Banned and Restricted Substances. David E. Olson, MD TPC 2017

Transcription

1 Banned and Restricted Substances David E. Olson, MD TPC 2017

2 No disclosures to report Disclosures

3 Famous Quote There is no room for second place. There is only one place in my game, and that s first place. Vince Lombardi

4 Winning isn t everything; it s the only thing. Red Sanders, UCLA football coach, 1950

5 The Most Famous per haps If you re not First, you re Last. Ricky Bobby

6 Goldman Dilemma If you were offered a banned performance enhancing substance that guaranteed that you would win an Olympic medal, and you could not be caught, would you take it? How many said YES? 195 out of 198 athletes Would you take a banned performance enhancing drug with a guarantee that you will not be caught; you will win every competition for the next 5 years, but then die from the side effects of the substance? How many said YES? >50% of the athletes willing to take the risk Goldman B. Death in the locker room II. Chicago. Elite Sports Medicine Publications. 1992;

7 Objectives We ve learned some about drug testing in the NFL/NCAA Look specifically at Stimulants and Supplements Discuss how to counsel athletes on supplements and where the potential issues are

8 History of Doping Ancient Greece Late 1800 s Cycling German troops - steroids WWII Mushrooms - Berserkers 60 s/70 s Eastern Block Present Numerous cases in Sport

9 Anti-Doping Programs Players go to great lengths to avoid testing (no pun intended)

10 Stimulants Can be found in: Illicit drugs Prescription Drugs Supplements Drinks Foods Nature Many athletes taking for medical reasons ADHD Many athletes not aware of using them Many accidental positives in NCAA/NFL

11 NCAA Banned Substances

12 Amphetamines Common Stimulant Have been used as far back as WWII when soldiers used them to delay fatigue First study in 1959 showed significant improvement in performance Available data suggest Amphetamines can improve performance in sports where speed, power and endurance are required

13 Side Effects: Related to drugs effect on CNS: insomnia, instability, agitation and restlessness Confusion, paranoia, hallucinations Dyskinesia, especially in facial muscles Cardiac complications: HTN, arrhythmias GI disturbances Severe rebound of fatigue and depression after discontinuance

14 Reasons for False Positive Test Cola Coffee Chocolate Poppy seed goods Electrolyte solutions Other OTC products and supplements (big issue) Protein shakes OTC protein powders Vitamins Other mixes Tainted OTC supplements!!

15 Caffeine Is banned by IOC and NCAA in large doses Legal limit = 15 micrograms / ml Equal to 6-8 cups of coffee at one sitting, with testing within 2-3 hours Beneficial most in endurance events, such as cycling Doses up to 5 mg / kg were required to see benefits. Doses of 17 mg/kg produce the maximum legal limit.

16 Side Effects: Similar to s/e of other stimulants: insomnia, irritability, nervousness Tachycardia, arrhythmias, and possibly death!

17 Ephedrine What it is: Is a drug found in herbal products containing Ma haung, anti-asthmatic medications, and many cold and cough products. Claims: Increases body fat loss What really does: Acts as a CNS stimulant, delays fatigue by sparing body glycogen reserves. Increase in BP, respiratory, heart rate, insomnia, and nervousness Max dose : 24 milligrams per day!!!!!!

18 Yohimbe What it is: Supplement derived from tree bark Claims: Anabolic effect, Increased virility What it does: Stimulant effect, no anabolic effect. Can cause nervousness, HA, nausea, Vomiting, increased B/P

19 Stimulants -Standard TUE May be granted for any substance or method on banned list Bigger process Must submit form showing Physicians diagnosis of condition ADHD Reason for need ***Often demonstrating a full independent workup Exhaustion of alternatives Reviewed by TUE Committee Document!!! NCAA retro checked and cleared for pos test

20 Must show Stimulant TUE s Full appropriate work up (independent in NFL) Significant health problem without the substance or method Therapeutic use must not enhance performance No reasonable alternative

21 Supplements Any product that contains vitamins, minerals, amino acids, herbs, botanicals or a concentrate, metabolite, constituent, extract or combination of any of these ingredients

22 The Perfect Supplement? The secret is to find something that is effective in improving performance, but not against the rules, and with no side effects Easier said then done.

23 Billion Dollar Industry Supplements Rampant use in HS, College, Pro and Recreational Athletes Widely available at stores Wide range of safety Hard to keep track of all that s out there Check NCAA/NFL safe supplement lists

24 1994 Dietary Supplement Health and Education Act Manufacturers don t have to provide proof of claims Can t state it will diagnose, treat or cure disease FDA has to have proof of danger to remove 2007 FDA tried to get a bit more strict Most Common Nutritional Supplements: 1. Multivitamins 2. Sports nutrition supplements 3. Calcium 4. B vitamins 5. Vitamin C 6. Glucosamine and Chondroitin 7. Vitamin D 8. Fish oils

25 Reasons athletes use supplements: Have to use them to be competitive Need the edge Not genetically gifted Dissatisfaction with size/ weight Peer/ Team Pressure Studies have shown that significant percentages of athletes would be ok decreasing their life span for an immediate athletic edge

26 Questions to ask on supplements??? What claims have been made? Is there any scientific basis? Does it work? Is it allowed? Very few controlled studies have been done on supplements.. Nutritional Supplements not FDA regulated or evaluated No guarantee of amount No guarantee of concentration of ingredients Products frequently lack purity and can be laced with other compounds

27 FDA Dangerous Herb List Ephedra Willow Bark: Reye Syndrome Lobelia: possible death Yohimbe: paralysis Comfrey: ingestion is toxic Chaparral: liver Disease

28 Summary -Many different stimulants/supplements are available -Help counsel athletes to make sure they don t have accidental positive tests and that they are making safe supplement choices -Get full evaluation and documentation (TUE s) for anyone taking prescription stimulants

29 Thank You!!