DOPING RISK MANAGEMENT

REQUIREMENTS ON ATHLETES At all times, you should educate your athletes to minimize the risk of an accidental infraction: 1. Education! 2. Ensure all medications and products do not contain banned ingredients before taking them. 3. Do not encourage the use of supplements and if you do, minimize the risks. 4. Always comply with testing requests when your athletes are notified for doping control. 5. Know what responsibilities your athletes have, including whereabouts and medical exemption requirements.

CCES QUICK REFERENCE CARD

MEDICATION There are two ways for athletes to obtain medication: by prescription from your doctor or directly from the shelves. Anytime your athletes need a prescription, have them remind the doctor that they are an athlete and are subject to anti-doping regulations. With any medication that does not require a prescription (commonly referred to as "over-thecounter") ask the pharmacist for help using the CCES resources

CHECK YOUR MEDICATIONS! Do it yourself: The Global DRO is an online database (www.globaldro.com) that allows athletes to quickly and accurately find information on the status of pharmaceutical products over-thecounter medicinal products.

CHECK YOUR MEDICATIONS!

CHECK YOUR MEDICATIONS! The CCES publishes a Substance Classification Booklet that is based on the current WADA Prohibited List. This booklet provides an overview of prohibited substances and methods, including their Canadian brand names. It also identifies non-prohibited alternatives to prohibited substances in the event that an athlete needs to take a medication. CCES has put together some lists of medications for common ailments to help you decide what is safe to take. Educate athletes to print the listings for cough and cold medications or anti-asthma medications and take them to the drugstore.

SUBSTANCE CLASSIFICATION BOOKLET

PAGES 10-54

CHECK YOUR MEDICATIONS! Ask CCES: Complete the CCES online substance inquiry form. Contact the CCES by email at substances@cces.ca. Call them! You can reach CCES toll-free from anywhere in North America at 1-800-672-7775.

MEDICATION CONTAINING A PROHIBITED SUBSTANCE WADA Code recognizes the right of athletes to the best possible treatment for any medical condition.

THERAPEUTIC USE EXEMPTION Medical exemption processes depend on the sport practiced by the athlete. Canadian athletes must comply in all respects with the requirements set out in WADA s International Standard for TUE if; Athletes included in any Registered Testing Pool; Athletes who attend international events; Athletes that have been specifically notified in advance; National-level athletes that will be participating in Canadian national championships in the sports specified by CCES.

TUE APPLICATION APPROVAL A TUE application is only considered by the CCES under the following circumstances: the athlete would experience a significant impairment to health if the prohibited substance or method were to be withheld in the course of treating an acute or chronic medical condition; the use of the prohibited substance or method would produce no additional enhancement of performance other than that which might be anticipated by a return to a state of normal health following the treatment of a legitimate medical condition; and there are no reasonable therapeutic alternatives or other alternatives are ineffective. Examples include: Insulin for the treatment of Type 1 Diabetes Mellitus; Beta-2 Agonist inhaler, such as terbutaline, for the treatment of asthma; and Methylphenidate for the treatment of ADD or ADHD.

HOW LONG IS A TUE VALID? TUEs granted by the CCES are valid for the duration of the treatment as prescribed by the physician, up to a maximum of two years, or four years for inhaled asthma medications. It is the athlete s responsibility to know when the TUE expires and to apply for renewal before this date if necessary.

WHO SHOULD APPLY FOR A TUE? All athletes who are subject to doping control must be aware of the TUE rules and requirements that apply to them. These rules and requirements will vary depending on the athlete s level of competition and will determine when and to which organization an athlete must submit a TUE application.

TUE WIZARD

TESTING REQUEST

BEST TESTING RESOURCE Local doping control officer -organize through CCES or CSC

NUTRITIONAL SUPPLEMENTS? Extreme caution is recommended regarding supplement use. The use of dietary supplements by athletes is a concern because in many countries the manufacturing and labeling of supplements may not follow strict rules, which may lead to a supplement containing an undeclared substance that is prohibited under antidoping regulations. A significant number of positive tests have been attributed to the misuse of supplements and taking a poorly labeled dietary supplement is not an adequate defense in a doping hearing.

ARE SUPPLEMENTS TESTED? The World Anti-Doping Agency (WADA) is not involved in the testing of dietary/nutritional supplements.

RESOURCES NSF Certified for Sport Program http://www.nsfsport.com/

EMERGENCY CARE In exceptional circumstances, when an acute life-threatening medical condition requires immediate intervention involving the use of a medication containing a prohibited substance, you and your physician must apply for a TUE immediately after the treatment has been delivered. However, it is expected that such cases will occur very rarely and TUEs will therefore be granted in emergency situations under close scrutiny.

FOREIGN MEDICATION Medications are marketed under different names in different countries- even if they have the same brand names. They may have a different chemical compositions in order to respect local laws and availability of certain substances. In one country, a product may be safe to take from an anti-doping perspective, while in another country the product sold under the same name may contain a prohibited substance. consult your team doctor contact the local NADO or contact CCES or use CCES resources

TRAVEL MEDICATION One way to prevent such situation from occurring is to bring a medical "travel kit" with small doses of medications from home that you know are safe to use and that you anticipate may be required (e.g., pain and fever, allergy, common cold, stomach aches, skin infections, etc.). Before bringing any medication into a foreign country, check whether customs regulations allow you to do so and ensure that you do not carry a substance that is illegal at your destination.

TOPICAL MEDICATION Prohibited substances come in different forms and shapes and they may enter your body in different ways: contact with your skin (creams and ointments), inhalation (if you breathe in the vapor or mist), contact with a mucus membrane (eye or ear drops, suppository, etc.). Any medication applied to your body will likely enter your system to act in the way that is intended (reduce inflammation, relieve pain, kill bacteria, etc), and will be present in your blood before eventually being eliminated by the kidneys and turn up in your urine.

ALTERNATIVE MEDICINE Homeopathic products, herbal remedies and other alternative medicinal products are very risky. Homeopathic products labels usually specify ingredients by origin (name of plant or animal it is extracted from) and it is difficult to determine whether a prohibited substance is present. In addition, athletes have to be careful about any home remediesmany are derived from herbal products and many prohibited substances originate from plants. Under the strict liability principle, it does not matter how or why a prohibited substance entered an athlete's body. Athletes are responsible for everything that goes into their body.

MAJOR CHANGES IN 2009 CODE

FIRMNESS & FAIRNESS Two general themes emerged firmness and fairness both targeted at strengthening the fight against doping in sport.

INCREASED SANCTIONS The 2009 Code provides for an increase of sanctions in doping cases involving aggravating circumstances. The 2009 Code thus broadens the spectrum of anti-doping rule violations that can lead to a 4-year ban for a first serious doping offence.

GREATER FLEXIBILITY Greater flexibility was introduced as relates to sanctions in general. While this flexibility provides for enhanced sanctions, lessened sanctions are possible where the athlete can establish that the substance involved was not intended to enhance performance.

SPECIFIED SUBSTANCES The 2009 Code now provides that all prohibited substances, except substances in the classes of anabolic agents and hormones and those stimulants so identified on the Prohibited List, shall be specified substances for the purposes of sanctions. This means that where an athlete can establish how a specified substance entered his/her body or came into his/her possession and that such specified substance was not intended to enhance sport performance, the sanction may be reduced to a reprimand and no period of ineligibility at a minimum, and a 2-year ban in non-aggravating circumstances.

INCENTIVES TO COME FORWARD Incentives to come forward have also been strengthened. The potential extent of the suspension of an ineligibility period has been enhanced. Substantial assistance = ¾ ineligibility period Voluntary admission = ½ ineligibility period

FINANCIAL SANCTIONS The 2009 Code does not preclude anti-doping organizations from providing, in their own rules, for financial sanctions, in addition to the period of ineligibility or other sanction imposed.

ACCELERATED MANAGEMENT OF DOPING CASES The 2009 Code addresses delays and calls for the acceleration of the process and management of doping cases i.e. reduced period between analysis of the A and B samples, and mandatory provisional suspension following an adverse analytical finding through analysis of the A sample for non-specified substances

WADA S RIGHT OF APPEAL The 2009 Code also clarifies WADA s right to appeal directly to the Court of Arbitration for Sport a case in which an anti-doping organization fails to render a decision with respect to whether an anti-doping rule violation was committed within a reasonable deadline, or if the anti-doping organization had rendered a decision finding no anti-doping rule violation.

GREATER HARMONIZATION Rules were harmonized and made more uniform, and mandatory as part of the Code review. The 2009 Code formalizes the past WADA recommendation that any combination of three missed tests and/or failures by an athlete to provide accurate whereabouts information within an 18-month period as determined by the anti-doping organizations with jurisdiction over the athlete shall constitute an antidoping rule violation.

MAJOR CHANGES FOR THE 2012 LIST

FORMOTEROL EXCEPTION Taking into account recent research results and concerns expressed by members of the sports community, inhaled formoterol at therapeutic doses is no longer prohibited. The List prohibits the administration of all beta-2 agonists except salbutamol (maximum 1600 micrograms over 24 hours), salmeterol when taken by inhalation, and now formoterol (maximum 36 micrograms taken over 24 hours).

NICOTINE PLACED ON MONITORING PROGRAM In order to detect potential patterns of abuse, nicotine has been placed on WADA s 2012 Monitoring Program. Nicotine is one of several stimulants added to the Monitoring Program, along with the narcotics hydrocone and tramadol. Out-of-competition use of glucocorticosteroids has also been included. Article 4.5 WADA is mandated to establish a monitoring program regarding substances that are not on the List, but which the Agency wishes to monitor in order to detect patterns of misuse.

NON-APPROVED SUBSTANCES The section for non-approve substances S0 has been moved under the section for Prohibited Substances so that it clarified that methods are not included. Furthermore, in order to broaden the scope of this section a word change has been made, with i.e. being replaced by e.g., while more substances have been added to clarify the scope of this section. Substances will be included in S0 only after all other categories have been considered inadequate. Substances included in S0 are considered specified.

CAFFEINE Caffeine was removed from the Prohibited List in 2004. Its use in sport is not prohibited. Caffeine is part of WADA s Monitoring Program. This program includes substances which are not prohibited in sport, but which WADA monitors in order to detect patterns of misuse in sport. The 2010 and 2011 Monitoring Programs did not reveal global specific patterns of misuse of caffeine in sport, though a significant increase in consumption in the athletic population is observed

CLENBUTEROL Clenbuterol is a prohibited substance and there is no threshold under which this substance is not prohibited. At present, and based on expert opinions, there is no plan to introduce a threshold level for clenbuterol. It is possible that under certain circumstance the presence of a low level of clenbuterol in an athlete sample can be the result of food contamination. However, each case is different and all elements need to be taken into account, along with the context of the case. Under the World Anti-Doping Code, result management of cases foresees the opportunity for an athlete to explain how a prohibited substance entered his/her body WADA is working closely with countries, International Federations and event organizers to help minimize the risk of contamination through the monitoring of meat to official hotels and restaurants. This is a government issue and not a WADA issue.

ACTOVEGIN It has not changed from last year and Actovegin is not prohibited in sport under the WADA List except if it is used by intravenous infusion. Intravenous infusions are prohibited according to section M2 (Chemical and Physical Manipulation) of the List. Intravenous injections with a simple syringe are permitted if the injected substance is not prohibited, the volume does not exceed 50 ml, and the intravenous injections are given at intervals equal or greater than six hours. However, WADA is aware of its use in some sports, possibly in conjunction with other substances that may be prohibited. WADA will therefore continue to closely monitor Actovegin.

WHAT IS A SPECIFIED SUBSTANCE? A specified substance is a substance which allows, under defined conditions, for a greater reduction of a two-year sanction when an athlete tests positive for that particular substance. The purpose is to recognize that it is possible for a substance to enter an athlete s body inadvertently, and therefore allow a tribunal more flexibility when making a sanctioning decision. This greater likelihood is simply not credible for certain substances such as steroids and human growth hormone and this is why these are not classified as specified.

RESOURCES