Questions & Answers on 2014 Prohibited List

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What noteworthy changes have been made to the 2014 List compared to the 2013 version?

IN – AND OUT-OF COMPETITION

Use of International Non-proprietary Names (INN)

With the assistance of the World Health Organisation, the nomenclature of some substances on the List has been updated to International Non-proprietary Names (INN). For ease, however, previous names have been maintained and no substance has been deleted.

 

S1. Anabolic Agents

To ensure clarification and accuracy, changes were made to the definitions of “exogenous” and “endogenous”

 

S2. Peptide Hormones, Growth Factors and Related Substances

As made clear through points S2.2, S2.3 and S2.4, Releasing factors are prohibited. Furthermore, other prohibited growth factors are listed separately.

 

S5. Diuretics and other Masking Agents

Vasopressing V2 antagonists (vaptans) were added as an example of a diuretic subclass.

 

M1. Manipulation of Blood and Blood Components

For the purpose of scientific accuracy, the term allogenic was introduced.

 

IN-COMPETITION

S6. Stimulants

Some drugs that metabolize to amphetamine or methamphetamine have been reclassified because improved analytical techniques permit the identification of the administered drug and corresponding metabolites; MDMA and MDA are reclassified because they are now recognized as less likely to be used as doping agents; cathinone and its analogues (e.g. mephedrone, methedrone, a- pyrrolidinovalerophenone) and trimetazidine have been added as examples to reflect emerging patterns of drug use.

 

IN PARTICULAR SPORTS

P1. Alcohol

In the interest of accuracy, changes were made to the wording describing the blood alcohol threshold. In addition, “Aeronautic” has been replaced by “Air Sports”, and “FITA” has been replaced by its new acronym “WA” (World Archery).

P2. Beta-blockers

“FITA” has been replaced by its new acronym “WA” (World Archery).

 

Monitoring Program

In order to detect potential patterns of abuse, mitragynine has been added to the Narcotics class of the Monitoring Program.

What is the status of methylhexaneamine (MHA)?

Methylhexaneamine (MHA), which sometimes is presented as dimethylamylamine, remains prohibited in competition as a specified stimulant under Section 6.b.

It has been considered a stimulant at least since WADA took over responsibility for the List in 2004. It was reclassified on the 2011 List to become a ‘specified substance’.

Methylhexaneamine was sold as a medicine up to the early 1970s and has medicinal properties, but to WADA’s knowledge it has not been sold as a medicine since then.

What is the link between geranium oil and methylhexaneamine (MHA)?

Recent scientific studies have clearly demonstrated that natural geranium oil does not contain methylhexaneamine (MHA), and the use of geranium oil cannot be considered as being the source of the presence of MHA or related metabolites in a urine sample collected for anti-doping purposes.

Methylhexaneamine (MHA) is a pharmacological substance classified as a stimulant that was commercialized up to the beginning of the seventies. MHA reappeared a few years ago as a constituent of dietary supplements sold freely on some markets or on the Internet.

MHA is prohibited as a stimulant under section S6.b of the 2013 List of Prohibited Substances and Methods.

Athletes should be aware that MHA has been made available under several names, one being geranium oil.

What is the status of 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.

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.

Specified substances are not necessarily less serious agents for the purpose of doping than other prohibited substances, and nor do they relieve athletes of the strict liability rule that makes them responsible for all substances that enter his or her body.

However, there is a greater likelihood that these substances could be susceptible to a credible non-doping explanation, as outlined in section 10.4 of the World Anti-Doping Code.

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.

What is the status of colostrum?

Colostrum is not prohibited per se, however it contains certain quantities of IGF-1 and other growth factors which are prohibited and can influence the outcome of anti-doping tests. Therefore WADA does not recommend the ingestion of this product.

What is the status of platelet derived preparations (PRP)?

Despite the presence of some growth factors, platelet-derived preparations were removed from the List as current studies on PRP do not demonstrate any potential for performance enhancement beyond a potential therapeutic effect.

Note that individual growth factors are still prohibited when given separately as purified substances as described in S.2.5.

Is dialysis a Prohibited Method?

Yes, Hemodyalisis is prohibited under M1.1, as blood is taken out from the patient (in a closed circuit) and then reintroduced into the circulatory system.  An athlete needing this treatment requires a TUE.

Is Plasmapheresis prohibited?

Plasmapheresis should be considered from 2 angles:

a.    For the donor, plasmapheresis is prohibited under M1.1 because the donor’s own red blood cells (and other blood components) are being reintroduced into the circulatory system after the   plasma has been separated.

b.    For the recipient, plasmapheresis is not prohibited under M1.1 or M1.3 as the patient receives only plasma but does not receive whole blood or red blood cells.  For the recipient  plasmapheresis would only be prohibited under M2.2 if it is not legitimately received in the course of a hospital admission when the volume is more than 50 mL per 6 hour period.

Is Intravenous Laser Therapy prohibited?

Yes it is prohibited under M1.3 as “Any form of intravascular manipulation of blood…”

Why may there be a delay in determining the status of some substances on the Prohibited List?

The WADA Prohibited List endeavours to capture as many known substances and methods that satisfy any two of the following three criteria:

1.    Potential to enhance or enhances sports performance

2.    An actual or potential health risk to the athlete

3.    Use violates the spirit of sport (outlined in the Code)

Substances or methods which mask the effect of prohibited substances are also prohibited.  In addition, a substance which has not been approved for human use is likely to be prohibited as well.

Substances are grouped under the “S” categories, which are either:

      i.        Closed categories: all the prohibited substances are included by name in the category e.g. S6.a (Non-specified stimulants), S7 (Narcotics).

 

     ii.        Open categories with examples: composed of a non-exhaustive list of examples representing the most typical drugs in the group, based on their chemical structure and/or mechanism of action, e.g. S2 (Peptide hormones, growth factors & related substances), S6.b (Specified stimulants).  Other substances in these categories  are either captured by the name of a family of compounds (e.g. Corticotrophins) or by more general statements such as:

1.   “other substances with similar chemical structure or similar biological effect(s)”. 

2.  “including but not limited to..”

3.  “any other growth factor affecting .....”

 

    iii.        Open categories without examples: no particular substances are listed but they are captured if they belong to a particular pharmacological class e.g. S9 (Glucocorticosteroids) or if they meet a particular criteria e.g. S0, which refers to substances not approved for human therapeutic use[1] .

 

This means that while the status of some substances is straight forward (e.g. for those that are specifically listed by name), this is not necessarily the case for substances that are not included by name on the List.    For these substances, it is necessary to gather information on, for example, their chemical structure, pharmacological/biologic actions and whether they are approved for human therapeutic use anywhere in the world.  This verification can take some time to complete, especially for non-approved drugs (e.g. designer drugs, new investigational drugs) for which little scientific information is publicly available. In such cases, WADA will not be able to immediately determine the status of that substance.  It is in the best interest of the athlete to refrain from taking any substance or use any method if its status is unknown or unclear.

 

This process of thoroughly collecting and analysing information on substances and methods is the way to practically manage the Prohibited List, as it encompasses thousands of substances and methods, and has the potential to capture many thousands more which have not yet caught the attention of the anti-doping movement.



[1] The full SO category description is “Any pharmacological substance which is not addressed by any of the subsequent sections of the List and with no current approval by any governmental regulatory health authority for human therapeutic use (e.g. drugs under pre-clinical or clinical development or discontinued, designer drugs, substances approved only for veterinary use) is prohibited at all times.”

Can I test positive for ingesting glycerol found in foodstuffs and toiletries?

Glycerol is prohibited as a plasma expander. The consumption of quantities of glycerol far beyond those commonly found in e.g. foods, beverages, personal care products, medicinal tablets tuffs, cough syrup is required to produce an Adverse Analytical Finding. Therefore, its prohibition is not intended to prevent the ingestion of this substance in the amounts commonly found in foodstuffs and toiletries, as such small quantities will not cause an athlete to test positive for this Prohibited Substance.

Are hormone releasing factors prohibited under S2?

Yes, factors acting on the release of peptide hormones, growth factors and related substances comprised in section S2 are prohibited at all times. They comprise natural and synthetic products.

Examples of Growth Hormone releasing factors include peptidyl and non-peptidyl synthetic growth hormone secretagogues like hexarelin, alexamorelin, GHRP-1, GHRP-2 (pralmorelin), GHRP-4, GHRP-5, GHRP-6, ghrelin and ghrelin mimetics like ipamorelin, anamorelin and macimorelin as well as natural Growth Hormone Releasing Hormone (GHRH) and GHRP mimetics like sermorelin, CJC1295 and tesamorelin.

Examples of gonadotrophin releasing factors include leuprolide, buserelin, nafarelin, histrelin, goserelin and deslorelin.  Examples of corticotrophin releasing factors include corticotrophin releasing hormone (corticoliberin) and corticorelin acetate.

This list is by no means exhaustive and athletes should be mindful of the existence of other releasing drugs for peptide hormones, growth factors and related substances that are covered by section S.2 of the Prohibited List.

  • Last Updated September 2013
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