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WADA updates list of banned substances, including tramadol, a popular opioid painkiller

HEALTH & MEDICINEWADA updates list of banned substances, including tramadol, a popular opioid painkiller

The World Anti-Doping Agency (WADA) has updated the list of banned substances and methods in sports, which will be enforced in 2024. The list includes a popular and potent painkiller from the opioid group, which has been commonly used especially by football players. Substances are put on the list mainly because of their potentially negative impact on athletes’ health. “However, doping does not only concern professional athletes but also amateur athletes,” points out Dr. Michał Rynkowski, the director of the Polish Anti-Doping Agency (POLADA). It’s particularly dangerous as some performance-enhancing substances are produced illegally, without supervision and adhering to safety and hygiene conditions, making them even more treacherous.

“The decision to add a substance or a banned method to the list is made by the committee of the World Anti-Doping Agency. The criteria it uses are related, first of all, to the fact that a given substance may affect or potentially affect the sports result. The second criterion is the impact or potential negative impact on the athlete’s health. And the third, very general criterion, is a contradiction with the spirit of sports. If two of these three criteria are met, then the list committee may decide to include a given substance or method in the registry.” Dr. Michał Rynkowski explains.

In late December, the World Anti-Doping Agency (WADA) published the updated list of banned substances and methods, which will be effective from 2024. It’s an international standard that is part of the World Anti-Doping Program. The list details substances and methods that will result in a positive anti-doping test. They are prohibited both in and out of competition, with some substances pertaining to specific sports. The list is absolutely binding. One of the main changes this year is the inclusion of tramadol, a popular potent painkiller from the opioid group, which is now in group S7 – Narcotics.

“Tramadol is a painkiller that was widely used by athletes in sports such as football, rugby, and cycling. The popularity of this drug led the World Anti-Doping Agency to add it to the list of banned substances, but this was not the only reason – the highly addictive nature of this substance means that it can be treated as a drug. It’s an opioid substance, its use can lead to addiction, onset of depressive states. There was a well-known case of one of the footballers, Chris Kirkland, who attempted suicide and did not hide the fact that after three months of using tramadol he had problems with discontinuing the product.” says the director of POLADA.

Due to the risk of addiction and overdose, tramadol has been banned by the International Cycling Union (UCI) since 2019. Last year in cycling, a major scandal erupted as this substance was detected in the urine sample of Colombian cyclist Nairo Quintana, who was disqualified from the 2022 Tour de France. However, this did not violate anti-doping rules as the then WADA list did not include tramadol.

“On this year’s list, there are also new examples of various banned substances from different groups, but this is more of an organising rather than a revolutionary character. The presence of tramadol is definitely the biggest change.” says Dr. Michał Rynkowski. “These substances, which are on the list, are not there for nothing, as they can adversely affect health. Examples are anabolic androgenic steroids, whose use affects the disruption of the whole hormonal economy, cardiovascular diseases or liver. The consequences are irreversible, even after discontinuing the steroids it is often difficult to return to balance.”

In previous updates of the list, key factors were the rules related to the administration of glucocorticoids. From 2022, their administration during competitions in the form of any injections has been banned. In 2021, a new category of so-called substances of abuse, was added, which includes cocaine, diamorphine (heroin), methylenedioxymethamphetamine (MDMA/”ecstasy”), and tetrahydrocannabinol (THC). As the expert emphasises, updating the list of banned substances is beneficial for athletes – the more specific substances on the list, the easier it is to avoid mistakes and unintentional doping.

“As for the banned substances that could potentially be on the list, they are various analogues of stimulating substances that are not literally mentioned on this list. Their inclusion would give athletes greater comfort in the world of sports and prevent potential mistakes. Because one aspect needs to be noted: the list is open, some groups of substances are only examples and there is a note ‘other substances with a similar chemical structure or biological effect'” the expert adds.

As he points out, statistically about 1-1.5% of tests conducted among athletes end with the detection of banned substances or other violations of anti-doping rules.

“Considering that about 300,000 samples are collected each year, it is not a particularly large number, although in recent years it varied. The COVID-19 pandemic affected the whole sports market but also the way anti-doping controls were carried out.” says the director of the Polish Anti-Doping Agency. “Of course, the question is how much this 1 or 1.5% actually reflects reality, because there are certainly more violations of anti-doping rules. This is shown by the example of the London Olympics, where only one case of detection of banned substances was found, but after re-analysis over 100 were detected. This shows that cases of use of banned substances occur. Today’s methods sometimes do not allow detecting everything that athletes use, and years later we learn that the scale of doping is larger than it may seem.”

The expert notes that doping is not only used by professional athletes, as amateur athletes also use it.

“There are no hard studies on this, we can mainly determine this based on information from the Police or other services that effectively lead to the closure of illegal laboratories producing, for example, anabolic androgenic steroids or warehouses of such substances. We conclude that the scale of the problem is serious, as these substances are produced in large quantities. And if the production is high, it means that the demand is also high.” says Dr. Michał Rynkowski. “Mainly amateur athletes or physically active people, using fitness clubs and gyms, which are more focused on working on their figure than on sports achievements – they are users of these kind of substances.”

The use of doping substances or those increasing the body’s efficiency does not remain without impact on the overall health condition. However, in the case of illegally produced preparations or dietary supplements, the conditions in which they are created and the lack of any certainty about what they actually contain are also a problem.

“They are produced in terrible conditions, which do not meet any safety and hygiene standards, it’s extremely dangerous. For example, the Supreme Audit Office in 2017 tested 100 products, dietary supplements, which were then on the market, and 50% of these products contained either substances banned in sports or those that are dangerous to health. Some of them did not contain declared active substances at all. So this supplement market in addition to hard doping is also specific and one should have limited trust in the products that are used.” emphasises Dr. Michał Rynkowski.

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