Cultural Drug Facts and Comparisons: Precautions for your traveling patient-athletes

Sports pharmacists offer advice in travel medicine, personalized for the patient-athlete or team physician, since the rules and regulations of the destination country are often different than the traveler’s home country. 

Import personal prescriptions or purchase local treatments

Carrying one’s own prescription medications and a limited supply of self-treatment medications offers the patient-athlete time to plan ahead and review with the pharmacist to verify the treatments selected are okay for a competitive athlete and okay to import into the destination country. Sports pharmacists review destination country travel rules for drug importation (including a review for what is illegal, such as traveling with cannabinoids), IOC travel recommendations to athletes, and consider alternatives or non-pharmaceutical options. Seeking therapeutic use exemptions when necessary for the patient-athlete is also vital in this planning process if going to a competitive event.

Purchasing locally, after arrival, can increase the risk for travelers unfamiliar with local medicine nomenclature, cultural medical practices, or the standard for government regulatory system for purity, labeling, and handling.

Precautionary advice for your traveling patient-athletes

Pharmacists should warn their patient-athletes about risks with sampling local medications or seeking self-treatment while abroad. Some medications that are prescription only in one country may be purchased directly from the pharmacist without a physician’s medical diagnosis in other countries. At times, the local drug name may be different from the registered International Non-Proprietary Name listed on the prohibited list as an example and may not be found in the athletes’ banned substance search engines. Similar or same brand names (registered, trademark, or label names) may have different ingredients in other countries.

Herbal therapies taken at the athlete’s own risk require additional research, since most cannot be checked against the prohibited substances lists, as only single chemicals are almost exclusively listed.

It is equally important for sports pharmacists to counsel their patient-athletes against the use of herbal products that may be a health risk or enhance performance to violate the spirit of sport. Without examples of herbal therapies on the prohibited substance list, pharmacists may do additional research on the mechanism of action, multi-ingredient product synergy or antagonism, and then weigh these findings against the risk that an herb (or herbal combination) is prohibited, mimics a prohibited substance effect, or may possibly be a health concern for a patient-athletes. Sports pharmacists should contact the local or world antidoping regulatory body for direction if they find an herb of high concern.

Complexity of mixed chemical constituents in herbal therapies

First hand knowledge of herbal products leads me to call for pharmacists to ask their patient-athletes directly, “What herbal products do you use or might you use?”

While in Zhejiang, China studying Chinese medicine and Mandarin, my herbal medicine professor taught me product identification and recipes. Traditional Chinese Medicine uses treatments to balance body energy as primary prevention, with the concept of synergy and antagonism woven deep in to selecting herbal combinations.

In the late 1990s, the chemical constituents were not yet well defined for individual herbal substances they way they are these days. Yet, three decades later, some of these may be candidates as prohibited substances, but await further evaluation by antidoping scientists. 

When used in a TCM herbal combination, the performance enhancing effects of one chemical may be diminished entirely by the selective addition of another herb. This is the yin-yang, the harmonious balance of Chinese medication that could negate the concern for doping or, instead, keep it under the radar.