Approval Or Disapproval Of a Therapeutic/Medical Exemption Only ...

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16 Δεκ 2012 (πριν από 7 χρόνια και 6 μήνες)

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INTRODUCTION AND
OVERVIEW

PART I

Welcome to the
PROFESSIONALS AGAINST DOPING IN
SPORTS
(PADS) Introduction to the anti
-
doping programs of the:


-

World Anti
-
Doping Agency (WADA)


-

National Collegiate Athletic Association (NCAA)



NAVIGATION


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-

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NOTE


The information presented covers the WADA and NCAA programs and is
intended to provide an overview of the structure, policy, and
implementation of these two programs.



The information presented here is not official policy of either WADA or
NCAA.


For clarification on the World Anti
-
doping Program any provider or
athlete may contact USADA.


For the NCAA each individual athlete should contact their institution or
Drug Free Sport (see reference below). Each individual institution
and/or conference must work through their compliance department to
get official policy interpretations.

OBJECTIVES

The OBJECTIVES are:



1.
To provide information and resources on two major anti
-
doping
programs to allow medical care providers to provide care consistent
with the program requirements.

2.
To emphasize the role of physicians and ancillary medical care
providers in preventing doping by athletes.


The use of only ethical and essential medical and training treatment is a
key in the fight against doping practices.


OUTLINE OF THIS OVERVIEW
(PART I)


ACSM statement on ethics applicable to anti
-
doping


Approach to the medical treatment of an athlete


Advisory on the programs and medical exemptions and
exceptions


Information on supplements


A listing of resources


A listing of references


Outline of the World Anti
-
Doping Program


Outline of the National Collegiate Athletic Association
Program



ACSM STATEMENT

ON ETHICS


The American College of Sports Medicine statement on ethics may be
found at:
http://www.acsm.org/Content/NavigationMenu/MemberServices/MemberR
esources/CodeofEthics/Code_of_Ethics.htm



ACSM members agree to:


treat or train athletes with the objective of maintaining the integrity of
competition and fair play.



treat or train every athlete with the utmost care and to the highest level
of their professional competence.



ACSM ETHICS Continued


be aware of international doping control standards as determined by the
… relevant Anti
-
Doping Authority.



treat athletes only as their medical conditions warrant and observe the
rules of the appropriate anti
-
doping organizations regarding use of
prohibited substances or methods.



not advise, aid, or abet any athlete to use prohibited substances or
methods of doping.



use all means possible to deter doping by athletes.



maintain confidentiality of personal medical information and protect
the right of the clean athlete to compete.


APPROACH TO MEDICAL
TREATMENT OF AN ATHLETE


If doping is documented or likely:


Treat any diagnosed condition in light of the possibility of doping


Discuss negative health consequences of doping



If doping is not likely:


Treat diagnosed condition


Provide guidance on healthy lifestyles and negative consequences of doping



For all athletes, assess the prohibited or permitted status of any treatment and when
possible use a permitted medication



When the only alternative is to use a prohibited medication, obtain approval from
the appropriate anti
-
doping authority.


RECOGNIZING POSSIBLE
DOPING


Minors:


If parents are involved the athlete should know why he is having visit with
physician.


Discuss adverse aspects of doping and long term effects as well as ethics.



Adults:


The provider must first establish trust before addressing the issue of appearance
and/or behavior that may indicate doping and must be cautious in discussions
with patient.


Team or sports medicine physicians may have opportunity for close
observation of the athlete and be aware of actual activities


but must be
willing to take action if doping is suspected.


RISK AND BEHAVIOR


Buckman, et al., found male college athletes that use Performance Enhancing Substances
(PEDMs) have higher risk of recreational drug use and exhibit more risk factors for substance
abuse than do peers that do not use PEDMs. (e.g. 70 % of the student athletes that use
PEDMs used marijuana in the last year compared to 22 % of the student athletes that did not
use PEDMs).




The study emphasizes the willingness of athletes to participate in risk taking for a variety of
reasons and to use substances that may, in fact, reduce their athletic performance.




Reference:


National Collegiate Athletic Association; NCAA Study of Substance Use Habits of
College Student
-
Athletes, Indianapolis, IN.


NCAA Committee on Competitive
Safeguards and Medical Aspects of Sport. 2006.




Buckman, J.F., et al., Risk Profile of Male College Athletes Who Use Performance
Enhancing Substances, J. Stud. Alcohol Drugs, 70: 919
-
923, 2009.



ADVISORY


USADA and NCAA Do Not Provide Medical Advice


All Decisions on Treatment Are Between The Athlete And
The Provider


USADA or NCAA Provides


Status Of Medications


Decision On Requests for Therapeutic (Medical
Exemptions)


Approval Or Disapproval Of a Therapeutic/Medical
Exemption Only Pertains To The Use Of The Medication
In Sport (Not To Denial Or Approval of Treatment)


Anti
-
doping Rules ONLY Govern Conditions Under Which
Sport Is Played

SUPPLEMENTS

WHAT IS A DIETARY
SUPPLEMENT?


A product other than tobacco that is intended to supplement the diet and
contains one or more of a vitamin, mineral, herb or other botanical, amino
acid, a dietary substance to increase total daily intake, or a concentrate,
constituent, extract, or combination of these ingredients.



Is taken in pill, capsule, tablet, or liquid form.



Is not represented as a conventional food or as the sole item of a meal or
diet.



Is labeled as a dietary supplement.


Reference: Dietary Supplement Health and Education Act of 1994. FDA,
Center for Food Safety and Applied Nutrition, December 1, 1995.

WARNING


Manufacturers may make claims of performance that are not necessarily
backed up by reliable, scientific research.



Dietary supplements are not approved by the FDA prior to sale. All quality
control is up to the manufacturer.



Note that a very small level of contamination may result in an adverse
finding if an athlete is tested for doping control.



Both USADA and NCAA warn that the
USE OF DIETARY
SUPPLEMENTS IS AT THE ATHLETE’S OWN RISK

and
recommend that athletes establish healthy life practices rather than use
supplements. Neither USADA nor NCAA guarantee the quality of dietary
supplements.


NCAA and SUPPLEMENTS



NCAA specifies certain substances which may be provided to student
athletes by the institution.



NCAA provides a list of ingredients which may NOT be provided to the
student athletes.


EXAMPLES OF PROHIBITED
SUBSTANCES CURRENTLY
FOUND IN SUPPLEMENTS


Geranium:


Methylhexaneamine

(MHA), 1,3
-
Dimethylamylamine
(DMAA), 1,3
-
Dimethylpentylamine; 4
-
methylhexan
-
2
-
amine; 4
-
methyl
-
2
-
hexaneamine; 4
-
methyl
-
2
-
hexylamine; 2
-
amino
-
4
-
methylhexane;
Forthane
;
Floradrene
;
Geranamine
; Sunrise; Hummer; Geranium extract, plant, oil,
parts, stem and leaf.


May be Found in:


Matrix energy drinks


USP Labs
Jacked 3d


Ergopharm

AMP


IBE


X
-
Force


Androsta
-
1,4
-
diene
-
3,17
-
dione


6
-
OXO and
androstenetrione


Plus many others





TOXICITY
-

Examples


Aristolochic Acid: Found in traditional Chinese medications
-

Aristolochia, Bragantia, Asarum


Nephrotoxic, carcinogen


Comfrey: 25 different species around world
-

e.g.,
Symphytum officinale


Hepatic injury by thrombotic and non
-
thrombotic veno
-
occlusive
disease


Chaparral:
Larrea tridentata

found in southwestern U.S. (and
Mediterranean area)


hepatotoxicity from mild hepatitis to fulminate liver failure


Kava: Indigenous to Polynesia and Micronesia (Piper methysticum)


Drug interactions, sedative and anxiolytic, hepatic failure


Pennyroyal:
Mentha puleguim
and
Hedeoma pulegoides


Hepatic failure, gastritis, renal dysfunction



TOXICITY


Other Examples


Germander: hepatotoxic


Yohimbine : tachycardia, hypertension, and urinary retention


Bitter Orange : drug interactions, vasoconstriction, hypertension


Vitamin A and beta carotene: high doses may have pro
-
oxidant activity,
increased risk of hip fracture in post menopausal women, teratogenicity in
early pregnancy. (NOTE on Vitamin E and C: No good clinical evidence
there is a benefit from high doses)


References:


Hammett
-
Stabler, C.A., and Dasgupta, A. Complementary and
Alternative Medicines. Clin. Lab. News: Dec 2005, pp 12
-
14.


Vitamin Supplements. The Medical Letter: 47, July 18, 2005, pp 57
-
58.


Zhou, S.F, et al, Metabolic Activation of Herbal and Dietary
Constituents and Its Clinical and Toxicological Implications. Curr.
Drug Metab. 2007, 8, 526
-
553.


THE MESSAGE


Medical care providers and consumers of supplements need to educate
themselves, not by relying on promotional materials, but by checking less
biased sources of information that can point out the true impact of “natural”
ingredients upon the human body.




Vitamins and minerals are not used by the body in the same manner that
food products are digested and used. Many vitamins can be synthesized
and most are reused in the body with the excess being excreted. (More is
not necessarily better).



Supplements may contain or be contaminated with substances that will
produce a positive test for prohibited (banned) substances.

RESOURCES AND REFERENCES

WEBSITES


World Anti
-
Doping Agency
(complete information on the World Program)


http://www.wada
-
ama.org


USADA

(information on the US implementation of the World Program)


http://www.usada.org


NCAA

(information on the Collegiate anti
-
doping programs and handbook)


http://www.ncaa.org/drugtesting


Drug Free Sport
(information on NCAA and other anti
-
doping programs / resources)


http://www.drugfreesport/rec


Hooton Foundation
(definitions and information on supplements, anabolic steroids, and
other appearance and performance enhancing drugs)


http://www.taylorhooton.org/


Substance Abuse Mental Health Services
(US Government drug free workplace programs)


http://www.workplace.samhsa.gov/


Partnership for a Drug Free America
(street drug of abuse information)


http://www.drugfree.org/

WADA ACCREDITED
LABORATORIES


United States


University of California, Los Angeles. Olympic Analytical Laboratory,
2122 Granville Ave, Los Angeles, CA 90025; (310) 825
-
2635


Sports Medicine Research and Testing Laboratory. 560
Arapeen

Way,
Suite 150, Salt Lake City, UT 84108; (801) 994
-
9454



List of Laboratories Accredited World wide


http://www.wada
-
ama.org/en/Science
-
Medicine/Anti
-
Doping
-
Laboratories/Accredited
-
Labs/


NOTE: The WADA accredited laboratories are not allowed to test athletes
outside of formal doping control testing or to test supplements for prohibited
substances.






DRUGS, SPORT, AND MEDICAL
CARE


“The conscious decision of all sport physicians and scientists to play no
role in doping practices would offer new hope that sport might
continue to represent competition between humans, not laboratory
preparations or the products of genetic engineering or polypharmacy.”



From: Andrew Pipe, MD and Thomas Best, MD, PhD; Clin Journ
Sport Med, 12:201
-
202


2002.


OUTLINE OF PART II
-

THE
WORLD ANTI
-
DOPING
PROGRAM


Introduction to the World Anti
-
Doping Agency (WADA)


Overview of the key components of the World Anti
-
Doping
Program


The Code


International Standards


Guidelines and other Documents


Requests for exemptions to allow the use of prohibited
substances or methods for therapeutic purposes and the


Information needed to support a request for medical
exemptions for specific conditions



OUTLINE OF PART III
-

THE
NCAA PROGRAM


Introduction to the National Collegiate Athletic Association
Anti
-
Doping Program


Banned Substance List


Other information


Requests for medical exemptions to allow the use of prohibited
substances or methods for therapeutic purposes