- Email: [email protected]
Doping and athletes—Prevention and counseling
Doping and athletes-Prevention and counseling Svein Oseid,
M.D.
Oslo. Nontg
Doping in sports is an old problem. De~elapmerrt of‘ modern techniques has made doping control possible for all drugs listed on the International Olwnpic Committee’s list. A .wrwy 1.~ given of the preventive measures (antidoping) that haw been carried out in Norway sinw / 97%. This comprises re&ar doping control (during cornpetition and at random in the truininp period) and ertensive injkrmation programs to change attitudes tolcvlrd the use and miwsr 0; drugs in sports. The basic principles of the antidoping c~ampaiprr iwlude upholding the ethic. , I! .sports. protection of athletes’ health, and preservation of’ equal c~l71mc~s ,for all. The campaign IS directed to the athletes, their coaches. and trainers as well as to the tewn ph~sicitrns. the diflkrent sports federations, and the public. The dec~ision to inten.s$v the random control.~ ji)r rrnabolic steroids in loaded sports has increased the number of pcwitive rrsu1t.s substantiallv. 7hc c’oncepts qf’ the antidoping catnpaign are nob\’ wideI! acknon~ledgetl at the national lewl. Rrc~ommertdatior~s are Ri\,en that the result.5 of the Norwegian antidoping work should hr* distributed internutionally. (J ALLERGY CLI:V IMMUNOL 73:73S. I%?4 .)
The idolization of winners and the enormoussocial (and often financial) rewards accordedsuccessfulathletes may tempt many to increase their performance by almost any meansavailable. Unhealthy national chauvinism together with ambition often lies behind these demandsfor increased performance. Athletes can be forced to push themselves further for fame and country than is medically advisable. To raise the level of achievement, modern methodsof training have been developed to the maximum, not always leading to satisfactory results. Many athletesfeel that they are neither able nor willing to submit themselves to more training, harder training, greater sacrifice, or higher stakes. It is therefore “natural” that other methods of achieving sporting victories are being considered.The methods that primarily aim to increase competitive performanceartificially leadsomeathletesto usepreparations broadly classified as drugs. This has created what is called “the doping problem.” “As for technology, modem man is a super human. But as for ethics, there are no more humans.” This quote, in many ways frightening, could possibly characterize athletics, unlessthose interests that causeathletes to aspire to results regardlessof costs can be curtailed.
From the Norwegian College of Physical Education and Sport. the Children’s Asthma and Allergy Institute. Voksentoppen, University Hospital. Oslo. Norway.
and the
The purpose of the present work is therefore to further athletic traditions and maintain an ethical attitude toward the goals and meansof athletics, which condemnsthe use of stimulating agents. UVHAT Is f3a?Pws? The European Council (1963) defined doping as: “the administeringor useof substances in any form alien to the body or of physiolgical substances in abnormalamountsand with abnormalmethodsby healthypersonswith the exclusiveaim of attainingan artificial and Iunfairincreaseof performancein oompetition. Furthermore,variouspsychologicalmethodsto increaseperfomlancein sportmustbe regardedasdoping.” The latter part of this definition is dSicult to interpret, but it originates from the use of hypnosis in sports. However, the effects of suchmethodsare highly questionable and their practice is impossible to monitor, so therefore they will not be consideredfurther in this context. The Joint Nordic Committee for scientitic athletic research (Helsinki. 1972) agreed upon another definition: “Doping comprisesthe administrationof medications-or-the use of other means to artificially increase an athlete’s competitive performance.” This definition is somewhat simpler, but it also involves other meansor methods that may be exrremely dif735
736
Oseid
J. ALLERGY
ficult to control, such as blood doping. Because these definitions and all others put forward to date are lacking, the problem must be examined. SCOPE
OF THE
PROBLEM
To improve athletic performance, drugs that stimulate the central nervous system and the heart and/or working muscles and drugs that stimulate protein synthesis are the most commonly used. The list of doping classes according to the International Olympic Committee (IOC) list includes: (A) psychomotor stimulant drugs, (B) sympathomimetic amines, (C) miscellaneous central nervous system stimulants, (D) narcotic analgesics, and (E) anabolic steroids. These groups of doping substances have been well known for many years, but additional drugs and related compounds have recently been added. The 1983 addition of caffeine and testosterone to the doping list complicated testing: The tests required quantitative analyses while ail other tests to date have been quaiitative only. Definition of a positive test for these additional drugs depends on the following: for caffeine-if the concentration in urine exceeds 15 pg/ml; for testosl terone-if the ratio of the total concentration of testosterone to that of epitestosterone in the urine exceeds 6. In Norway we also deal with a group F, which includes blood doping and drugs not presently included on the IOC list, such as B-blockers and drugs that facilitate the transmission of signals in the synapses. The operational purpose of group F is to state that the use of these drugs and methods is considered unethical even if such use is not presently monitored. However, B-blockers have been listed by the International Shooting Federation, and in 1983 the International Ski Federation stated that blood doping is regarded as doping and that an effort must be made to develop techniques to detect reinfusion of blood to athletes. Some international sports federations have developed their own lists of prohibited drugs, but most federations have recently agreed fhat the IOC list will be basic and will be used in any regulation under their control. Dealing with only one accepted international list of prohibited drugs also causes less confusion when athletes and their coaches are informed about the content of the doping list and also makes it easier to discuss drugs to be added to the list as well as to recommend that drugs be deleted from the list. Today it seems generally accepted that central nervous system stimulants, hormones, and blood doping represent the most severe problems. Various sympa-
CLIN. IMMUNOL. MAY 1984
thomimetics and miscellaneous central nervous system stimulants are being considered for deletion from the list because they pose no practical danger to health and do not increase performance: Typical of these drugs are different antiallergic compounds, cough mixtures, and nose drops. Doping substances can also be listed according to the suitability in relation to the training or the competition: anabolic hormones and neuromuscular stimulation in the training period; blood doping in close connection with a competition; psychomotor stimulant drugs, sympathomimetic amines, and miscellaneous central nervous system stimulants immediately before or during a competition; and miscellaneous drugs or methods after competition or between exercise events to promote restitution. WHY
PROHIBIT
DOPING?
Doping is prohibited for the following important reasons: physical reasons-it is an acute health hazard, and potentially fatal, and there is potential for chronic disability, possible fatal; ethical reasons-the use of doping agents is unethical to the concept of athletics, and use can lead to addiction, which can result in ethical and social degeneration; legal reasons-it is against the Norwegian Confederation of Sport’s statutes, and certain doping agents are also illegal according to the narcotics laws in many countries, and use therefore may be punishable by law. Physical side effects have been reported for several of the drugs on the doping list’. ’ and also by the athletes themselves. As early as 197 1 the ethical reasons were thoroughly discussed by the General Assembly of the Norwegian Confederation of Sport, and a statement was issued that condemned the use of “stimulant drugs and other means to artificially increase performance.” Many doping agents are distributed by the same people that distribute other drugs and narcotics to the young. This creates an additional hazard to health and social degradation as many of these young athletes have become drug addicts. HOW
TO PREVENT
DOPING?
Preventive measures must be based on the following two assumptions: acknowledgment that doping exists, even in our own environment and realization that prevention is better than therapy. The Norwegian antidoping programs have been worked out according to these assumptions. Since 1976 our efforts have been concentrated on both doping control (during competition and at random in the training period) and an extensive information program to change attitudes toward the use and misuse of drugs
VOLUME NUMRER
73 5 PART 2
TABLE I. Doping control, Norway
Doping
TABLE
1982
No. of controls: 77 + World ski championships. Nordic events Notified controls: I? + World ski championships. Nordic events Without prior notice: 65 Controls in connection with competition: Controls during the training period: Controls after summons: Total
no.
of tests:
539
(including world ski championships, Nordic events = 78) No. of dispatches to test laboratory:
9
in sports. These programs have been directed to the athlete, their coaches, and trainers as well as to the team physicians, the different sportsfederations, and the public. Doping control The Norwegian Confederation of Sport, General Assembly. decided in 1976to institute regular doping control for anabolic steroids, and these controls were started in 1977 according to the following guidelines: ( I) Prior to departure for international championships, selectedgroupsof Norwegian athleteswill be checked medically to determine if anabolic steroidshave been used; (2) randomcontrols may be carried out on Norwegian representatives in international competitions and at various times during the year to monitor the use of anabolic steroids; (3) each year doping tests will be carried out at selected Norwegian championships; and (4) the Sports Council takes the initiative to establishthesecontrols and tests. The arrangements and procedureswill be carried out in cooperation between the Sports Confederation, the Medical Council. the relevant sportsfederation (through its medicalcontact board), the medical officer of the meeting, and the analytic laboratory in question. Checksand doping tests must at all times be carried out within the established financial framework. All expensesconnected with Norwegian control proceduresare covered by the Sports Confederation budget, with an annual budget of 250.000 to 400.000 Norwegian Krugerrands (U.S. $35,000 to $45.000) for doping control. From 1979 the control measureswere extended to include all athletes regardlessof age, sex, athletic discipline, or individual performing capacity. From 1980the doping control programshave beenextended to include all drugs and agents adopted by the IOC Medical Commission list. From 1977 through 1982 there were relatively few positive test results,probably
ar!liete:j
737
II. Which sports were controlied? -_-_. -._-..--_-sport
48 21 8
a~::
Skating Skiing (Nordic and Alpine) Power lifting Judo Weight lifting Track and field Bowling
No. of controls
No.
of tests
.3 I1 Ii 7
Rowing Cycling
Iii
Orienteering Wrestling Water skiing
Swimminganddiving Canoeing Shooting Boxing
Archery Tennis
Motor cycling Karate Basketball Ice hockey and bandy
Handball Volleyball Tabletennis
TABLE
13. Top level athletics
without
doping
Aim: To test top Norwegian athletes regularly for anabolic steroids and central nervous system stimulants during the
preparationperiodfor the SummerandWinter Olympic Games Results ( 1980 Olympics): I7 Controls performed during 9 mo: 7 different sports
were checked 104individual testswere performed(87 maleathletes--I7 femaleathletesI* *All
tests were ne;:ative.
becausewe tested athletes in almost all sports and therefore included athletes who were lesslikely to be drug consumers. It was part of a general preventive program. Since 1980 it hasbecomeobvious that somesports (such as power lifting, weight lifting, and throwing events in track and field) were more loaded with drug problemsthan other sports-hence the term “loaded sports.” Thesefacts were consideredby the Norwegian Confederation of Sport. which led to another decision madeby the General Assembly in 1982 to: ( 1) intensify the random control for both anabolic steroidsand
738
J. ALLERGY
Oseid
central nervous system stimulants; (2) direct the controls more specifically toward sports and individual exercises that are known to be loaded; (3) increase the random controls during the training period; (4) demand that disqualified athletes submit to doping control regularly during the period of suspension; and (5) increase the sports confederation’s budget for doping control. In 1982 altogether 539 tests were carried out, mostly in connection with competition but a fair number also in the training period (Table I). In 1983 this was reversed; most of the controls were at random and in the training period. This resulted in four times as many positive test results during I yr than in the previous years together. Table 11 shows the sports that were controlled and illustrates the more frequent controls of power lifters and weight lifters and also athletes in field events. At the initiative of some of our top athletes (among them both winners and medalists in Olympic events and world championships). the project “Top Level Athletics Without Doping” was launched. These athletes wished to prove that it is possible to reach the top without using stimulant drugs or hormones. The results are shown in Table III. Preventive
measures
(“antidoping”)
Experience has shown that in addition to regular random controls, information programs and actions to influence attitudes are equally important. Such programs must consider what can be done to limit the extent of doping in sports. both at the national level and internationally. The most important tasks are to: ( I) provide information about the dangers of doping to health; (2) provide information about the limited value of most doping agents in increasing the performance; (3) attempt to produce ethical attitudes toward the goals and means of sports. directly leading to condemnation of doping and other artificial means used to achieve better results; (4) prepare and distribute exact and detailed lists of different doping agents, stating both the chemical composition and trade names of the various drugs in alphabetical order and in accordance with international resolutions; (5) work toward a stricter control over doctors’ prescriptions of medications falling under the concept of doping; (6) demand that more severe action be taken. not only of athletes but also of coaches and leaders having been found guilty of introducing doping agents to athletes; (7) institute and support practical and regular doping tests also at the national level by putting economic means at organizers’ disposal: (8) cooperate with the custom officials to prevent substantial import of drugs:
CLIN.
IMMUNOL. MAY 1984
and (9) cooperate with the police authorities to prevent distribution of narcotic drugs and doping agents. GUIDELINES
FOR THE ATHLETES
Our information programs are primarily directed toward the athletes. According to the guidelines an athlete must: know the doping regulations equally as well as the rules for competition. know the dangers of doping to health, know the doping classes with examples of relevant drugs (both the IOC list and the list of the individual international federation), know the procedural guidelines for doping control, know the consequences of refusing doping control and of a positive test result, know how to obtain a declaration in case of dependence on regular use of any drug for medical reasons, realize that import and distribution of prohibited drugs is strictly forbidden, realize the responsibility toward other members of the team in case of doping control, and demand that coaches/leaders procure necessary informational material about doping. In case an athlete is dependent on regular use of any drug(s) for medical reasons he should note the following recommendations: don’t stop taking the drug, and contact his physician to obtain information whether the drug contains any prohibited substances. The athlete should also consider the following possibilities: that he can stop taking the drug in connection with the competition involved, that he temporarily can use another drug of similar effect that is not prohibited. or that he can change to regular use of another drug composed of accepted substances. If the athlete’s physician states that it is not advisable or is contraindicated to change to another drug, he must request a written declaration so stating. This declaration must include: information about the medical condition or handicap and what kind of drug(s) the athlete is dependent on (the trade name and chemical composition). This document must be presented to the physician of the meet or the leader of the doping commission before the competition. Forms for such declarations have been worked out and distributed to team physicians and physicians attached to the different federations. Thus far these declarations are valid only at the national level and not internationally. The main reason for these exceptions is that many athletes depend on regular use of various antiallergic drugs that are still banned. In addition, allergic athletes are informed about allergen elimination. occasional pharmacoprophylaxis (premeditation) to prevent exercise-induced asthma. and continuous pharmacoprophylaxis (medication taken one to four times daily. long term. if required to
VOLUME
;‘3
NUMBER
5. PART 2
Doping an;! athletes 739
preventboth asthmaand allergic rhinitis). Because asthma or bronchial obstruction is a multifactorial disease, athletes should also be thoroughly informed about the different provocative causes and the reasons for changes in tolerance thresholds with respect to exrrcise. Since outdoor sports are very popular in Scandinavia regardless of the weather conditions, asthmatics suffer more on cold and windy days. To overcome this problem, various face masks to prevent cold, dry air from entering the airways have been tried with promising results in asthma-disposed athletes.
GUIDELINES
FOR COACHES/LEADERS
The coach/leader must: know the guidelines for the athletes, increase his knowledge about doping to better be able to inform the athletes, suit information to the different groups of athletes (age groups, level of education. etc.). plan and arrange teaching sessions about doping, develop a two-way communication system and open support in case of problems, stimulate contact with the athlete’s surroundings (parents, school. working place, etc.), stimulate contacts with mass media to increase the level of information, show a positive attitude to and respect for the rules and ethics of sports, be prepared to deal with the problems in case of drug misuse, be aware of the dangers and temptations involved when an athlete travels abroad. be prepared to assist in doping control of his own athletes, and increase his knowledge about training principles and new developments to be able to substitute eventual drug misuse with better training.
In informationprogramsit is importantro btzaware of all the different problems that may arise. A few of them are listed below: (1) Different international federations have different lists of doping agents; (2) there are different prescription rules and attrtude:, in different countries: (3) different sanctions are practiced by the international federations; (4) the tcsrosteronc:epitestosterone ratio indicative of a posttivr: test result is still being debated; (5) the question of what is doping and what is therapy; and (6) the long-tertn side effects of doping agents. particularly hormone\. arc not well known in contrast to the immediate sidr reactions. We presume that most of the reactions disappear when drug intake is stopped-but wc do not really- know. The future of doping in sports is uncertain. but we must strive to obtain mutual international agreement about the necessity of efficient doping control, not only at international competitions but also randomly at the national level. Our information programs must bc extensive and realistic. and we must move forward with ongoing vigilance to protect sport as well as athletes from being degraded. Many questions remain unanswered. But the goal of responsible leadership is clear: to eradicate abuse and assure thck good health of our athletes. REFERENCES I.
Prokup Med
2. Lamb work I983
L: Dnq 3:85-7.
abuse
in intemattonal
athlrtt
XRI
J Sports
well Med
do they 17:.71-X.
I975
DR: Allabolic steroids in athletics: NW and hou dangerous are they? MI J Spvn\
M.D.
Oslo. Nontg
Doping in sports is an old problem. De~elapmerrt of‘ modern techniques has made doping control possible for all drugs listed on the International Olwnpic Committee’s list. A .wrwy 1.~ given of the preventive measures (antidoping) that haw been carried out in Norway sinw / 97%. This comprises re&ar doping control (during cornpetition and at random in the truininp period) and ertensive injkrmation programs to change attitudes tolcvlrd the use and miwsr 0; drugs in sports. The basic principles of the antidoping c~ampaiprr iwlude upholding the ethic. , I! .sports. protection of athletes’ health, and preservation of’ equal c~l71mc~s ,for all. The campaign IS directed to the athletes, their coaches. and trainers as well as to the tewn ph~sicitrns. the diflkrent sports federations, and the public. The dec~ision to inten.s$v the random control.~ ji)r rrnabolic steroids in loaded sports has increased the number of pcwitive rrsu1t.s substantiallv. 7hc c’oncepts qf’ the antidoping catnpaign are nob\’ wideI! acknon~ledgetl at the national lewl. Rrc~ommertdatior~s are Ri\,en that the result.5 of the Norwegian antidoping work should hr* distributed internutionally. (J ALLERGY CLI:V IMMUNOL 73:73S. I%?4 .)
The idolization of winners and the enormoussocial (and often financial) rewards accordedsuccessfulathletes may tempt many to increase their performance by almost any meansavailable. Unhealthy national chauvinism together with ambition often lies behind these demandsfor increased performance. Athletes can be forced to push themselves further for fame and country than is medically advisable. To raise the level of achievement, modern methodsof training have been developed to the maximum, not always leading to satisfactory results. Many athletesfeel that they are neither able nor willing to submit themselves to more training, harder training, greater sacrifice, or higher stakes. It is therefore “natural” that other methods of achieving sporting victories are being considered.The methods that primarily aim to increase competitive performanceartificially leadsomeathletesto usepreparations broadly classified as drugs. This has created what is called “the doping problem.” “As for technology, modem man is a super human. But as for ethics, there are no more humans.” This quote, in many ways frightening, could possibly characterize athletics, unlessthose interests that causeathletes to aspire to results regardlessof costs can be curtailed.
From the Norwegian College of Physical Education and Sport. the Children’s Asthma and Allergy Institute. Voksentoppen, University Hospital. Oslo. Norway.
and the
The purpose of the present work is therefore to further athletic traditions and maintain an ethical attitude toward the goals and meansof athletics, which condemnsthe use of stimulating agents. UVHAT Is f3a?Pws? The European Council (1963) defined doping as: “the administeringor useof substances in any form alien to the body or of physiolgical substances in abnormalamountsand with abnormalmethodsby healthypersonswith the exclusiveaim of attainingan artificial and Iunfairincreaseof performancein oompetition. Furthermore,variouspsychologicalmethodsto increaseperfomlancein sportmustbe regardedasdoping.” The latter part of this definition is dSicult to interpret, but it originates from the use of hypnosis in sports. However, the effects of suchmethodsare highly questionable and their practice is impossible to monitor, so therefore they will not be consideredfurther in this context. The Joint Nordic Committee for scientitic athletic research (Helsinki. 1972) agreed upon another definition: “Doping comprisesthe administrationof medications-or-the use of other means to artificially increase an athlete’s competitive performance.” This definition is somewhat simpler, but it also involves other meansor methods that may be exrremely dif735
736
Oseid
J. ALLERGY
ficult to control, such as blood doping. Because these definitions and all others put forward to date are lacking, the problem must be examined. SCOPE
OF THE
PROBLEM
To improve athletic performance, drugs that stimulate the central nervous system and the heart and/or working muscles and drugs that stimulate protein synthesis are the most commonly used. The list of doping classes according to the International Olympic Committee (IOC) list includes: (A) psychomotor stimulant drugs, (B) sympathomimetic amines, (C) miscellaneous central nervous system stimulants, (D) narcotic analgesics, and (E) anabolic steroids. These groups of doping substances have been well known for many years, but additional drugs and related compounds have recently been added. The 1983 addition of caffeine and testosterone to the doping list complicated testing: The tests required quantitative analyses while ail other tests to date have been quaiitative only. Definition of a positive test for these additional drugs depends on the following: for caffeine-if the concentration in urine exceeds 15 pg/ml; for testosl terone-if the ratio of the total concentration of testosterone to that of epitestosterone in the urine exceeds 6. In Norway we also deal with a group F, which includes blood doping and drugs not presently included on the IOC list, such as B-blockers and drugs that facilitate the transmission of signals in the synapses. The operational purpose of group F is to state that the use of these drugs and methods is considered unethical even if such use is not presently monitored. However, B-blockers have been listed by the International Shooting Federation, and in 1983 the International Ski Federation stated that blood doping is regarded as doping and that an effort must be made to develop techniques to detect reinfusion of blood to athletes. Some international sports federations have developed their own lists of prohibited drugs, but most federations have recently agreed fhat the IOC list will be basic and will be used in any regulation under their control. Dealing with only one accepted international list of prohibited drugs also causes less confusion when athletes and their coaches are informed about the content of the doping list and also makes it easier to discuss drugs to be added to the list as well as to recommend that drugs be deleted from the list. Today it seems generally accepted that central nervous system stimulants, hormones, and blood doping represent the most severe problems. Various sympa-
CLIN. IMMUNOL. MAY 1984
thomimetics and miscellaneous central nervous system stimulants are being considered for deletion from the list because they pose no practical danger to health and do not increase performance: Typical of these drugs are different antiallergic compounds, cough mixtures, and nose drops. Doping substances can also be listed according to the suitability in relation to the training or the competition: anabolic hormones and neuromuscular stimulation in the training period; blood doping in close connection with a competition; psychomotor stimulant drugs, sympathomimetic amines, and miscellaneous central nervous system stimulants immediately before or during a competition; and miscellaneous drugs or methods after competition or between exercise events to promote restitution. WHY
PROHIBIT
DOPING?
Doping is prohibited for the following important reasons: physical reasons-it is an acute health hazard, and potentially fatal, and there is potential for chronic disability, possible fatal; ethical reasons-the use of doping agents is unethical to the concept of athletics, and use can lead to addiction, which can result in ethical and social degeneration; legal reasons-it is against the Norwegian Confederation of Sport’s statutes, and certain doping agents are also illegal according to the narcotics laws in many countries, and use therefore may be punishable by law. Physical side effects have been reported for several of the drugs on the doping list’. ’ and also by the athletes themselves. As early as 197 1 the ethical reasons were thoroughly discussed by the General Assembly of the Norwegian Confederation of Sport, and a statement was issued that condemned the use of “stimulant drugs and other means to artificially increase performance.” Many doping agents are distributed by the same people that distribute other drugs and narcotics to the young. This creates an additional hazard to health and social degradation as many of these young athletes have become drug addicts. HOW
TO PREVENT
DOPING?
Preventive measures must be based on the following two assumptions: acknowledgment that doping exists, even in our own environment and realization that prevention is better than therapy. The Norwegian antidoping programs have been worked out according to these assumptions. Since 1976 our efforts have been concentrated on both doping control (during competition and at random in the training period) and an extensive information program to change attitudes toward the use and misuse of drugs
VOLUME NUMRER
73 5 PART 2
TABLE I. Doping control, Norway
Doping
TABLE
1982
No. of controls: 77 + World ski championships. Nordic events Notified controls: I? + World ski championships. Nordic events Without prior notice: 65 Controls in connection with competition: Controls during the training period: Controls after summons: Total
no.
of tests:
539
(including world ski championships, Nordic events = 78) No. of dispatches to test laboratory:
9
in sports. These programs have been directed to the athlete, their coaches, and trainers as well as to the team physicians, the different sportsfederations, and the public. Doping control The Norwegian Confederation of Sport, General Assembly. decided in 1976to institute regular doping control for anabolic steroids, and these controls were started in 1977 according to the following guidelines: ( I) Prior to departure for international championships, selectedgroupsof Norwegian athleteswill be checked medically to determine if anabolic steroidshave been used; (2) randomcontrols may be carried out on Norwegian representatives in international competitions and at various times during the year to monitor the use of anabolic steroids; (3) each year doping tests will be carried out at selected Norwegian championships; and (4) the Sports Council takes the initiative to establishthesecontrols and tests. The arrangements and procedureswill be carried out in cooperation between the Sports Confederation, the Medical Council. the relevant sportsfederation (through its medicalcontact board), the medical officer of the meeting, and the analytic laboratory in question. Checksand doping tests must at all times be carried out within the established financial framework. All expensesconnected with Norwegian control proceduresare covered by the Sports Confederation budget, with an annual budget of 250.000 to 400.000 Norwegian Krugerrands (U.S. $35,000 to $45.000) for doping control. From 1979 the control measureswere extended to include all athletes regardlessof age, sex, athletic discipline, or individual performing capacity. From 1980the doping control programshave beenextended to include all drugs and agents adopted by the IOC Medical Commission list. From 1977 through 1982 there were relatively few positive test results,probably
ar!liete:j
737
II. Which sports were controlied? -_-_. -._-..--_-sport
48 21 8
a~::
Skating Skiing (Nordic and Alpine) Power lifting Judo Weight lifting Track and field Bowling
No. of controls
No.
of tests
.3 I1 Ii 7
Rowing Cycling
Iii
Orienteering Wrestling Water skiing
Swimminganddiving Canoeing Shooting Boxing
Archery Tennis
Motor cycling Karate Basketball Ice hockey and bandy
Handball Volleyball Tabletennis
TABLE
13. Top level athletics
without
doping
Aim: To test top Norwegian athletes regularly for anabolic steroids and central nervous system stimulants during the
preparationperiodfor the SummerandWinter Olympic Games Results ( 1980 Olympics): I7 Controls performed during 9 mo: 7 different sports
were checked 104individual testswere performed(87 maleathletes--I7 femaleathletesI* *All
tests were ne;:ative.
becausewe tested athletes in almost all sports and therefore included athletes who were lesslikely to be drug consumers. It was part of a general preventive program. Since 1980 it hasbecomeobvious that somesports (such as power lifting, weight lifting, and throwing events in track and field) were more loaded with drug problemsthan other sports-hence the term “loaded sports.” Thesefacts were consideredby the Norwegian Confederation of Sport. which led to another decision madeby the General Assembly in 1982 to: ( 1) intensify the random control for both anabolic steroidsand
738
J. ALLERGY
Oseid
central nervous system stimulants; (2) direct the controls more specifically toward sports and individual exercises that are known to be loaded; (3) increase the random controls during the training period; (4) demand that disqualified athletes submit to doping control regularly during the period of suspension; and (5) increase the sports confederation’s budget for doping control. In 1982 altogether 539 tests were carried out, mostly in connection with competition but a fair number also in the training period (Table I). In 1983 this was reversed; most of the controls were at random and in the training period. This resulted in four times as many positive test results during I yr than in the previous years together. Table 11 shows the sports that were controlled and illustrates the more frequent controls of power lifters and weight lifters and also athletes in field events. At the initiative of some of our top athletes (among them both winners and medalists in Olympic events and world championships). the project “Top Level Athletics Without Doping” was launched. These athletes wished to prove that it is possible to reach the top without using stimulant drugs or hormones. The results are shown in Table III. Preventive
measures
(“antidoping”)
Experience has shown that in addition to regular random controls, information programs and actions to influence attitudes are equally important. Such programs must consider what can be done to limit the extent of doping in sports. both at the national level and internationally. The most important tasks are to: ( I) provide information about the dangers of doping to health; (2) provide information about the limited value of most doping agents in increasing the performance; (3) attempt to produce ethical attitudes toward the goals and means of sports. directly leading to condemnation of doping and other artificial means used to achieve better results; (4) prepare and distribute exact and detailed lists of different doping agents, stating both the chemical composition and trade names of the various drugs in alphabetical order and in accordance with international resolutions; (5) work toward a stricter control over doctors’ prescriptions of medications falling under the concept of doping; (6) demand that more severe action be taken. not only of athletes but also of coaches and leaders having been found guilty of introducing doping agents to athletes; (7) institute and support practical and regular doping tests also at the national level by putting economic means at organizers’ disposal: (8) cooperate with the custom officials to prevent substantial import of drugs:
CLIN.
IMMUNOL. MAY 1984
and (9) cooperate with the police authorities to prevent distribution of narcotic drugs and doping agents. GUIDELINES
FOR THE ATHLETES
Our information programs are primarily directed toward the athletes. According to the guidelines an athlete must: know the doping regulations equally as well as the rules for competition. know the dangers of doping to health, know the doping classes with examples of relevant drugs (both the IOC list and the list of the individual international federation), know the procedural guidelines for doping control, know the consequences of refusing doping control and of a positive test result, know how to obtain a declaration in case of dependence on regular use of any drug for medical reasons, realize that import and distribution of prohibited drugs is strictly forbidden, realize the responsibility toward other members of the team in case of doping control, and demand that coaches/leaders procure necessary informational material about doping. In case an athlete is dependent on regular use of any drug(s) for medical reasons he should note the following recommendations: don’t stop taking the drug, and contact his physician to obtain information whether the drug contains any prohibited substances. The athlete should also consider the following possibilities: that he can stop taking the drug in connection with the competition involved, that he temporarily can use another drug of similar effect that is not prohibited. or that he can change to regular use of another drug composed of accepted substances. If the athlete’s physician states that it is not advisable or is contraindicated to change to another drug, he must request a written declaration so stating. This declaration must include: information about the medical condition or handicap and what kind of drug(s) the athlete is dependent on (the trade name and chemical composition). This document must be presented to the physician of the meet or the leader of the doping commission before the competition. Forms for such declarations have been worked out and distributed to team physicians and physicians attached to the different federations. Thus far these declarations are valid only at the national level and not internationally. The main reason for these exceptions is that many athletes depend on regular use of various antiallergic drugs that are still banned. In addition, allergic athletes are informed about allergen elimination. occasional pharmacoprophylaxis (premeditation) to prevent exercise-induced asthma. and continuous pharmacoprophylaxis (medication taken one to four times daily. long term. if required to
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preventboth asthmaand allergic rhinitis). Because asthma or bronchial obstruction is a multifactorial disease, athletes should also be thoroughly informed about the different provocative causes and the reasons for changes in tolerance thresholds with respect to exrrcise. Since outdoor sports are very popular in Scandinavia regardless of the weather conditions, asthmatics suffer more on cold and windy days. To overcome this problem, various face masks to prevent cold, dry air from entering the airways have been tried with promising results in asthma-disposed athletes.
GUIDELINES
FOR COACHES/LEADERS
The coach/leader must: know the guidelines for the athletes, increase his knowledge about doping to better be able to inform the athletes, suit information to the different groups of athletes (age groups, level of education. etc.). plan and arrange teaching sessions about doping, develop a two-way communication system and open support in case of problems, stimulate contact with the athlete’s surroundings (parents, school. working place, etc.), stimulate contacts with mass media to increase the level of information, show a positive attitude to and respect for the rules and ethics of sports, be prepared to deal with the problems in case of drug misuse, be aware of the dangers and temptations involved when an athlete travels abroad. be prepared to assist in doping control of his own athletes, and increase his knowledge about training principles and new developments to be able to substitute eventual drug misuse with better training.
In informationprogramsit is importantro btzaware of all the different problems that may arise. A few of them are listed below: (1) Different international federations have different lists of doping agents; (2) there are different prescription rules and attrtude:, in different countries: (3) different sanctions are practiced by the international federations; (4) the tcsrosteronc:epitestosterone ratio indicative of a posttivr: test result is still being debated; (5) the question of what is doping and what is therapy; and (6) the long-tertn side effects of doping agents. particularly hormone\. arc not well known in contrast to the immediate sidr reactions. We presume that most of the reactions disappear when drug intake is stopped-but wc do not really- know. The future of doping in sports is uncertain. but we must strive to obtain mutual international agreement about the necessity of efficient doping control, not only at international competitions but also randomly at the national level. Our information programs must bc extensive and realistic. and we must move forward with ongoing vigilance to protect sport as well as athletes from being degraded. Many questions remain unanswered. But the goal of responsible leadership is clear: to eradicate abuse and assure thck good health of our athletes. REFERENCES I.
Prokup Med
2. Lamb work I983
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abuse
in intemattonal
athlrtt
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I975
DR: Allabolic steroids in athletics: NW and hou dangerous are they? MI J Spvn\