This is a presentation including all the subtopics about doping and every aspect covered keeping in mind exam point of view.

1. MGM ALLIED HEALTH SCIENCES
INSTITUTE , INDORE
TOPIC - DOPING
PRESENTED BY : MUSKAN GUPTA

2. INTRODUCTION
• DOPING IS DEFINED AS OCCURRENCE OF ONE OF THE FOLLOWING :
• presence of prohibited substances in an athelete's sample.
• use or attempted use
• refusing justification to submit urine sample
• violation of applicable requirements regarding athelete's availability
• trafficing of drugs
• Tampering or attempted tampering
• Administration or attempted administration

3. HISTORICAL PERSPECTIVE
• The ancient greeks used mushrooms, while the roman wrestlers used special
mixtures of herbs to improve performance. The use of performance
enhancing substances have been prevalent since ancient times , like since
norwegian warriors , south african tribes used a local stimulant called “dop”
leading to the use of the word “doping”.
• The origin of current epidemic of drug use among sportsperson dates back to
the introduction of various substances during world war II. Substances
including caffiene, opium, nitroglycerine etc. amphetamines were taken by
US troops to keep them awake at the battlefront. Some sportspeople began
taking amphetamines for performance enhancement. This problem came to
light when danish cyclist, Kurt Jensen died from heat related illness during
olympics.

4. • The consequent deaths of various sports people lead to the establishment of
medical council by IOC in 1967 and to ban the use of pharmaceutical agents
to enhance performance. Around the same time , Arnold Bekket introduces
drug testing techniques in london using gas chromatography.
• There are various alleged cases which are quite historical like:An organic
chemist named fred koch developed a form of testosterone which produced
agressive behaviour and masculine characteristics.

5. • In 1998, a large number of prohibited medical substances was found in a raid
during the tour de France. The scandal led to a major reappraisal of the roleo
f public authorities in anti-doping affairs. At that time, a number of
organizations, many with conflicts of interest, were involved in the developing
policies and sacntions. The IOC convened world conference of doping in
Lassaune , Switzerland in february 1999 to promote and control the fight
against doping in sports internationally.

6. Why athelete's take drugs ?
• knowledge or belief that their competitors are taking drugs
• determination to do anything possible to attain success
• direct or indirect pressure from coaches , parents and peers
• pressure from government or authorities themselves
• lack of access t legal and natural methods to enhance performance
• financial rewards
• influence from media in facillitating expectations and rewards

7. WADA
• On a global level, the authority for monitoring doping in sports persons is WADA ( world anti-
doping agency). It was established in 1999 and its headquaters are in Montrea , Canada.
• WADA was setup under the initiative of the IOC with the support and participation of
intergovernmental organizations , governments , public authorities and other private and
public bodies fighting against doping in sport.
• WADA consists of equal representatives from the olympic movement and public authorities.
• On National level , India has the highest number of failed dope tests internationally. The
weight lifting association of India has been suspended twice.

8. NADA
• It is an anti-doping agency responsible for promoting , coordinating and monitoring the
doping control program in sports in all its formsin the country. It works towards vision of dope
free sport in India.
• PRIMARY FUNCTIONS OF NADA
• Adopting and implementing antidoping rules and policies.
• Co-operating with other sports related organizations and anti-doping organisation.
• Encouraging reciprocal testing between national antidoping organisations.

9. PROHIBITED SUBSTANCES
• Substances will be added to the list if the satisfy any two of the three criteria :
1. potential for enhanced performance
2. potential for being detrimental
3. violate the spirit of sport , this list is renewed annually and updated list commences on 1st
Jan every year.
• It monitors certain other substances to detect the pattern of misuse.
• In case of medical emergency, athelete may want to take drugs that are banned for use. In
these cases, atheletes may apply for therapeutic use exemption from National Anti doping
organization of there internationa federation to obtain permission to use respectiove
substances.WADA doesn't grant permission but may consider appeals related to granting or
denying.

10. • PROHIBITED CLASSES OF SUBSTANCES (IN AND OUT COMPETITION)
• Anabolic agents (also known as anabolic androgenic steroids like testosterone)
• Hormones and related substances
• Beta - 2 agonists
• Diuretics and other masking agents
• PROHIBITED CLASSES OF SUBSTANCES (IN COMPETITION)
• Stimulants
• Narcotics
• Cannabinoids
• Glucocorticosteroids

11. • Prohibited methods(in and out of competition)
• Enhancement of oxygen transfer
• Chemical and physical manipulation
• gene doping
• Substances prohibited in certain sports
• Alcohol
• Beta - blockers

12. Anabolic steroids
• Derivatives of testosterone.
• Anticatabolic effects - reverse catabolic effect or may improve utilisation of
the ingested protein causing nitrogen retention.
• This effect depends upon adequate protein intake.
• Athelets in heavy weight lifitng are in a catabolic statedue to high intensity
training and no recovery time which lead to overuse injuries. Anabolic
syeroids reverse this catabolic effects.
• TETRAHYDROGESTRONE
• It was a desiGner steroid which was developed and went undetectable on
testing.

13. • It was created for dual purpose of imparting anabolic steroids effects to
atheletes and allowing atheletes to avoid detection by standard control drug
testing.
• CLENBUTEROL
• It is considered both anabolic and beta-2 agonist which is used as an
errogenic aid and aids to increase lean muscle mass.
• HORMONES AND RELATED SUBSTANCES
• ERYTHROPOIETIN
• Increased endurance
• Atheletes competing in endurance sports used recombinant erythropoietin.

14. • HUMAN GROWTH HORMONE
• It is a polypeptide hormone produced by anterior pitutary.It is a somatotrophin ,essential for
growth and developement.
• Recombinant hGH have been used by atheletes due to its anabolic effects which leads to
increased muscle mass and decreased fat mass.
• HUMAN CHORIONIC GONADOTROPHIN
• It Is abused my male atheletes for endogenous production of testosterone without increasing
urinary testosterone above normal ratio. It is used as an attempt to maintain testicular
volume in the male athelete.
• INSULIN
• It is a small hormone synthesized by pancreas.
• Functions - lipogenesisby promotind fatty acid synthesis. Its main function is carbohydrate
metabolism, increasing both glucose and amino acid uptake by cells and increased protein
synthesis.It also decreases protein catabolism.
• used by atheletes in power sports like weight lifting and bodybuilding.
• BETA2-AGONIST
• has anabolic effects like inn fat reduction and muscle building.

15. • AGENTS WITH ANTIESTROGENIC ACTIVITY
• these lower or inhibit estrogen production and activity of estrogen receptors
respestively.
• Male atheletes use this to prevent gyanecomastia and reduce body fat and
female atheletes use this for body building. this could lead to masculinization.
• DIURETICS
• to loose weight prior to competetion where weight limits are set. These
include boxing, wrestling, weightlifthing, judo etc.

16. CLASSES OF DRUGS BANNED IN CERTAIN SPORTS
• Alcohol is prohibited in competition only in the following sports. Detection will be conducted
by the analysis of breadth and/or blood. The doping violation threshold for each federation is
reported.
• Aeronautics
• Archery
• Automobile
• Billiards
• Boules
• Karate
• Morderm pentathlon
• Motorcycling
• Powerboating

17. • Alcohol generally has a negative effect on athelete performance, impairing reaction time,
hand-eye coordination, accuracy , balance, gross motor skills and strength.
• BETA - BLOCKERS
• Unless otherwise specified , beta - blockers are prohibited in competition only , in the
following sports :
• Aeronautics
• Archery
• Automobiles
• Billiards
• Boules
• Bridge
• Chess

18. • Beta - blockers are drugs commonly used in the treatment of hypertension , angina
,arrythmia , migraine , anxiety , tremor and following myocardial infarction. Their anxiolytic
and anti - tremor effects resulted in their use in the sports of shooting and archery where
steadiness of hand and arm is important.
• Beta - blockers do not show any other positive effect on the performance , infact, they may
have negative effects may include fatigue , depression , nightmares, bronchospasm and
sexual dysfunction .

19. SPECIFIED SUBSTANCES
• A doping violation involving such subsatnces may result in a reduced sanction provided that
the athelete can establish that the use of such a specified substance was not intended to
enhance sports performance.
• cathine , cropropamide , crotetamide, propylhexedrine , selegiline , sibutramine cannabinoids
• all glucorticosteroids
• alcohol
• all betablockers

20. THERAPEUTIC USE OF A PROHIBITED SUBSTANCES
• Atheletes may have illnesses or condition that require them to take particular medications.
• The criteria necessary to be fulfilled to grant “therapeutic use” are :
• the athelete would experience significant health problems without taking the prohibited
substance or method
• the therapeutic use of the substance would not produce significant enhancement of
performance and
• there is no reasonable therapeutic alternative to the use of the otherwise prohibited
substance or methods.

21. TESTING
• NADA is responsible to implement an effective number of incompetition and
cut-off competition tests in the atheletes in its negotiated testing pool. This
incluudes both international and national level atheletes being tested by
NADA.
• The NADA developes number of samples for each sport or discipline required
for effective deterrence. This plan includes out of competition testing ,
incompetition testing and may include urine and blood sample collection.
• Drug Testing Methodology
• There are various specific methods that are frequently used to interpret drug
test results :

22. TESTING PROCEDURE
• SELECTION : An athelete can be selected for a drug test at any time (
including while injured and/or post - operatively )
• Notification - An athelete can be notified of their selection for a drug test by a
drug control official either :
• In a person (at any time, in and out of competition )
• By telephone (out of competition)
• By writtern notice ( out of competition)
• The criteria for deciding varies from event to event . At some competitions
placegetters will be tested and in others randomly selected competitiors
would be targeted.

23. PRESENTING FOR A DRUG TEST
• The drug control official records the athelete's details on a notification form,
which is then signed by the athelete. A copy is kept by the athelete for his/her
records. In the presence of the chaperone the athelete may :
• recieve necessary medical attention
• attend a victory ceremony
• fullfil media commitments
• compete in furthur events
• warm - down
• eat and drink at his or her own risk during competiton events sealed drinks
are provided and it is recommended that the atheletes only consume these
fluids after the testing is completed

24. SAMPLE COLLECTION
• The athelete is required to provide a urine sample in the direct view of a drug
control official who is the same gender as the athelete. The athelete's
representative is not permitted to observe the actual collection of the sample,
only the testing procedures and paperwork.
• A minimum of 80ml of urine is required for a competition and 60 ml for an out
of competition testing.
• Then the athelete will return to the doping control room where the second
doping official would be present as well as the athelete's representative to
complete the sealing and paperwork.

25. • The athelete is asked to select a sample collection kit which consists of two
bottles (labelled “A” and “B”) housed in a sealed polystyrene outercase. It is
important that the athelete and his/her representative, checks that the kits are
sealed correctly, that the bottles are clean and the lids are suitable.
• SPLITTING , SEALING AND LABELING OF THE SAMPLE
• The athelete will be asked to pour a measured amount of urine into the “A”
and “B” bottles, leaving a small amount behind for the drug control offficial to
testthe pH and/or specific gravity. The sample code number will be identified
and recorded on the drug testing form.

26. CHECKING pH AND CONCENTRATION OF THE
SAMPLE
• The drug control official will check the pH is less than 5 or greater than 9, or
the urine has a specific gravity of less than 1.010, a second specimen is also
outside this range, then the test will still proceed.

27. FINAL PAPERWORK
• At this stage, the competitior provides the medical declaration. The medical
declaration is extremely important. The competitior is asked to list all the
medications taken in the previous week, including over the counter
medications, prescription drugs and other substances taken by mouth ,
injection , inhalation pr suppository.
• This list should include all vitamins, amino acids and other supplements. It is
vitally important that this list be completed accurately as all substances taken
in that period are likely to show up in the lab test.
• The competitior , drug official and representative checks all the writtern
information and, if satisfied, sign the drug testing form. The competitor is
given a copy of the form.

28. • The sealed samples and paperwork does not include the athelete's name
and are sent to an accredited laboratory where the sample is analysed using
gas chromatoography and mass spectrometry.
• Initially only the sample is analyzed . If the laboratory finds a positive test
result in the sample in the A bottle, it informs the drug testing agency, which
then informs the competitior that a possible positive test result has been
recorded. The competitor or a representative, is then entitled to be present at
the unsealing and testing of the sample B.
• If the sample B also proves positive, the relevant sporting organizations are
informed . It is the responsibility of the relevant sporting organization to
determine what penalty or sanctions have to be applied.

29. Blood doping
• It is the administration of blood or red blood cells to an athelete to increase
the red blood cells mass. This may be autologous (infusion with the athelete's
own blood)or homologous (infusion with appropriately cross-matched
donated blood).
• The usual method is to withdraw two units of an athelete's own blood four to
six weeks prior to competition. This allows time for red blood cell countto
return to normal prior to reinfusing the blood two or three days before the
competetion.

30. • This method has been prohobited since 1984 but its use dropped
dramatically when EPO testing came into light.
• The American cyclist Tyler Hamilton was one of the first atheletes to be found
guilty of blood doping in 2004.
• Allergic reactions, HIV, Hep - B and C may occur as side effects.

31. Artificial oxygen carriers
• They are blood substitutes are being developed to serve as a temporary
replacement for transfused red blood cells in the prevention of ischaemic
tissue damage and hypovolaemic shock. Two types are available :
• i. haemoglobin oxygen carriers
ii. perfluorocarbons

32. • Haemoglobin oxygen carriers
• It is a haemoglobin substitute in cases of severe injuries where human blood
is unavailable. as free hb is unstable, biochemical modifications have been
made to the molecule. Three principles approaches are there to stabilise and
modify tetramic hb :
• Polymerisation
• Conjugation
• Cross linking
• Hb is available in three forms : bovine blood, human blood and genetic
engineering. HBOs has several advantages. They can be pasteurized and
ultafiltered and safe from injections. They are readily available and has shelf
life upto 2 years. however they only lasts for 12 to 48 hours unlike normal
rbcs (120 days).

33. • Perflourocarbon emulsions
• group of synthetic materials similar to teflon
• flourine atoms are added to it, so it's inert, inexpensive to produce
• made up in a sponge like emulsion containing small particles of 0.2 ᴜm in
diameter
• can deliver oxygen to tissues through smallest vessels
• they dissolve large amounts oxygen in plasma. however their function directly
depends upon the partialpressure of the gas. A high partial pressure gradient
is required in dissolution in plasma and while absortion in tissues.
• First generation of this compund proved unsatisfactory but second generation
products showed high concentration of the active compound.
• It would be futile to analyze urine samples in search of PFCs and HBOs as
they are not processed in urine, remain in emulsionsin blood. although , a
blood might reveal their presence as long as the sample is taken post
competition soon.

34. Chemical and Physical manipulations
• It is the use of substances and methods that alter or may reasonably be
expected to alter the intergrity and validity of the urine samples used in
doping controls. Intravenous infusions are prohibited, except as legitimate
acute medical treatment. These include , without limitation:
• catheterization
• sample substitution and/or tampering
• The success or failure of the useof a prohibited or method is not material. It is
sufficient that the said substance procedure was used or attempted for the
infraction to be considered as consummated.

35. Gene doping
• The non - therapeutic use of cells , genes , genetic elements , or the modulation of gene
expression , having the capacity to enhance performance , is prohibited.
• This technique improves atheletic performance but it is a serious threat to integrity of elite
sports.
• PRICIPLE - delivery of a cell of a therapeutic gene that may compensate for the absent or
abnormal gene.
• The genetic material encodes for a therapeutic protein and needs to be delivered to the cell
nucleus to be active. This material can be encapsulated in a crippled virus or into a lipid such
as a liposome.The encapsulated genetic material is referred to as a vector and is introduced
into the body by direct injection into the target organ or administered by aerosol for lung
delivery.
• Depending upon the nature of the promotor and vector , the protein expression may be of
short duration or long duration. The expressed protein may be confined to the cell that was
treated or may even get released in the circulation.

36. • Potential areas of gene doping are EPO for endurance performance and IGF-1 for muscle
strength. An adenovirus was used to deliver the EPO gene in mice and monkey and this
boosted the hemocrit by almost 40% to 90% in mice and 40% to 70% in monkey.
• Genetic doping is very difficult. Engineered gened and endogenous genes look
alike.Detection of viral particals requires muscle biopsies. Lbelling of gene tranfer products
with genetic bar codes might help in differentiating the engineered and endogenous genes
but would require the cooperation of the scientists.

37. BATTLE AGAINST DRUGS
• The sports community is in a constant battle against use of drugs in sports.
The turning point of battle was seen when 100m sprinter Ben Johnson was
disqualified at Seoul Olympic Games in 1988. As a reult of this event many
sporting bodies came to adress the problem. As a reult government inquiries,
out of competition testing became available. Countries like Australia and
Canada have taken the lead while other countries have still not included
random out of testing procedure as a part of normal testing procedure.

38. BATTLE AGAINST DRUGS
• FOUR PRINCIPLES TO BE FOLLOWED IF THE DRUG USE IS TO BE
PREVENTED :
• We must be honest with atheletes about the advantages and side effects of
drugs.
• We must educate our atheletes, particularly school-age atheletes about the
problems with drug taking.
• Random, internationally verified, out of competition drug testing must be
carrid out regularly.
• Society's attitude that winning is the only thing that matters must be gradually
changed.

39. ROLE OF THE CLINICIAN
• The team clinician has an extremely important role to play in the preventon and management
of doping problems . The primary role of the team clinician should be education of team
members. This should involve regular breifings , especially prior to the season :
1. the Prohibited list
2. prescription drugs: the stheletes must inform clinicians that they are subject to drug testing
and ensure that the clinician confirms that the medication being prescribed does not contain
any banned substance.
3. inadvertent doping: checking the contents of all medications, especially over the counter
substances and supplements
4. drug testing protocols : especially listing contents and supplements of the drugs
5. travel : be aware while traveling in foreign countries that the drugs with the same or similar
brand names in one country may have a different composition in another country. Always
ensure that you take your own regular medications with you.