Doping

Doping?

The use of drugs in an attempt to enhance sporting performance is often referred to as doping. It is thought that the word ‘dope’ originated from the African language. Dope referred to a primitive drink that was used as a stimulant in ceremonial dances. Gradually the term adopted a wider usage and in reference to sport, it became known as ‘doping’. In today’s sporting context, doping refers to the use by athletes of banned substances or methods that may enhance performance.

This section provides answers to common questions about the health and safety risks associated with substances and methods on the WADA Prohibited List (List). It also provides information concerning the legitimate medical use of substances. When these compounds are misused, it constitutes a breach of ethics both by the user and supplier.

Role of sports dentists in doping

• The dentist must know the recent list of Prohibited substances before treating and/or writing prescriptions to athletes. The List designates what substances and methods are prohibited both in- and out-of-competition, and which substances are banned in particular sports. Every doctor is responsible when writing a prescription to athletes for ascertaining whether the drugs are contaminated or not with prohibited substances, for in the case of a positive doping test an athlete and who helped him are liable to the relevant sanctions.
• He may also contribute in the doping control team and start to be Doping Control Officer (DCO) in sports’ contexts. In addition to contribution in maintaining a fair play doping-free world, he may meet people from other nations and cultures, including top athletes.  As a DCO applicant he will go through a various number of educational steps. The first step is to complete an introduction course and pass a final test to qualify for a formal application.

Usually, after the passed introduction course, he will be asked to fill in a formal application and an interview.

If passed, the next step in the education process is a pre-scheduled DCO seminar usually organized by the National Anti-Doping Organization (NADO), where he/she will undergo comprehensive practical and theoretical training on sample collection procedures, the system for locating athletes, how to successfully plan the mission and implement the tests with high quality control according to the procedural guidelines (in and out-of-competition)?

Sometimes, while waiting for this seminar, the dentist may also have opportunities for to be recruited to assist a certified DCO on a mission. If this was not available before the seminar, he/she will be given the opportunity to assist after the seminar.

Finally, a theoretical exam and a practical test for DCO certification is the last step.

• He/she may be promoted and act as an active member in anti-doping activities of National Anti-Doping Organization (NADO).

Therapeutic Use Exemption (TUE):

Athletes may have illnesses or conditions that require them to take particular medications. If the medication an athlete is required to take to treat an illness or condition happens to fall under the Prohibited List, a Therapeutic Use Exemption (TUE) may give that athlete the authorization to take the needed medicine. The purpose of the International Standard for Therapeutic Use Exemptions (ISTUE) is to ensure that the process of granting TUEs is harmonized across sports and countries.

Let us review a list of some of the most common medicines used in the field of dentistry and correlate it with the World Anti-Doping Agency (WADA) publication of the 2017 List of Prohibited Substances and Methods; along with, the 2017 Summary of Major Modifications and Explanatory Notes.

Important notes to the reader

In case any further information is required, the user is kindly requested to refer directly to:

• The continuously renewed list of the categories of prohibited substances and prohibited methods of doping.
• The pharmaceutical company concerned.

While every effort is made to ensure that the contents are accurate at the time of publishing, Sports Dentistry on Web can accept no responsibility for errors or omissions caused either in the preparation or publication of this index nor from corrupted or misleading data received about pharmaceutical composition. Meanwhile, we always appreciate any advice, additions or omissions, which help reaching our goal to protect the health and promote the medical service to athletes and to encourage fare sports competition between the nations.

Additionally, I would prefer, as stated below, that the dentist should write on his recordings and declare to the team doctor which substances have been used; stating diagnosis, dose, when and for how long prescribed and method of administration.

 

LOCAL ANAESTHETICS

• Cocaine is prohibited.
• Local or intra-articular injections of lidocaine (also called xylocaine or lignocaine), procaine (also known as novocaine), articaine (also called septocaine or ubistesin), bupivacaine (a long-acting anesthetic), and mepivacaine are permitted.

 

VASOCONSTRICTOR AGENTS with local anesthetic agents as epinephrine (adrenaline) are permitted.

 

VITAMINS AND ANTIBIOTICS are permitted.

 

GLUCOCORTICOIDS

All glucocorticoids are prohibited when administered by oral, intravenous, intramuscular, or rectal routes. Local applications or intra-articular injections were not mentioned in 2017 prohibited list and though are permitted.

However, and it is only the author’s opinion, I would prefer, if it is possible that glucocorticoids in various dental medicaments for oral ulceration and sedative dressings could be avoided and alternative techniques would be used.

Other applications of corticosteroids must be specified to the Sports Medical Committee in writing on TUE forms.

 

NARCOTICS

During postoperative dental management, the dentist should avoid the use of narcotics and should instead rely mainly on non-steroidal anti-inflammatory drugs.

Please consider also using TUE forms in treatment of dental pain attributable to acute maxillary sinus congestion or infection, which might include the use of a decongestant or nasal spray, should be delayed until the proposed drugs have been approved. Some surgeries, as in correction of oro-anrtal fistula, may require administration of medicines to decrease cough, sneezing or even to decrease the possibility of catching common cold.

 

Some Examples of Prohibited Materials:

	Material	Some Suggested Trade Names in Egypt
Stimulants, such as:	Caffeine	Migril, Petro, Askin, Optalidon, Asco, Asconal, Amigraine, Migranil, Nova C Retard, Antiflu, Flu Stop, Flurest, Nova C M, Rhino-C, Triaminic
	Ephedrine	Tussivan-N, Minosan, Koffex, Expectyl, Tussilar Compound, Tussipect, Ephedrin, Ephedrine HCl

 

Caffeine: included in the 2017 Monitoring Program, and is not considered Prohibited Substances.

 

	Material	Some Suggested Trade Names in Egypt
Narcotic analgesics, such as:	Morphine	Morphine Sulphate
	Nalbuphine	Nubain, Nalufin
Diuretics, such as:	Amiloride	Hydical, Moduretic, Yostiretic
	Xipamide	Epilac, Epitex

 

Local administration of felypressin in dental anaesthesia is permitted. 

 

Complications Might Be Manifested in the Dental Practice with Performance-enhancing Drugs (PEDs).

PEDs have the ability or potential to drastically alter the human body and biological functions, including the ability to considerably improve athletic performance in certain instances. These drugs, however, can be potentially dangerous and can cause death, if not taken under restrict medical supervision. Consequently, and due to the negative effects these drugs, no athlete should ever have to consider PED use to succeed in sport.

 

Warning!

Some studies that were carried out on so-called food supplements for athletes have shown that these products are contaminated with anabolic-androgenic steroids or so-called pro-hormones i.e. with prohibited substances (in- and out-of-competition). Unfortunately, we could not detect this contamination from the indications given on the packaging or on the enclosed information leaflets of most of the locally available products. Accordingly, each athlete who uses such food supplements is responsible for analyzing these products to be 100% sure that they are not contaminated with prohibited substances. Otherwise, the athlete would be liable to the relevant sanctions, for in the case of a positive doping test.

These drugs opened the world awareness of many issues as physical, psychological, economic, and legal issues. In addition, the use of these drugs costs the world’s economy billions of dollars each year in an attempt to curb their use while also costing the lives of many brave law enforcement officers in this seemingly never-ending struggle.
So, each dentist must be aware of these drugs to avoid the possible contraindications during dental procedures, be aware of their multiple intra-oral and extra-oral manifestations, be able to provide necessary dental treatment while participating actively on the fight against these drugs and finally, to be able to help these patients and refer them to the proper professionals for counseling.

 

Anabolic Agents (Including Testosterone)

The primary medical use of these compounds is to treat delayed puberty, some types of impotence, and wasting of the body caused by HIV infection or other muscle-wasting diseases. What are some potential side effects of anabolic steroid abuse? Some physiological and psychological side effects of anabolic steroid abuse have potential to impact any user, while other side effects are gender specific. The following list is not comprehensive.

Physiological Acne Male pattern baldness Liver Damage* Premature closure of the growth centers of long bones (in adolescents) which may result in stunted growth* Stunted growth and disruption of puberty in children

Psychological Increased aggressiveness and sexual appetite, sometimes resulting in abnormal sexual and criminal behavior, often referred to as “Roid Rage” Withdrawal from anabolic steroid use can be associated with depression, and in some cases, suicide.

Gender Specific – Males Breast tissue development* Shrinking of the testicles* Impotence Reduction in sperm production Gender Specific – Females Deepening of the voice* Cessation of breast development Growth of hair on the face, stomach and upper back* Enlarged clitoris* Abnormal menstrual cycles

*Effects may be permanent and can vary by individual.

 

Peptide Hormones, Growth Factors, and Related Substances

The primary medical uses of these compounds vary, but include treatment of cancer or aiding those born prematurely. The presence of an abnormal concentration of a hormone, its metabolites, relevant ratios or markers in your sample is deemed to contain a prohibited substance unless you can demonstrate the concentration was due to a physiological or pathological condition. Examples include human growth hormone (hGH), erythropoietin (EPO), insulin, human chorionic gonadotrophin (HCG), and adrenocorticotrophin (ACTH). Despite the presence of some growth factors, platelet-derived preparations were removed from the List as current studies on PRP do not demonstrate any potential for performance enhancement beyond a potential therapeutic effect.

Physiological hypertension (EPO/hGH) blood cancers/leukemia (EPO/hGH) Anemia (EPO) strokes (EPO) heart attacks Pulmonary embolism (EPO) feminization (HCG) thyroid problems (hGH)

 

Note that individual growth factors are still prohibited when given separately as purified substances.

Human Growth Hormone (hGH)

Physiological Severe headaches Loss of vision Acromegaly (Protruding or enlarged jaw, brow, skull, hands and feet) High blood pressure and heart failure Diabetes and tumors Crippling arthritis

 

Beta-2 agonists

The primary medical use of these compounds is to treat conditions such as asthma and other respiratory ailments. Some studies have shown beta-2 agonists have performance-enhancing effects when consistently high levels are present in the blood.

Physiological Palpitations Headaches Sweating Nausea Muscle cramps Nervousness

 

Diuretics

The primary medical use of these compounds is to treat conditions such as hypertension, kidney disease and congestive heart failure. Taken without medical supervision, diuretics can result in potassium depletion and possibly even death.

Physiological Dehydration Muscle cramps Dizziness or fainting Drop in blood pressure Loss of coordination and balance

 

Stimulants

The primary medical use of these compounds is to treat conditions such as Attention Deficit Disorders (ADD/ADHD), asthma, narcolepsy, and obesity.

Physiological      Insomnia Anxiety Weight loss Dependence and addiction Dehydration Tremors Increased heart rate and blood pressure Increased risk of stroke, heart attack, and cardiac arrhythmia

 

Narcotics

In small doses narcotics have medical uses that include relieving severe pain and inducing sleep. However, narcotic overdose is a medical emergency and can lead to respiratory depression and even death.

While a sensation of euphoria and psychological stimulation are effects common to the use of narcotics, the misuse of narcotics can pose ethical questions about the handling of the substance as well as great health risks. Those include:

Physiological A false sense of invincibility Nausea and vomiting Increased pain threshold and failure to recognize injury Decreased heart rate Physical and psychological dependence; leading to addiction

 

Cannabinoids (Marijuana)

Marijuana has a high potential for abuse, no accepted medical use in the most countries as United States, and of course in Egypt. Moreover, Marijuana lacks accepted safety data for use under medical supervision. Side effects of cannabinoid use include:

Physiological Increased heart rate Impaired short-term memory Slowed coordination and reaction of reflexes Diminished ability to concentrate Distorted sense of time and space Respiratory diseases

Psychological Mood instability Impaired thinking and reading comprehension

 

Glucocorticosteroids

The primary medical use of these compounds is to treat allergies, asthma, inflammatory conditions, and skin disorders among other ailments.

Physiological Loss of muscle mass Weakening of injured areas in muscle, bone, tendon, or ligament Decrease in or cessation of growth in young people

 

Beta Blockers

The primary medical use of beta-blockers is to control hypertension, cardiac arrhythmias, angina pectoris (severe chest pain), migraine, and nervous or anxiety-related conditions.

Physiological Lowered blood pressure Slow heart rate Sleep disorders Spasm of the airways

 

Blood doping

Blood doping is the practice of misusing certain techniques and substances to increase the red blood cell mass in the body. Since the red blood cells carry oxygen to the muscles, this allows the body to transport more oxygen to working muscles and therefore can increase their aerobic capacity and endurance. There are three widely known substances or methods used for blood doping, namely, erythropoietin (EPO), synthetic oxygen carriers and blood transfusions*. The primary use of blood transfusions and synthetic oxygen carriers are for patients who have suffered massive blood loss, either during a major surgical procedure or caused by major trauma. Erythropoietin is used in the treatment of anemia related to kidney disease. However, misuse of these substances and techniques could lead to:

Physiological Increased stress on the heart Blood clotting Stroke

 

* With transfusions, there is an increased risk of infectious disease such as AIDS or hepatitis

 

MY FINAL ADVICE

    Take care, the maturity of athletes are good, but little of them are cheaters. Additionally, you may be faced among your patients with non-professional athletes who innocently might take these drugs where some of them are considering these drugs are only prohibited for professional athletes and some does not know about their hazards at all. So, keep everything documented on his/her dental file.

      Prescribe only the regular dentally used medicines as antibiotics, NSAIs, vitamins. Please, do not act as a physician.

 

UNDER RE-CONSTRUCTION …