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David Mottram is professor of pharmacy practice
at Liverpool John Moores University and Jennifer Archer is assistant
director—direct learning at the Centre for Pharmacy Postgraduate Education
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Although the use of performance enhancing substances by athletes can
be traced back to the ancient Olympic Games, the revelation of anabolic
steroid use by Ben Johnson at Seoul in 1988 heralded the modern era of
drug misuse in sport. Since then, it has been exceptional for a high-profile
sporting event to take place without its “drug scandal”.
A recent example has been that of the double gold-medal winning US athlete,
Kelli White, who tested positive for the stimulant modafinil at the 2003
World Athletic Championships in Paris. Ms White claimed that she was
taking the drug to treat narcolepsy, although it was reported that a
notification for therapeutic use exemption had not been submitted before
the competition. The prevalence of drug use in sport is difficult to
gauge accurately. What is certain is that it exceeds the level (of around
2 per cent positive test results) reported annually by International
Olympic Committee (IOC) accredited laboratories.
The World Anti-Doping Code list of banned doping substances and methods
is extensive and diverse. The latest list, to come into effect on 1 January
2004, has recently been published by the World Anti-Doping Agency (WADA)
(see www.wada-ama.org). The list includes recreational drugs such as
marijuana, prescription drugs such as anabolic steroids, peptide hormones,
diuretics and beta-2 agonists, and over-the-counter drugs such as ephedrine.
The situation is made more complex by the inclusion of cut-off levels
for many of the drugs included in the banned list. Not surprisingly,
athletes are often confused as to what they are permitted to take and
therefore they require a great deal of support from those qualified to
identify what substances they can take for medical reasons without being
at risk of a doping infraction.
Premier professionals
As befits their training and experience, pharmacists are considered the
premier professionals regarding drug use in sport. At the recent Commonwealth
Games in Manchester, a working group of pharmacists advised the organisers
on the pharmaceutical needs of the athletes at the games. Then, throughout
the games, a dedicated team of volunteer pharmacists, under the leadership
of the superintendent pharmacist Mark Stuart, manned the pharmacy in
the athletes’ village. Since the games, Mr Stuart has set up
a web site specifically aimed at pharmacists (www.sportspharmacy.com).
On a day-to-day basis, community pharmacists provide an invaluable resource
not only for athletes but also for the significant number of people who
undertake regular exercise, at whatever level. They act as a first point
of contact with regard to information on prescription and OTC medicines,
as a source of advice for healthier lifestyles and for treatment for
minor injuries.
As the issue of drug misuse in sport has become more high profile, there
has been a need for health professionals to become more informed and
more proactive. In 2001, the British Medical Association increased the
awareness of the medical profession to the issue of drug misuse in sport
by commissioning the book ‘Drugs in sport: the pressure to perform’,
which was launched at an international conference in London in April
2002 (PJ, 11 May 2002, p640).
CPPE workshops
For many years, pharmacists throughout Britain have expressed an interest
in the subject of drug misuse in sport through frequent requests by
local branches of the Royal Pharmaceutical Society for a lecture on
drugs in sport. More recently, the Centre for Pharmacy Postgraduate
Education (CPPE) has recognised the importance of increasing pharmacists’ understanding
and knowledge of the issues concerning drug use in sport and other
aspects of health and exercise. Throughout the early months of 2003,
multi-professional teams, under the co-ordination of the CPPE project
leader, Trudy Thomas, produced three inter-linked workshops for pharmacists
entitled “Drug use in sport”, “Management of injury
and ailment related to sports and exercise”, “Pharmacists — key
players in sports and fitness — exercise and diet”.
These workshops, which are now available for pharmacists to attend in
England, were developed in line with current drug-free sport policy and
information provided by UK Sport, the organisation responsible for drug
testing, results management and for information and education on anti-doping
in the United Kingdom (www.uksport.gov.uk).
The “Drug use in sport” workshop covers the major classes
of drugs that are subject to doping control. Prohibited methods, such
as blood doping and gene doping, are also reviewed. Methods for drug
testing are described and the statistical evidence for the prevalence
of drug misuse in sport is discussed. This workshop has just been updated
to incorporate the changes to the list, introduced by WADA, for January
2004.
The “Management of injury and ailment related to sports and exercise” workshop
is designed to assist pharmacists to provide evidence-based treatment
and advice for those who sustain an injury as a result of participating
in sport or exercise. It offers the opportunity to practise some hands-on
techniques that will help pharmacists to respond to injuries typically
presented in the pharmacy or to know when to refer and to whom. The “Pharmacists — key
players in sports and fitness — exercise and diet” workshop
highlights the fact that the majority of the population are undertaking
levels of physical activity which are below that required for optimal
health. Pharmacists are encouraged to promote an active lifestyle as
a way to improve health. This workshop also explores the role of diet
and dietary supplements in an active lifestyle. It highlights the potential
dangers of using supplements in an attempt to enhance sporting performance,
as illustrated by the rash of positive test cases involving the
anabolic steroid nandrolone. In many of these cases athletes claimed
to have tested positive through the use of nutritional
supplements.
All three of these workshops include both lecture presentations and small-group
work incorporating case study, problem-solving exercises. Emphasis is
placed on where pharmacists and athletes can obtain specialist advice
and information.
Code of conduct
Recent events, surrounding the failure by the footballer Rio Ferdinand
to attend an out-of-competition drug testing event and the evolving
story concerning the widespread use of the anabolic steroid tetra-hydrogestrinone
(THG) have highlighted the need for health professionals to be aware
of the code of conduct and rules surrounding drug misuse in sport.
Understanding these issues and providing an advisory service to athletes,
their supporters and families is a valuable and rewarding aspect to
a pharmacist’s career.
The CPPE workshops provide a significant resource for pharmacists who
wish to learn more about this subject and how to become a key player
in sport-related matters. Information on the workshops can be obtained
from CPPE brochures that
are sent to pharmacists in England three times a year or from the CPPE
website (www.cppe.man.ac.uk). |
