|Year : 2019 | Volume
| Issue : 1 | Page : 1-3
Drugs in sport: The curse of doping and role of pharmacologist
Dhruv Mahendru, Subodh Kumar, Ajay Prakash, Bikash Medhi
Department of Pharmacology, PGIMER, Chandigarh, India
|Date of Submission||05-Mar-2019|
|Date of Acceptance||11-Mar-2019|
|Date of Web Publication||19-Mar-2019|
Dr. Bikash Medhi
Department of Pharmacology, PGIMER, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mahendru D, Kumar S, Prakash A, Medhi B. Drugs in sport: The curse of doping and role of pharmacologist. Indian J Pharmacol 2019;51:1-3
The origin of using drugs in sports goes back to the very creation of sports itself. There are reports of using special diets by athletes in 688 BC Ancient Olympic Games in Greece. Various plants were also being used for their stimulant effects in speed and endurance in the ancient Greek Olympics. The use of Ma Huang which is an extract from plant Ephedra was also used as a performance enhancer in China about 5000 years ago. The term doping also came into existence in the around late 1800s when a potion comprising opium was being abused in horses.
The main principle of the Olympics is just not about conquering, but it is all about healthy competition. As moral, it may sound; however, nowadays, it has nothing to do with the harsh reality of the sporting world. A drug is banned by the World Anti-Doping Agency (WADA) when it has been shown to increase performance, if it has a risk to the health or if the spirit of sport is violated.
To improve the performance where a milli-second difference may be a deciding factor between winner and runner-up, athlete's are lured towards doping. The International Olympic Committee did not start testing for doping until 1968 when a Danish cyclist Knud Enemark Jensen died following a cycle crash in 1960 Olympics, and later, it was found that the athlete had consumed amphetamine. In 1998, erythropoietin among many other banned substances was found out by police during Tour de France. During world conference (1999) on doping and sport, formation of World Anti-Doping Agency took place where initiatives were taken to develop the standards for a consistent doping control program. The National Anti-Doping Agency (NADA) affiliated to WADA was established in 2009 by the Union Government which had a vision of dope-free sports. The WADA updates the list of doping substances every year on its website (https://www.wada-ama.org/en/resources/science-medicine/prohibited-list-documents).
Doping control test results underestimate the true doping prevalence as not all the samples from the athletes who are doping come to the laboratory. In India, National Dope Testing Laboratory (NDTL) was established in 1990 as Dope Control Centre under Sports Authority of India and was accredited by the WADA in 2008. The main aim of NDTL is providing precise and dependable services as well as the results for dope testing of athletes. The laboratory has to get yearly accreditation. Along with the human dope testing, horses dope testing is also being conducted with approximately 3000 samples in a year. The testing for athletes and horses is not only restricted for India, but it has been conducting doping tests for various international tournaments also.
| » What is the Doping Scenario: India and Worldwide|| |
A survey conducted in the past which was reported in Sports Illustrated issue of 1997 showed that >95% athletes were willing to use performance-enhancing substances if they were assured of winning and the same survey showed that 50% of athletes were willing to consume these substances and win for 5 years and then they were ready to die. This shows that athletes are willing to cross any boundaries to win. Doping is a worldwide problem, but it is almost impossible to know the true prevalence of doping in sport. Rough assessment is that around 14%–39% of the athletes intentionally use performance-enhancing substances. Hence, the athletes who are being caught are only the tip of the iceberg whereas the problem lies much deeper.
In India, doping continues to be major worry for the authorities. Russia and Italy are at the top of the doping list, but India is also not far behind which is a big concern. That is why the Indian government has planned to set up various regional anti-doping centers and also is regularly conducting anti-doping awareness programs for the athletes as well as coaches throughout India.
| » Therapeutic Use Exemption: Role of Pharmacologist|| |
Therapeutic use exemption (TUE) is a process by which the permission to use a prohibited substance or method is granted where it is necessary for the treatment of a documented clinical condition.
The criteria which need to be satisfied to get TUE are:
- Worsening of health if the prohibited drug or method is not used
- Appropriate therapeutic alternative is not available
- There will no additional enhancement of performance, but the medicine will restore the health to normal
- Requirement for the usage of the banned substance or method is not due to the prior use without a TUE which was prohibited at the time of use.
For many athletes, making a career in sports is not safe without the use of drugs, and it can be demonstrated best by the case of American sailor Kevin Hall. He had to lose his testicles because of cancer, and he needed testosterone injections for maintaining his health. Testosterone is an anabolic steroid because of which he had to prove many different authorities or governing bodies for TUE.
TUE committee operates at various levels: one at the national level in the NADA of the particular country and then there are International Federation (IF) and Major Event Organization (MEO). It must consist of three clinicians experienced in treating athletes and having sufficient information regarding sports medicine. Application by the athlete for TUE depends upon which level of competition he/she is going to take part as it can be at the national level or international level. TUE granted by the NADA is only valid in the domestic competitions and not in international events; for it to be valid even in international events, the TUE must be applied in IF or MEO but in <30 days of the participation at an international event if the banned substance is banned in-competition.
In 2016, a serious cyberattack occurred by a Russian cyber espionage group which was confirmed by theWADA which led to data leakage of athletes under TUE related to Rio Olympic Games. The athletes whose data were leaked were the likes of 2016 Olympics gold medalist Simone Biles and the famous William sisters which led to huge debates worldwide about authenticity of TUE.
Between 1985 and 1995, around 121 athletes from the US suddenly lost consciousness and died after or during their training sessions or while in the competition. These deaths were mainly due to either hypertrophic cardiomyopathy or heart malformations. Increased incidence of cardiac complications and deaths in young athletes led to a recommendation by the American Heart Association that athletes must undergo cardiac screening before training or participating. There may be a possibility that drugs being used by an unwell athlete may lead to enhancing the performance; however, as always, safety should come first.
| » What is Sports Pharmacology?|| |
It involves the study of medicine involving all the sportspersons and playing a vital role in sports and athletics. The health of the sportspersons is regularly assessed with maintenance and management of medical history along with the treatment of sports-related injury. Pharmacologists, pharmacists, nurses, nutritionists, psychologist, physiotherapist, physicians, and even athletes having basic knowledge of physiology, pharmacokinetics, and pharmacodynamics of biologically active substances can help prevent many of the doping cases. It also helps them to know about the effect of the substances entering their body in the form of food or medicines. Pharmacists dispensing the drugs to athletes must know about the banned and permitted drugs and the drugs banned during competition and out of competition. Training of the pharmacists on these many aspects constitutes sports pharmacy. Sports pharmacologists along with all the other stakeholders can be of huge help to the athletes and even to their physicians for information regarding dietary supplements, drugs, etc. For this, all the stakeholders should keep updating their knowledge of WADA code.
Medical knowledge provided in India to undergraduates and even to postgraduates and to postgraduates in pharmacology does not provide much of exposure to sports medicine or sports pharmacology. As there is increase in popularity of sports medicine, specialized training to pharmacologists and postgraduates related to sports pharmacology is necessary. Pharmacologists along with all the other stakeholders can help restore the spirit and integrity of the game.
| » Why Role of Pharmacologist is Important?|| |
Many of the over-the-counter medications and other commonly used medications can lead to enhancement or reduction in the performance of the athlete and can lead him/her into trouble. Nutritional supplements can be a cause of accidental doping. Hence, it is important to know the pharmacology of these drugs and which led to the concept of sports pharmacology. It plays an important role to make the sportspersons achieve their goals by improving the quality of life with the help of various drugs and other substances (well within standardized limits). Induction of sports pharmacology in the curriculum for postgraduates will certainly benefit the sporting fraternity in India. Collaborating pharmacologists, pharmacists, and other healthcare professionals can prevent the hazards of inadvertent drug abuse in athletes on a regular basis.
| » What is the Role of Industry in the Prevention of Doping?|| |
Interprofessional collaboration is a way forward to reduce the menace of doping. A campaign was launched in 2012 known as 2 Fields 1 Goal which was a collaboration between IF of Pharmaceutical Manufacturers and Associations, the global Biotechnology Industry Organization, and the WADA. The main aim of this cooperation is for identifying the compounds during the clinical trials which have a potential for misuse by athletes in the sport. During the launch of this campaign, a booklet was also released with the guidelines of identifying such agents before they come to market and sharing of such information with the Anti-Doping organizations for developing various methods to detect these agents to curb the illegal or illicit use by athletes.
| » Conclusion|| |
- Workshops, seminars, and training of doctors must be conducted regularly, and they should remain updated about the banned drugs in sports
- Anti-doping awareness programs must be regularly conducted not only in established sports set-ups but also at the grass-root level such as in primary schools throughout the country
- Like in the USA where the dietary supplement's industry along with US anti-doping agency collaborated with the US-FDA for making the athletes aware about the contamination of these supplements with various performance-enhancing substances, in India also, such a collaboration between NADA and Food Safety and Standards Authority of India will help to decrease the use of such supplements which might be containing substances of abuse
- An application created by the anti-doping agency of Australia which helps the athletes in finding the appropriate supplements which will not lead to doping. Such initiative will be quite helpful in India also where many supplements are often contaminated
- Popularity of sports medicine has increased in India, and various institutes also have started offering courses. Doctors should be aware of the drugs banned in or out of the competition so that the athletes career does not have to suffer, so incorporation of sports pharmacology and sports medicine in MBBS curriculum as well as in Pharmacy Council of India and Indian Nursing Council will increase the knowledge in this field from the undergraduate level and will help in contributing to doping-free India.
| » References|| |
Malve HO. Sports pharmacology: A medical pharmacologist's perspective. J Pharm Bioallied Sci 2018;10:126-36.
Savulescu J, Foddy B, Clayton M. Why we should allow performance enhancing drugs in sport. Br J Sports Med 2004;38:666-70.
de Hon O, Kuipers H, van Bottenburg M. Prevalence of doping use in elite sports: A review of numbers and methods. Sports Med 2015;45:57-69.
Gerrard D, Pipe A. Therapeutic use exemptions. Med Sport Sci 2017;62:55-67.
Pitsiladis Y, Wang G, Lacoste A, Schneider C, Smith AD, Di Gianfrancesco A, et al.
Make sport great again: The use and abuse of the therapeutic use exemptions process. Curr Sports Med Rep 2017;16:123-5.
Potera C. AHA panel outlines sudden death screening standards. Phys Sportsmed 1996;24:27-8.
Ambrose PJ. An advanced pharmacy practice experience in sports pharmacy. Am J Pharm Educ 2008;72:19.
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