DRUGS IN SPORT

WHAT YOU NEED TO KNOW IN 2017

AND

WHAT’S REALLY HAPPENING AT THE POINTY END OF ANTI-DOPING

WHAT YOU NEED TO KNOW IN 2017……

WADA 2017 PROHIBITED LIST

-NOT MUCH CHANGE

Additions

S1 – Deta 2 – added as an example of DHEA (found in supplements), S2 – ESAs –sotatercept, S4 – Aromatase inhibitors – arimistane added as an example

Reconfirmed - Higenamine as a prohibited B2agonist found in supplements

Changed salbutamol dosing to 800mcg in 12 hrs (remains confusing!!)

Monitoring List 2017: Codeine, Concurrent use of B2agonists* (Royal Commission in

Scandinavia)

WHAT COULD HAVE HAPPENED!!

April 2016: 2017 Draft List “ All Glucocorticoids prohibited when administered by

injection, oral or rectal routes”

Explanatory notes said “ local injections can be administered no later than 72

hours before the start of an in-competition period (i.e. <72 hrs = TUE)

- Strongly supported by Europeans on List Committee

- Overwhelming objections from stakeholders so it was rejected BUT they (Europeans) are planning on trying again for 2018

ASDMAC’S POSITION (AND MANY OTHERS)

DO NOT prohibit local injections of glucocorticoids within 72 hours of competition, because..

• Rationale is not clear

- ? performance enhancing - no evidence

- ? Poor medical practice - potential harm to health –better managed by rule changes

- ? concern about “masking” oral or IM use in competition - not on testing results

• Logistics of results management/TUEs etc would be a nightmare. – Anti-doping time, money and energy could be far better spent

WADA PROHIBITED LIST- HAVE YOUR SAY

• CLINICAL INPUT IS GENERALLY LACKING (2017 THE WADA LIST COMMITTEE HAS 4

PHYSICIANS, INCLUDING PETER HARCOURT)

• STAKE HOLDER COMMENTS ARE CONSIDERED – NATIONAL SPORTS, ACESP, ASDMAC

• IT IS IMPORTANT TO PROVIDE A CLINICAL PERSPECTIVE – WE ARE ALL RESPONSIBLE

• IF YOU HAVE AN OPPORTUNITY….. RESPOND (? ACSEP/ASDMAC GROUP – PROVIDE

GUIDANCE?...........GCS INJECTIONS, ASTHMA MEDICATION DOSING

ASDMAC- CURRENT ISSUES/QUERIES/REQUESTS

1) IV fluids

• defining “in-hospital” – easy in Australia, hard for the World

• IV clinics – vitamins/hangovers (*social media)

• Fe infusions – does the Fe need to be justified to grant TUE?? (*WADA is looking at this)

2) Rh PDGF

• TUE requests for delayed bone union, off label use???

3) Phone/Urgent approvals

• ASDMAC provides this service – but this reassurance Is being abused by some.

Not giving the complete circumstances, not producing paperwork in a reasonable time –Blacklist/reject

POSITIVE TESTS (IN AUSTRALIA) IN 2016

• Majority –methylhexanamine, oxilofrine, higenamine (B2-agonist)….. likely to

be due to “tainted” supplements

• Anabolic Agents – cycling, lifting/bodybuilding sports

• Ostarine – SARM – motorcycling, weightlifting

• Therapeutic drugs without TUEs

– terbutaline, prednisolone, probenecid, ADHD meds

TUES- WHO NEEDS THEM?

DEPENDS ON LEVEL OF ATHLETE AND SPORT PLAYED

1. International athletes- apply to International Federation TUE Committee

2. National Level athlete – in advance TUE –apply to ASDMAC

3. Below National Level ( see classification for each sport and competition in TUE section of the ASADA website) – only need a TUE if drug tested and

return a positive test = Planned Retroactive TUE*

* still needs to meet the WADA TUE criteria ( not an automatic right)

TUES –WHAT YOU NEED TO DO

- Check athletes’ medications –particularly after hospital admissions-probenicid, oral narcotics

- Check international players- baseball, cricket, soccer - ? TUE, ? Valid duration,

- Send a clinical letter, investigations, 2nd opinions

- Check level of athlete – in advance means IN ADVANCE ( if no TUE when tested, can apply for a retroactive TUE but must meet the criteria of-“emergency” or “exceptional circumstances” – I “forgot” or “didn’t know” is NOT a criteria )

ANTI-DOPING IN 2016

WHAT’S REALLY HAPPENING AT THE

POINTY END??

Fancy Bears / Dancing Bears/ Fuzzy Balls

– a Russian distraction tactic

• Release of TUE information- including medical documents and TUE certificates

• Accessed from ADAMs – WADA’s apparently secure data storage system

WADA’s response

- Multiple cyber experts

- Email password access – Rio Olympic Athletes – all current and past TUEs

- No access to whereabouts

- Reassured stakeholders could continue to use safely ?!

FANCY BEARS

ASADA/ASDMAC response

- Stopped using ADAMS for TUEs and results management in September

- Contacted affected athletes and offered advice/counselling

As of December 2016

- Australian Government Cyber experts satisfied ADAMs now secure –

ASADA/ASDMAC started using ADAMs again

FANCY BEARS- MAY HAVE HELPED

• Not all TUE Committees are competent

• Not all TUE committees are composed according to the WADA Code ie 3 physicians

• Not all TUEs are scrutinised by WADA (lack of resources)

WADA TUE Expert Group have advised

- Audit TUE Committees – compositions and TUE processes

- WADA increase surveillance of submitted TUEs

“ARE WE CATCHING THE

CHEATS”

WE CAN CATCH CHEATS:- 2016 A RECORD!!

• Retesting of stored samples as detection techniques improve – IOC re-analysis of Beijing and London samples (new steroid metabolite detection)

• Haematological Passport

• Whistle-blowers from Russia – McLaren reports indicate systematic,

government sanctioned doping – evidence to proceed on up to 100 athletes and support staff

IOC RE-ANALYSIS PROGRAMME-

BETTER LATE THAN NEVER

• 1st re-analysis Beijing – 2009 and London -2015….6 athletes sanctioned

• In 2016, reanalysis of samples – 95 Adverse Analytical Findings

• Beijing retesting finished (8 year time frame exceeded) but more AAFs from

London likely

No. tests No. reanalysed No. of sanctions

Beijing 4,800 1,053 61

London 5,000 492 40

IOC RE-ANALYSIS – by country

.

Beijing ’09 Beijing ‘16 London ‘15 London ‘16

Armenia 0 2 (25) 0 2 (24)

Belarus 0 9 (175) 0 7 (161)

Russia 0 17 (454) 0 13 (430)

Ukraine 0 4 (241) 1 5 (230)

Kazakhstan 0 7 (130) 0 5 (115)

others 5 17 0 7

TOTAL 5 56 1 39

IOC RE-ANALYSIS –by sport

SPORT BEIJING LONDON TOTAL

Athletics 29 14 43

Boxing 0 1 1

Cycling 2 1 3

Swimming 0 1 1

Weightlifting 25 22 47

Wrestling 5 1 6

TOTAL 61 40 101

HAEMATOLOGICAL PASSPORT (ABP)

ABP - background

First articulated as potential counter to all forms of blood doping in 2001 by AIS scientists (WADA research grant application successful – never proceeded due to Australian government ban)

First entered lexicon by haematologist in 2003 (Dr Mario Cazzola then Editor of Haematologica)

First ‘sold’ by Dr Mike Ashenden – AIS (throughout 2004 - 2008)

First implemented in 2008 by cycling, 2009 by athletics

First challenged/appealed in 2011 by Italian cyclists (Caucchioli and Pellizotti)

ADAMS system implemented by WADA in 2012

What does it look like?

Suspicious

OFF Score

Probability

Males

1:1000 – 128.6

Females

1:1000 – 112.6

Classified as: normal, suspicious, likely doping or possible medical condition

How effective is the ABP?

Initially used for ‘intelligence’ only

Fully fledged sanctioning test now for 7 years

All appeals to the CAS have been dismissed

SINCE 2000

~300 blood doping cases

More than 100 cases of ADRV due to ABP Profiling

Effect on Cycling2003Introduction of Urine test cyclists started taking smaller EPO doses slightly increasing retics only with less chance of detection of re-EPO in urine ; also reflects a return to blood transfusions where Post-Tx retic levels are significantly reduced

2008Introduction of ABPCyclists not only had to watch what they may be excreting in urine but also how their blood parameters were behaving –micro-doping now pervades: what benefits however!

The Sunday Times Leaked Database of IAAF bloods 2015/6

Blood data had been collected since 2001

ABP was officially introduced by IAAF in 2009

Leaked IAAF Database : 12364 results on over 5000 athletes

Reviewed by 2 well respected Australian scientists

Almost 900 athletes had suspicious results

These 900 athletes - won a third of all medals since 2001

Leaked DatabaseNoteworthy observations

Males Females

Highest Hb(M:140-180 F:120-160)

220 201

Greatest variance 55 85

Highest OFF-score 168 170

n= >1:10000males:128.6 females:112.6

78 198

,

But few progressed to ADRVs with sanctions

Possibly due to distractions of bribery and corruption by IAAF President?????

IAAF website says they are working on integrity issues……..

MORE DODGY DEALINGS….

THE RUSSIANSDec ‘14- German documentary

Nov ‘15 and Jan ‘16 – Independent WADA Commission reports

July ‘16 – 1st Independent Person (McLaren) Report

Dec ‘16 – 2nd McLaren report

• Institutional conspiracy- Ministry of Sport, RUSADA, Moscow Lab, CSP (aka KGB)

• London 2012, University Games 2013, IAAF Worlds 2013, Sochi 2014, and…

• Anabolic “cocktails” prescribed by Dr Rodchenkov

• Swapping and tampering with samples – DNA and salt testing, B bottle scratches

• Disappearing positive tests –not logged in ADAMs

• Pre departure urine screening

2ND MCLAREN REPORT FINDINGS

• >1000 Russian athletes (summer, winter and paralympic) benefitted from these manipulations

Examples of evidence gained

• 15 medal winners from London 2012 identified – 10 have had medals stripped

• IAAF 2013 – 4 samples swapped

• Sochi 2014

• 2 female ice hockey samples had male DNA

• Sochi- 12 medal winning athletes had B samples with evidence of tampering (including a physiologically impossible salt reading)

• 6 athletes (21 Paralympic medals) – samples tampered

BUT… WADA cannot sanction. Evidence passed onto IFs, IOC

AND FINALLY…

RIO – FROM A FINA PERSPECTIVE

July 2016 – 1st McLaren Independent Report released.. evidence of widespread, state-sanctioned doping by the Russians

• Widespread calls for IOC to ban entire Russian team for Rio

• IOC “handballs” decision of eligibility for Rio to the IFs. IAAF complete ban, FISA –some crews banned

• Some IFs immediately confirmed all Russian athletes eligible to compete

( these sports were noted to have almost no OOC of athletes)

• FINA’s Doping Control Review Board (DCRB) – asked to assess eligibility of Russian swimmers by FINA Executive (given 24 hours)

• Late night phone hook up 2 days before Opening Ceremony

RIO , THE RUSSIANS AND FINA

• DCRB determined criteria to be “reasonably satisfied” an athlete had not

doped (i.e. no previous suspicious ABP, testing outside Russia in previous 18

months etc)

• DCRB advised FINA Executive that approx. 40% swimmers and all water polo

players did not meet the criteria

• FINA Executive ….. Silence

• DCRB were able to infer the FINA Executive

decision to allow the Russians to compete by watching the TV

RIO , THE RUSSIANS AND FINA

• DCRB requested a response from FINA Executive towards the end of Rio

Games and were told….. “decision not to act was difficult and was made

by the IOC”

(the FINA President later denied/retracted this, saying FINA decided)

• 3 members of DCRB (including Chair) resigned over “lack of transparency”

• Worth noting a lavish World Cup was hosted in Russian just after Rio and the Russian President was awarded the highest FINA honour during 2014, just

prior to World Champs in Kazan

THE BIGGEST CURRENT CHALLENGE IN ANTI-

DOPING

• Not science/detection but GOVERNANCE

• Self regulation is not working in many International Federations and some Anti-doping Organisations and possibly IOC

What are the solutions?

• Independent governance – WADA? Other bodies?

• Involvement of international governments, external scrutiny of governance of IFs and ethical scientists/doctors/administrators

ASDMAC MEMBERS

• SUSAN WHITE

• GRACE BRYANT

• ANIK SHAWDON

• CAROLYN BRODERICK

• CHARLES HOWSE

• GEOFF THOMPSON

• LARISSA TREASE

• REVIEW PANEL- PETER HARCOURT, ANDREW POTTER, MARK YOUNG