Anti-doping info: WADA Prohibited List 2010

On October 1 WADA released the Prohibited List which will apply across all sports from January 1 2010.

There are significant changes to the List – some of them are technical but two in particular will have significant effects on athletes and doctors.

Drug Free Sport NZ will provide more information and updated resources later in the year but wishes to bring the following matters to your attention.

1/ Cold/Flu/Sinus Medication.

Pseudoephedrine, the active ingredient in many cold and flu remedies such as “Coldrex” and “Sudafed”, will become prohibited in high doses from January 1.

Note that:
a/ This does not apply until January 1, 2010.
b/ It will only apply for in competition tests.
c/ A high reporting level has been set which will allow proper therapeutic doses to be used without fear of an adverse finding. More information will follow later in the year.

2/ Asthma Relievers.

The status of salbutamol (ventolin) and salmeterol (seretide/serevent) will change and they will require only a “declaration” and not a full TUE from January 1, 2010. (DFSNZ has introduced a policy to cover the intervening period – see below.)

Further detail and interim policy.

Four examples of beta 2 agonists have been permitted by way of “Abbreviated TUE’s” in previous years and full TUE’s in the current year. They have been Formoterol (found in “Foradil”, “Oxis” and “Symbicort”), Terbutaline (found in “Bricanyl”), Salbutamol (found in “Ventolin”) and Salmeterol (found in “Seretide” and “Serevent”).
As of January 1 the status of the first two (Formoterol and Terbutaline) is unchanged and either a full TUE or, for “national” level athletes, a “medical file” which can be submitted in the event of a test will remain necessary.
However, from January 1, use of Salbutamol and Salmeterol by inhaler is permitted provided it is declared. Only in the event that a sample records salbutamol above 1000ng/ml (a very high threshold which can not be reached from normal therapeutic administration) will an adverse finding be reported.

Interim Drug Free Sport Policy re Beta 2 Agonists.

The 2009 List will remain in force from now until December 31. This creates a problem for athletes who become “national level” during this period as they will be expected to complete the full range of tests necessary to qualify under the TUE criteria for beta 2 agonists. In an effort to minimise this problem, while fulfilling its obligations to apply the current Prohibited List, Drug Free Sport NZ has adopted the following position.

For the period October 1 2009 to December 31 2009, and with respect only to the “S3. Beta 2 Agonists” as set out in the 2009 Prohibited List International Standard, only those athletes who have been included in either the “Registered Testing Pool” or “National Testing Pool” shall be considered as “National” level athletes.
Points to note:

• The affect of this is to limit the need for full scale TUE applications to use beta 2 agonists to a few hundred named athletes in the testing pools who will already be aware of the requirement and should have already complied.
• All other athletes, in the unlikely event of an adverse finding for a beta 2 agonist, will be required to comply with the current rules for “non-national” level athletes regarding retrospective TUE applications for these substances (i.e. they will need to demonstrate the medical need but will not have to supply detailed lung function or bronchial provocation tests results).
• This has the practical affect of eliminating the need for athletes to undergo expensive testing within the 3 month period while the 2009 list applies but continues to require medical justification of the use of beta 2 agonists.
• The policy is inclusive of terbutaline and formoterol for which there is no alteration of policy in 2010 but the examples of adverse findings for these substances are very rare and the complications associated with subdividing the list at this point are more likely to confuse rather than assist.
• For all other substances the standing criteria for determining who is a “national level” athlete will continue to apply (refer to http://www.drugfreesport.org.nz ).
• This interim policy has no application to “International” level athletes who will need to comply with their IF requirements.

Advice to Doctors and Athletes.

1/ Given the simple process to allow use of salbutamol and salmeterol it is recommended that; where possible and medically appropriate, athletes use these substances rather than terbutaline and formoterol. It is suggested that this 3 month period be used for any trialling that may be necessary for this to occur.

2/ For those athletes for whom it remains necessary to use terbutaline and/or formoterol and who have not previously obtained a Therapeutic Use Exemption it is strongly suggested that an application is submitted, incorporating all the necessary elements set out in annex 1 to the TUE Standard, as soon as possible to enable consideration before January 1. In particular athletes who have been covered to December 31 2009 by an “Abbreviated” TUE will no longer be covered from January 1 and will need a full TUE if they are to continue using terbutaline or formoterol.

For further information contact Drug Free Sport NZ on 0800 Drugfree or info@drugfreesport.org.nz