Magazine article Drug Topics

Are You Dispensing to Athletes? Beware of Banned Substances

Magazine article Drug Topics

Are You Dispensing to Athletes? Beware of Banned Substances

Article excerpt

Think your everyday patients have trouble keeping track of their medications? Pity the poor athletes. They have 24,000 substances to worry about. That imposing figure is actually the number of substances banned by the International Olympic Committee aOC) or the National Collegiate Athletic Association (NCAA), noted Jack Rosenberg, Pharm.D., Ph.D., professor of pharmacology and pharmacy practice and director of International Drug Information Center, Arnold & Marie Schwartz College of Pharmacy & Health Sciences, Long Island University.

Compounding the problem is the recent call for an independent agency-not managed by the IOC-to handle doping control of athletes. This is expected to subject athletes to stricter screening.

According to Rosenberg, a list called the Athletic Drug Reference, published jointly by Glaxo Wellcome, Research Triangle Park, N.C., and Clean Data, in Durham, will be available in a new, updated version this month. It can be obtained from a Glaxo representative or by calling Clean Data directly, at (919) 544-8752.

One might assume that if there's a list of these substances available for the reading, athletes have no excuse for getting "caught in the cup" with them, so to speak. Not so, noted Peter J. Ambrose, Pharrm.D., associate clinical professor, School of Pharmacy, University of California, San Francisco. Unfortunately, Ambrose said, several of the substances banned from competition may be those actually taken for a legitimate medical reason. For instance, beta-blockers, normally used to control blood pressure, are also employed by rifle competitors and archers to slow their heart rate and steady their hands. The good news for the legitimate user is that these agents can often be replaced by other blood pressure-controlling medications that aren't on the black list.

Another example of often innocently taken substances are the active ingredients in over-the-counter decongestants and cough and cold formulas. Many of these products contain phenylpropanolamine or pseudoephedrine (which are banned by the IOC) or ephedrine (recently banned by both the IOC and the NCAA). In these cases, suitable alternatives are not as easy to come by. Though a nasal spray, which has a much lower concentration of the active ingredient, might be an acceptable substitute, Ambrose stressed that competing athletes are best advised to avoid formulas containing any of these drugs altogether-in any form-during competition.

Unfortunately, even some drugs that are very difficult to replace may be on the banned list For instance, bronchodilators, used to treat asthma, are another substance under scrutiny with a legitimate indication, said Ambrose. In their case, finding an effective alternative can be quite challenging. Still, despite the difficulty in replacing bronchodilators, several athletic governing bodies ban them because of their wrongful use as stimulants. But Ambrose, a volunteer crew chief in the NCAA's drug-testing program, said he knows for sure that the NCAA doesn't ban inhalation bronchodilators, although it may ban oral forms. A caveat, though, added Rosenberg: The USOC permits inhaled albuterol, salmeterol, and terbutaline only with prior written permission.

Perhaps one of the most difficult substances to deal with is an anabolic androgenic steroid. If a male athlete is taking it because his body does not produce enough of it, said Ambrose, there really is no other option. He emphasized that although he is not the official spokesperson for the NCAA, he has learned from his experience as an NCAA crew chief that "it is not the NCAA's position to withhold legitimate medication from student athletes when it's medically indicated." He said he believes that what the NCAA is trying to do is "make sure that the playing field is even ... and protect the health and welfare of the athlete, directly or indirectly."

So what should an athlete who is taking a medication that's on the banned substances list do? …

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