What is not prohibited in anti-doping domain

A recent statement by a former international athlete in a newspaper interview that aspirin was one of the banned substances in the Prohibited List issued by the World Anti Doping Agency (WADA) not only showed how inadequate information flow has been in this field in India but also the complexity of the subject of banned drugs.

We have heard of a variety of substances of routine use in ‘over-the-counter medications’, at least in India, being in the Prohibited List.  Ephedrine and pseudoephedrine, available in cold and cough medications, readily come to mind.

But aspirin?

No, aspirin is not prohibited. In combination with another drug it could get among the prohibited substances, say for example oxycodone, an opioid, combined with aspirin. But on its own aspirin is safe for the athlete from an anti-doping perspective.

Aspirin, which belongs to a group of medicines classified non-steroidal anti-inflammatory drugs (NSAIDs), is so commonly used, say for headache and toothache, for cold and flu, for sprains and strains and rheumatic pain and to even manage a heart attack (as an anticoagulant)  in an emergency situation that living without it, even in the sports field, would be unimaginable.

Aspirin (Disprin is a one of the popular brands available in the Indian market that contains aspirin), is commonly used for its anti-inflammatory and analgesic properties. Aspirin is also available in several medicines that are given for the management of coronary artery disease (CAD), say for example Clavix AS which is a combination of Clopidogrel, an anti-platelet drug, and aspirin.

Check it out online

It is interesting to note in this respect that on the website of the Canadian Centre for Ethics in Sports (CCES), Canada’s anti-doping authority, one can check out even the drugs that are not prohibited, not just the ones that are banned.

That is something that should be extremely useful to the athletes since many medicines for routine problems may not be checked out by all through their personal physicians.

 The National Anti Doping Agency (NADA) has a list of brand names of the banned drugs but not of commonly-used drugs that are allowed. Its website needs improvements in several areas.

It is a fact, however, that there has long been a feeling among athletes, coaches, officials, disciplinary panel members, and lawyers that the Prohibited List, issued every year by WADA,  is rather complicated and difficult to understand for the athletes.

Even medical practitioners, especially in India’s hospitals, have found it difficult to exercise caution while prescribing drugs for athletes found to have “some requirement” for steroid use, if one goes by the number of times athletes bring in medical reasons and prescriptions at hearings to explain a ‘positive’ test. This might just be an excuse to avoid sanctions but in the odd case there could well be a lack of understanding of the specific requirement of an athlete and/or the Prohibited List.

True, the list contains an assortment of drugs you might have never heard of (quinbolone, peginesatide, fulvestrant, tuaminoheptane, pindolol etc for example) or even your doctor may have difficulty in recalling some of them except with the aid of that bulky drugs reference book they have. In any case you don't come across these drugs in routine medications that you and I may need.

'Strict liability' principle

It is an athlete’s responsibility, however, to make sure that nothing prohibited enters his/her body. The ‘strict liability’ principle pins the athlete down to such an extent that ‘escape’ from a doping charge becomes almost impossible.

We know of Aparna Popat’s use of D’Cold Total (phenylpropanolamine) and subsequent suspension. It clearly looked an accidental use by the badminton star. (Phenylpropanolamine and phenylephrine are not in the current WADA Prohibited List except under the monitoring programme for 2015).

Athletes failing a test after having ostensibly used cold and cough medications have been aplenty. Discus thrower Seema Antil was in the year 2000 stripped of her gold medal in the World Junior Championships in Chile after she tested positive for pseudoephedrine.

Currently, pseudoephedrine, ephedrine and methylephedrine etc, all used in cold and cough medications, are not banned per se. Concentration levels in urine beyond a prescribed limit will, however, get you a ‘positive’ against your name.

Prescribed thresholds

Medicines of everyday use like ephedrine etc are being regulated in this manner since they are so commonly used but have also been found to be in widespread misuse by sportspersons. The athlete who uses it for therapeutic purposes need not worry thus.

However, athletes do bring in medical reasons and prescriptions to explain the use of even steroids during disciplinary proceedings. And sometimes they do gain some sympathy and leniency, especially if they are from a rural background and might not have had the benefit of the internet etc.

As it happened in the case of a 17-year-old UP athlete in 2012. The distance runner produced a prescription from a health centre in Jaunpur that mentioned Decabolin (nandrolone) among other medicines. He was given the medicine, an injectible steroid, for the “treatment” of typhoid, according to his version.

“The medicines prescribed to the athlete on 26.11.2011 conform to the treatment which is given to patients of Typhoid in such rural dispensaries,” wrote the disciplinary panel in its order while reducing his sanction to one year. There was skepticism but WADA and the IAAF allowed that decision to stand rather than challenge it.

Falls into the trap again

The athlete’s story did not end there. Seven months after his scheduled date of return, he tested positive in a reinstatement test. This time again for nandrolone! He did not respond to notices by NADA. He was handed out a suspension of six years for his second offence, in absentia.

In early years of disciplinary hearings in India, panels tended to overlook the necessity for the athletes to have a therapeutic use exemption (TUE) to use banned substances in case they produced a medical prescription. At least they used to be swayed by the arguments about doctors prescribing medicines for apparently genuine ailments. They are stricter these days.

Useful information for the benefit of the athletes is still at a premium in India. NADA is yet to have a Global Drug Reference Online (DRO), as I keep pointing out. The Global DRO has been jointly managed by the US Anti Doping Agency (USADA), the UK Anti-Doping (UKAD) and the CCES, the Canadian agency. The Japanese Anti Doping Agency (JADA) is an official licensee of the DRO.

You can check out a medicine on this online facility in case you have a doubt about a particular drug that your doctor could have prescribed. There could be the odd problem associated with different brand names especially for Indian products if NADA becomes a licensee, but this is something that our athletes will have to live with till NADA creates its own online facility. 

Supplements guide

The USADA can also guide an athlete to a supplements section where he/she can check out a supplement and its safety from an anti-doping perspective. The ultimate responsibility would still lie with the athlete, but at least there is a facility that can give sound advice.

A similar help is also available at the UKAD. The UKAD recently warned that supplements use resulting in a ‘positive’ test would from now on get four-year suspensions. To balance that there is of course a new clause that deals with supplements contamination which could result in a reprieve.

Drug alerts are common on the websites of NADOs. Like this one issued by CCES last May. 

If you are wondering whether there had been any new drug found to have been misused by athletes, yes there has been. This one has not even hit the production line and yet two cyclists got them and have tested positive!

NADA has to keep updating its website with the latest information, not just on rule changes but on new drugs, marketing of substances like methylhexaneamine under new names etc. At least those who want to keep away from accidental use of such drugs would benefit.