There are many substances that are included on the prohibited list for the Tokyo Olympics that are considered standard medications for certain disease states.
After a year of anticipation caused by COVID-19 delays, the media recently focused its attention to the drug testing protocols employed during the Tokyo Olympic Games. American sprinter Sha’Carri Richardson was suspended for a month after a positive drug test for marijuana shortly before the Games were to begin.
Although this story caused a lot of controversy in the American media, it is not unique. Several athletes in the past have been banned from the Olympic Games or stripped of their medals due to noncompliance with the standards of the World Anti-Doping Agency (WADA). This raises the question of how are these substances regulated?
When completing drug screenings during the Olympics, substances in question can be broken down into 2 categories: prohibited at all times and prohibited in-competition. Before exploring the specific agents that belong in each category, the difference between these groupings needs to be defined.
When a substance is considered prohibited in-competition, this period begins on midnight the day of competition and continues through the entire duration of the contest. Agents that are deemed prohibited at all times are forbidden both in and out of competition.1
Although there are different levels of prohibition, what determines a substance to be prohibited at all? An agent or method is considered prohibited on the WADA list if it meets 2 of 3 criteria: “it has potential to enhance or enhances sport performance, it represents an actual or potential health risk to the athlete, or it violates the spirit of the sport.”2
WADA is in charge of updating the Prohibited List annually on January 1 following substantial review and consultation.3 There are also identified substances that are not considered prohibited at this time, but WADA is monitoring their effects extensively in athletic competition.
The agents that made the monitoring program in 2021 include bupropion (Wellbutrin), caffeine, nicotine, and phenylephrine.1 Testing is performed at the Olympics through the International Testing Agency (ITA).
Urine or blood samples are gathered from athletes and analyzed through an agency recognized by the WADA. When a urine sample is required, athletes can collect the sample themselves with a representative of the same gender present to mitigate any suspicious activity.4
The comprehensive WADA 2021 Prohibited List can be found on the USDA website. The agents that are prohibited in-competition include stimulants, pseudoephedrine, narcotics, cannabinoids, glucocorticoids, and potentially beta blockers.
Pseudoephedrine is prohibited when an athlete’s urine sample contains more than 150 micrograms/mL of the active ingredient.1
During the 2000 Olympic Games held in Sydney, Australia, a Romanian gymnast was stripped of her gold medal due to a positive drug screening for pseudoephedrine.5 Beta blockers can also be considered prohibited in-competition for certain sports, including auto racing, billiards, darts, golf, skiing, and snowboarding.1
Substances that are considered prohibited at all times are continually being monitored through random drug screenings. The prohibited list for the Tokyo Olympics contained agents that fall into the following categories: anabolic steroids, erythropoietins, peptide hormones, beta-2 agonists, aromatase inhibitors, anti-estrogenic substances, agents preventing activin receptor IIb activation, metabolic modulators, diuretics, and potentially beta blockers.1
In this category, beta-blockers are considered prohibited at all times in archery and shooting.There are many substances that are included on this list that are considered standard medications for certain disease states. For example, many beta-2 agonists are used for asthma exacerbations.There are exceptions for 2 of the medications listed in this drug class: formoterol is allowed to be inhaled up to a maximum of 54 micrograms in 24 hours and almeterol is considered acceptable if inhaled less than 200 micrograms in 24 hours.1
There are 2 prominent medical diagnoses that warrant a Therapeutic Use Exemption (TUE). Type 1 diabetes mellitus is a disorder that is insulin-dependent, requiring affected athletes to have an insulin supply on-hand based on their blood glucose levels.
Insulin is one of the specific agents considered a metabolic modulator, a substance prohibited at all times. Likewise, attention-deficit hyperactivity disorder is a diagnosis that has become more prevalent in recent years.
Many athletes rely on stimulants for treatment and these agents are considered prohibited in-competition.6 TUE applications are submitted anonymously and are extensively reviewed by medical professionals from an array of specialties.
Athletes are required to demonstrate an official diagnosis from a medical professional. Additionally, the agent in question must be used only to bring the athlete back to their “normal level of health, rather than offering performance-enhancing benefits.”6
After reviewing the detailed anti-doping policies exemplified by WADA for Olympic athletes, the ultimate goal is to provide a level playing field for competition. Although there are a lot of substances considered prohibited, athletes need to remain knowledgeable about these agents.
With the help of their athletic and medical team, this is a discussion that needs to be prioritized to ensure everyone is on the same page. Olympians dedicate much of their lives preparing for the peak moments of their athletic career. It is vital that athletes have all of the necessary information at their disposal without jeopardizing years of sacrifice.
About the Author
Payton E. Atkins is a PharmD candidate at the University of Kentucky College of Pharmacy in Lexington. She is a former student-athlete at UK having participated as a member of the UK Women’s Soccer Team.
(1) World Anti-Doping Agency. (2021, January 1). World Anti-Doping Code International Standard Prohibited List 2021. Montreal, Quebec. https://www.usada.org/wp-content/uploads/wada_2021_english_prohibited_list.pdf
(2) World anti-doping Agency (WADA) Prohibited List: USADA. U.S. Anti-Doping Agency (USADA). (2021, June 23). https://www.usada.org/athletes/substances/prohibited-list/.
(3) What is prohibited. World Anti-Doping Agency. (2021, April 26). https://www.wada-ama.org/en/content/what-is-prohibited.
(4) Doping control during the games. Tokyo 2020. (n.d.). https://olympics.com/tokyo-2020/en/games/anti-doping-control/.
(5) Shipley, A. (2000, September 26). Romanian gymnast stripped of gold. The Washington Post. https://www.washingtonpost.com/archive/sports/2000/09/26/romanian-gymnast-stripped-of-gold/e8c4f17a-a86a-41ce-b281-9d71b496d96f/.
(6) What do athletes with ADHD need to know ABOUT TUES: USADA. U.S. Anti-Doping Agency (USADA). (2020, October 19). https://www.usada.org/spirit-of-sport/education/athletes-adhd-know-about-tues/