances in each cat- request system, available from www.abcd.gov.br. Docu- egory. The complete list can be found in English on WADA ments proving admission to the emergency room and a website (www.wada-ama.org) or in Portuguese, on the clinical report of the emergency should also be sent. The website of the Brazilian Doping Control Authority (Au- request for therapeutic use of a prohibited substance with toridade Brasileira de Controle de Dopagem – ABCD): www. retroactive approval is possible only in cases of emergen- abcd.gov.br. cy treatment due to acute medical conditions, or in ex- ceptional situations where the sending of the request for AUTHORIZATION FOR THERAPEUTIC USE therapeutic use prior to doping control is not possible. An athlete can use any substance that is part of WADA list for medical treatment, after requesting and being CONCLUSION granted a therapeutic use exemption (TUE) to/by the One of the principles of doping control is to seek to en- competent body. It is also necessary that each of the fol- sure the maintenance of the athlete’s health and fair play. lowing situations is covered: We must remember that the athlete is responsible for all 102 REV ASSOC MED BRAS 2016; 62(2):101-105 WHAT EVERY PHYSICIAN SHOULD KNOW ABOUT DOPING AND DOPING CONTROL substances that may be found in his or her body. For this cepts of doping control, not only to provide the best ther- reason, we consider that all medical professionals, re- apeutic alternatives, but mostly to avoid iatrogenic events gardless of their specialty, should have – as part of their that can jeopardize the credibility and career of an ath- medical knowledge wealth – the domain of basic con- lete patient.

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