The
Pharmaceutical Journal Vol 266 No 7130 p60
I was fortunate to have the opportunity of working as a pharmacist
at the pharmacy in the athletes’ village at the Olympic Games in Sydney, Australia,
last year. It gave me a unique insight into sports medicine and the operation
of an Olympic pharmacy. A team of 20 volunteer pharmacists was chosen from nearly
1,000 applicants from all over Australia to operate the pharmacy over the two-week
period of the games, providing a service to nearly 12,000 athletes.
The pharmacy was within the polyclinic in the village, along with other medical
services including sports medicine, physiotherapy, radiology, dentistry, massage,
hydrotherapy, opthalmology, an emergency department with three intensive care
beds, and general medical consulting services. A team of doctors, nurses, pharmacists
and other health care professionals made up the medical team, all volunteering
their services for the duration of the games.
The polyclinic services were available to all residents of the village, mainly
athletes and team officials. The pharmacy was open from 8am to 11pm daily and
a 24-hour on-call service was available from a resident pharmacist. At any one
time there were up to five pharmacists on duty, processing around 250 prescriptions
daily, approximately 70 per cent of these to athletes.
The most commonly dispensed drug was diclofenac in tablet form, mainly to athletes
with muscle injuries. Other anti- inflammatory drugs were frequently dispensed
including celecoxib, diclofenac topical gel and piroxicam gel. Another popular
drug was loratadine, a non-sedating antihistamine. Sydney’s spring weather seemed
to bring out allergies in foreign visitors.
Antifungal preparations were in huge demand. Athlete’s foot was a common complaint.
Hundreds of tubes of antifungal creams were dispensed, the most common containing
miconazole and clotrimazole.
It was unfortunate that some athletes caught colds and respiratory infections
as this may have impaired their performance. Antibiotics including amoxicillin,
co-amoxiclav, and ciprofloxacin were fast movers along with decongestant nasal
sprays, cough syrups and sore throat lozenges.
Given the location of Australia and the large time differences to many countries,
it was not surprising that jet lag was experienced by many athletes and officials
arriving close to the start of the games. It was important for the athletes
to normalise sleeping patterns quickly to maintain peak performance. Some sedative
drugs were dispensed for this purpose.
Thousands of dollars worth of drugs were dispensed free of charge to residents
of the Olympic village. A large Australian pharmaceutical wholesaler was the
main supplier of drugs to the pharmacy. In its warehouse a separate section
was allocated for the packing and dispatch of drugs for the Olympic pharmacy.
Daily deliveries were received after the order had first been approved by the
Olympic Organising Committee head office. A number of drug companies donated
stock for use during the Olympics.
A computer dispensing program was specifically designed to meet the needs
of the pharmacy. When a drug was dispensed the program would alert the pharmacist
as to the status of the drug in accordance with International Olympic Committee
guidelines on restricted substances in sport.
Drugs could fall into any of three categories. Permitted substances were not
subject to usage restrictions in sport. Prohibited substances were not to be
used by any competing Olympic athlete. Prohibited substances included drugs
such as anabolic agents, stimulants, narcotics, diuretics, peptide hormones,
hormone mimetics and hormone analogues. Other drugs, such as beta-blockers,
are prohibited only in certain sports, including aquatics, archery, football,
shooting and sailing.
Certain drugs, including inhaled b2- agonists, eg, salbutamol and
terbutaline, are classified as “Restricted with notification” substances and
are permitted for use by competing athletes only with prior notification to
the International Olympic Committee.
Extreme caution was exercised when dispensing any drug to competing athletes
to ensure that doping control guidelines were met. Administration routes for
drugs needed close observation. Eye-drops containing prohibited beta-blockers,
eg, timolol, can be absorbed systemically. Betamethasone, a corticosteroid,
was prohibited when administered orally, rectally and by intramuscular and intravenous
injection, but intra-articular and local injection were permitted.
Pharmacists were also asked to check that certain dietary supplements, eg, protein
powders, did not contain restricted substances. Although used by some athletes,
herbal medicines could not be guaranteed as permitted, as constituents can be
unpredictable and possibly result in a positive drug test. For example the herb
Ephedra sinica contains traces of ephedrine which is a prohibited substance.
Any medicine dispensed from the pharmacy, whether to athletes or officials,
had to be on a specially designed prescription form written by an authorised
Australian doctor or a registered international team doctor. Even over-the-counter
drugs, such as throat lozenges and paracetamol, were required to be on prescription.
Patients were given a maximum seven days’ supply of a drug or a complete course
of antibiotics.
Prohibited and restricted substances were clearly labelled as such when dispensed,
confirmed with prescriber, and the patient counselled accordingly. Athletes
were given copies of prescriptions for their own records.
It was challenging trying to counsel non-English speaking patients from many
countries. A team of interpreters was always available to help communicate directions
to the athletes and to help foreign team doctors liaise with pharmacy.
The pharmacy was also the distribution point in the village for free condoms.
This was the first time condoms had been available in an Olympic village, the
concept being a trial for future games. Over the two weeks of the Olympic period,
tens of thousands were given to the athletes.
In the weeks following the Olympic games, the pharmacy served the athletes of
the Paralympic games. There were plans for the athletes’ village after the Olympics.
The polyclinic had been designed in such a way that it could be converted into
a school after the games. The athletes’ residences were to be sold as private
housing, thus creating a new suburb of Sydney.
Working at the Olympic games gave me a once-in-a-lifetime experience, being able to meet Olympic athletes from all over the world and hear their stories. It was challenging to play a part in maintaining the health of the athletes using medicines within the restrictions of Olympic anti-doping rules. Being part of the medical team gave me an inspiring insight into the dedicated lives of the world’s top athletes and valuable experience in the field of sports medicine.