TYPE OF PROBIHITED DRUGS IN SPORTS BASED ON WADA

WHAT IS WADA?

The World Anti-Doping Agency (WADA) is a foundation set up by the International

Olympic Committee with its headquarters in Canada to help, coordinate and monitor the war
on drugs in sports. The Organization's core activities are research studies, education,
improvement of anti-doping capabilities and monitoring of the World Anti-Doping Code, the
terms of which are enforced by the UNESCO International Convention against Doping in
Sport. The priorities of the Anti-Doping Convention of the Council of Europe and the United
States Anti-Doping Agency are also closely associated with those of WADA.

The International Olympic Committee (IOC) agreed to convene a World Conference on

Doping after the events that shook the world of cycling in the summer of 1998, putting
together all the parties involved in the fight against doping. The Lausanne Declaration on
Doping in Sport was drawn up by the First World Conference on Doping in Sport, held in
Lausanne, Switzerland, from 2-4 February 1999. For the XXVII Olympic Games in Sydney
in 2000, the paper called for the creation of an independent international anti-doping body.
The World Anti-Doping Agency (WADA) was founded in Lausanne on 10 November 1999,
under the terms of the Lausanne Declaration, to help and coordinate the fight against doping
in sports worldwide. With the support and involvement of intergovernmental organizations,
governments, public authorities and other public and private bodies fighting against doping in
sport, WADA was founded as a foundation under the initiative of the IOC. The Agency
consists of equal representatives from the Olympic Movement and public authorities.
SUBSTANCES & METHODS PROHIBITED AT ALL TIMES (IN AND OUT OF
COMPETITION)
Prohibited at all times is not only illegal for athletes during the games but it also during out of
the tournament. It is important to remember that not all substances and methods are named on
the Prohibited List.

NON-APPROVED SUBSTANCES

Any pharmacological substance which is not addressed by any of the subsequent sections of
the List and with no current approval by any governmental regulatory health authority for
human therapeutic use for examples drugs under pre-clinical or clinical development or
discontinued, designer drugs, substances approved only for veterinary use is prohibited at all
times.

ANABOLIC ANDROGENIC STEROIDS (AAS)

Anabolic androgenic steroids (AAS), also referred to simply as 'anabolic steroids', are
testosterone-derived substances, a hormone produced in male testes and, to a much lesser
degree, in female ovaries. Testosterone is partly responsible for the changes in growth that
occur during puberty and adolescence, and is also involved in regulating the build-up and
breakdown of all tissues, including muscle, through the key biochemical components. There
are two types of anabolic steroids:

 Exogenous steroids are synthetically created versions of the testosterone hormone.

These substances are not naturally produced by the body.
 Endogenous steroids are naturally occurring substances in the human body that are
involved with the metabolic pathways of testosterone.

Since testosterone influences muscle development, increasing blood levels can help athletes
increase muscle size and strength, along with some other advantages, such as improved
endurance. In tablet form, anabolic steroids may be taken or directly injected into the muscle.
Athletes who use anabolic steroids say that they decrease body fat and recovery time
following injury, as well as increase muscle mass. However, particularly in women, the
androgenic masculinizing side effects such as increased body hair and a deepening of the
voice are not always desirable. Scientists developed steroids to combat these side effects,
which maintain their anabolic effects but have a lower androgenic effect.
The misuse of anabolic steroids has been linked with significant health risks. Some of the
effects are mild when the drug is being taken, or just last; others are more extreme and long-
term. Anabolic steroids, for instance, may trigger high blood pressure, acne, liver function
disorders, menstrual cycle changes in women, decrease in sperm output, impotence and
gynaecomastia growth of breasts in men, kidney failure and heart disease. They can also
make both men and women more irritable, potentially leading to mood swings.

Since the 1970s, when simple radioimmunoassay methods were used, research for anabolic
steroids has come a long way. Today, using mass spectrometry, anabolic steroids and their
metabolites can usually be detected in urine. However, since testosterone exists naturally and
quantities fluctuate daily in the body and can differ from individual to individual, setting a
threshold over which an athlete is considered to be ‘using’ anabolic steroids remains a subject
of debate. Today, anti-doping labs use a range of complex techniques and technology to
distinguish between testosterone produced naturally by the body (endogenous) and that which
is a result of synthetic compounds (exogenous).

PEPTIDE HOEMONES, GROWTH FACTORS, RELATED SUBSTANCES AND

MIMETICS
In order to bring about a multitude of physiological responses, hormones are essential
regulatory substances released by the endocrine system. Prominent sports-doping agents are
the peptide hormone growth hormone and the protein hormone Erythropoietin (EPO). Highly
anabolic growth hormone increases skeletal muscle mass and decreases body fat and is also
particularly used by strength and power sports athletes. Erythropoiesis, the production of red
blood cells, is triggered by EPO and related agents, resulting in an increase in the oxygen
carrying ability of the blood and is thus particularly used by endurance athletes. High doses
of these agents have adverse health and quality of life consequences, including death.
Peptides are short amino acid chains that are the protein building blocks. They exist naturally
in the body, but in supplement form, they may also be taken. Some peptide supplements are
legal, and to help the body recover from strenuous exercise, they function similarly to protein
supplements. There are also a number of peptides, however, which allow the body to release
growth hormones. This form of peptide improves muscle growth with less side effects than
anabolic steroids. They are sold as either a cream or in an injection solution. The ACC study
states that different forms of peptide-releasing growth hormone are being used, including
hexapeptides such as GHRP-2 and GHRP-6. The study states that this type of peptides are
often used to maintain muscle gains in combination with anabolic steroids . This is a few of
the prohibited medications that contain the peptide hormones:
 Epoetin Alfa (Procrit / Epomax)
 Darbepoetin (Aranesp)

BETA-2 AGONIST
As potentially performance-enhancing substances, beta-2 agonists are on the list of
prohibited substances. Beta-2 agonists are contained in asthma medications. They improve
breathing by widening the bronchi in the lungs. They can be administered orally or by
inhalation. In high doses, they also stimulate muscle growth.

Asthma is a chronic inflammation of the mucosa of the airways. Normally, about five to
ten percent of all people suffer from this disorder. To treat the condition, they use asthma
inhalers containing beta-2 agonists. Among elite athletes, light to moderate deficits in
bronchial function are diagnosed noticeably more often than in the average population. As
a result, sports doctors in the past 1990 – 2006 often prescribed asthma medications to
athletes. By contrast, non-asthmatic people do not benefit from asthma medications, they
only suffer from their side effects. Asthma medications are therefore now no longer used
by athletes across the board.

Because they promote protein synthesis, beta-2 agonists in high doses have a muscle-
building anabolic, and simultaneously, a fat-reducing effect. That is why doping athletes
use them as an alternative to anabolic. In some countries, beta-2 agonists are also used
illegally as growth-promoting drugs in animal fattening. In Switzerland, only a few
veterinary medications for the treatment of respiratory disorders contain clenbuterol. It is
not used in human medicine.

Beta-2 agonists are used particularly in endurance sports such as cycling, swimming,
cross-country skiing and athletics. In these disciplines, a high oxygen supply is especially
useful. By widening the airways with beta-2 agonists contained in asthma inhalers, athletes
attempt to supply the lung with more oxygen. However, recent studies have not provided
clear evidence of such an effect. To the contrary, non-asthmatic persons only suffer the
adverse effects of these medications.

HORMONE AND METABOLIC MODULATORS

Substances classified as hormone and metabolic modulators modify the effects of
hormones or accelerate or slow down specific enzyme reactions. For example, anti-
oestrogens can block the conversion of the male sex hormone testosterone into the female
sex hormone oestrogen. Hormone and metabolic modulators are substances that influence
the hormones and thus modify their effects and act on the body's metabolism. Hormone
and metabolic modulators have been prohibited as doping agents in and out of competition
since 2001 for men and since 2005 for women.

The class of hormone and metabolic modulators comprises a variety of substances that
modify the effects of hormones, either by blocking or stimulating receptors, or by boosting
or inhibiting specific enzyme reactions. An anti-oestrogenic effect can be achieved in two
basic ways:

 So-called aromatase inhibitors inhibit the enzyme aromatase which converts

testosterone into oestrogen.

 By contrast, selective oestrogen receptor modulators (SERM) bind to oestrogen

receptors and thus block the effects of oestrogen.

In the body, anabolic are partially converted into oestrogen. Administered anti-oestrogens
weaken the effect of oestrogen, either by inhibiting aromatase enzymes which convert
testosterone into oestrogen or by antagonistically blocking the oestrogen receptors.

Hormone and metabolic modulators with anti-oestrogenic effect are used to prevent the
adverse effects of anabolic. As a result, abuse occurs in the same sports where anabolic are
also abused. Hence, strength and combat sports such as weightlifting and boxing as well as
endurance sports such as cycling and cross-country skiing are affected. The most
widespread abuse occurs in the body building scene. This is precisely the domain where
anabolic are often taken in large doses.
DIURETICS AND OTHER MASKING AGENTS

Masking agents such as diuretics are used to falsify the results of doping controls and to conceal
doping. Substances suitable for this purpose are therefore included in the Prohibited List of the
WADA. The substance class of masking agents comprises primarily of diuretics but also includes
probenecid and plasma expanders, as well as substances with a similar chemical structure that alter
doping samples, modify urine excretion or conceal the presence of other doping agents.

Diuretics affect the function of the kidneys and thus alter the body's fluid and salt balance
electrolytes. They affect various transport systems in the kidney and thus increase the
excretion of urine. Body weight is reduced and urine is diluted.

Because of their concealing effect, diuretics and other masking agents can be abused in all
sports. In recent years, positive doping controls have emerged in canoeing, taekwondo,
football, fencing and cycling.

In sports with weight classes such as boxing, wrestling, judo, weightlifting and others,
diuretics are used to reduce body weight. Diuretics are also used in disciplines where a
particularly low body weight enhances performance. In 2001, the Russian Dmitry Vasilyev
became the first doping case in ski jumping. He had reduced his weight with the diuretic
furosemide.

Diuretics are also widespread in body building, where they are nicknamed "water pills".
They are used before competitions to flush as much water as possible out of the body. The
aim is to make the muscles appear more defined.

MANIPULATION OF BLOOD
The Banned List also defines prohibited methods in addition to prohibited drugs. This
involves blood and blood component alteration as well as the administration of synthetic
blood substitutes such as perfluorocarbon emulsions. All these strategies are forbidden
because they increase the supply of oxygen to the body.

In 1947, the improvement in endurance efficiency by moving blood into the bloodstream
of another person was first described. At that time, the goal of the approach was to boost
the efficiency of pilots who were challenged by high altitude oxygen deficiency. Blood
doping by homologous or autologous transfusion emerged in sport in the 1980s and has
been legally banned since 1985.

The blood doping process gave way to the substance erythropoietin in the 1990s (EPO).
EPO doping has similar consequences to blood doping, but it is much simpler to
administer and poses a smaller risk to your health. The use of blood doping has undergone
a strong revival since the year 2000, when EPO became directly detectable in urine.
Whereas homologous blood doping is readily observable, there is still no direct procedure
for autologous doping detection. As a result, athletes are increasingly subjected to long-
term blood profiling in vital endurance sports, which could provide evidence of blood
manipulation.

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

CHEMICAL AND PHYSICAL MANIPULATION

Chemical and physical manipulation consists of the use of methods, which may alter the
integrity, or validity of urine samples obtained in doping controls. These include, but are not
limited to, catheterisation, urine substitution and tampering with doping control. Urine
samples can be manipulated to cover up the use of prohibited substances. Athletes knowing
that they have used a prohibited substance could attempt to cover up this use. Several of the
methods have possible harmful side effects.
Catheterisation:
 Cystitis (bladder infection)
 Inflammation of lower urinary track
Urine Substitution:
 Infections

GENE AND CELL DOPING

The essential difference between gene doping and conventional doping is the fact that
instead of substances such as anabolic, hormones or blood, genetic material or other
substances that modify how gene expression is regulated are introduced into the body.

This genetic material, or these substances, are 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
owing 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 they can no
longer be reversed.

Every human carries gene that predispose them to particular abilities. In terms of sporting
ability, for example, some are faster than others from childhood, while others are stronger,
taller or better coordinated. Genes play a very central role in these differences. The
particular way in which a genotype is eventually expressed character, predilections,
physical features and etc also depends on environmental influences. 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 at an advantage because of their stature.
 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.

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 feared  side
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.
SUBSTANCES PROHIBITED IN-COMPETITION
Prohibited in competition only illegal for athletes during the games and not during out of
the tournament. But athletes need to take precaution because a period of time defined by
each sport, but in athletics this means within 24 hours of competition.

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. The chemical composition of traditional stimulants such as
amphetamine or ephedrine is identical to that formed in the adrenal medulla by adrenaline
and noradrenaline, the body's own stress hormones. As a consequence, their effect on the
organism is identical as well. They activate and mimic the sympathetic nervous system
that regulates blood vessels and glands by increasing, accelerating or enhancing nerve
functions.

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. Administered stimulants act
predominantly on the autonomic nervous system. They stimulate and imitate sympathetic
activity, which increases alertness, boosts the body's energy turnover and delays fatigue.
They raise body temperature, heart rate and blood pressure and uplift the mood or feels
euphoria.

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. Although
stimulants are easily detectable, they continue to be abused for performance-enhancing
purposes. In addition to anabolic, they are the second most frequent substance class
detected by anti-doping laboratories worldwide.
NARCOTICS
Narcotics prohibited in-Competition are potent pain relievers belonging to the class of
opioids. They are used to suppress severe pain. Narcotics are among the oldest doping
substances used in sport.

Like their biological relatives, the endorphins produced by the hypothalamus an area in a
part of the brain called diencephalon and the pituitary gland, narcotics act predominantly
on the central nervous system. By docking onto opioid receptors on the nerve cells, they
trigger processes in the cells and modulate ion channels with the end effect of reducing the
transmitter release. By this mechanism, they suppress the propagation of pain stimuli and
reduce the perception of pain. Administered narcotics act predominantly on the autonomic
nervous system. By reducing the release of neurotransmitters in the target nerve cells,
narcotics suppress the propagation of pain stimuli and reduce the perception of pain.

Narcotics can be used in pain-causing sports, such as martial arts, to reduce the perception
of pain. In bicycle sports during the first half of the 20th century, narcotics in combination
with stimulants were used on a massive scale. The combination with stimulants was
intended to trigger a performance high while simultaneously suppressing pain signals.

Nowadays, only a small proportion of positive doping samples are attributable to

narcotics, because they are easily detectable and therefore less often abused. Moreover,
popular non-opioid pain relievers such as aspirin, Voltaren are not on the Prohibited List.
Nevertheless, professional cyclists have repeatedly been caught in possession of narcotics
in recent years. In 2002, large quantities of morphine were found during a police raid at
the home of the Belgian professional cyclist Frank Vandenbroucke. In 2009, the athlete
died of pulmonary embolism at the age of 34.

CANNABINOIODS
Cannabinoids are natural substances extracted from Indian 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. In recent years, nearly every second doping case in
Switzerland has been attributable to cannabis consumption. 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.

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, for example they stimulate the production of the messenger substance
dopamine which induces pleasant feelings of self-affirmation and well-being being high.
Cannabinoids act predominantly on the brain.

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, delayed reactivity,
impaired coordination and reduced motivation for physical performance. Cannabinoid abuse
occurs mostly outside of, and unrelated to, the 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.

GLUCOCORTICOIDS
Glucocorticoids belong to the group of corticosteroids, a class of steroid hormones
produced in the adrenal cortex. Like all corticosteroids, they arise from the starting
substance cholesterol. Glucocorticoids have pain-relieving and anti-inflammatory effects,
which is the reason why they are abused for doping purposes. Glucocorticoids are steroid
hormones produced by the body or manufactured synthetically that influence the body's
metabolism and have pain-relieving and anti-inflammatory effects.

Glucocorticoids have a boosting effect on the new formation of glucose (gluconeogenesis).

Protein and fat deposits are broken down and used for the production of energy.
Glucocorticoids reduce inflammation and relieve pain. In addition, they suppress the
sensation of physical fatigue and have a mildly euphoriant or mood-lifting effect. The
body's own glucocorticoids are produced in the adrenal cortex and released when the body
has to cope with a stress situation.

They reach the blood circulation, are distributed throughout the body and bind to
glucocorticoid receptors which are present in nearly all tissues. Additionally, administered
glucocorticoids also bind to these receptors. By this mechanism, the administration of
glucocorticoids promotes gluconeogenesis and the breakdown of protein and fat in the
body. In addition, glucocorticoids have anti-inflammatory and pain-relieving effects.

Glucocorticoids are administered in various ways. Administration of glucocorticoids by

puncturing a joint is called intra-articular injection. Periarticular refers to injection in the
area adjacent to a joint, while peritendinous refers to injection in the area adjacent to a
tendon. Peridural administration is an injection into the peridural cavity. The peridural
cavity is a space between the bone membrane and the outermost membrane covering the
spinal cord. Topical administration means that the medication is applied to the skin.
Finally, there is inhalation, which refers to inhaling from an aerosol, a mixture of
suspended particles and air. According to the current Prohibited List, all glucocorticoids
are prohibited in competition when administered by oral, intravenous, intramuscular or
rectal use. Other routes of administration are thereby permitted.
SUBSTANCES PROHIBITED IN PARTICULAR SPORTS
Prohibited in particular sports only illegal for athletes during the games because these
substances give athletes more precision.

BETA-BLOCKERS
Beta-blockers inhibit the effect of the body's stress hormones adrenaline and
noradrenaline. As a result, they have a relaxing effect on the heart and blood circulation
and prevent anxiety and muscle trembling. Beta-blockers are prohibited only in certain
sports.

Beta-blockers are beta-adrenoceptor antagonists, they block the receptors that mediate the
action of adrenaline and noradrenaline and thus inhibit the effect of the stress hormones.
Beta-blockers have a relaxing effect, they lower the blood pressure and the resting heart
rate. They prevent anxiety and hand trembling. Beta-blockers weaken the activating effect
of the sympathetic nervous system on the target organs. Beta-blockers also have an
inhibiting effect on the sympathetic nervous system, a part of the autonomic nervous
system that primes the body for physical performance. The reduction in the heart rate may
in an extreme case lead to heart failure. Additional adverse effects include asthma attacks,
erectile dysfunction, fatigue and depression.

Because beta-blockers lower the heart rate and have a strongly relaxing effect, and also
because they prevent muscle trembling, abuse for doping purposes occurs in sports that
require particular accuracy and concentration for example in shooting, archery, darts, golf
and snooker. In addition, beta-blockers reduce anxiety. For this reason, they are also
prohibited in motor sports, in ski jumping and in freestyle skiing and snowboarding
aerials, halfpipe and big air.