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Beginning Jan. 1, 2022, updates to anti-doping rules for triathletes will take effect in line with the World Anti-Doping Agency (WADA) Code changes.
“The [WADA] Code is reviewed every few years to ensure it becomes more robust and better at protecting clean sport and athletes,” said WADA representative Maggie Durand. This review includes a line-by-line discussion of the WADA prohibited list to determine which substances and treatment methods should be prohibited in sport and/or out of competition. WADA signatories, including national federations like USA Triathlon and major race series like Ironman, use the WADA Code to enforce a consistent set of anti-doping rules in age-group and professional athletes. That means the rules that triathletes and many other athletes must follow get updated.
For 2022, the WADA prohibited list includes several changes to substances and treatments, including commonly-prescribed medications for asthma. Athletes should be aware of these changes to ensure they are in compliance with the WADA code. You can see the full WADA prohibited list here and the Global Drug Reference Online is also a useful tool to look up whether individual medications are in compliance.
Per WADA rules, any athlete who needs to use a prohibited substance for medical reasons must apply for a Therapeutic Use Exemption (TUE)—a special permission allowing an athlete with a medical necessity to use an otherwise banned substance or method. In emergency situations TUEs can be granted after the fact. For instance, in life-threatening circumstances, when a banned medication is administered or required at a hospital or by emergency personnel, both WADA and USADA note that an athlete’s health comes first and the athlete must then submit the necessary paperwork after they are no longer in danger. In all other circumstances, WADA encourages athletes to submit a TUE Pre-Check Form to determine if a TUE is necessary and, in the U.S., applications go through the U.S. Anti-Doping Agency. However, it should be noted the focus in clearing applications is on elite and international level athletes.
Beginning Jan. 1, 2022, all glucocorticoid injections are prohibited in competition. This class of drugs, which includes cortisone, dexamethasone, hydrocortisone, methylprednisolone, and prednisolone, is typically used to treat inflammation caused by a wide variety of illnesses, including asthma, inflammatory bowel disease (IBD), arthritis, autoimmune diseases, and cancer.
Previously, glucocorticoid injections into joints, bursa, or the epidural space were allowed. However, injections were found to cause a significant increase in glucocorticoids circulating in the blood, which has the potential to result in performance enhancement or cause harm to health. Oral and rectal routes of glucocorticoid administration remain prohibited. WADA does allow glucocorticoids in and out of competition when administered by the following routes:
- Nasal sprays
- Eye drops
- Topical creams
- Dental applications
Albuterol (also known as salbutamol) is a beta-2 antagonist used to prevent and treat wheezing and shortness of breath caused by breathing problems (e.g., asthma, chronic obstructive pulmonary disease). It is also used to prevent asthma brought on by exercise. When used by athletes who do not have asthma, beta-2 antagonists may confer performance-enhancing benefits, but also performance-hindering side effects like dizziness, headaches, and nausea. The likelihood of these negative side effects increases with higher doses.
Under the 2022 WADA prohibited list, the daily dosing intervals for albuterol (salbutamol) is reduced to 600 micrograms, or 6 “puffs,” over 8 hours, or a total daily (24 hour) dose of 1600 micrograms. Previously, the limit was 800 micrograms over 12 hours. Athletes who require doses exceeding these limits need to apply for a Therapeutic Use Exemption (TUE).
Dosing limits for other beta-2 antagonists remain the same. These include formoterol (maximum delivered dose of 54 micrograms over 24 hours), salmeterol (maximum 200 micrograms over 24 hours) and vilanterol (maximum 25 micrograms over 24 hours).
BPC-157, an experimental compound making its way into wellness and anti-aging treatments, was added to the WADA prohibited list for 2022 due to a lack of clinical data. BPC-157 is currently not used to treat any specific medical condition, nor has a safe dose been established. As such, there is no basis for granting a TUE for BPC-157.
Athletes should be aware that supplements may contain prohibited substances not listed on the label. Between 2007 and 2016, the Food and Drug Administration (FDA) found that 776 dietary supplements from more than 145 companies were contaminated with drugs, including prescription medicines, banned and unapproved chemicals, and steroids or steroid-like ingredients. Under the principle of strict liability in anti-doping regulations, athletes are ultimately responsible for everything that goes into their body, including contaminated supplements. For extra insurance against tainted supplements, athletes can check the NSF International’s global Certified for Sport list, an independent third-party certification program, for a full list of certified “clean” companies.