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prePLAY

Doping prevention through peer learning among youth

prePLAY Handbook for Ambassadors


prePLAY Handbook for Ambassadors Published by: Slovenian Anti-Doping Organisation Financed by: Erasmus+ Programme of the European Union Handbook design by: Neža Tomori Kontrec Printed by: Tiskarna Žnidarič d.o.o. Photo credit: www.123rf.com No. of copies: 200 Date of publication: May 2015 Acknowledgement: This handbook was elaborated through the joint efforts of anti-doping experts from Slovenia, Estonia, Croatia, Latvia, Malta and Germany as part of prePLAY project, (557209-EPP-1-2014-1-Si-SPO-SCP), with the overall aim of promoting doping free sport. The project was co-funded by the European Commission, in the framework of the Erasmus+ Programme. Parts of the content of this Handbook were extracted from WADA and NADOs websites.

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Table of Contents 5 6 7 12 12 13 14 15 16 16 17 19 20 22 22 26 28 30 34 35 37 40 41 43 43 44 44 45 48 49 50 50 51 52

INTRODUCTION WORLDWIDE EFFORT FOR CLEAN SPORT WORLD ANTI-DOPING PROGRAM THE SPIRIT OF SPORT ADO’S ROLE IN CLEAN SPORT ATHLETE’S ROLE IN CLEAN SPORT SUPPORT PERSONNEL’S ROLE IN CLEAN SPORT CLEAN SPORT RULES WHAT IS PROHIBITED? PROHIBITED LIST SUPPLEMENTS RECREATIONAL DRUGS COMMON MEDICATIONS HEALTH CONSEQUENCES OF DOPING ANABOLIC STEROIDS ERYTHROPOIETIN (EPO) HUMAN GROWTH HORMONE (HGH) STIMULANTS CANNABINOIDS MANIPULATION OF BLOOD GENE DOPING THERAPEUTIC USE EXEMPTIONS (TUE) OVERVIEW OF THE THERAPEUTIC USE EXEMPTION PROCESS DOPING CONTROL WHO CAN BE TESTED? WHERE DOES TESTING TAKE PLACE? ATHLETES RIGHTS AND RESPONSIBILITIES DOPING CONTROL 101 ANALYSIS AND RESULTS ATHLETE WHEREABOUTS THE CONSEQUENCES OF ANTI-DOPING RULE VIOLATION WHAT HAPPENS IF AN ATHLETE COMMITS AN ANTI DOPING RULE VIOLATION? SANCTIONS BEING INFORMED

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INTRODUCTION Globalisation has placed sport in new dimensions of universality, where only results at the highest level still achieve adequate sporting and economic value. Professionalism has developed and has become the only way to achieve internationally comparable results. Developed and economically powerful areas and regions naturally have an advantage, but sport is not only based on the laws of the market. The values of sport are also important. The dark side of the commercial development of sport is reflected in the numerous dangers that threaten fair play, the values of sport and the health of athletes. Doping is the most prominent of these dangers. The World Anti-Doping Code is an instrument that aims to harmonise anti-doping efforts around the world through a network of organisations and laboratories and with the support of national authorities. It is not, however, sufficiently successful in educational and awareness-raising programmes, and in particular lacks an adequate prevention programme. Those most at risk are young athletes aged between 12 and 18, since in their desire to emulate their sporting idols they are prepared to use all means to achieve their sporting goals. Young athletes have the right to know more about this danger. They should be informed of the risks and be prepared to confront them every step of their sporting career. What can we do to help them? Above all we can help raise awareness and provide information. PrePLAY (Doping prevention through peer learning among youth) is an international project co-funded by the European Union that is working to develop a prevention model of awareness-raising based on the peer networking of young athletes and the efforts of anti-doping ambassadors. This handbook provides anti-doping ambassadors with the necessary content and guidelines to help them in their work with young athletes. The results will of course depend on the athletes themselves, but we believe that a better level of information and awareness among young athletes will achieve its purpose in the efforts of all of us to ensure that sport is clean and fair. Janko Dvoršak, SLOADO CEO

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WORLDWIDE EFFORT FOR CLEAN SPORT After the events that shook the world of cycling in the summer of 1998, the International Olympic Committee (IOC) decided to convene a World Conference on Doping, bringing together all parties involved in the fight against doping. The First World Conference on Doping in Sport held, in Lausanne, Switzerland, on February 2-4, 1999, produced the Lausanne Declaration on Doping in Sport. This document provided for the creation of an independent international anti-doping agency to be operational for the Games of the XXVII Olympiad in Sydney in 2000. Pursuant to the terms of the Lausanne Declaration, the World Anti-Doping Agency (WADA) was established on November 10, 1999, in Lausanne to promote and coordinate the fight against doping in sport internationally. WADA was set up as a foundation under the initiative of the IOC with the support and participation of intergovernmental organizations, governments, public authorities, and other public and private bodies fighting doping in sport. The Agency consists of equal representatives from the Olympic Movement and public authorities. Its key activities include scientific research, education, development of anti-doping capacities, and monitoring of the World Anti-Doping Code (Code) – the document harmonizing anti-doping policies in all sports and all countries. WADA

works towards a vision of a world where all athletes compete in a doping-free sporting environment. WADA developed the World Anti-Doping Program, which consists of, the: • World Anti-Doping Code (Code) developed to harmonize anti-doping rules and sanctions on a worldwide basis • International Standards: The Code works in conjunction with five International Standards aimed at creating harmonization among anti doping organizations in various technical areas including: Testing, Therapeutic Use Exemptions, Laboratory Practices, Protection of Privacy and Personal Information, and the List of Prohibited Substances and Methods • Models of Best Practice, which provide state-of-the-art solutions in various areas of anti-doping that are encouraged but not mandatory

WADA’s mission is to lead a collaborative worldwide movement for doping-free sport. 6

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Beginning in August 2004, International Federations (IFs), National Olympic Committees (NOCs), the International Paralympic Committee (IPC) and many other sports organizations and governments, formally adopted the Code. This collective agreement to harmonize antidoping efforts has significantly improved the fairness and effectiveness in the effort to achieve true sport within the Olympic movement.

LOGO STORY

The square shape of the logo background represents the customs and the rules that define sport. The colour black evokes neutrality and is the traditional colour of the referee. The “equal sign” expresses equity and fairness. The sign is depicted with a human touch to reflect the individuality of every athlete. The colour green evokes health, nature, and the field of play. The “play true” tag line encapsulates WADA’s core values and is intended as a guiding principle for all athletes at every level of competition.

WORLD ANTI-DOPING PROGRAM The purposes of the World Anti-Doping Code and the World Anti-Doping Program which supports it are: • To protect the Athletes’ fundamental right to participate in doping-free sport and thus promote health, fairness and equality for Athletes worldwide, and • To ensure harmonized, coordinated and effective anti-doping programs at the international and national level with regard to detection, deterrence and prevention of doping The World Anti-Doping Program encompasses all of the elements needed in order to ensure optimal harmonization and best practice in international and national antidoping programs. The main elements are: Level 1: The Code Level 2: International Standards Level 3: Models of Best Practice and Guidelines

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The Code

The Code is the fundamental and universal document upon which the World Anti-Doping Program in sport is based. The purpose of the Code is to advance the anti-doping effort through universal harmonization of core anti-doping elements. It is intended to be specific enough to achieve complete harmonization on issues where uniformity is required, yet general enough in other areas to permit flexibility on how agreed-upon anti-doping principles are implemented. The Code has been drafted giving consideration to the principles of proportionality and human rights.

International Standards

The purpose of the International Standards is harmonization among Anti-Doping Organizations responsible for specific technical and operational parts of anti-doping programs. Adherence to the International Standards is mandatory for compliance with the Code.

List of Prohibited Substances and Methods

Since 2004, and as mandated by World Anti-Doping Code, WADA has published an annual List of Prohibited Substances and Methods (List).The List, which forms one of the five International Standards, identifies the substances and methods prohibited in- and out-of-competition, and in particular sports. The substances and methods on the List are classified by different categories (e.g., steroids, stimulants, gene doping). WADA’s role, through its List Expert Group and Health, Medical and Research Committee, is to facilitate a consultation period before preparing and publishing the List by 1 October in order to allow for its introduction at the start of the following year.

International Standard for Testing and Investigations

The International Standard for Testing and Investigations is a mandatory International Standard developed as part of the World Anti-Doping Program. The first purpose of the International Standard for Testing and Investigations is to plan for intelligent and effective testing, both in-competition and out-of-competition, and to maintain the integrity and identity of the Samples collected from the point the athlete is notified of the test to the point the samples are delivered to the laboratory for analysis. To that end, the International Standard for Testing and Investigations (including its Annexes) establishes mandatory standards for test distribution planning (including collection and use of athlete whereabouts information), notification of

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athletes, preparing for and conducting sample collection, security/post-test administration of samples and documentation, and transport of samples to laboratories for analysis. The second purpose of the International Standard for Testing and Investigations is to establish mandatory standards for the efficient and effective gathering, assessment and use of antidoping intelligence and for the efficient and effective conduct of investigations into possible anti-doping rule violations.

Like the Code, the International Standard for Testing and Investigations has been drafted giving due consideration to the principles of respect for human rights, proportionality, and other applicable legal principles. It shall be interpreted and applied in that light.

International Standard for Therapeutic Use Exemptions The International Standard for Therapeutic Use Exemptions is a mandatory International Standard developed as part of the World Anti-Doping Program. The purpose of the International Standard for Therapeutic Use Exemptions is to establish: • The conditions that must be satisfied in order for a Therapeutic Use Exemption (or TUE) to be granted, permitting the presence of a prohibited substance in an athlete’s sample or the athlete’s use or attempted use, possession and/or administration or attempted administration of a prohibited substance or prohibited method for therapeutic reasons • The responsibilities imposed on Anti-Doping Organizations in making and communicating TUE decisions • The process for an athlete to apply for a TUE • The process for an athlete to get a TUE granted by one Anti-Doping Organization recognized by another Anti-Doping Organization • The process for WADA to review TUE decisions; and • The strict confidentiality provisions that apply to the TUE process

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International Standard for Protection of Privacy and Personal Information

The purpose of the International Standard for the Protection of Privacy and Personal Information is to ensure that Anti-Doping Organizations apply appropriate, sufficient and effective privacy protections to the personal information they process when conducting anti-doping programs, in recognition of the fact that personal Information gathered in the anti-doping context can impinge upon and implicate the privacy rights of persons involved in and associated with organized sport.

The Code, in particular, requires athletes and athlete support personnel to furnish a significant amount of personal information to Anti-Doping Organizations. As a result, it is essential that Anti-Doping Organizations appropriately protect the personal information that they process both to meet legal standards and to ensure the continued confidence and trust of those involved in organized sport.

The Code recognizes and affirms the importance of ensuring that the privacy rights of persons subject to anti-doping programs based on the Code are fully respected. In support of this commitment, this International Standard provides mandatory rules and standards relating to the protection of personal information by Anti-Doping Organizations. Consistent with other International Standards that have been developed and implemented to date, this International Standard sets forth a minimum, common set of rules to which Anti-Doping Organizations must conform when collecting and handling personal information pursuant to the Code. In some cases, Anti-Doping Organizations may be required by applicable laws to apply rules or standards that exceed those set forth in this Standard.

International Standard for Laboratories

The main purpose of the International Standard for Laboratories (ISL) is to ensure laboratory production of valid test results and evidentiary data and to achieve uniform and harmonized results and reporting from all laboratories. The ISL includes requirements for obtaining and maintaining WADA accreditation of laboratories, operating standards for laboratory performance and a description of the accreditation process. The ISL, including all Annexes and Technical Documents, is mandatory for all Signatories to the Code.

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Compliance with an International Standard (as opposed to another alternative standard, practice or procedure) shall be sufficient to conclude that the procedures covered by the International Standard were performed properly. A laboratory’s failure to follow a requirement in effect at the time of sample analysis which has subsequently been eliminated from this International Standard for Laboratories or applicable Technical Document at the time of a hearing shall not be a defence to an anti-doping rule violation. This document sets out the requirements for laboratories that wish to demonstrate that they are technically competent, operate an effective quality management system, and are able to produce forensically valid results. Doping Control analysis involves the detection, identification, and in some cases demonstration of the presence greater than a threshold concentration or ratio of measured analytical values (e.g. concentrations, chromatogram peak height or area) of drugs and other substances in human biological fluids or tissues as identified on the List of Prohibited Substances and Prohibited Methods (the Prohibited List). Laboratories may undertake other forms of analysis, within the limits of the Code of Ethics, which are not under the scope of WADA Accreditation (e.g. Equine testing, Forensic testing). Any such testing shall not be covered by WADA Accreditation.

Models of Best Practice and Guidelines

Models of best practice and guidelines based on the Code and International Standards are developed to provide solutions in different areas of anti-doping. The models and guidelines are recommended by WADA and made available to Signatories and other relevant stakeholders, but are not mandatory.

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THE SPIRIT OF SPORT Anti-doping programs seek to preserve what is intrinsically valuable about sport. This intrinsic value is often referred to as “the spirit of sport”. It is the essence of Olympism, the pursuit of human excellence through the dedicated perfection of each person’s natural talents. It is how we play true. The spirit of sport is the celebration of the human spirit, body and mind, and is reflected in values we find in and through sport, including: • Ethics, fair play and honesty • Health • Excellence in performance • Character and education • Fun and joy • Teamwork • Dedication and commitment • Respect for rules and laws • Respect for self and other Participants • Courage • Community and solidarity Doping is fundamentally contrary to the spirit of sport. To fight doping by promoting the spirit of sport, the Code requires each Anti-Doping Organization to develop and implement education and prevention programs for athletes, including youth, and athlete support personnel.

EVERY ATHLETE HAS A RIGHT TO CLEAN SPORT.

ADO’S ROLE IN CLEAN SPORT Anti-Doping Organisations are at the heart of the anti-doping movement. They protect the right of athletes to clean sport in their own countries and territories, and abroad. They prevent doping, they deter doping and they detect doping. They educate and inform athletes, their coaches and sport doctors, and other support personnel. They collect doping control samples and they conduct results management if a sample returns an atypical or adverse analytical finding. They conduct anti-doping investigations and they prosecute individuals based on antidoping intelligence. They strive for doping-free sport. National Anti-Doping Organisations advise governments and they administer national rules against doping in sport. They liaise with and provide anti-doping services to international sport organisations and to major games.

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To achieve all the above ADOs need to reach athletes and support personnel with meaningful and resonant messages and engage them to protect clean sport: • Athletes need to speak out and report doping • Athletes need to know that ADOs are running legitimate and effective programs • Athletes need to be able to trust their ADOs • Athletes need to be champions of the fight against doping in sport and support the work being done by ADOs Long term athlete and athlete support personnel education is crucial in fostering commitment to doping-free sport environment.

ATHLETE’S ROLE IN CLEAN SPORT Athletes have a responsibility to play their part in creating a culture of clean sport that rewards talent, hard work and dedication, not cheating through drug use. It does not matter whether athletes are just beginning in sport or they are an elite athlete competing on the international stage – clean sport matters! A

culture of clean sport means that sport is fair and competitive. It allows no room for cheats who seek to enhance their performance by taking prohibited substances or using prohibited methods. Clean sport means athletes: • Compete on a level playing field • Are rewarded for their hard-work, talent and skills • Value the spirit of sport • Respect and look after their bodies and their health • Follow the anti-doping rules • Understand the importance of a drug testing regime to catch cheats and protect clean athletes Athletes need to understand and respect the key elements of clean sport. They have certain responsibilities they need to fulfil to help keep their sport clean and drug free. If athletes are competing at any level of sport, they could be drug tested at any time, particularly if they compete at a national or international level. This means they need to take care with everything that they consume: food, drugs, medications, supplements, vitamins, vaccinations, energy drinks – everything. It does not matter whether they intend to cheat through doping use or not: if they return a positive test or break other antidoping rules they could face a ban from all sport. prePLAY Handbook for Ambassadors

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Everyone needs to work together to create a culture of clean sport that has no place for those who cheat by taking prohibited substances or using prohibited methods to improve their performance. In order to do this, athletes need to practise the values and behaviours of clean sport. This involves: • Making the right choices for their body, their health and their sport • Taking responsibility for everything that goes into their body • Learning about the anti-doping rules • Using their support team to help them follow the rules

It is athlete’s responsibility A key principle to clean sporting success is to remember that athletes are ultimately responsible for everything that goes into their body. It does not matter whether they intend to cheat or not, if they test positive for a prohibited substance then they could be subject to a ban from all sport.

SUPPORT PERSONNEL’S ROLE IN CLEAN SPORT Everyone who is supporting an athlete, as a parent, a coach, trainer, agent, manager, or a medical professional, needs to be aware of his or hers responsibilities to help them compete clean. They are likely to be a role model for the athlete they support, so their views on anti-doping and clean sport will count for a lot. Here are some tips on supporting an athlete to compete clean and drug-free: • Promote the value of clean, drug-free sport • Understand the anti-doping rules • Make sure the athlete competes in a clean coaching environment • Help the athlete to understand the principle of strict liability: they are responsible for any prohibited substance found in their body • Make the athlete aware of the risk of supplements and herbal remedies • Support the athlete during periods of high-risk (movement to the next level of sport, preparing for an elite event, stress or injury) • Provide support for the athlete during a drug test • Check the medications, supplements, vitamins etc. that athlete takes • Report any doping activity or suspicions in confidence to NADO

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CLEAN SPORT RULES Anti-Doping Rules in all Code signatories’ countries should reflect those of the World Anti-Doping Agency’s (WADA) World Anti-Doping Code and Prohibited List. WADA’s Code and List are recognized throughout the world. There are ten key anti-doping rules. We have summarized them below. WADA’s anti-doping rules state that an athlete should not: 1) 1 Test positive for a prohibited substance 2 Use or attempt to use a prohibited substance 2) or method 3 Refuse to provide a sample for testing 3) 4 Fail to file accurate whereabouts information or 4) miss a test (if athlete is in a Registered Testing Pool) 5 Tamper with any part of the doping control process 5) 6 Possess prohibited substances or methods 6) 7 Traffic or attempt to traffic a prohibited substance or 7) method 8 Administer a prohibited substance or method 8) 9) 9 Cover up an anti-doping rule violation 10 Associate with someone, such as a coach or medical 10) professional, who has been found guilty of an anti doping rule violation. If athlete is found to have committed any of the above, he or she could be banned from all sport for a period of years. It could end his or hers career and ruin reputation.

Know the anti-doping rules If athlete breaks the rules, whether he or she intend to cheat or not, he or she could face a ban from all sport.

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WHAT IS PROHIBITED? PROHIBITED LIST The Prohibited List is put out by the World Anti-Doping Agency (WADA) every year and details all substances and methods that are prohibited in sport. A substance or method may be included on the list if it meets any two of the following criteria: • It has the potential to enhance sporting performance • It presents an actual or potential health risk to the athlete • It violates the spirit of sport Athletes can view the full Prohibited List on WADA website, www.wada-ama.org or on the website of their NADO, but the tables on the following pages will give you a summary of the kinds of substances and methods that are prohibited in sport. Prohibited at all times (in and out-ofcompetition)

Prohibited in competition

Prohibited in particular sports

Substance

• Non-Approved Substances • Anabolic Androgenic Steroids • Peptide Hormones, Growth Factors and related substances • Beta-2-Agonists • Hormone and Metabolic Modulators • Diuretics and other Masking Agents

• Stimulants • Narcotics • Cannabinoids (including synthetic) • Glucocorticoids

• Alcohol • Beta-Blockers

Method

• Manipulation of blood and blood components • Chemical or physical manipulation of a sample • Gene doping

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It is up to an athlete It is athletes’ responsibility to check the status of any substance or method before using it. To see a full version of the Prohibited List athletes should visit www.wadaama.org. To check medication athletes can use different tools provided by ADO like Global DRO or contact ADO by e-mail or telephone.

SUPPLEMENTS There are many dietary supplements available and athletes may be tempted to use them. They will need to assess their need for supplements carefully because taking them can be risky.

Here is why:

• Supplements could contain substances that are prohibited in sport • Supplements may not have adequate quality control or accurately label ingredients so athletes cannot be sure of exactly what is in them. Athletes should be extremely wary of products, which market themselves as aiding in weight loss, building muscle or providing energy because these are more likely to contain substances, which are included on the Prohibited List. Guideline on dietary supplements: • Athletes are advised to exercise extreme caution regarding the use of any dietary supplement as no guarantee can be provided that any particular supplement, including vitamins and minerals, ergogenic aids and herbal remedies are totally free from prohibited substances • The biggest risk associated with the use of dietary supplements is cross contamination or lacing with substances that are prohibited. A product could also contain ingredients that are also not listed on the label which are prohibited or are listed under an alternate name, which may not be listed on the Prohibited List • Athletes should also be aware that products marketed under the same brand in different countries might contain different ingredients, which may not always appear on the product label • Strict Liability – an athlete is solely responsible for any prohibited substances found to be present in his or her body. It is not necessary that intent or fault on the athlete’s part be shown in order for an anti-doping rule violation prePLAY Handbook for Ambassadors

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• • • • •

to be established. Nor is lack of intent a defence to testing positive to a prohibited substance because of a contaminated supplement The use of any nutritional or dietary supplement by an athlete is at his or hers own risk The principle of personal responsibility cannot be abdicated because of the actions of coaches or medical advisers or any other person associated with the athlete. The fact that supplements may be provided by for example athlete’s club, will not absolve the athlete of his or her responsibility for the consequences if the use of such supplements results in an anti-doping rule violation. This will be the case even if there was no reason to suspect that the supplement contained a prohibited substance The only way to completely eliminate the risk of dietary supplements is to not take them Athletes are more likely to benefit from a healthy, well balanced diet which should be put in place by an appropriately qualified nutritionist Dietary or nutritional supplements, ergogenic aids and herbal products should only be considered for use where the nutritional review and supplementation process is controlled and individually monitored by appropriately qualified medical practitioners or nutritionists and where the appropriate batches of the products have undergone the applicable tests to ensure that the products do not contain any prohibited substances

Athletes who insist on using dietary supplements should consider the following risk assessment prior to using any dietary supplement:

• Seek expert guidance to assess their dietary and performance needs from an appropriately qualified person • Is there any valid evidence that the supplement they feel they need to take really works? Many of the claimed benefits are not clearly supported by scientific research • Be wary of products that claim to increase strength, muscle mass, energy or weight loss • Research well known products/brands • Read the label and list of ingredients very carefully and undertake a search on each ingredient to ensure that it is not linked to a substance on the Prohibited List • Avoid purchasing supplements over the internet • Avoid taking or sharing supplements with fellow athletes, friends or athletes from other sports • Avoid purchasing supplements from a manufacturer who also produces supplements that contain or are known to contain Prohibited Substances • Seriously consider having a supplement tested by a laboratory to ensure the batch does not contain any prohibited substances prior to using it Note: The above points do not abdicate an athlete’s responsibility as the

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consumption of any supplement remains at the athlete’s own risk regardless of the precautionary measures the athlete adopts

Athletes should use supplements at their own risk ADOs cannot guarantee the safety of any supplement, but athletes can lower the risk by buying the supplements at pharmacies or from well-known companies.

RECREATIONAL DRUGS Athletes need to respect their body and treat it well. This means steering clear of things that could be harmful to their health, including recreational drugs. Many recreational drugs are prohibited in sport so they need to know that if they are drug tested and something like cannabis is found in their system, they could face a ban from all sport.

Here is what athletes need to know about recreational drugs: • • • • •

Recreational drugs are potentially harmful to their health and their use violates the spirit of sport Cannabis and all its synthetic forms is prohibited in-competition Other recreational drugs, including cocaine, BZP and amphetamines are prohibited in-competition Cannabis and other drugs can be stored in the body for an extended period Passive inhalation of cannabis or other drugs is unlikely to result in a positive test, but athletes should try to avoid this if they can

Athletes should not risk it Testing positive for a recreational drug can result in a ban from all sport.

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COMMON MEDICATIONS Athletes train hard, but sometimes they will get injured or sick. On the other hand, they may need to take regular medication for an ongoing condition, such as asthma or diabetes. Many common medications can contain ingredients that are prohibited in sport so they need to be very careful about everything you take.

Athletes should tell their doctor Tell their medical professional that as athletes they could be tested for prohibited substances and methods. They should insist that doctors check that the medication they are prescribing is allowed in sport.

Advice for travelling athletes

If athletes are travelling overseas and require medication for an ongoing condition, we recommend that they plan ahead and take enough medication to last for the period they are away. Some medications that athletes can buy in other countries have the same brand name as those in their own country, but contain different ingredients and possibly prohibited ingredients. Athletes should be extremely careful when purchasing any medication in foreign countries and always inform a doctor or pharmacist that they are an athlete who could be tested for prohibited substances and methods.

Athletes should not assume medications or supplements purchased in foreign countries are the same as in their country. They could contain, or be contaminated with, prohibited substances.

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HEALTH CONSEQUENCES OF DOPING The use of prohibited substances may lead to serious health risks and even death. Here are highlighted some of the side effects of prohibited substances and methods to help athletes to make better choices to protect their health and to say ‘no’ to doping. Any prohibited substance or method included in the prohibited list has its own potential risks and/or adverse side effects. Some of the prohibited substances are intended for therapeutic purposes and should only be prescribed by registered physicians. Those substances that are offered to athletes are often manufactured and sold illegally and are likely to contain impurities. When these substances are used, they can cause severe health problems.

ANABOLIC STEROIDS The group of anabolic agents (anabolic = tissue-building) is subdivided into:

1) Exogenous and endogenous anabolic androgenic steroids (AAS)

These include steroid hormones such as the male sex hormone testosterone and substances with similar effects as testosterone (androgenic = masculinising). These substances are either manufactured synthetically and introduced into the body from outside (exogenous) or produced naturally by the body itself (endogenous).

2) Other anabolic agents, such as the beta-

2 agonists clenbuterol and zilpaterol, which have an anabolic effect on the musculature, or the selective androgen receptor modulators (SARMs), whose effects are similar to those of the anabolic androgenic steroids.

In 1988, Ben Johnson (Canada) tested positive for the synthetic anabolic androgenic steroid stanozolol.

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Anabolic steroids are used in sport to promote muscle growth, to improve strength and power and to accelerate recovery (regeneration, new growth of tissue). They are also widely used in mass sports. Since anabolic steroids are not administered on a permanent basis but only during certain training periods, out-ofcompetition controls are extremely important for the detection of abuse.

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Anabolic steroids cause a performance explosion in sport

When anabolic steroids began to be used in sport in the 1950s, they caused a veritable performance explosion, particularly in strength sports. For example, the world record in the men’s shot put increased by 2.24m to 20.06m in the period from 1950 to 1960 alone. In the subsequent 30 years, the world record rose by another three metres, but such distances are unattainable for currently active athletes. To curb the use of anabolic steroids in sport, they were put on the Prohibited List as of 1974. Anabolic steroids occur naturally in the body (e.g. testosterone) or are manufactured synthetically (e.g. stanozolol). Reliable analytical methods are available to detect classical anabolic steroids. However, the uncontrollable development of constantly new synthetic steroids and sophisticated administration protocols make their detection more difficult.

Effects of anabolic agents

The administration of anabolic steroids increases protein synthesis (the production of protein in the body) and thus induces a positive nitrogen balance of the organism (anabolic effect). Anabolic steroids shorten recovery time and reduce body fat percentage. At the same time, however, they also affect the male sexual characteristics. This is referred to as ÂŤandrogenic effectÂť. Despite intensive efforts in the development of synthetic anabolic steroids to disconnect the undesired androgenic effect from the anabolic effect, satisfactory results have not yet been obtained.

Affected sports

Because anabolic steroids stimulate muscle growth, they are abused mostly in sports where strength, power or muscle mass are decisive for victory. Since they also shorten recovery time, there is a danger that athletes in endurance disciplines may use anabolic steroids to help cope with their large training loads. In contrast to strength athletes, they use anabolic steroids only in low doses because excessive muscle mass would negatively affect their performance.

Recreational athletes most frequently involved

The abuse of anabolic steroids today occurs most frequently in the fitness and body-building scene. In this little regulated domain of sport, very few doping controls are carried out worldwide. Most countries even lack a legal basis to prosecute violations. According to projections and results from scientific studies, it is assumed that five percent of adolescents in the USA consume anabolic steroids. In European industrial countries, the rate is probably similar.

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General physical side effects of anabolic abuse

In addition to enhancing performance, anabolic steroids have a number of adverse effects, some of which are dangerous. They can provoke physical alterations that cannot be reversed. The general adverse effects of anabolic steroids include damage to the cardiovascular system and the liver, alterations in lipid metabolism and the retention of water in body tissues.

Anabolic steroids harden the arteries

A dangerous effect of anabolic steroids abuse is hardening of the arteries (arteriosclerosis). The deterioration of blood fat levels disturbs the free flow of blood through the vessels. This increases the danger of arterial occlusion and can result in a stroke or a heart attack.

Anabolic steroids harm the liver

Abuse of anabolic steroids for prolonged periods can lead to liver disease, including liver cancer.

Anabolic steroids cause weight gain Anabolic steroids damage the cardiovascular system and may cause fatal heart attacks.

The administration of anabolic steroids reduces the excretion of sodium, which leads to increased water retention in the tissues and an increase in body weight.

Multiplicator effect

To combat the numerous adverse effects, abusers often use additional doping substances such as hormones, hormone antagonists and diuretics which in turn have their own adverse health effects.

Psychological side effects of anabolic abuse

Anabolic abuse has many and varied psychological effects. Mood changes can occur that may be either positive, such as increased motivation and euphoria, or negative, such as irritability, emotional instability and a tendency to violence. All these psychological side effects may also cause problems in the private relationships of the person consuming anabolic steroids.

Depression

Anabolic abuse can lead to depression. Depression is a mental disorder characterised by a severely depressed mood and a lack of energy.

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Aggressiveness

Irritability and over-aggressiveness can occur and lead to increasingly confrontational and reckless behaviour. Research has shown a significantly positive correlation between the sex hormone testosterone and aggressiveness.

Sex drive

Anabolic androgenic steroids also affect sexual arousal. Sexual desire may strongly increase, but anabolic abuse can also lead to sexual disinterest and male erectile dysfunction.

Addictive potential

Anabolic steroids have a potential for addiction, as demonstrated e.g. by depressive mood changes after discontinuation / consumption of the products.

Specific side effects in men

Because anabolic steroids disturb the balance of the body’s self-produced sex hormones, the do not only have general but also sex-specific adverse effects.

Possible psychological side effects include depression, irritability, loss of sex drive and psychological dependence.

Anabolic steroids destroy masculinity

In men, the use of anabolic steroids carries the risk that the testicles may shrink and the production of sperm may diminish. In addition, sexual sensation and erectile function may deteriorate to the point of infertility.

Anabolic steroids alter physical appearance

Anabolic steroids abuse often leads to acne. Moreover, feminisation of the body can occur because excess testosterone is partly converted into the female sex hormone oestrogen. This can lead to breast enlargement (gynaecomastia) in men. Adolescents additionally run the risk of premature growth arrest.

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Unnatural growth of male breast glands (gynaecomastia) caused by abuse of anabolic steroids.

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Specific side effects in women Anabolic steroids destroy femininity

In women, the use of anabolic steroids can lead to masculinisation. The symptoms of masculinisation, also called virilisation, include a masculine physique, masculine facial features, acne, growth of facial hair, a deeper voice due to enlargement of the voice box, disturbances in the menstrual cycle and enlargement of the clitoris (irreversible). The breasts may shrink because the distribution of fatty tissue is suddenly altered, and the risk of breast cancer increases. Cysts and pathological growth of uterine tissue are additional adverse effects. In women, anabolic steroids abuse leads to masculinisation.

ERYTHROPOIETIN (EPO) Erythropoietin (EPO) is a natural hormone produced by the kidney that stimulates the production of red blood cells (erythrocytes) in the bone marrow. The ultimate effect is an increase in exercise endurance and a reduction of recovery time. Its improper use for doping purposes is prohibited.

Effective drug in treating kidney failure

Synthetic EPO was developed in the 1980s. It is mostly used to treat anaemia. People with chronic kidney disease nearly always suffer from anaemia because their kidneys completely or partially fail to produce EPO.

Difficult detection of EPO in urine

Until the year 2000, it was impossible to detect injected synthetic EPO. Only after 2000, doping analysis succeeded in distinguishing synthetic from natural EPO. Confessions as well as the retesting of urine samples revealed that in the years before the detection method was introduced, doping with EPO was almost universal among the world elite in several endurance disciplines.

Effect of EPO

EPO is a glycoprotein hormone produced in the kidneys. A reduced supply of oxygen to the body (e.g. when at high altitudes) triggers the production of EPO. EPO

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is distributed to the body through the blood vessels and stimulates stem cells residing in the red bone marrow to transform into red blood cells (erythrocytes). The maturation of stem cells in the bone marrow via young red blood cells (reticulocytes) into functional erythrocytes takes five to nine days. Red blood cells transport oxygen from the lung to the tissues (e.g. to the muscles). They also play an important role in the removal of carbon dioxide from the muscles. An increased amount of red blood cells thus leads to higher exercise endurance and faster recovery. This effect can be achieved naturally by altitude training and artificially by the illicit administration of the EPO drug or by blood doping.

Affected sports

Because EPO increases the number of red blood cells in the blood, more oxygen can be transported to the muscles and, in return, more carbon dioxide can be removed from them. As a result, the muscle fatigues less quickly and exercise endurance increases. EPO is therefore used mainly in endurance disciplines. In the perception of the public, improper EPO use in professional cycling has gained the greatest attention. Other endurance disciplines such as cross-country skiing, biathlon, marathon, ice speed skating and triathlon have also made headlines.

In January 2013, Lance Armstrong admitted to systematic doping for years with EPO, blood transfusions, growth hormones, testosterone and cortisone.

Doping with EPO in many different sports

In athletics, EPO is used not only by long- and middle-distance runners. EPO is used with the intent to shorten regeneration time after exhaustive periods of training or competitions. This means that nearly all athletes in all sports are vulnerable to the abuse of EPO. Cases have been documented from boxing, weightlifting and even from equestrian sports.

Adverse effects and consequences of EPO abuse

The increased formation of red blood cells stimulated by EPO raises the proportion of formed elements in prePLAY Handbook for Ambassadors

Not only endurance athletes dope with EPO. British 100m sprinter Dwain Chambers has admitted to having injected EPO for years in addition to the anabolic steroid THG.

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the blood (haematocrit). The blood becomes more viscous (less fluid) and blood pressure rises. Especially when the body is dehydrated after strenuous exercise, this thickening of the blood promotes thrombosis that may cause myocardial infarction, a stroke, or in the worst case, death. The risk of developing cancer also rises when EPO is abused.

The administration of EPO in the absence of any medical necessity, especially over long periods and at high doses, is hazardous.

HUMAN GROWTH HORMONE (HGH) Human growth hormone (hGH) is a peptide hormone produced by the body. hGH stimulates cell division and cell growth and therefore has an anabolic (musclebuilding) effect. Its improper abuse for doping purposes is prohibited. Since 1963, hGH has been used in the medical treatment of short stature caused by a deficiency of this hormone. Growth hormones were extracted from the pituitary glands (hypophyses) of corpses until the practice was globally banned in 1985. Since 1985, hGH can also be manufactured synthetically. In 1989, the IOC put growth hormones on the Prohibited List.

Method of detection

The rugby player Terry Newton went down in history as the first case of hGH doping.

Due to short half-lives, doping with growth hormones is detectable only within a short time window (approx. 72 hours) after administration. Moreover, the detection method for hGH in blood developed in 1999 by Christian Strasburger (Isoform Differential Immunoassays) is complex and expensive. In 2004, prior to the Athens Olympic Games, the IOC announced its intention to test for synthetic hGH. However, it was only in November 2009 that hGH was detected in the blood of an athlete.

In 2012, the World Anti-Doping Agency (WADA) presented a more effective (biomarker) test at the London Olympic Games. The test relies on the detection of two biomarkers (IGF-1 and P-III-NP) whose values show an unnatural increase after exogenous administration of hGH. The great advantage of this method is the much longer time window for detection (up to 14 days) after doping with hGH. On the basis of this

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biomarker method, the two Russian weightlifters, Nikolai Marfin and Vadim Rakitin, tested positive at the 2012 Paralympics in London and were consequently banned for two years.

Effects of hGH

Growth hormones have a direct and an indirect effect: On the one hand, hGH has a direct effect on blood sugar level and promotes the destruction of fat cells. On the other hand, hGH acts indirectly by binding to somatotropin receptors, which stimulates the production of the protein insulin-like growth factor 1 (IGF-1), particularly in the liver. IGF-1 released into the bloodstream binds to IGF-1 receptors, which are present in nearly all tissues, and controls the expression (production) of numerous other proteins. By these mechanisms, hGH stimulates cell division and cell growth and deploys its tissue-building (anabolic) and regeneration-promoting effect. In adolescents, it promotes the longitudinal growth of the long bones.

Affected sports

Recent studies indicate that growth hormones have a performance-enhancing effect on the power of sprinters. Growth hormones also have a high potential of abuse in all strength and endurance disciplines. To date, about a dozen proven cases of hGH doping have emerged worldwide (e.g. Terry Newton, Patrik Sinkewitz, Inna Eftimova, Anders Veerpalu), and there are clear indications (from confessions, reports and raids) that growth hormones are widely used in sport. Abuse of hGH is known in cycling, athletics, crosscountry skiing and in Paralympic weightlifting and is suspected in swimming and various team sports. Particularly extensive abuse occurs among professional body builders, who serve as role models for many fitness athletes. For this reason, and because hGH is readily available through internet retailers, it has found its way into the mass sports sector.

Adverse effects and consequences of hGH abuse

Body builders were already using hGH in the 1980s and it has found its way into the mass sports sector through internet retailers.

Exogenous administration of hGH inhibits the body’s own growth hormone production via the hypothalamic-pituitary axis. This effect is called negative feedback.

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hGH may stimulate growth in internal organs (e.g. heart, liver) and cause severe damage to them. Enlargement of the heart and excessive blood pressure may trigger a heart attack. Additionally, hGH causes disproportional growth of the hands and feet, but also of the chin, nose and ears (acromegaly). These alterations are irreversible. Another possible consequence of hGH abuse is cancer of the colon. Moreover, the alteration of glucose metabolism by hGH entails the risk of triggering diabetes.

hGH can cause acromegaly. The substantial enlargement of the heart clearly raises the risk of myocardial infarction.

STIMULANTS Stimulants cause increased physical and mental activity. They suppress the sensation of fatigue, increase performance and uplift the mood. The risk of dependence is high. The group of stimulants also includes illegal drugs such as cocaine and ecstasy. Stimulants are prohibited in competition. For centuries, humans have used herbal stimulants, such as caffeine in coffee or cocaine in coca leaves, to enhance performance. Chemical manufacturing processes have facilitated the use of stimulants and strongly increased their efficacy. In World War Two, amphetamines were distributed to fighter pilots. Since then, they have also been used by athletes aiming at mobilising the body’s last resources.

Tragic death paves way to seriously combat doping

After the war, amphetamines were especially popular in cycling. At the 1967 Tour de France, the English professional Tom Simpson died after he had ingested amphetamines. An additional supply of this substance was found in his jersey pocket. This widely publicised doping case prompted the introduction of systematic anti-doping measures.

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The problem with methylhexanamine

Although stimulants can be easily detected in urine, they are still being used today as doping agents in competition. In 2012, stimulants were detected in nearly 700 urine samples of athletes worldwide. About one-half of these cases (45.9%) involved the prohibited substance methylhexanamine, an additive of some nutritional supplements.

Effect of stimulants

The chemical structure of typical stimulants such as amphetamine or ephedrine is similar to that of adrenaline and noradrenaline, the body’s own stress hormones produced in the adrenal medulla. As a result, their effect on the organism is also similar. By increasing, accelerating or improving nerve activity, they stimulate and imitate the sympathetic nervous system which controls blood vessels and glands.

On 14 July 2013, it was announced that the Jamaican sprinter Asafa Powell (left) had tested positive for the prohibited stimulant oxilofrine

This leads to an improvement in concentration and alertness, an increase in self-confidence and the suppression of fatigue. In addition, stimulants help the body achieve greater performance by widening the airways (improved oxygen uptake) and increasing cardiac output and heart rate (improved oxygen transport).

Affected sports

Stimulants are used particularly in competition because they improve concentration, suppress fatigue and make it possible to mobilise the autonomously protected energy reserves. These are the energy resources the body keeps specifically protected for emergency reactions, mainly to safeguard vital functions such as respiration, brain activity and blood circulation. The most widespread abuse of stimulants occurs in endurance and power sports. But they are also frequently used in combat sports such as boxing. In principle, they can enhance performance in all sports: • After winning the 100 m world championship in 2003, the American women’s sprinter Kelli White tested positive for the stimulant modafinil and was banned • In 2009, no less than five Jamaican sprinters tested positive for the stimulant methylxanthine at the national championships • In 2010, the Romanian international footballer Adrian Mutu was banned for nine months for abuse of the stimulant sibutramine • In 2013, the former 100 m world record holder Asafa Powell (JAM) tested positive for the prohibited stimulant oxilofrine

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Although stimulants are easily detectable, they continue to be abused for performance-enhancing purposes. In addition to anabolic steroids, they are the second most frequent substance class detected by anti-doping laboratories worldwide.

Cocaine

Positive doping tests for cocaine have emerged repeatedly in recent years. In 2012, cocaine was the second most frequent stimulant, following methylhexanamine, detected in doping controls. In sports such as football, ski jumping or tennis, well-known athletes have admitted to the consumption of cocaine. Examples include the former Austrian ski jumper Andreas Goldberger (one of the most successful ski jumpers of the 1990s) and the Romanian footballer Adrian Mutu, who had to pay Chelsea FC around 17 million euros in damages as a result of his cocaine abuse. Other athletes have tried, with greater or lesser success, to protest their innocence after positive tests for cocaine.

Adverse effects and consequences of stimulant abuse Nervous system and brain

Stimulants act on the nervous system. The do not supply energy to the body but only activate the mobilisation of energy. Body temperature rises sharply and sensations of hunger and thirst are suppressed, leading to a major loss of fluid. At high doses, the arousing effect of stimulants can quickly turn into restlessness, hyperexcitability and aggressiveness. Other possible consequences include persistent sleep disturbances as well as acute hallucinations, anxiety states, delusions and depression. The addiction potential is very high!

Stimulants act on the brain and nervous system. Due to their strongly euphoriant and performance-increasing potential, especially amphetamines can quickly induce psychological dependence.

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Because stimulants suppress the sensation of exhaustion, the body mobilises even the autonomously protected reserves, which can lead to total exhaustion and in extreme cases to death.

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Cardiovascular and respiratory systems

Stimulants place strain especially on the cardiovascular system. Constriction of the blood vessels causes an increase in blood pressure and body temperature. This is life-threatening and can lead to a heart attack. Heart rate irregularities, convulsive fits and circulatory failure can also be caused by the consumption of stimulants. Especially in conjunction with sporting activity, life-threatening respiratory paralysis can occur.

Caution! Ephedrine and pseudoephedrine in over-the-counter cold remedies

Stimulants strain the cardiovascular system Such a specific stimulant is ephedrine, which is and may cause fatal heart contained in many over-the-counter flu medicines. attacks. It acts on the airways by relaxing the bronchi and decongesting the nasal mucosa. To avoid a positive test, athletes must stop taking such medicines at least 48 hours before competition.

Caffeine is not prohibited

From 1984 to 2004, caffeine was on the IOC/WADA Prohibited List. However, since tolerance and the breakdown of caffeine in the human body are subject to great individual variation and its stimulant effect is weak compared to other stimulants, caffeine was removed from the Prohibited List in 2004. As a result, athletes who consume caffeine-containing beverages (coffee, cola, energy drinks, etc.) run no risk of testing positive.

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Andrea Raducan was stripped of the gold medal she had won at the 2000 Olympic Games. The team doctor had prescribed her a cold remedy containing pseudoephedrine.

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CANNABINOIDS Cannabinoids are natural substances extracted from Indian hemp (Cannabis sativa) as well as their synthetic analogues (similar artificially produced substances). The principal active substance is tetrahydrocannabinol (THC). Cannabinoids have a relaxing and mildly euphoriant effect. Cannabis is rarely consumed to enhance performance, but its abuse outside of sport leads to many positive doping samples. Cannabis is prohibited in competition in all sports. On the one hand, because its relaxing and mildly disinhibiting effect can indirectly influence performance, and on the other hand, because it can be a safety risk. Additionally, the prohibition aims at supporting the fight against cannabinoids, which are banned in many countries, and at reinforcing the role model function of athletes. The high number of cannabis doping cases is more a reflection of the drug’s pervasiveness in individual societies than of consumption with the intent to enhance performance.

Effect of cannabinoids

Cannabinoids act predominantly on cannabinoid receptors type 1. Cannabinoid receptors type 1 (CB1) are located particularly on the nerve cells of the central nervous system. The brain regions in which the CB1 receptors are mainly located play an important role for memory (hippocampus and cerebellum) as well as motor control (basal ganglia and cerebellum). Cannabinoids reduce the excitability of the brain and activate its dopaminergic reward system, i.e. they stimulate the production of the messenger substance dopamine which induces pleasant feelings of selfaffirmation and well-being (being high).

Affected sports The American judo fighter Nicholas Delpopolo was expelled from the 2012 London Olympic Games after testing positive for cannabis.

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Cannabinoids can reduce pre-competition tenseness and anxiety and increase the willingness to take risks, which may be performance enhancing in some circumstances. In most sports, however, the undesired performance-decreasing effects predominate, e.g. delayed reactivity, impaired coordination and reduced motivation for physical performance. Cannabinoid abuse occurs mostly outside of, and unrelated to, the

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sport context. As a result, doping cases have emerged in all kinds of sports. They are particularly frequent in team sports (professional to amateur leagues).

Adverse effects and consequences of cannabinoid abuse

Cannabinoids act predominantly on the brain and can have a wide range of adverse effects. In the short term, they reduce motivation for physical performance and impair perception and short-term memory. At high doses, psychotic states, restlessness, anxiety, panic reactions and disorientation can occur. Long-term abuse can lead to attention deficit disorder, memory loss and reduced learning ability as well as changes in personality structure and, last but not least, psychological dependence.

MANIPULATION OF BLOOD In addition to prohibited substances, the Prohibited List also specifies prohibited methods. This includes the manipulation of blood and blood components as well as the administration of synthetic blood substitutes such as emulsions of perfluorocarbons. All of these methods are prohibited because they improve the body’s oxygen supply. The improvement of endurance performance by transferring blood of another person into the circulation was first described in 1947. At the time, the method was aimed at improving the performance of pilots who were challenged by oxygen deficiency at high altitude. In sport, the manipulation of blood by homologous or autologous transfusion made its appearance in the 1980s and has been officially prohibited since 1985.

EPO versus blood doping

In the 1990s, the method of blood doping made way for the substance erythropoietin (EPO). Doping with EPO has similar effects as blood doping, but it is much easier to administer and involves a lower health risk. Since the year 2000, when EPO became directly detectable in urine, the use of blood doping has experienced a strong resurgence. Whereas doping with homologous blood is readily detectable, there is still no direct method to detect autologous doping. As a consequence, athletes in critical (endurance) sports are increasingly subjected to long-term blood profiling (Athlete’s Biological Passport), which may provide evidence of blood manipulation.

Blood banks

In the past few years, several blood banks in Spain and Austria have been discovered. Hundreds of athletes used the banks to have blood removed and stored for re-infusion shortly before a competition.

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Effect of blood doping

For autologous doping, an athlete has an amount of blood removed from his body several weeks before a competition. From this blood, the red blood cells (erythrocytes) are removed and stored at a low temperature. In the meantime, the body compensates the loss of blood by producing new erythrocytes. Shortly before or during the competition, the stored erythrocyte concentrate is returned (transfused) to the athlete’s body. This procedure increases the number of red blood cells that transport oxygen. The oxygen supply of the musculature is improved and performance endurance is increased. In homologous doping, the erythrocyte concentrate of a donor is used, exactly the same method as for blood transfusions to patients with anaemia. Instead of traditional blood transfusions, synthetically manufactured products can also be used. These molecules cause the organism to increase its oxygen uptake, oxygen transport or oxygen release - depending on the type of molecule.

Affected sports

Blood doping improves endurance performance and is therefore used in the classical endurance disciplines, particularly in cycling and cross-country skiing.

Direct detection of homologous doping

Today, the detection of homologous doping is fairly simple. The first and best-known case involved the US-American professional cyclist Tyler Hamilton. During his full confession in the Lance Armstrong affair, he put on record that he had actually intended to dope with his own blood, but this did not happen because the blood bags of different athletes had been mixed up.

Indirect detection of autologous doping In 2004, the USAmerican professional racing cyclist Tyler Hamilton was tested positive for homologous blood doping twice and as a result was suspended for two-years.

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As no direct detection method for autologous doping is available yet, most cases of autologous doping are discovered through police investigations and confessions. Moreover, athletes in critical (endurance) sports are increasingly subjected to long-term blood profiling (Athlete’s Biological Passport) which may provide evidence of blood manipulation.

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Adverse effects and consequences of blood doping Risk of death caused by an excessive haematocrit level

Blood doping and the use of synthetically produced (recombinant) EPO increase the number of red blood cells. An increase in haematocrit to a level around 60 % or more, whether in this unnatural way or by a natural process (by dehydration = water deficiency), entails serious health risks. The flow properties of the blood deteriorate markedly, leading to a greater likelihood of thromboses (blood clots) and embolism (a clot obstructing a blood vessel) and, in the worst case, to death.

Russian roulette due to improper handling of banked blood

Several cases have been documented, such as Tyler Hamilton or Riccardo Riccò, where athletes incurred serious health risks because the blood had been improperly collected, stored, transported or transfused. This can lead to life-threatening sepsis (blood poisoning). With homologous blood doping, additional severe complications are possible. First, disease causing agents carried by the donor, such as the hepatitis virus or HIV, may be transmitted. Second, a blood incompatibility reaction may be triggered and cause an allergic shock. This state of shock may lead to death.

GENE DOPING In the context of gene doping, the World Anti-Doping Agency (WADA) prohibits the following methods due to their potential performance-enhancing effect: • The transfer of nucleic acids or their analogues • The use of normal or genetically modified cells The essential difference between gene doping and conventional doping is the fact that instead of substances such as anabolic steroids, hormones or blood, genetic material is introduced into the body. This genetic material is capable of directly influencing muscle growth, fat reduction, or the production of specific hormones in the body. As a result, gene doping might in the future complement or even replace conventional doping methods due to its ability to turn the body into its own doping factory. This is precisely what makes gene doping so incalculably dangerous: once processes are triggered in this way, they can no longer be reversed.

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Genetic material can directly influence muscle growth, fat reduction, or the production of specific hormones in the body.

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The importance of genes in sport

Every human carries genes that predispose him to particular abilities. In terms of sporting ability, for example, some are faster than others already from childhood, while others are stronger, taller or better coordinated. Genes play a very central role in these differences. However, the particular way in which a genotype is eventually expressed (character, predilections, physical features, etc.) also depends on the influence of the environment on each individual. “There is no genetic factor that can be studied independently of environmental influences. And no environmental factor whose effect is independent of the genome. A personality trait develops from the mutual interaction of genes and environmental factors.”(Michael Meaney, gene expression expert, Canada).

Genes are the foundation of sporting potential

The fact that sporting potential depends on the genetic make-up can be readily inferred from a few examples: • The fastest sprinters are dark-skinned people • The best marathon runners originate from East Africa • In gymnastics, Asian females are advantaged by their physical type • Europeans dominate in strength disciplines It has been scientifically demonstrated that sprinters are endowed with muscles that contract especially fast but also fatigue quickly. In contrast, the muscles of endurance runners contract more slowly but can work much longer. These differences, too, are attributable to the genes.

Science on the march

Scientists are continually discovering genes that are related to physical performance. Thus, there are genes that determine the muscle fibre types, the synthesis of growth factors or hormones, such as the blood formation hormone EPO, the control of the body’s energy balance, and many more. By the year 2000, 29 of these sporting genes were known. By 2011, the number had already grown to 221 – and new ones are being discovered at regular intervals.

Risks of gene doping The risks of gene doping are many and varied! Manufacturing risk: If one of the gene therapy methods currently under development is already being used illegally for doping, then the genetic material, having been manufactured in some obscure laboratory, carries enormous risks.

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The gene ferry: In gene therapy, viruses are used as gene ferries. These viruses are modified before administration to make them non-infectious. Nevertheless, even inactivated viruses still retain a small residual potential to cause disease. The setting: Because the illegal manufacture of substances for gene transfer escapes public regulation and monitoring, there is a risk that incompletely inactivated viruses, contaminated products or infected instruments are used. Additionally, there is a risk that medical supervision during treatment is inadequate, or even that unauthorised, dangerous experiments on humans might be carried out. Transfer risk: Even correctly inactivated viruses remain foreign bodies in the patient’s organism and are therefore susceptible to attack by the immune system. The symptoms caused by this immune defence are similar to those of influenza. More serious problems arise if the immune system rejects the proteins produced by the inserted genes. This leads to allergic reactions including, in the worst case, fatal allergic shock.

Genetic risk: When a therapeutic gene is administered to a patient, it is

not possible to control at which location it is inserted into the patient’s genetic substance. Depending on the specific instance, this may have grave consequences. It is possible that an interaction between adjacent gene sections and the newly inserted gene produces an adverse or unknown effect. Not all of these possible interactions in gene therapy are known yet, and still much fewer have been scientifically investigated.

Possible adverse effects of gene doping

At the current state of knowledge, alterations of the genetic substance by gene doping cannot be fully reversed. While many adverse effects of conventional doping subside when administration of the substance is discontinued, the effects of gene doping, including its adverse effects, are sustained and durable. Although at present, no well-founded statement can yet be made about the dreaded adverse effects of gene doping, the following scenarios are conceivable: A growth factor, such as IGF-1, promotes the growth of muscle cells but might also stimulate the growth of tumour cells. As a result, a single pre-cancerous cell that would under normal circumstances be eliminated by the body’s own control mechanisms might quickly grow into a tumour – or a cancerous disease such as leukaemia.

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THERAPEUTIC USE EXEMPTIONS (TUE) At some point, an athlete is bound to get sick or injured and he or she may need to take a particular medication as treatment or may need to take something for an ongoing condition, such as asthma, diabetes or Crohn’s disease. If an athlete needs to take a medication that is prohibited he or she can apply for a Therapeutic Use Exemption or TUE.

Before a TUE is granted, the following will be considered: • • •

Will an athlete experience significant health problems if he or she does not take the medication? Will the substance significantly enhance athletes’ sporting performance? Is there a reasonable and permitted alternative medication athlete could take for the illness or condition?

Who needs to apply for a TUE?

If an athlete is a national or international level athlete and he or she needs to take a medication that is on the Prohibited List, he or she must apply for a TUE before he or she takes the medication (unless it’s a medical emergency).

What does an athlete needs to include with TUE application? Athletes’ medical practitioner will need to provide a variety of information in support of TUE application.

This includes: • Comprehensive medical evidence to justify the use of the treatment, preferably from a specialist • Confirmation that permitted alternative medications have been tried If an athlete or athletes’ medical professional do not submit all of the required information, then the application will be delayed so it is important that the correct documentation is included.

Remember, a TUE application can take up to three weeks so athletes should not leave it until the last minute to apply. What if an athlete needs emergency treatment?

If an athlete has a serious accident or he or she require emergency medical treatment, he or she should not hesitate. Health always comes first and athletes should seek medical help immediately.

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Athletes should advise all medical staff that they are athletes who could be tested for prohibited substances and methods and ask them to check whether all medications are prohibited in sport. However, if an athlete needs a prohibited substance or method for the sake of his or hers health, a TUE application should be made immediately after treatment (a retroactive TUE).

To whom do athletes apply to for a TUE?

A TUE application can only be sent to one authority – NADO, athletes’ sport’s International Federation or a Major Event Organizer (e.g. IOC). Most athletes can apply to NADO. Athletes can call or e-mail to NADO and check to whom they should apply for TUE.

OVERVIEW OF THE THERAPEUTIC USE EXEMPTION PROCESS This list outlines the entire process for athletes: • Doctor or medical professional recommends a medication • Athlete should check the status of medication • If the medication is prohibited athlete needs to discuss permitted alternatives with his or hers medical professional • If there is NO ALTERNATIVE, a TUE application must be completed before an athlete takes the medication (in emergency situations, treatment may begin immediately) • Athletes can download an application form from NADO website or call NADO to check whether they need to apply to their International Federation • A medical practitioner (preferably the prescribing doctor) must complete the application in full and all relevant supporting documentation attached • Submit the application to NADO (or to International Federation if that is appropriate) • A TUE committee made up of medical professionals will review Athlete’ application • Athlete and athletes’ medical professional will be told whether the application has been accepted or rejected. They will be told of any conditions attached to the TUE, including the date of expiry and restrictions on the use of the medication

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DOPING CONTROL Doping Control plays an essential part in promoting and protecting doping free sport. Testing worldwide is conducted in accordance with the World Anti-Doping Code and applicable International Standards. Athletes who compete in events sanctioned by, or are members or license holders of a National Governing Body, or who fall under the NADO testing jurisdiction as defined in the NADO Anti-Doping Rules, are subject to testing. Testing program utilizes both in-competition (event) testing as well as noadvanced notice, out-of-competition testing. Athletes are subject to both urine and blood testing 365 days a year and tests can occur at any time and any place. The following information identifies athlete rights and responsibilities, the processes unique to each type of test, and the procedures athletes can expect to follow when providing a sample. The steps for blood and urine sample collection and processing are similar for both in-competition and out-of competition testing.

WHO CAN BE TESTED? If an athlete competes in a sport that has agreed to national Anti-Doping Rules, he or she could be tested for prohibited substances and methods. Most sports have signed up to these rules and that means no matter what level athlete is competing at he or she needs to comply. Athletes in National Registered Testing Pool (NRTP) or in the Registered Testing Pool of International Federations (IF RTP) are tested more regularly than other athletes are. However, if an athlete is not in the IF RTP or the NTP, it does not mean that he or she will not be tested. Any athlete can be tested at any time – either in-competition or out-ofcompetition.

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WHERE DOES TESTING TAKE PLACE? In-competition testing takes place either immediately after the athlete finished competing or at any time during the course of the event, tournament, regatta, or games. Out-of-competition testing can take place at any time of the year and at any location, including athlete’s home, training venue, hotel or when they are in foreign countries. If an athlete is selected for testing, a doping control official working for ADO will notify him or her.

ATHLETES RIGHTS AND RESPONSIBILITIES If an athlete is selected for testing, he or she will be advised of rights and responsibilities. Going through the doping control process can be unnerving, especially if it’s athlete’s first time. Remember that athletes can have a support person with them and they are advised to do so. If an athlete has been selected for testing, he or she must provide a sample. If he or she fails to do so, it may result in an anti-doping rule violation and a ban from all sport. Throughout the doping control process, athletes have the right to: • Have a representative (parent, coach or friend) with them • Have an interpreter if required • Ask for additional information about the sample collection process • Request a delay in reporting to the doping control station for valid reasons (e.g. attending a medal ceremony, fulfilling media commitments) • Request modifications if they have a disability or are under 18 years old In addition, they have the responsibility to: • Remain in sight of the doping control official at all times • Produce valid identification at doping control • Comply with the sample collection process • Report to the doping control station as soon as possible • Recognize that if they choose to eat or drink prior to providing a sample, they do so at your own risk

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DOPING CONTROL 101 Doping control will be a part of athlete life as long as they choose to compete as an elite athlete. It may not be the most glamorous part of their career, but it is critical in the global fight for clean sport. The following information provides an overview of urine and blood sample collection process.

Doping control procedure – urine

1 NOTIFICATION If an athlete has been selected for testing, he or she will be notified by a Doping Control Officer (DCO) or Chaperone. They will ask him or her to provide photo identification.

2 REPORTING TO THE DOPING CONTROL STATION Following notification, athlete must stay within direct observation of the Chaperone. He or she should report to the Doping Control Station immediately, unless a valid reason is discussed with and permitted by a DCO or Chaperone.

3 CHOOSING A COLLECTION VESSEL Athlete will be asked to select a sealed sample collection vessel from a choice of vessels. He or she should check and inspect the collection vessel to ensure that it has not been tampered with and rinse his or hers hands with water only before opening the vessel.

4 PROVIDING A SAMPLE Athlete will be required to provide a urine sample of 90 ml under direct observation of a DCO or witnessing Chaperone of the same gender.

5 CHOOSING A SAMPLE COLLECTION VESSEL Athlete will be offered a choice of sealed Sample Collection Equipment (which includes A Sample and B Sample bottles). He or she should check and inspect the equipment to ensure that it has not been tampered with.

* While sample collection equipment may vary slightly according to the sample collection agency or region, the integrity of the sample will always be maintained.

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6 DIVIDING THE SAMPLE Athlete will then divide his or hers sample between the A Sample and B Sample bottles and seal them. The DCO should not handle any of the equipment during the procedure unless requested to do so by athlete. Athlete has to maintain control of his or hers sample until the sample is sealed.

The DCO will check the specific gravity (concentration) of the sample. Additional samples may be requested if the sample is not within the required range.

7 SEALING THE SAMPLE Once the sample is sealed, athlete will be asked to place the A Sample and B Sample bottles into plastic bags and into a transportation box.

8 COMPLETING THE PROCEDURE When instructed by the DCO, athlete should declare any substances or medications he or she may have taken on the Doping Control Form (DCF) and provide details of any Therapeutic Use Exemptions (TUEs) he or she have.

Athlete should than check the entire DCF thoroughly to ensure that the information is correct and then sign it. He or she will then receive a copy of the test session documentation.

Doping control procedure – blood

1 NOTIFICATION If an athlete has been selected for testing, he or she will be notified by a Doping Control Officer (DCO) or Chaperone. They will ask him or her to provide photo identification.

2 REPORTING TO THE DOPING CONTROL STATION Following notification, athlete must stay within direct observation of the Chaperone. He or she should report to the Doping Control Station immediately, unless a valid reason is discussed with and permitted by a DCO or Chaperone.

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3 CHOOSING A KIT FOR SAMPLE COLLECTION Athlete will be asked to select a venepuncture and sample security kit from a choice of kits. He or she should check and inspect the kits to ensure that it has not been tampered with.

4 RELAX Athlete will be required to rest (remain in a seated position) for a minimum of 10-minutes prior to the blood draw.

5 BLOOD COLLECTION The BCO will begin the blood collection process by cleaning athlete skin with a sterile disinfectant swab in the location where blood is drawn.

The BCO will apply a tourniquet to aid in the collection and the BCO will begin to draw the blood sample. The BCO will make a maximum of three needle stick attempts to draw blood.

6 SEALING THE KITS After the relevant tubes are filled with blood, the BCO will label each tube with the corresponding sample code number for the security bottles, confirming with the athlete that each tube was labelled appropriately.

The DCO will direct the BCO to secure each tube in its respective security bottle and verify that each tube is securely placed within the security bottles.

7 COMPLETING THE PROCEDURE The DCO will guide the athlete through the remaining sample collection documentation corresponding to the blood collection session. During the completion of the final sample collection documentation, athlete will be asked a series of questions that correspond with blood collection (for example: ABP supplementary report form).

Athlete should than check the entire DCF thoroughly to ensure that the information is correct and then sign it. He or she will then receive a copy of the test session documentation.

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ANALYSIS AND RESULTS Athlete’s sample will be transported to a World Anti-Doping Agency (WADA) accredited or approved laboratory. The laboratory will analyse the sample and then notify ADO of the result. If the sample tests positive, ADO will check that the proper procedures were followed to collect the sample. ADO will also check whether an athlete has a TUE in place to explain the findings. Athlete will be notified that they have returned a positive test and asked for an explanation. They will also have the opportunity to request that analysis of their “B” sample be carried out. ADO will then decide whether to refer an allegation of an Anti-Doping Rule Violation (ADRV) against the athlete to the Anti-Doping Tribunal.

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ATHLETE WHEREABOUTS All anti-doping organisations carry out doping control outside of competition without providing notice to the athlete being tested. These “surprise” tests help to detect and deter use of prohibited substances and methods and protect clean athletes. In general, there are two groups of athletes who are regularly tested for prohibited drug substances and methods: • Athletes in the Registered Testing Pool of International Federation (IF RTP) and • Athletes in the National Registered Testing Pool (NRTP) IF or NADO informs athletes if they are assigned to one of these testing pools. If an athlete is in IF RTP or in NRTP he or she needs to file regular ‘whereabouts’ information in ADAMS so that he or she can be easily located for testing at any time. This includes logging details about their regular activities such as where they are living, training, working, competing and travelling. Besides that, athletes are required to identify a 60-minute time slot between 5am and 11pm each day when they will be available for testing at a location of their choice. They can select a time slot that fits their schedule, but they must be available and accessible for testing during that time. Athletes need to file whereabouts information every quarter and they will need to regularly update information if and when their plans change.

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THE CONSEQUENCES OF ANTI-DOPING RULE VIOLATION The consequences of breaking the rules are tough and may ruin athlete reputation and possibly end his or hers career.

The sanctions for an anti-doping rule violation can include: • Being labelled a cheat or doper • Being banned from all sport (competing, training, coaching) • Disqualification of competition results • Forfeiture of any medals, points and prizes • Possible financial penalties • Public announcement of anti-doping rule violation • Losing the respect of athlete peers or team mates • Loss of sponsors

Under the 2015 World Anti-Doping Code, most violations now face a four-year ban and if it is a second offence athlete could face a life ban from all sport.

It is not worth it It is not worth the risk. Athletes have to understand what the rules are, meet their responsibilities, compete clean and know that they are safe.

WHAT HAPPENS IF AN ATHLETE COMMITS AN ANTI-DOPING RULE VIOLATION? Athlete is provisionally suspended from all sport activities including training and playing with a team pending the outcome of a hearing before a Judicial Committee. If athletes’ case involves a positive test, he or she has the right to has his or hers B sample analysed. He or she is entitled to present his or hers case before a Judicial Committee who then decides on any applicable sanction and provide a written decision which shall be published on the ADO website. Athlete has a right of appeal if he or she does not agree with the decision in the first instance.

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SANCTIONS Sanctioning depends on the substance and the type of anti-doping rule violation. In general, the standard sanction for an anti-doping rule violation is four years, which can be reduced or extended depending on the individual circumstances of each case.

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BEING INFORMED It is responsibility of NADOs to make it easy for athletes to compete clean.

Athletes can get more information about the anti-doping rules and what they need to do to comply with them in the following ways: • Attend an education seminar with other athletes to get a good understanding of the rules • Visit the website of National Anti-Doping Organization • Check all medications and supplements before using them • Check out the WADA World Anti-Doping Code at

www.wada-ama.org/en/what-we-do/the-code • Read the WADA Prohibited List at

www.wada-ama.org/en/what-we-do/prohibited-list If athletes have witnessed doping activity or they suspect it may be going on, they should report it in confidence to Anti-Doping Organisation.

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Clean sport is our mission. Athletes have the right to compete in sport knowing that they, and their competitors, are clean.

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prePLAY

Doping prevention through peer learning among youth

www.preplay.si

Project partners:

www.sloado.si

www.antidoping.ee

www.antidoping-hzta.hr

www.nocmalta.org

www.antidopings.lv

www.inado.org


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