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CONTENTS
1. Definitions of doping 5

2. History 5

3. Some important dates in the history of anti-doping 6

4. Socio-psychological background to doping 7

5. Anti-doping Organisations 8

6. Prohibited Substances and Methods: A Brief History 9

7. Drugs prohibited in Sports 10

8. Details of some Drugs 11

9. Potential side effects associated with Performance 15

Enhancing Drugs

10. Mechanism of Drug Action and Drug Targets 16

11. How drugs act at receptors 17

12. Testing and Sample Analysis 18

13. Some Famous Cases 20

14. Estimated number of unreported cases 22

15. References 24

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 Definitions of doping
The use of drugs in sports has had a long and well documented history. The IAAF became
the first International Sporting Federation to prohibit doping, doing so in 1928 by
including the following wording in its Handbook:

“Doping is the use of any stimulant not normally employed to increase the poser of action
in athletic competition above the average. Any person knowingly acting or assisting as
explained above shall be excluded from any place where these rules are in force or, if he is
a competitor, be suspended for a time or otherwise from further participation in amateur
athletics under the jurisdiction of this Federation.”

The International Olympic Committee's (IOC) definition of doping is the "use of an

expedient (substance or method) which is potentially harmful to athletes' health and/or
capable of enhancing their performance, or the presence in the athletes' body of a
prohibited substance or evidence of the use thereof or evidence of the use of a prohibited
method". There is no mention of intent or of how the substance entered the body. If the
substance is in the athlete's body, then he or she is responsible. That is the basis of
sanctions for testing positive for a prohibited substance. Sir Arthur Porritt, first chairman of
the IOC Medical Commission, noted: "To define doping is, if not impossible, at best
extremely difficult, and yet everyone who takes part in competitive sport or who
administers it knows exactly what it means. The definition lies not in words but in integrity
of character". Such agents are also known as "performance enhancing substances" (PES) or
"performance enhancing drugs" (PED). The American Academy of Paediatrics defines these
agents as: "...any substance when taken in non-pharmacological doses specifically for the
purposes of improving sport performance. A substance should be considered performance
enhancing if it benefits sports performance by increasing strength, power, speed or
endurance (ergogenic) or by altering body weight or body composition.

History
Drugs in sport is a topic which has a very long history, going as far back
as early Greek Olympians, who took various concoctions of herbs and mushrooms
believing they would help improve performance.

The issues around drug use in sport are varied, complex and often
interlinked, with the key criteria for substances being banned focusing on the potential to
enhance sports performance, actual or potential health risk to the athlete, and the use of
drugs violating the spirit of sport.

When drug use in sport is discussed or written about it is generally in

reference to elite athletes who use various drugs to improve their performance by building

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muscles and strength. However, non-elite athletes also use drugs to enhance their
appearance, body shape, and strength as well. There have been fatalities from the misuse
of steroids by all level of athletes, from professional to amateur.

The use of drugs by athletes encompasses broader issues, such as the

ethics of drug use in sport, the role of regulatory bodies, and the impact of substances on
health. Use of drugs in sports is not just about steroids and doping, however; therapeutic
medications are also at play, used in treating health problems such as long-term
conditions like diabetes, short-term conditions such as a cold or sore throat, or for the
treatment of sport injuries.

In the 1988 Seoul Olympics, the final six of eight competitors in the
men‟s 100m sprint were implicated either then or later in doping activities that would have
gotten them banned from the Games. Most recently there was the of Dwain Chambers, a
UK athlete who tested positive for the steroid Tetrahydrogestrinone in June 2003, served a
2-year ban, then discovered that the British Olympic Association‟s stance of “zero
tolerance” would not allow him, or other previously banned British athletes, to compete in
the London Olympics. This position was contested by the World AntiDoping Agency
(WADA) at the Court of Arbitration for Sport (CAS), and after the court overturned the
British Olympic Association‟s policy of lifetime bans, Dwain Chambers and other formerly
banned athletes are now eligible to compete in the 2012 London Games.

Some important dates in the history of anti-doping

1928 The IAAF becomes the first federation to ban doping

1966 The IAAF, the Union Cyclists International (UCI), and the Federation International de
Football Association (FIFA) introduce urine drug tests in their respective championships

1967 The International Olympic Committee (IOC) institutes its Medical Commission and
sets up the first list of prohibited substances

1968 Drug tests introduced at the Olympic Games

1970s Marked increase in the number of doping-related disqualifications after the

introduction by the IOC of anabolic steroids to its list of prohibited substances

1980s Introduction of out-of-competition testing

1986 Blood transfusion banned by IOC

1990s rEPO included in the IOC’s list of prohibited substances

1990s Introduction of blood tests

1999 WADA is established

2004 The World Anti-Doping Code is adopted worldwide

2005 United Nations Educational, Scientific and Cultural Organization (UNESCO)

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2008 The UCI is the first federation to introduce the Athlete Biological Passport

Socio-psychological background to doping

Sporting competition in the society has become the spectacle that mobilises and brings
together the greatest number of people throughout the world, with the corresponding
cultural and economic influence that this implies. As a result, the desire for athletic
prowess has led sportspersons to undergo intense training programs and to consume
substances that improve their performance, at times having recourse to doping
techniques. At present, doping is the result of a combination of social, individual,
physiological and cultural factors, which affect not only professional, but also amateur
sportspeople. In order for the control and eradication of doping to be efficient, it is
necessary to understand the problem and the substances that are most employed,
amongst which special mention is merited by hormonal substances due to the complexity
of detecting them and their possible repercussions on health.

Anti-doping Organisations
The World Anti-Doping Agency (WADA) was established in 1999 as an international
independent agency composed and funded equally by the sport movement and
governments of the world. Its key activities include scientific research, education,
development of anti-doping capacities, and monitoring of the World Anti-Doping Code
(“The Code”) – the document harmonizing anti-doping policies in all sports and countries.
WADA is a Swiss private law foundation; its seat is in Lausanne, Switzerland, with
headquarters in Montreal, Canada. WADA works toward a vision of a world in which all
athletes compete in a doping-free sporting environment.

The WADA has defined doping in their World Anti-Doping Code (the “Code”). Under the
Code, a violation of one or more of the following rules is considered doping and may
result in sanction:

 the presence of a prohibited substance or its metabolites or markers in an athlete's

bodily specimen - the use or attempted use of a prohibited substance or a prohibited
method - possession of prohibited substances and methods - administration or attempted
administration of a prohibited substance or prohibited method to any athlete - assisting,
encouraging, aiding, abetting, covering up or any other type of complicity involving an
anti-doping rule violation or any attempted rule violation. - A substance or method is
considered for inclusion on the WADA's prohibited list if the WADA determines that the
substance or method meets any two of the following three criteria:

 Medical or other scientific evidence, pharmacological effect, or experience that the

substance or method has the potential to enhance or enhances sport performance. -
Medical or other scientific evidence, pharmacological effect, or experience that the use of
the substance or method represents an actual or potential health risk to the athlete. -

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determination by the WADA that the use of the substance or method violates the spirit of
sport as described in the “Introduction to the Code” - The current emphasis of prohibition
also appears to be based on four factors:

1. Substances within the athlete's body.

2. Methods that enhance oxygen transfer through blood doping or artificial measures.

3. Altering collected body fluid samples.

4. Genetic manipulation.

The interpretation of the Code is a legal one and largely untested. The broad interpretation
of the principles behind the Code would seem to be related to any substance or method
that (potentially or actually) enhances sport performance, becomes a health threat to the
athlete, or is against the spirit of the sport.

The WADA characterises spirit of sport under the Code as:

1. Ethics, fair play and honesty;

2. Health;

3. Excellence in performance;

4. Character and education;

5. Fun and joy;

6. Teamwork; dedication and commitment;

7. Respect for rules and laws;

8. Respect for self and other participants;

9. Courage;

10. Community and solidarity.

While these objectives are noble and worthy principles for sport, their abstract nature
sometimes creates confusion when applied to the day-to-day realities that athletes face.

UK Anti-Doping has a responsibility for ensuring sports bodies in the UK are compliant
with the World Anti-Doping Code through implementation and management of the UK
National Anti-Doping Policy. Their functions include an education and information
programme, athlete testing across more than 40 sports, intelligence management and
exclusive results management authority for the determination of anti-doping rule
violations. They also run REPORT DOPING IN SPORT, a 24-hour confidential phone line
developed to support the fight against doping in sport. The phone line provides a
confidential service to athletes, support personal and concerned family and friends to
securely pass on information to UK Anti-Doping. Information about supplements is also
available from the website.

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The Global Drug Reference Online (Global DRO) provides athletes and support
personnel with information about the prohibited status of specific substances based on the
current World Anti-Doping Agency (WADA) Prohibited List. Visitors can search the Global
DRO for specific information on products such as licensed medications sold in the United
Kingdom, Canada and the United States. Global DRO is managed via a partnership
between UK Anti-Doping (UKAD), the Canadian Centre for Ethics in Sport (CCES) and the
United States Anti-Doping Agency (USADA).

How Stuff Works (USA) discusses why some athletes use drugs, what the major classes of
drugs and their side effects are, and how drug use is tested.

The Australian Sports Anti-Doping Authority (ASADA) is a government statutory

authority that is Australia's driving force for pure performance in sport. It is the
organisation with prime responsibility for implementation of the World Anti-Doping Code
in Australia. [Link]

National Measurement Institute Australia’s drug testing laboratory, Sports

Antidoping Research laboratory (known worldwide as the Australian Sports Drug
Testing Laboratory or ASDTL), is accredited by the World Anti-Doping Agency to carry
out doping control analysis in human sport; as such, it performs virtually all of the sports
drug testing carried out in Australia and New Zealand.

Drug Free Sport New Zealand (DFSNZ) is an independent Crown Entity originally
established in 1994 with responsible for implementing and applying the World Anti-
Doping Code in New Zealand.

The WINCLEANUK campaign is the result of a partnership between the London

Organising Committee of the Olympic and Paralympic Games (LOCOG), the World Anti-
Doping Agency, and the Department of Culture, Olympics, Media and Sport. The campaign
aims to let athletes and their entourages know in no uncertain terms that doping will not
be tolerated at London 2012. It also sends out a strong message to the next generation of
athletes that doping is wrong: it is cheating, unethical and a serious health risk.

The Canadian Centre for Ethics in Sport serves to elevate the conscience of sport in
Canada and works for, and on behalf of athletes, players, coaches, parents, officials and
administrators. Doping information.

The South African Institute for Drug-Free Sport's core focus is to tackle doping in sport
in order to ensure a culture of ethics and fair play within South Africa. The Drug-Free Sport
Act gives the Institute authority and jurisdiction to carry out drug testing across all sports.

ProCon is a US non-profit organisation providing factual information on a variety of topics,

including a resource that gives a timeline of drug use by athletes from across the world.

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Prohibited Substances and Methods: A Brief History
Following is a brief history and selection of how the Prohibited List has evolved over the
years. The classes of substance are listed by their current WADA Prohibited List titles,
however these too have changed often.

The Prohibited List (the List) originally consisted only of:

• Psychomotor stimulant drugs

• Miscellaneous central nervous system stimulants

• Narcotic Analgesics

• Anabolic Steroids

At first, few individual drugs were specifically named on the List, which
remained divided by substance class. The List has subsequently been under constant
revision and changed considerably, with more individual substances mentioned within
each group and some even deleted. In addition to Classes of Substances, the categories
Prohibited Methods, Substances Prohibited Out-of-Competition, Specified Substances, and
Substances Prohibited in Particular Sports have been added.

1. Anabolic Steroids
a. Anabolic steroids initially included on the prohibited list were: methandi- enone,
stanazolol, esters of nortestosterone, and related compounds.

b. Testosterone and its esters were added in 1979 and in 1986 the list was expanded to
include any substance that increased the testosterone:epi- testosterone (T:E) ratio, which
was initially set at 6:1 by the IOC, but decreased to 4:1 in 2005. Further investigation may
be needed to determine whether the ratio is due to a physiological or pathological
condition.

c. In 1993 Anabolic Agents were divided into two categories:

i. Androgenic Anabolic Steroids; and

ii. Other Anabolic Agents (e.g. beta-2 agonists)

d. Dihydrotestosterone was added to the list in 1995 and deemed to be positive where the
concentration in urine exceeds the range of normal values. A sample is not regarded
positive for dihydrotestosterone or testosterone where an athlete proves that the ratio or
concentration is attributable to pathological or physiological condition. This principle was
also applied in 2002 to any Prohibited Substance that is capable of being produced by
the body naturally. In 2000 it was stated that evidence obtained from metabolic profiles
and/or isotopic ratio measure- ment may be used to draw definite conclusions.

Epitestosterone was listed in 1995 under Prohibited Techniques.

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 Hormones and Related Substances

a. 1990 the hCG, ACTH and hGH were included in the list

b. In 1992 Erythropoietin (EPO) was added

c. In 2000 the following were added as well: Pituitary and Synthetic Gonadotrophins (LH),
Insulin-like Growth Factor (IGF-1) and Insulin (but permitted to treat insulin-dependent
diabetes), all other erythropoiesis- stimulating proteins.

d. In 2005 Mechano-Growth Factors (MGFs) were added to the prohibited list.

Drugs prohibited in Sports:

Drugs such as

I. Erythropoietin (EPO or epoetin alfa)

II. Anabolic steroids
III. Stimulants
IV. Human Growth Hormone
V. Diuretics

Have been shown to impart significant performance enhancing effects. However, these
substances can also be associated with dangerous and possibly life-threatening side
effects. Athletes should avoid these performance-enhancing substances not only because
they may compromise the privilege to compete, but also because they can be harmful or
even fatal with long-term use.

Substances prohibited at all times

 Non-approved Substances
 Anabolic Agents
 Peptide Hormones, Growth Factors and Related Substances
 Beta-2 Agonists
 Hormone and Metabolic Modulators
 Diuretics and Other Masking Agents

Substances prohibited in-competition

 Stimulants
 Narcotics
 Cannabinoids
 Glucocorticosteroids

Substances prohibited in particular sports

 Alcohol
 Beta-Blockers

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Details of some Drugs
1. Beta-2 Agonists
a. Beta-2 Agonists first appeared on the list in 1993 as Other Anabolic Agents with
clenbuterol as an example.

b. Salbutamol and Terbutaline by inhalation were permitted in 1995 as exceptions, when

prescribed for therapeutic purposes by properly qualified medical personnel.

c. Salmeterol was added to the “permissible list” in 1996 and Formoterol in 2000.

d. In 2004 it was emphasised that all beta-2 agonists are prohibited except that formoterol,
salbutamol, salmeterol, and terbutaline are permitted by inhalation only to prevent and/or
treat asthma and exercise-induced asthma/ bronchoconstriction. However, a concentration
of salbutamol greater than 1000 ng/mL is considered an adverse finding, despite the
granting of a Therapeutic Use Exemption (TUE). In 2004 Beta-2 Agonists were classified
as a Specified Substance.

2. Agents with Anti-Oestrogenic Activity

a. Agents with Anti-Oestrogenic Activity appear on the list in 2002 as Clomifene, cyclofenil,
tamoxifen, and aromatase inhibitors (prohibited in males only).

b. In 2004 Selective Oestrogen Receptor Modulators were added.

3. Diuretics and Other Masking Agents

a. Masking Agents were placed on the list as their own category in 2004, including but not
limited to: diuretics, epitestosterone, probenecid, and plasma expanders.

b. In 2005 the name of the group was changed to Diuretics and other Masking Agents, and
alpha-Reductase Inhibitors were added to the list.

c. Diuretics were classified as Specified Substance in 2004, but deleted from that list in
2005.

4. Stimulants
a. Stimulant substances were initially classified in two groups as indicated previously; i. in
1985 they were all grouped together and simply known as Stimulants; ii. in 1990 they were
divided into Amphetamines and Stimulants; iii. and in 2004 they were again merged into
one group as Stimulants.

b. Caffeine was placed on the list in 1983 but removed in 2004.

c. Ephedrine was on the original list and in 2002 a positive finding was stipulated as
concentration of more than 10 mcg/ml in urine. In 2004 it became classified as a Specified
Substance.

d. Cocaine was included in the list in 1990.

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5. Narcotic Analgesics
a. Only a few narcotic analgesics were listed initially.

b. In 1979 Codeine was “permitted for therapeutic uses.”

c. In 2006 analgesics are prohibited only in competition.

6. Cannabinoids Cannabinoids

Cannabinoids Cannabinoids were placed on the list in 2004 and classified as a specified
Substance. They are prohibited in competition only.

7. Glucocorticosteroids

a. Corticosteroids were put on the list in 1992 and prohibited by oral, intramuscular or
intravenous application.

b. Rectal administration was added in 2000.

c. In 2006 Glucocorticosteroids are only prohibited in competition, and are classified as a

Specified Substance.

8. Enhancement of Oxygen Transfer

a. Prohibited techniques were first introduced as such in 1990 and defined as “blood
doping and techniques.”

b. Erythropoietin (EPO) was added in 1992; and blood plasma expanding products (e.g.
HES) and artificial oxygen carriers were included in 2000.

c. In 2002 any sort of blood transfusion was prohibited as well as all erythropoiesis-
stimulating proteins.

d. The term Blood Doping was changed to Enhancement of Oxygen Transfer in 2004 and
defined as the use of autologous, homologous or heterologous or red blood products of
any origin, other than for medical treatment.

e. Use of products that enhance the uptake, transport, or delivery of oxygen is prohibited.

9. Chemical and Physical Manipulation

a. Originally entitled “Techniques,” these were defined as the use of substances that alter
the integrity of the urine samples such as catheterisation, urine substitution and/or
tampering, or inhibition of renal excretion, e.g. by probenecid and related compounds.

b. Epitestosterone was added in 1995, diuretics in 1996, and bromantan in 1998.

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c. In 2004 the term Prohibited Techniques was changed to Pharmacological, Chemical and
Physical Manipulation

d. In 2005 intravenous infusions were prohibited except as legitimate acute medical

treatment.

10. Gene Doping

Gene Doping appears on the list for the first time in 2004.

11. Substances Prohibited in Particular Sports

Substances Prohibited in Particular Sports were added to the List in 2005 and consist of
Alcohol and Beta-blockers. Each International Sporting Federation is able to choose
whether or not they prohibit these substances. Neither of these two substances are
currently prohibited by the IAAF.

12. Specified Substances

Specified Substances were introduced in 2004 as substances that are susceptible to

unintentional anti-doping rule violations because of availability in medicinal products.
Athletes who test positive to these substances may receive a reduced sanction if they can
prove they were not taken to enhance performance. Examples of substances included on
this list are: Ephedrine, L-methylamphetamine, Cannabinoids, Inhaled Beta-2 Agonists
(except clenbuterol), Diuretics (deleted 2005), Probenecid, and Glucocorticosteroids.

Potential side effects associated with Performance

Enhancing Drugs

Substances Potential Side Effects

Anabolic agents • Kidney problems

• Mood swings
• Anxiety
• Aggression, etc.

Stimulants • High blood pressure

• Irregular and faster heartbeat.
• Irritable
• unable to sleep, etc.

Narcotic • Loss of concentration.

analgesics • Loss of balance.

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 • Loss of coordination making sport
dangerous, etc.

Diuretics • Dehydration and possibly dizziness.

• Muscle cramps.
• Headaches, nausea and fatigue.
• Kidney illness can develop, etc.

Beta-blockers  Reduce the heart rate

 Hyperglycaemia, etc.

Other  Dizziness
Prescription  Muscle Cramps
 Rash
Drugs
 Gout, etc.

Mechanism of Drug Action and Drug Targets

Receptors: Neurotransmitter receptors in the plasma membrane of postsynaptic cells
fall into two broad classes: ligand-gated ion channels and G protein – coupled receptors.
Synapses containing either type can be excitatory or inhibitory, but the two types vary
greatly in the speed of their response.

Ligand-Gated Ion Channels: (Fast synaptic signalling) Binding of the

neurotransmitter to the extracellular binding domain on a ligand gated ion channel causes
an immediate conformational change that opens the channel portion of the protein,
allowing ions to cross the membrane and causing the membrane potential to change
within 0.1 – 2 milliseconds. Binding of ligand to excitatory receptors opens cation channels
that allow passage of both Na+ and K+ ions, leading to rapid depolarization of the
postsynaptic membrane; in contrast, binding of ligand to inhibitory receptors opens Cl−
channels, leading to hyperpolarization of the postsynaptic membrane.

G Protein coupled receptors (GPCRs): (Slow synaptic transmission) Many

functions of the nervous system operate with time course of seconds or minutes;
regulation of the heart rate, for instance, requires that action of neurotransmitters extend
over several beating cycles measured in seconds. In general, the neurotransmitter
receptors utilized in slow synapses are coupled to G proteins. GPCR signalling is also
common in non-neuronal cells. Binding of the neurotransmitter leads to a conformational
change in the receptor,that results in activation of a specific G protein. The G-protein may
directly binds to and activate or inhibit ion-channels. In other cases, the receptor activated
G protein activates (or inhibits) adenylate cyclase or phospholipase C, triggering a rise in
cytosolic cAMP or Ca2+, respectively; these second messengers in turn affect the ion

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conductance of a linked ion channel, or trigger kinase cascades that result in
phosphorylation/dephosphorylation of target proteins. The postsynaptic responses
induced by neurotransmitter binding to GPCR are intrinsically slower and longer lasting
than those induced by ligand-gated channels.

the diversity of receptors for and responses to a single kind of neurotransmitter is

illustrated by acetylcholine. Synapses in which acetylcholine is the neurotransmitter are
termed cholinergic synapses. Acetylcholine receptors that cause excitatory responses
lasting only milliseconds are called nicotinic acetylcholine receptors. They are so named
because nicotine, like acetylcholine, causes a rapid depolarization . These receptors are
ligand-gated channels for Na+ and K+ ions. Other acetylcholine receptors are called
muscarinic acetylcholine receptors because muscarine (a mushroom alkaloid) causes the
same response as acetylcholine. There are several subtypes of muscarinic acetylcholine
receptors present in different cell types; all are coupled to G proteins, but they induce
different responses.

How drugs act at receptors

Affinity: a measure of how tightly a drug binds to the receptor. If the drug does not
bind well, then the action of the drug will be shorter and the chance of binding will also be
less. This can be measured numerically by using the dissociation constant KD. The KD is
the concentration of drug when 50% of receptors are occupied. Thus, the higher the KD
the lower the affinity of the drug (the more drug it’ll take to bind to the receptors).

Potency: is a measure of how much a drug is required in order to produce a particular

effect. This is defined in a concentration response curve by the EC50 – the concentration of
drug required to produce 50% of maximal response. If a drug has high potency drug only
a small amount is required to induce a large response. Efficacy is the ability of a drug
produce a response. Agonists are described as having affinity and efficacy, partial agonists
are drugs which bind with affinity, but do not produce maximal response – even at 100%
receptor occupancy, thus they are less efficacious than full agonists. Antagonists are drugs
which have no intrinsic efficacy – they can bind to the receptor (i.e. they have affinity), but
do not induce a conformational change in the receptor. They produce their effects by
preventing agonist from binding.

Enzymes: Many enzymes form useful drug targets eg acetylcholinesterase (neostigmine);

cyclooxygenase (asprin), angiotensin converting enzyme (captopril). Often the drug
mimics the natural substrate acting as a competitive inhibitor of the enzyme (eg captopril);
in other cases the binding is non-competitive and irreversible (eg asprin). Drugs may also
act as false substrates, where the drug molecule undergoes transformation to form an
adnormal product that subverts the normal metabolic pathway.

Carrier/Transporter Molecules: Transportation of polar molecules across lipid

membranes often requires a carrier protein. The carrier proteins embody a recognition site
that makes them specific for a particular permeating species, and these sites can also be
targets for drugs, whose effect is generally to block the transporter. We will consider the

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example of the serotonin transporter, which are the drug target for selective serotonin
reuptake inhibitors (SSRIs), for depression.

Ion Channels: Ion channels are protein molecules that span the cell membrane, and can
switch between open and closes states, allowing the controlled entry or exit of specific ions
across the cell membrane in their open state. Ion channels are highly selective for the ions
that they control. The channels are all gated i.e they have particular triggers that allow for
their opening. You are already familiar with two forms of gating – ligand gated ion
channels, which are an intergral part of a receptor, and second messenger gated ion
channels, which are opened either by G-proteins directly, or downstream effector
molecules such as cAMP. The third major class of gated-ion channel are the voltage gated
ion channels, which open in response to voltage changes across cell membrane. These
channels open when the membrane becomes depolarized, and are critical to the
mechanism of membrane excitability (development of action potentials). Channel opening
is usually short lasting. Drugs may bind directly within the ion channel and prevent the
flow of ions, or may bind elsewhere on the molecule and increase or decrease the
probability of the channel opening in response to a change in voltage. Local anaesthetics
are a class of drugs which block pain pathways by blocking voltage gated sodium channels
and therefore preventing the action potential that carries the pain signal from the site of
injury to the brain.

Testing and Sample Analysis

Testing is done both in-competition and out-of-competition, and any athlete may at any
time be subject to testing. It is a condition of membership of the IAAF that each Member
includes in its constitution the authority for them as well as for IAAF to conduct out-of-
competition testing on its athletes and that the IAAF has the authority to test at all
National Championships if required. In-competition testing is the responsibility of IAAF at
certain International Competitions and selection is based on final position/random basis
and may include target testing and athletes breaking an Area and/or World Records. The
IAAF concentrates its out-of-competition testing efforts on international level athletes who
are required to provide their whereabouts information directly to the IAAF in order for this
testing to occur. There are sanctions in place if athletes do not comply with this
requirement. Analysis of samples shall be done at WADA-accredited laboratories to detect
prohibited substances and methods and samples remain the property of the IAAF. When
analysis indicates the presence of a prohibited substance or substances, the WADA
laboratory informs the IAAF of this fact. Results management in a case of an adverse
analytical finding, is first done by reviewing the case to determine if there is a Therapeutic
Use Exemption (TUE) on file, or a departure from the required collection process has
occurred. If this is not the case, the athlete must be informed of the adverse finding and
can ask for analysis of the B sample at which they are entitled to have a representative
present. If the B sample confirms the A sample the athlete must bear the costs of this
analysis. An Anti-doping rule violation, i.e. doping is defined as: a. the presence of a
banned substance or metabolite in an athlete’s body; b. the use or attempted use of
prohibited substances or methods; c. the refusal or failure to submit to doping control or
undergo an anti-doping test; d. 3 missed out-of-competition tests in a period of 5 years;
e. tampering or attempting to tamper with any part of the doping process; f. possession of

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a prohibited substance or methods, without TUE; g. trafficking in prohibited substance or
method; h. the administration of a prohibited substance or method or assisting in an anti-
doping violation; i. competing, or attempting to compete, whilst suspended or ineligible.
Standards of proof of doping are the burden of the IAAF or other prosecuting authority,
which must establish that an anti-doping rule violation has occurred. The proof is a
positive sample analysis by a WADA-accredited laboratory.

1. In-Competition Testing

The Doping Control Station shall be clean and clearly identified and consist of a waiting
room, working room, and WCs (men and women) equipped with all necessary material.
Only authorised persons are allowed in the Doping Control Station. Selection of athletes to
be tested shall be done on a final position and/or random basis. Sample collection shall
be conducted on any athlete who has broken or equalled an Area and/or World record.
Tests for rh-EPO shall be conducted on any athlete who has broken or equalled Area or
World record in races of 60 m upwards including multi-events and walks. Notification of
the athlete shall be done appropriately by the Doping Control Officer (DCO) and the
athlete’s identity must be confirmed. The DCO shall inform the athlete:

A. which type of sample collection he or she is required to undergo;

B. his or her right to an assistant/representative;
C. that he or she must remain within the sight of the DCO;
D. that he or she must report to the doping station in no later than 60 minutes. The
athlete shall sign an appropriate form to accept the notification. The DCO shall consider
any request by the athlete to delay reporting to the Doping Control Station or to leave
after reporting for testing for the following reasons only if the athlete can be continuously
chaperoned:
A. medals ceremony;
B. media commitments;
C. further competition;
D. warm down;
E. medical treatment;
F. locating an appropriate witness.

The urine sample collection process shall be explained to the athlete after his or her arrival
and the athlete is offered a choice of sample collection vessels when he or she is ready to
provide a sample. The athlete shall check that all seals are intact and if not satisfied select
another. After selection, only the athlete and DCO of the same gender shall proceed to the
WC. The DCO shall witness the sample leaving the athlete’s body and record this fact. The
athlete is required to disrobe as necessary for the witnessing to take place.
Athletes shall provide no less than 75 ml of urine.
For EPO testing no less than 100 ml is required. Where the volume is insufficient the
athlete shall be asked to provide more urine but the originally obtained sample shall be
kept in a sealed container. The athlete shall remain under observation and be able to drink.
When the athlete is ready to provide the remaining amount needed, the sample collection
procedure shall be repeated. Once a sample has been provided, the athlete him or herself

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shall pour the provided urine into the bottles he/she has previously selected. A small
amount is retained to measure specific gravity. The athlete seals the bottles. The DCO tests
the specific gravity; 1.010 or higher is recommended. If the specific gravity is too low the
athlete is required to provide a further sample, but not until after one hour has elapsed.
The collection procedure shall be the same. The athlete shall have fulfilled his or her duty
to submit to doping control only after having delivered the required volume of acceptable
urine, irrespective of the time necessary for this. Blood sample collection may be required
and begins after the procedure has been explained to the athlete and he or she has signed
the consent form. If the athlete refuses this procedure, it shall be regarded as refusal to
submit to doping control. The athlete may nevertheless be required to provide a urine
sample. The athlete chooses a sampling kit from a selection. The Collection official shall
provide proof of his or her qualification to withdraw blood. The sample should be taken
from a superficial vein only from the arm or hand. No more than 25 ml should be
withdrawn and no more than three attempts made. The athlete is only entitled to refuse if
the above criteria are not fulfilled.

2. Out-of-Competition Testing (OOCT)

The testing pool is established by IAAF, which may appoint a third party to conduct the
testing. Registered athletes may be subject to no advance notice OOCT at any time.
Athletes are required to inform IAAF of their whereabouts and notify IAAF of changes. If
the athlete fails to provide the information or is unable to be located 3 times in 5 years, he
or she will be evaluated for anti-doping rule violation. Selection of athletes for testing is
done by IAAF by random and targeted methods. Notification of athletes shall usually be
the no advance notice method for OOCT. Only exceptionally will there be advance notice.
For no advance notice OOCT, the DCO shall make reasonable attempts to locate and notify
the selected athlete and include attempts at alternative times and locations. If the athlete
cannot be contacted it shall be reported to the IAAF. When in exceptional cases advance
notice is given, the DCO shall arrange with the athlete a time and place for the testing. It is
the athlete’s responsibility to check that there is no confusion over the agreed time and
location. Identification of each party and the same sample procedures shall be applied as
in competition. Following the sample collection, any behaviour by the athlete or associated
persons that may compromise the sample collection shall be recorded. The athlete shall
have the opportunity to document any concerns. Detailed information shall be recorded
on the Doping Control Form, such as: time of notification and sampling, athlete’s name,
date of birth, gender, address and discipline, the code number and name of responsible
officials, and signature of the athletes and officials.

Some Famous Cases:

1. Tyson Gay – 2013 In July of last year, US track and field athlete Tyson Gay was found
to have tested positive for banned substances, forcing his withdrawal from the World
Championships in Moscow. Gay had a 100 meter 9.69 second US-record, behind world
record holder Usain Bolt. The track star has amassed countless medals in international
competitions including a gold-medal sweep at the 2007 World Championships in Osaka.

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He has been suspended until June of this year, and stripped of his silver medal from the
2012 Summer Olympics

2. Marion Jones – 2007 Marion Jones was a hero to many young girls, as a world
champion track and field athlete who rose to fame for her talent and power in the 2000s.
She took home five medals in the 2000 Olympics, while her husband at the time, C.J.
Hunter – an Olympic shot-putter – had been called out by the IOC for failing drug tests. A
year after their divorce in 2002, Jones gave birth to a son with sprinter boyfriend Tim
Montgomery. In 2004, Montgomery was charged with his involvement in the BALCO
scandal. At this point, having been closely linked to two performance-enhancing drug
abusers, Marion Jones was further scrutinized. In 2007 she admitted to her use of steroids
and involvement in the BALCO affair, which got her a six-month prison sentence for
perjury because of her initial denial. She was also forced to forfeit all medals – including
those five gold’s – and prizes dating back to her steroid use in 1999 and onwards.

3. Ben Johnson – 1988 The fastest man in history at the 1988 Seoul Olympics turned
out to be taking steroids to help set his record time of 9.79 seconds in the 100-meter
sprint. Johnson, a Canadian athlete, was stripped of his medal. US athlete Carl Lewis, the
second place finisher, received the gold instead – although Lewis, technically, should also
have been disqualified as he and Johnson, as well as several other racers, all failed drug
tests during their Olympic trials. The only medalist who did not fail was Calvin Smith, who
took home the bronze. Their race was later dubbed the “dirtiest race in history” by the
media.

4. Lance Armstrong – 2012 After the Landis scandal six years prior, Armstrong spent
years vehemently denying his use of performance enhancing drugs, while literally
dominating the world of cycling, amassing cash winnings, media attention and a
worldwide following. After seven consecutive wins at the Tour de France, he was outed for
his long-time doping use and in 2012 was stripped of all titles, and banned for life from
competitive cycling. He has since publicly apologized for lying about his use of drugs for
the purpose of winning, and for letting down his fans. It proved a bit too late for apologies
and Armstrong has become one of the most maligned American athletes of all time.

5. Alex Rodriguez – 2009 In 2009, Major League Baseball uncovered a large

Biogenesis scandal that saw 14 players punished for their use of this company’s
testosterone and human-growth hormones, over a number of years. Alex Rodriguez, also
known as A-Rod by fans, was a popular third baseman for the New York Yankees and was
the only player not to accept his punishment with a bowed head. Despite his admission to
having used steroids in the past from 2001-2003, Rodriguez fought against his 211-game
suspension as a result of the Biogenesis scandal, and eventually during arbitration it was
reduced to 162 games. He has been off the field for the entire 2014 season.

6. Floyd Landis – 2006 One of the first cycling sports stars to be publicly outed for
doping, the American team’s Landis won the Tour de France in 2006 despite a huge lag
behind in stage 16. Somehow, by the next round, he was in the lead. This left many
scratching their heads at the sheer implausibility of his comeback. At this point, doping in
cycling was not as widely known or as widely (unfortunately, unofficially) accepted a part of
the sport as it is now. Landis’ urine samples after the event came back with three times the

18
amount of testosterone than normal. The scandal rocked the cycling world, and uncovered
a large number of other cyclists who were using performance enhancing drugs. Landis, in
his downfall, pointed a finger at Lance, who adamantly denied his own involvement – that
is, until 2012.

7. Wu Yanyan – 2000 Prior to the 2000 Olympics, China was dominating in swimming
events, specifically in female competition, and had been doing so for nearly a decade. At
the 1992 Barcelona Olympics China won four gold’s, and two years later the Chinese
women took home a whopping 12 of the 16 World championship medals. However, it
came to light between this time and the 2000 games that coaches and swimmers,
including the reigning queen of the water Wu Yanyan, had been incorporating anabolic
steroids into their winning strategies. 10 coaches and swimmers were suspended. Then,
before the games in Sydney, China withdrew 27 members of its Olympic team, likely due to
the IOC’s announcement to approve blood testing for the first time.

8. Diego Maradona – 1994 Diego Maradona was an Argentine soccer player and
considered one of the best, despite his controversial association with performance altering
substances. He was often failing drug tests for cocaine – considered to be a stimulant –
and eventually received a suspension from soccer for 15 months in 1991, in Italy. This
didn’t seem to curb his bad habits, and three years later he was again banned from the
game – in the 1994 World Cup, in the US – after testing positive for another stimulant
drug, ephedrine.

9. Andreas Krieger – 1986 The strange tale of Heidi Krieger is one for the records.
East Germany had been supplying their Olympic athletes with steroids for more than 20
years. The athletes in question included shot putter Heidi, who started to receive the
injections regularly at age 16. She went on to earn the European championship in 1986,
but was left with all the traits of a man, after enduring long-term hormone abuse. When
she retired in 1990, Heide had a sex change operation and lives now as Andreas. He is 44-
years-old and has told the media that he’s unsure if he would have remained a woman or
not, but that the choice was stolen from him with those little blue pills given to him by his
coach as a young teenager.

10. Thomas Hicks – 1904 one of the first examples of doping in sports came at the turn
of the century with track and field athlete Thomas Hicks, who took home the gold in the
marathon event from the 1904 Olympics. It turns out he was one of a number of runners in
the event who had injected strychnine which, in small doses, acts as a stimulant. He
collapsed after crossing the finish line and could easily have died from the incredibly
dangerous substance. Needless to say, it’s now a banned drug in competition.

Estimated number of unreported cases

Recent studies have suggested that the use of doping substances and
particularly of anabolic androgenic steroids (AAS) is often practised by fitness centre
visitors. These studies employed direct interview techniques and questionnaires to assess
the estimated number of unreported cases of doping. Because people hesitate to provide
compromising information about themselves, these techniques are subject to response

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errors. In one study it was applied an alternative interview technique to assess more
accurately unreported cases of doping in fitness centres. The investigation employed the
randomized response technique (RRT) to reduce response errors. A cohort of 500 people
from 49 fitness centres participated in this study. The RRT revealed a high prevalence of
doping (13 %). In addition, and most importantly, the present RRT study revealed an
alarmingly high prevalence of illicit drug use, specifically of cocaine use, that has been
severely underestimated by previous studies. The RRT confirmed previously estimated
rates of AAS use assessed by direct interview techniques and voluntary questionnaires, but
uncovered a much higher usage rate of illicit drugs among fitness centre visitors. This
outcome enabled us to construct a 'probability' rating for the use of doping substances in
fitness centre visitors. Given its high prevalence and the predominant use of AAS, doping
among fitness centre visitors is an issue of extreme relevance for the health care system.
The study may help to characterize further doping substance users and to develop and
apply prevention and intervention programmes specifically to individuals at high risk.

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