Drugs and Anti-Doping in Sport

Original Editor - Wanda van Niekerk based on the course by James Laskin

Top Contributors - Wanda van Niekerk and Jess Bell  

Definitions of Doping

Doping is defined as the presence of prohibited substances or methods to unfairly improve sporting performance and to gain an advantage over competitors.

The World Anti-Doping Agency (WADA) defines that doping is the occurrence of one or more of the anti-doping rule violations set forth in Article 2.1 through 2.11 of the World Anti-Doping Code.

Categories of Drugs

Drugs	Definition	Function/ Effects	Side Effects	Examples
Anabolic Steroids	Synthetic hormones that help build muscle faster and enable faster recovery from training (promotes muscle growth)	Mimic testosterone Aid in muscle repair and speed up muscle building, so an athlete can train harder and more often to increase results at a faster rate	Kidney failure Mood swings Anxiety Aggression High blood pressure Increased risk for heart attack Stroke Impotence Infertility Voice deepening Increased facial hair in females Menstrual disturbances	Testosterone Trenbolone Oxymetholone Methandrostenolone Nandrolone Stanozolol Boldenone Oxandrolone
	Read more: Anabolic-Androgenic Steroid Use in Sports, Health, and Society Anabolic Steroid Abuse The influence of anabolic steroids on physiologic processes and exercise
Peptides	Peptide hormones and analogues are synthetic substances that copy natural hormones in the body	Human Growth Hormone: acts like an anabolic steroid develops muscle increases fat burning reduces tiredness Erythropoietin (EPO): promotes the production of red blood cells and thus increases the amount of oxygen blood can transport at any one time More oxygen to the muscle allows the athlete to work harder and longer	Human Growth Hormone cardiomegaly hypertension diabetes neuropathies peripheral oedema orthostatic hypertension carpal tunnel syndrome lipid profile abnormalities Erythropoietin with hematocrit level above 55%: risk of cardiovascular effects hypertension acute myocardial infarction arrhythmias thrombosis oedema stimulates angiogenesis and red blood cell aplasia	Human Growth Hormone (HGH) Erythropoietin (EPO)
	Read more: The influence of human growth hormone (HGH) on physiologic processes and exercise
Analgesics	Painkillers Addictive drugs Can be oral or injectable medications	Reduces the sensation of the central nervous system (CNS) and so helps with pain relief Masks pain so athlete is back from injury sooner	Loss of concentration Loss of balance Dizziness Sedation Nausea Vomiting Constipation Addiction	Heroin Methadone Pethidine Morphine Codeine
	Read more: A painful dilemma? Analgesic use in sport and the role of anti-doping. International Olympic Committee consensus statement on pain management in elite athletes Analgesic Medication and Exercise The Influence of NSAIDs on Physiologic Processes and Exercise
Stimulants	"Stimulants act on the central and peripheral nervous system to produce a number of possible psychostimulant actions such as increased alertness, hyperactivity, and altered mood."	Used to reduce feeling of tiredness so an athlete can train for longer Stimulates the central nervous system (CNS), making an athlete more alert Improved reaction time Improved memory Increased arousal Triggers relaxation and confidence	Irritability Insomnia Anxiety Tremors Increased blood pressure Tachycardia Gastric irritation	Amphetamines Ephedrine Cocaine Caffeine
	Read more: Methamphetamine and Exercise Caffeine and Exercise
Diuretics	Drugs which increase the rate of water loss from the body	Speeds up kidney function by producing more urine, reducing fluid retention and causing rapid weight loss Often used in sports with weight categories (athletes may use it to "make the required weight" for competition) Often used as masking agents to hide the effect of other performance-enhancing drugs	Dehydration Possible dizziness Muscle cramps Headaches Nausea Fatigue Development of kidney illness	Acetazolamide
Beta Blockers	Used as a relaxant, by weakening the effects of stress hormones	Athletes maintain a slow heart rate and low blood pressure - which is useful in tense situations such as competition Calming effect also helps in high-risk sports where speed is involved	Risk to athletes with low blood pressure, heart conditions, asthma May cause depressive symptoms, insomnia Tiredness	Propranolol Acebutolol

Why do Athletes Take Performance Enhancing Drugs?

Reasons include:

• To recover from injury more quickly
• To mask pain
• Influenced by others
• The will to win overrides the moral conscience
• A desire to be the best at all costs, especially when winning brings financial rewards
• Better results lead to better sponsors and endorsement contracts
• Desire to meet expectations of others
• Making the most of a short sporting life
• Willingness to cheat for public acclaim
• Feeling that their natural ability is not good enough

Why are Drugs Banned in Sports?

Conventional Arguments and Philosophical Flaws to Support Drug Bans

Considerations in Performance Enhancement and Drug Control in Sports

Argument	Philosophical Flaw
Naturalness - sport should be about testing the natural abilities of an athlete, without help from substances and methods external to the athlete	Athletes do many things that are "unnatural", such as high altitude training, using technology/ equipment that promotes success in sport. Why are drugs singled out?
Fairness - the provision of a level playing field is clouded by athletes using performance-enhancing drugs	Does a level playing field really exist in other areas outside of drugs? Consider factors such as uneven access to funding, facilities, and coaching worldwide.
Health - the use of performance-enhancing drugs poses short and long-term health risks to athletes	What does health mean with respect to athletes? Consider elite athletes pushing their bodies to the limit, sometimes even with questionable training methods.
Harm to others - the risk of athletes that are using performance-enhancing drugs coercing other impressionable athletes into taking these drugs (for example, elite athletes doping and then younger athletes following suit)	Impressionable athletes may feel coerced to take part in unhealthy training or nutritional practices because their idols recommend these, and there is no policing of this type of information sharing.

Recommended Podcast by Anti-Doping Science wherein these considerations are discussed in more detail.

Thomas Murray discusses the moral foundation for anti-doping in sport alongside the three reasons typically used in the defence of anti-doping. These reasons are:

• to protect the health of the athlete
• to promote fairness
• to preserve the meaning and values of and in sport ("the spirit of sport")

Recommended podcast by Anti-Doping Science wherein the article by Murray is discussed. A key point here is that "the spirit of sport is defined as "the pursuit of human excellence through the dedicated perfection of each person's natural talents".

World Anti-Doping Agency (WADA)

Purpose of WADA

The purposes of the World Anti-Doping Code and World Anti-Doping programme are:

• "To protect the Athletes' fundamental right to participate in doping-free sport and thus promote, health, fairness, and equality for athletes worldwide."
• "To ensure harmonised, coordinated and effective anti-doping programmes at the international and national level with regard to the prevention of doping."

Read more about the Purpose, Scope and Organisation of the World-Anti-Doping Programme and the Code: World Anti-Doping Code 2021 (pages 9 to 12)

Rule Violations

A violation of the anti-doping rules is NOT only about testing positive. The 11 rule violations are:

1. Presence of a prohibited substance or its metabolites or markers in an athlete's sample
2. Use or attempted use by an athlete of a prohibited substance or a prohibited method
3. Evading, refusing or failing to submit to sample collection by an athlete
4. Whereabouts failures by an athlete
5. Tampering or attempted tampering with any part of doping control by an athlete or other person
6. Possession of a prohibited substance or a prohibited method by an athlete or athlete support person
7. Trafficking or attempted trafficking in any prohibited substance or prohibited method by an athlete or other person
8. Administration or attempted administration by an athlete or other person to any athlete in-competition of any prohibited substance or method or administration or attempted administration by an athlete or other person to any athlete out of competition of any prohibited substance or any prohibited method that is prohibited out of competition
9. Complicity or attempted complicity by an athlete or other person
10. Prohibited association by an athlete or other person
11. Acts by an athlete or other person to discourage or retaliate against reporting to authorities

Read more detail on the anti-doping rule violations here: World Anti-Doping Code 2021 (Article 2, page 19 to 26)

Roles and Responsibilities of Athlete Support Personnel

Athlete support personnel have the following roles and responsibilities:

• To be aware of and comply with all anti-doping policies
• To cooperate with the the athlete testing programme
• To use their influence on athlete values and behaviour to foster anti-doping attitudes
• To disclose to their national anti-doping organisation and international federation any decision by a non-signatory finding that they committed an anti-doping rule violation within the previous ten years
• To cooperate with anti-doping organisations investigating anti-doping rule violations
• Athlete support personnel shall not use or possess any prohibited substance or prohibited method without valid justification

Read more on athlete responsibilities in Article 12 (page 136) of the World Anti-Doping Code 2021

Athlete support personnel play a vital role in creating supportive environments that protect against doping. Recent research highlights three overarching themes to consider by athlete support personnel:

1. "Everyone has the responsibility for anti-doping, but most of the work rests unevenly on a few shoulders."
2. "Education is fundamental to doping prevention."
3. "Preventing doping is all about the way we work with players and each other."

Read the article here: The role of athlete support personnel in preventing doping: a qualitative study of a rugby union academy.

Note: The athlete and the athlete alone is responsible for everything that enters their body!

Methods of Doping

• Blood doping
  • the misuse of techniques or substances to increase one's red blood cell count
• Drugs
  • use of prohibited substances that enhance the body's performance
• Chemical and physical
  • an attempt to tamper with the validity of collected samples; manipulation such as drinking a lot of water or taking probenecid before the tests to dilute the effect of a banned substance
• Gene doping
  • the manipulation or cells or genes to enhance the body's performance (e.g., faster reaction time or increased physical strength)

World Anti-Doping Agency Prohibited Substances

When deciding if a particular substance should be prohibited or not, it must be determined that it meets at least two of the following criteria:

• Use of the substance has the potential to enhance or enhances performance
• Use of the substance represents an actual or potential health risk to the athlete
• Use of the substance violates the spirit of sport

The list is released three months before it comes into effect, so that athletes and others involved can familarise themselves with modifications to the list. Note that substances or methods that mask the use of other prohibited substances and methods are also prohibited.

If an athlete has a legitimate medical reason for using a prohibited substance, they can apply for a Therapeutic Use Exemption. Read more: Therapeutic Use Exemptions (TEUs) and International Standard for Therapeutic Use Exemptions (ISTUE).

Download the latest Prohibited List, available in 12 languages ( in force, published 1 January 2023) here: Prohibited List

Table 3. Categories of WADA Prohibited List

Substances and Methods Prohibited at All Times	S0 - Non-approved substances S1 - Anabolic agents S2 - Peptide hormones, growth factors, related substances, and mimetics S3 - Beta - 2 Agonists S4 - Hormone and metabolic modulators S5 - Diuretics and masking agents M1 - M2 - M3 - Prohibited methods
Substances and Methods Prohibited In-Competition	S6 - Stimulants S7 - Narcotics S8 - Cannabinoids S9 - Glucocorticoids
Substances Prohibited in Particular Sports	P1 - Beta-blockers

Testing for Prohibitive Substances

• Testing is mandatory
• An athlete can be called for dope testing at any time in or out of competition
• Types of testing are listed in Table 4:

Table 4. Summary of Testing Procedures

Blood Testing	Urine Testing
Used to detect artificial oxygen carriers Two samples are taken in the presence of an official Samples are sealed in the presence of the athlete Sample codes are provided by an official A medical declaration is completed by the athlete Samples are sent to the registered lab	Samples are provided in the presence of a coach or doctor Sample is taken in the presence of an official of the same gender Sample is split into two and sealed by the athlete A medical declaration is provided by the athlete

Recommended Reading: At a glance: Anti-doping overview

Stages of Doping Control

• Doping control:
  • Urine or blood sample can be collected anytime and anywhere for doping control
• Athlete selection:
  • The athlete will be notified by a doping control officer (DCO) or chaperone about selection for doping control and asked to sign a document confirming that the athlete understands their rights and responsibilities
• Report to station:
  • The athlete must report to the doping control station as soon as possible
• Choose vessel:
  • The athlete will choose a collection vessel from the selection provided
• Provide sample:
  • A minimum of 90 ml of urine will need to be provided and a chaperone or DCO of the same sex will observe
• Split the sample:
  • The athlete must choose a sample collection kit from the selection provided
  • Split the sample in the A and B bottles
  • Pour urine up to the line in the B bottle first, next fill the A bottle and leave a small portion in the collection vessel
• Seal the sample:
  • Seal the A and B bottles
• Specific gravity:
  • The DCO will measure the specific gravity of the sample to ensure it is not too diluted to analyse
• Sign the form:
  • Athlete completes the doping form
• Sample analysis:
  • Samples will be sent to WADA accredited laboratory in strict confidentiality and will be tracked to ensure security
  • The A sample will be analysed and the B sample stored for further testing if required

Read more: Anti-Doping Process

Athlete Rights and Responsibilities

Table 5. Rights and Responsibilities of Athletes

Rights	Responsibilities
Athletes have the right to: have a representative and interpreter (if available) ask for additional information about the process request a delay in reporting to the doping control station for valid reasons request modifications to sample collection procedure (if you are an athlete with a disability)	Athletes have a responsibility to: remain within direct observation of the DCO/chaperone at all times from the point of notification until completion of sample collection process produce appropriate identification comply with sample collection procedures report immediately for doping control (unless there are compelling reasons for a delay)

Read more: At a glance: The Doping Control Process; Rights and Responsibilities