Drugs in Sport

431 Pages·2018·4.36 MB·English

by  David R. Mottram

Drugs in Sport
Drugs in Sport is the most comprehensive and accurate text on the emotive, complex
and critical subject of doping and illegal performance enhancement in sport. Thoroughly
updated in light of the latest World Anti-Doping Code and taking into account the latest
regulations, methods and landmark cases, this seventh edition explores the science behind
drug-use in sport, as well as its ethical, social, political and administrative context.
Introducing an increased focus on inadvertent doping, athlete-support personnel as key
stakeholders in the doping process, societal drug-use, and the role of national governing
bodies and anti-doping organisations, the book covers key topics including:
• an assessment of the prevalence of drug-taking in sport
• the latest doping control regulations stipulated by the World Anti-Doping Agency
(WADA)
• the science and side effects of each major class of drug used in sport
• cutting-edge issues such as gene doping and biological passports
• issues surrounding legal substances and ergogenic aids in supplements
• medical and pharmaceutical services at major sporting events
Accessibly written, and supported throughout with illustrative case studies and data, Drugs
in Sport provides a crucial and objective resource for students and researchers, athletes,
sports scientists, coaches and athlete-support staff, journalists, sports administrators and
policymakers, alike.
David R. Mottram is Emeritus Professor of Pharmacy at Liverpool John Moores University,
UK. He was a member of the organising committee for pharmacy services for the London 2012
Olympic and Paralympic Games, and part of the medical services team at the Polyclinic in the
Athlete Village during the Rio 2016 Olympic Games. David is currently providing education
and training programmes on medicines management in sport for the International Olympic
Committee (IOC), the World Anti-Doping Agency (WADA) and UK Anti-Doping (UKAD).
Neil Chester is Senior Lecturer in Sport and Exercise Sciences at Liverpool John Moores
University, UK. His teaching commitments are in exercise physiology with a particular focus
in sports nutrition, supplementation, drug use and anti-doping in addition to research eth-
ics and ethics in sport and professional practice. Neil works closely with UK Anti-Doping
in a research, education and testing capacity and is a committee member of the British
Association for Sport and Exercise Sciences Clean Sport Interest Group.

Drugs in Sport
Seventh Edition
Edited by David R. Mottram
and Neil Chester
Seventh edition published 2018
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
and by Routledge
711 Third Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an informa business
 2018 selection and editorial matter, David R. Mottram and Neil
Chester; individual chapters, the contributors
The right of David R. Mottram and Neil Chester to be identified as the
authors of the editorial material, and of the authors for their individual
chapters, has been asserted in accordance with sections 77 and 78 of the
Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced
or utilised in any form or by any electronic, mechanical, or other means,
now known or hereafter invented, including photocopying and recording,
or in any information storage or retrieval system, without permission in
writing from the publishers.
Trademark notice: Product or corporate names may be trademarks
or registered trademarks, and are used only for identification and
explanation without intent to infringe.
Every effort has been made to contact copyright-holders. Please advise
the publisher of any errors or omissions, and these will be corrected in
subsequent editions.
First edition published by Human Kinetics 1988
Sixth edition published by Routledge 2015
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
Names: Mottram, D. R. (David R.), 1944- editor. | Chester, Neil, editor.
Title: Drugs in sport / [edited by] David R. Mottram and Neil Chester.
Description: Seventh edition. | Milton Park, Abingdon ; New York, NY :
Routledge, 2018. | Includes bibliographical references and index.
Identifiers: LCCN 2017042157 (print) | LCCN 2017043366 (ebook) |
ISBN 9781315222790 (Master eBook) | ISBN 9780415789394 (hbk) |
ISBN 9780415789417 (pbk) | ISBN 9781315222790 (ebk)
Subjects: LCSH: Doping in sports. | Sports medicine. | Substance abuse.
Classification: LCC RC1230 (ebook) | LCC RC1230 .D783 2018 (print) |
DDC 617.1/027—dc23
LC record available at https://lccn.loc.gov/2017042157
ISBN: 978-0-415-78939-4 (hbk)
ISBN: 978-0-415-78941-7 (pbk)
ISBN: 978-1-315-22279-0 (ebk)
Typeset in Goudy
by Swales & Willis Ltd, Exeter, Devon, UK
Contents
List of figures xiv
List of tables xvi
List of boxes xix
List of contributors xxi
SECTION 1
The use, misuse and regulation of drugs in sport 1
1 Drugs and their use in sport 3
DAVID R. MOTTRAM
1.1 Introduction 3
1.2 What is a drug? 3
1.3 Why might athletes take drugs? 12
1.4 The use of drugs for performance enhancement 16
1.5 Summary 19
1.6 References 20
2 The evolution of doping and anti-doping in sport 21
DAVID R. MOTTRAM
2.1 Introduction 21
2.2 The ancient Olympic and Roman Games 21
2.3 Nineteenth century 23
2.4 Early twentieth century 23
2.5 The 1940s and ‘50s 23
2.6 The 1960s 24
2.7 The 1970s 25
2.8 The 1980s 26
2.9 The 1990s 27
2.10 2000 to 2010 28
2.11 2011 and onwards 33
2.12 Summary 36
2.13 References 37
vi Contents
3 Prevalence of doping in sport 39
KELSEY ERICKSON AND SUSAN H. BACKHOUSE
3.1 Introduction 39
3.2 WADA-accredited laboratory anti-doping testing figures 40
3.3 Indirect estimates of doping prevalence 45
3.4 Summary 47
3.5 References 48
4 Regulation of anti-doping in sport: international and
national operational frameworks 50
NEIL CHESTER AND NICK WOJEK
4.1 Introduction 50
4.2 Why regulate drug use in sport? 50
4.3 The history of the anti-doping movement 51
4.4 Anti-doping structure 53
4.5 The World Anti-Doping Agency 54
4.6 The UNESCO International Convention against Doping in Sport 55
4.7 The World Anti-Doping Code 55
4.8 Court of Arbitration for Sport 62
4.9 Summary 62
4.10 References 62
5 Doping control in sport 64
NEIL CHESTER, NICK WOJEK AND YORCK OLAF SCHUMACHER
5.1 Introduction 64
5.2 Analytical investigations 64
5.3 Athlete Biological Passport 72
5.4 Non-analytical investigations 77
5.5 Sanctions 78
5.6 Education 80
5.7 Summary 81
5.8 References 81
6 Inadvertent use of prohibited substances in sport 83
DAVID R. MOTTRAM AND NEIL CHESTER
6.1 Introduction 83
6.2 Why athletes may take prohibited substances inadvertently 83
6.3 Risk levels for inadvertent prohibited substance use in sport 84
6.4 WADA rules and regulations regarding inadvertent
use of prohibited substances 92
6.5 The role of Athlete Support Personnel in preventing deliberate and
inadvertent use of prohibited substances 93
Contents vii
6.6 Summary 95
6.7 References 95
7 The role of Athlete Support Personnel in drug use in sport 99
NEIL CHESTER, MARK STUART AND DAVID R. MOTTRAM
7.1 Introduction 99
7.2 Athlete Support Personnel 99
7.3 Medical support personnel and athlete therapy 105
7.4 The World Anti-Doping Code and Athlete Support Personnel 106
7.5 Education and support for Athlete Support Personnel 111
7.6 Summary 111
7.7 References 112
8 Medical and pharmacy services for international games 114
MARK STUART
8.1 Introduction 114
8.2 Medical services at sporting venues 114
8.3 The games polyclinic 115
8.4 Polyclinic services 116
8.5 Role of healthcare professionals in anti-doping 117
8.6 Medical workforce and training 117
8.7 Drug administration to athletes 118
8.8 Prescribing prohibited substances to athletes 118
8.9 Medicines governance 119
8.10 Selection of medicines for athlete treatment at games 120
8.11 Patterns of drug use 121
8.12 Importation of drugs for team use 123
8.13 Anti-doping support for local healthcare services 124
8.14 Summary 124
8.15 Bibliography 124
SECTION 2
Substances and methods prohibited in sport 127
9 Anabolic agents 129
NEIL CHESTER
9.1 Introduction 129
9.2 Anabolic androgenic steroids 130
9.3 Pharmacology of anabolic androgenic steroids 131
9.4 Clinical uses of anabolic androgenic steroids 134
9.5 Anabolic androgenic steroids as performance- and
image-enhancing agents 134
viii Contents
9.6 Adverse effects following anabolic androgenic steroid use 136
9.7 Use of anabolic androgenic steroids in sport 138
9.8 Prevalence of anabolic androgenic steroid use 141
9.9 Designer steroids 143
9.10 Prohormones 143
9.11 Detection of anabolic androgenic steroids 144
9.12 Selective Androgen Receptor Modulators 145
9.13 Beta-2 agonists 145
9.14 Tibolone 146
9.15 Summary 146
9.16 References 146
10 Peptide hormones, growth factors and related substances 151
DAVID R. MOTTRAM AND NEIL CHESTER
10.1 Introduction 151
10.2 Erythropoiesis-stimulating agents 152
10.3 Hypoxia-inducible factor (HIF) stabilizers 156
10.4 Chorionic gonadotrophin (CG) 156
10.5 Luteinizing hormone (LH) and its use in sport 157
10.6 Corticotrophins 158
10.7 Growth hormone (GH) 158
10.8 The abuse of growth hormone in sport 160
10.9 Growth hormone releasing factors (GHRFs) 163
10.10 Detection of growth hormone abuse 163
10.11 Growth factors 165
10.12 Prevalence of peptide hormone use in sport 166
10.13 Peptide hormones as potential targets for gene doping 167
10.14 Summary 167
10.15 References 168
11 Beta-2 agonists 173
NEIL CHESTER AND DAVID R. MOTTRAM
11.1 Introduction 173
11.2 What are beta-2 agonists? 173
11.3 Clinical uses of beta-2 agonists 174
11.4 The illicit use of beta-2 agonists in sport 179
11.5 Beta-2 agonists and the WADA Prohibited List 183
11.6 Summary 184
11.7 References 184
12 Hormone and metabolic modulators 188
NEIL CHESTER
12.1 Introduction 188
12.2 Hormone and metabolic modulators and the WADA Prohibited List 188
Contents ix
12.3 Aromatase inhibitors 189
12.4 Selective Oestrogen Receptor Modulators 190
12.5 Other anti-oestrogenic substances 191
12.6 Agents modifying myostatin function(s) 192
12.7 Metabolic modulators 193
12.8 Summary 196
12.9 References 196
13 Diuretics and masking agents 199
DAVID R. MOTTRAM
13.1 Introduction 199
13.2 What are diuretics? 199
13.3 Action and use of diuretics in sport 199
13.4 Action and uses of masking agents in sport 202
13.5 History of diuretics and masking agents in sport 203
13.6 WADA classification of diuretics and masking agents 206
13.7 Summary 208
13.8 References 208
14 Manipulation of blood and blood components 210
YORCK OLAF SCHUMACHER
14.1 Introduction 210
14.2 Blood transfusions 211
14.3 Erythropoiesis stimulating agents 212
14.4 New developments in erythropoietic drugs 213
14.5 Blood substitutes 215
14.6 Summary 217
14.7 References 217
15 Chemical and physical manipulation 219
DAVID R. MOTTRAM
15.1 Introduction 219
15.2 Current (2017) WADA regulations with respect to
chemical and physical manipulation 219
15.3 Prevalence of chemical and physical manipulation in sport 220
15.4 Institutionalised manipulation of the doping control process 223
15.5 Techniques for identifying chemical and physical manipulation 225
15.6 Summary 226
15.7 References 226
16 Gene doping 228
DOMINIC J. WELLS
16.1 Introduction 228
16.2 What is gene doping? 228