Athletes are cut from national or international sports teams every year due to failing a doping test. What is doping? Can the tests produce false positives? Which sports tend to have the most trouble with doping? How long does it take the body to process the substance to an undetectable level? Some athletes need to take a prohibited medication — what provision is made for them to continue competing without getting flagged for doping?
Anti-doping rules are meant to keep sports competitions healthy and players safe.
Players who must take a drug on the prohibited list must file a Therapeutic Use Exemption.
Players can be tested anytime, anywhere.
Washout periods vary by medication and by the metabolic activity of the individual.
From the earliest days of sports competitions, athletes have sought ways to enhance their performance. Reports of special diets date back to ancient Greece, and the word “doping” arose in the 1800s with the use of opioids in horses. The pressure on today's competitive athletes is intense. Therefore, now more than ever, athletes must be aware of the health risks of taking performance-enhancing drugs and the substantial professional risk of getting caught.
What is doping?
According to FIFA (Fédération Internationale de Football Association (French) or International Association Football Federation), soccer's international governing body, “Doping is when players take prohibited substances or use prohibited methods to improve their performance.”
FIFA maintains a list of prohibited substances. This list includes anabolic steroids, hormones, diuretics, stimulants, narcotics, cannabinoids, and glucocorticoids. Furthermore, natural supplements from plants such as cannabis sativa, ephedra, orange peel or bitter orange, and tinospora cripsa contain prohibited substances as well.
Prohibited “methods” include blood doping, which is using a blood transfusion to force the body to carry oxygen more efficiently.
How does doping control work?
Athletes competing at the national or international level can be tested anytime, anywhere, as part of the doping control program administered by the World Anti-Doping Agency (WADA). The athlete must be escorted while providing a urine or blood sample. The samples are split into A and B bottles so the athlete can retain one for independent testing if tests positive.
How is doping detected?
To detect a drug, metabolites must first be identified for testing — these are called analytic targets. Metabolites are the byproducts of a drug after enzymes in the body break it down into pharmacologically active substances. Some metabolites linger in the body longer than others. Some prohibited substances act as “masking” agents, such as diuretics that dilute the concentration of a metabolite in the urine to reduce the chances of detection.
Can current tests detect all possible doping compounds?
An Olympic athlete can take a biological compound not currently on the prohibited substances list but be sanctioned years later and lose their medal. That is because WADA freezes and stores doping control samples for many years. During this time, advances in testing can detect drug metabolites that were unknown when the sample was collected.
Other doping compounds are not yet registered as pharmaceuticals but can be sourced online. One example is selective androgen receptor modulators (SARMs) which have similar effects as anabolic steroids but are less harmful. Chemists are researching the best analytical targets for SARMs.
How long does it take a drug to clear the body?
Some drugs are only prohibited during competition; thus, athletes must know when to stop taking the drug before competing in an event. A drug’s “half-life” is the amount of time for half of the active drug to be completely broken down. A pharmacist can tell you a drug’s half-life, but the metabolites, which are the analytic targets of a drug test, may last much longer. The half-life may also vary depending on whether it is a blood or urine sample.
How long it takes for a drug to clear depends on the type, how it is taken, and the athlete’s metabolism. For instance, marijuana can be detected for days to weeks, depending on what part of the plant is consumed and how it is taken. On the other hand, pseudoephedrine — a stimulant found in over-the-counter cold medication — can clear in as quickly as 24 hours but may take a couple of days.
Minimum “washout” periods for glucocorticoids are provided by the US Anti-Doping Agency (USADA). These drugs are prohibited when taken orally, rectally, or injected. Until January 1, 2022, these drugs were permitted for injection in joints or the epidural space in the spine for treatment. However, the WADA determined that injections allowed for high concentrations in the system, which could improve performance.
What if an athlete needs the medication?
The Therapeutic Use Exemption provides a pathway for athletes to receive medications that might otherwise cause a doping violation. Some conditions for which an athlete may need to use prohibited substances include ADHD, asthma, diabetes, cardiovascular conditions, infertility, sleep disorders, or for pain management. In one case, an acne medication contained a masking agent, which resulted in the athlete's suspension.
Which sports have the most doping violations?
According to 2019 statistics compiled by the WADA, the highest number of anti-doping rule violations (ADRV) by sport were in bodybuilding, athletics (such as track and field), cycling, and weightlifting. Together, these sports comprised more than half of all ADRVs.
What are the odds of being sanctioned?
Of the 278,047 samples collected in 2019, approximately 1% (2,701) tested positive. Of these positive samples, the committee dismissed 2% of cases after athlete exoneration and 11% due to valid medical reasons. However, WADA sanctioned 57% of tested athletes (20% of cases were still pending, and 10% were closed).
What is the athlete's biological passport?
The World Anti-Doping Agency developed the athlete biological passport (APB) in 2009 to strengthen its anti-doping programs. It aims to keep an accurate historical record of an athlete’s blood or urine sample biological markers to detect variations. This helps athletes who must take maintenance medication.
It is heartbreaking to read about stories of athletes who had no intent to use a doping or masking agent but had to serve out a suspension before being able to participate again. Even when athletes have a condition requiring medication, it is their responsibility to know which drugs are on the prohibited list and file the proper paperwork to ensure they will not be sanctioned if a drug is detected. Some of this risk can be eliminated by relying on supplements that are NSF Certified for Sport.