Sports Pharmacy Consulting for Drugs Banned In-Competition

When substances are prohibited in-competition only, consult a sports pharmacist.

When certain drug use (including prescriptions, Over-The-Counter drugs, illicit drugs or dietary supplements) is okay outside of an event and not allowed during an event period, this is referred to as “Prohibited In-Competition Only” by WADA. It can vary by sport and competition; so, look closely at the details with your patient-athlete. This may be unlike NCAA Banned Substances List or Professional sports lists of banned substances.

As pharmacists know, human beings metabolize medications at different rates, and even personal lifestyle choices and demographic changes will affect clearance rates within an individual. The time it takes for a substance to become undetectable in a sample of an athlete has to be considered with the same confounding factors. That is why expert pharmacists (or other expert antidoping healthcare providers) would provide directions to individuals, instead of publishing guidelines for athletes on clearance.

Athletes must avoid many drugs and other substances during the In-Competition period, such as stimulants, psychoactive drugs, and certain uses of steroidal anti-inflammatories (glucocorticoids / corticosteroids). The American public learned about the marijuana anti-doping rule violation by a star athlete just prior to the Tokyo 2020 Olympics. Our first thought, in jest, was, “Well, that athlete didn’t ask a sports pharmacist how long it would take to clear from the body.”

That athlete’s story is a much more complex case involving personal tragedy, self-treatment, and a possible misunderstanding of the definition of Out-of-Competition use or clearance of a substance. Determining cannabis clearance from the body requires an in depth use history and transparency from the user about the Cannabis spp., route, frequency of use, along with the most recent use and all the standard Comprehensive Medication List work up done by a pharmacist. Yet, this substance clearance is still seemingly unpredictable in some users. We almost exclusively warn elite athletes that using marijuana is at the risk of testing positive at any event, and that warning should include use of some CBD products.

One category of substances prohibited by WADA In-Competition Only that will soon have more detailed guidance for healthcare providers working with athletes is glucocorticoids (also called corticosteroids). For 2022, WADA will provide additional guidance on clearance of glucocorticoids as changes come again to this category of substances. All injectable glucocorticoids will be prohibited in competition.

Please read about the washout periods described in “A novel approach to improve detection of glucocorticoid doping in sport with new guidance for physicians prescribing for athletes” published prior to the 2022 WADA Prohibited List changes.

Several patient-athlete advocacy groups and international federations of sport applaud the change to ban the use of all injectable corticosteroids during or leading up to events. Union Cycliste Internationale may be one of the most well-recognized organizations supporting this change to the prohibited list, which puts the health of the athlete ahead of the win-at-all-costs mentality. Pharmacists can quickly get on board with this patient-athlete advocacy step!

Other categories of prohibited substances are much less likely to have such specific guidance any time soon. With that, pharmacist role in interpreting pharmacokinetic factors related to individual patient-athletes remains vital to avoiding accidental doping with prescriptions and over-the-counter products (or recreational, decriminalized drug use) prohibited in-competition.