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	The Pharmaceutical Journal Vol 268 No 7184 p170 9 February 2002	This article Reprint Photocopy
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News feature

Keeping up with the cheats: novel pharmaceuticals and drugs in sport

With the 2002 Winter Olympics starting this week, the issue of drugs in sport is back in the news. Particular attention has been given to the use of new pharmaceutical products which may evade the drug testers net. Jonathan Buisson investigates

Related websites
World Anti-Doping Agency's website (www.wada-ama.org)
UK Sport (www.uksport.gov.uk)

Pharmacists wanted for Commonwealth Games this summer

Pharmacists are being asked to volunteer to help run a pharmacy for the Commonwealth Games in Manchester and north west England from 25 July to 4 August. Volunteers will be expected to work eight 8.5 hour shifts over the 10 days of the games. Details are available from Karen Hatch (tel 01925 704130, e-mail karen.hatch@doh.gsi.gov.uk).

New pharmaceutical and medical products bring benefits for patients and for hard pressed health services. But new developments can be seized upon for more dubious reasons. Athletes who seek to cheat and gain advantage in their sports are also quick to take advantage.

The 2002 Winter Olympics began on 8 February at Salt Lake City, Utah, United States. Over two weeks, around 3,500 athletes and officials from 80 Olympic organisations will be taking part, with competitions covering 70 separate medal events. Behind the scenes, medical testing of athletes for the use of banned substances will be routine.

The latest substance to come under the spotlight is Aranesp (darbepoetin alfa) Amgen's new treatment for anaemia associated with renal failure. Amgen originally developed the first recombinant human erythropoietin (EPO). Erythropoietin stimulates the synthesis of cellular haemoglobin allowing the blood to carry more oxygen to the muscles increasing endurance. The recombinant version has been used by athletes, and in particular some professional cyclists, to increase performance. Because of its similarity to the natural hormone, it has been difficult to detect. However, a combined blood and urine test is to be used for EPO at the Winter Olympics.

The same reasons that make Aranesp a clinical improvement on EPO — a longer half-life allowing less frequent or lower dosing — make the product attractive to those looking to enhance performance.

According to an investigation by BBC Radio 5 Live, use of Aranesp (or "nesp") is now well established among professional cyclists. They believe that current doping controls cannot detect its use. However, as a genetically modified hormone, it should be possible to develop a specific assay for the molecule in time.

Olympic movement's banned substances

The Olympic Movement Antidoping Code bans a number of stimulant, narcotic and anabolic agents. Other substances are prohibited in certain circumstances or sports. The use of some treatments, such as beta-agonists for asthma, require prior medical approval. Certain procedures, such as administering blood products or artificial oxygen carriers, are also banned.

Prohibited stimulants include amphetamines, caffeine (above specified levels), cocaine, ephedrines and beta-agonists (except under medical approval).

Prohibited narcotics include buprenorphine, diamorphine, methadone and pethidine, but codeine, dextromethorphan, dextropropoxyphene, dihydrocodeine and tramadol are permitted.

Other prohibited agents include anabolic steroids, diuretics and peptide hormones or their analogues.

Further information can be found at the World Anti-Doping Agency's website (www.wada-ama.org). UK Sport, the Government's sports funding organisation, has a database against which available preparations and medicines can be checked for their sports use status (www.uksport.gov.uk).

Aranesp is not the only new development causing concern. According to Dr David Armstrong, reader in physiology at the school of pharmacy, Liverpool John Moores University, and an expert in drugs in sport, isolated incidents caused by the use of synthetic blood substitutes have been reported, even though these products are still in clinical development. These products can carry oxygen in solution in the blood.

Haemoglobin-based oxygen carriers are also being developed for use in critical care.

"These molecules sit in the haemoglobin and unload the oxygen. They need to be used with a high oxygen saturation or they can desaturate the blood," Dr Armstrong explained. "I would be concerned about these products being used before or during high intensity aerobic exercise."

UK Sport, the Government's sport funding organisation, is calling for closer links between pharmaceutical companies, medical agencies and drug-testing organisations to allow better and earlier testing. One way to tackle this, according to Richard Callicott, UK Sport's chief executive, would be for the pharmaceutical industry to place markers in certain products that would show up during sports testing processes in order to identify inappropriate use.

The problems of drug use in sport are unlikely to go away while the rewards for success are so high. Thus an ongoing game of cat-and-mouse will continue to be played out between the cheats and the testers.