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Home , Sports medicine

SPORTS the emerging speciality of pharmacy

– Written by David Mottram and Mark Stuart, UK

INTRODUCTION the concept of sports pharmacists on an services for the London Olympic Games Participation in and is international scale. began in 2008, immediately after the Beijing undertaken at all levels, from amateur Olympic and Paralympic Games. enthusiasts to elite . Pharmacists RECENT EXPERIENCES OF SPORTS are frequently approached by people who PHARMACY Medical Services for London 2012 engage in sport and exercise for advice about The London 2012 Olympic and Paralympic LOCOG Medical Services comprised a drug treatment or on general healthcare Games number of specialist work streams including associated with their participation in The 2012 Olympic and Paralympic pharmacy, sports , primary care, sport. There is a growing need for specialist Games were awarded to the City of London physiotherapy, , pharmacists in the area of sport and exercise in 2005. The London Organising Committee , optometry, and medical in order to fulfil this valuable healthcare for the Olympic and Paralympic Games imaging. These services operated across role. These specialists may be described as (LOCOG) was established to plan and deliver three polyclinics at the Villages sports pharmacists. the Games. at Stratford (Olympic Park), Eton Dorney In this article the authors will draw Within the LOCOG Medical Services, (rowing and canoe sprint events) and on their recent experiences of working the authors set up a Pharmacy Planning Weymoth (sailing events). with pharmacists in a sport-orientated Committee1. Mr Mark Stuart was the The operation period of the service was environment and then speculate on how Pharmacy Clinical Lead and Superintendent 70 days between July and September 2012, these experiences may be used to develop Pharmacist. Planning for the pharmacy from the opening of the Olympic Village

66 the emerging speciality of sports pharmacy Image: The London 2012 Anti-Doping Laboratory operated by King’s College London. Image Credit: LOCOG. to the close of the Paralympic Village. 6. Run a minor ailments scheme for all sports across 34 competition venues and The service to spectators covered 17 days non-athlete accredited personnel. also the medicine needs of the Paralympic of Olympic competition and 11 days of 7. Provide a comprehensive Games, which included 4,200 athletes of Paralympic competition. information service for all medical 20 Paralympic sports across 21 competition personnel. venues. In total, the pharmacy services Pharmacy Services at London 2012 The polyclinics each contained a fully covered the needs of around 200,000 Pharmacy services at the London stocked pharmacy to provide the medicines accredited people, as well as an estimated 2012 Olympic and Paralympic Games requirements of accredited athletes, team 9.2 million spectators attending events. were amongst the most advanced and officials, Olympic and Paralympic family comprehensive of any Olympic and and other residents of the Villages. Paralympic Games. The Olympic Village Pharmacy was The principal scope of the pharmacy situated in a purpose-built polyclinic There is a growing service was to: located in the athletes’ residential area. 1. Provide three fully equipped outpatient The in the Weymouth Sailing need for specialist pharmacies in each of the three Village Village and Eton Dorney Rowing Village pharmacists in the Polyclinics. were situated in facilities within the 2. Write the Olympic and Paralympic residential areas of these villages. area of sport and Pharmacy Guides, incorporating the The pharmacies operated in a similar drug formulary. style to an outpatient dispensary. exercise 3. Develop policies and procedures for Additionally, they were the co-ordinating the operation of pharmacy services points of medicines supply for the athlete at all Games venues for all healthcare and spectator medical facilities at all professional groups. Olympic and Paralympic venues, including 4. Provide safe and reliable systems for the five cities hosting the preliminary drug supply and stock control at all Olympic football matches. Games venues. Pharmacy clinical services provided the 5. Recruit, educate and train the pharmacy medicine needs for the Olympic Games, volunteers. this included 11,200 athletes of 26 Olympic

67 SPORTS pharmacy

Sports pharmacists THE WIDER ROLE OF SPORTS PHARMACISTS In contrast to the unique environment of medical and pharmacy services at must contribute to the international games, sports pharmacists must contribute to the health of health of sportspersons sportspersons in a variety of other clinical in a variety of other settings. Sports pharmacy in daily practice Clinical settings may range from clinical settings community-based pharmacy, which offers a convenient and accessible resource, to a orthopaedic ward where a pharmacist may be involved as part of a The pharmacies dispensed close to 6,000 the end of the Games, all the pharmacists multidisciplinary team in the monitoring prescription items written by local UK had an enhanced level of knowledge in and management of medication for doctors and for around 1,000 visiting team sports pharmacology, and were aware of of an acute or chronic nature as a result of doctors from 205 different countries. the fundamental clinical aspects of sports sport or exercise . In order to provide the pharmacy medicine, enabling them to confidently In all clinical settings, sports pharmacists services for the London 2012 Games, over contribute to the care of athletes within the can complement the work of the sports 100 pharmacist volunteers were recruited specialised multidisciplinary environment , physiotherapist, and from around the UK. These volunteers had a of the polyclinic. The opportunities for other healthcare professionals involved variable range of experience in sport-related pharmacists in this specialised environment with athlete care. The pharmacist’s role in pharmacy. As described later in this article, highlighted the important role that the sports medicine often co-exists with other the authors provided education and training profession has alongside other athlete- health specialties and can form part of a for the pharmacists, prior to the Games. By focussed care disciplines. holistic approach to patient care.

Image: The Polyclinic in the Olympic Village.

68 Pharmacists at sporting events An extended role for sports pharmacists is as a specialist at major sporting events. At international games including Olympic and Paralympic, Asian, All-Africa and Pan American Games, purpose-built medical facilities are provided. Medical services invariably include clinical pharmacy services. Specialist sports pharmacists are ideally placed to fulfil this high profile and specialist role. In summary, scope of the specialty of sports pharmacy is presented in Figure 1.

EDUCATIONAL TRAINING FOR SPORTS PHARMACISTS Most pharmacy degree courses are generalist in nature and therefore produce pharmacy graduates who have knowledge and skills across the whole range of pharmacy practice. It is at the post-graduate level that pharmacists become specialists in disciplines such as , paediatrics psychopharmacy. With the increasing involvement of pharmacists in sport, it is clear that specialised training in the field of sports medicine for pharmacists is needed.

SPECIALISED EDUCATION AND GOVERNANCE Existing education programmes The authors have recently produced a web-based learning programme, which was used to educate pharmacists and other Image 3: The Polyclinic in the Olympic Village. healthcare professionals in their role as volunteers for the London 2012 Olympic and Paralympic Games2. The general responsibilities of sports (WADA) Prohibited List. For a minority Pharmacist volunteers for London 2012 pharmacists of athletes, deliberate use of prohibited were required to undertake this web-based A sports pharmacist must be aware of substances and methods is perceived as a learning programme and to successfully the specific care and support required by shortcut to improved performance. complete the associated online assessment, people who engage in sport and exercise. However, there have been many cases prior to undertaking their role at the The sportsperson may require advice on in which the use of a prohibited substance, Games. The programme was also made the drug treatment for acute or chronic by an athlete, has been inadvertent; available to other healthcare volunteers at medical conditions, the management of none-the-less, strict-liability rules have the Games. New initiatives such as this are sport injuries or on the use of dietary or resulted in severe penalties being applied. warranted on a larger scale to develop a ergogenic supplements. For competitive WADA has recognised this problem and robust system of learning and accreditation athletes, advice on the prohibited status of introduced a Specified Substances clause for pharmacists across the globe wanting substances is a prime consideration. to the Prohibited List regulations. Had to specialise and practice in the sports these athletes had better access to well- medicine environment. Specific role of sports pharmacists for elite informed professional advice, many of these athletes cases could be avoided with a significant Development of new education programmes Regrettably, there are circumstances reduction in both the administrative cost of A system of ongoing learning when an athlete may take a drug that adverse-findings cases and the associated programmes that can be used to educate appears on the World Anti-Doping Agency stress for the athletes. pharmacists worldwide and to develop their

69 SPORTS pharmacy

The specialty of Sports Pharmacy covers

Figure 1: The scope Awareness of drugs in sport in the community, medicine & of sports Awareness industry for both performance modification and the prevention pharmacy. and treatment of disease.

Knowledge of therapeutic use of drugs in sport and how pharmacist interventions can support sport related illness or injury.

Use of pharmacotherapy to prevent sport-related illness or injury Prevention and maintain well-being.

Safe and rational use of and supplements to optimise Optimisation performance.

Knowledge of the use of drugs in sport for competitive Abuse advantage.

Detection The science of detecting drugs of abuse in the body.

skills to become sports pharmacists is long • To create a standardised level of course would be required, along with full overdue. accreditation for the specialty. registration to practice with a national Such programmes might be studied by • To ensure that those who participate pharmacy regulatory body. A portfolio of distance learning, thereby allowing any in sport and exercise can access continuing professional development in pharmacist or other healthcare specialist professionals with sound knowledge of the area of sport and exercise medicine to undertake their studies regardless of drug use in sport, including prohibited would need to be considered in line with their country of residence. Continuing substances and anti-doping regulations. modern approaches in continuing medical professional development is a requirement • To help to prevent athletes from education. for all healthcare professionals worldwide. inadvertent use of prohibited The creation of such a professional The development of new education substances. body would require close collaboration programmes would contribute to the • To strengthen the anti-doping and support from major national and portfolio of materials available for this movement through awareness and international sporting and medical purpose. education. organisations. • To develop leaders for the promotion of Professional standards anti-. A new professional body to regulate • To provide a valuable resource to advise the specialty of sports pharmacy is also and participate in medical services for warranted, in line with other professions major sporting events. working in the field of sports medicine. If such a professional body was created, Such a professional body might perform the stringent membership requirements would following functions: be needed to ensure that high international • To develop pharmacy healthcare standards were maintained and that the professionals worldwide, who body represented a reputable collection of have specialist knowledge and experts in the field. understanding of drug use in sport and Completion of a specified international exercise in its widest context. diploma or postgraduate certificate

70 CONCLUSION References David R. Mottram, B.Pharm., Ph.D., F.R.Pharm.S. In most countries, there is an increasing 1. Stuart M, Mottram D. The final level of participation in sport and exercise preparations of pharmacy services for Emeritus Professor of Pharmacy Practice from amateur level to international elite the London 2012 games. Pharmaceutical Liverpool John Moores University competition. This worldwide population Journal 2012, Vol. 289: 60. Liverpool, UK of sport enthusiasts require advice and 2. Mottram D. E-learning modules for the support from well-informed healthcare Contact: [email protected] London 2012 Olympic and Paralympic professionals. Games. Pharmaceutical Journal 2011, Vol. While the concept of sports , 287: 584. Mark C. Stuart, B.Pharm., F.R.Pharm.S. sports scientists and sports physiologists is Pharmacy Clinical Lead well established, the profession of pharmacy London 2012 Olympic and Paralympic is newly emerging as a valuable contributor Games Organising Committee to the health of athletes. Future initiatives focussing on standardised education and Contact: [email protected] professional regulation are required to cement pharmacy as an important and necessary faculty in the field of sports medicine.

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