Abstract
This paper describes nine instances of positive anti-doping tests that could be accounted for by the use of permitted generic prescription drugs contaminated with diuretics, which are prohibited in sport at all times under the WADA Prohibited List. The contamination levels found in the medications are reported and were below FDA limits for manufacturers that are based primarily on safety considerations. These cases demonstrate that great care must be taken to identify the source of low-level anti-doping positives for diuretics reported by WADA-accredited laboratories, and possibly other prohibited substances as well, in order to avoid sanctioning innocent athletes. An evaluation of the cases in this paper supports an approach which establishes a laboratory minimum reporting level (MRL) for diuretics found most commonly in medications. A global consensus after extensive review of similar anti-doping cases has resulted in implementation of a recently announced solution regarding potential diuretic contamination cases.
Highlights
Sport drug testing is the backbone of the anti-doping movement and the fight for clean sport
In an attempt to delineate legitimate use of prescription diuretics from accidental contamination, we plotted the urinary concentrations from anti-doping tests from athletes that received anti-doping rule violations or had Therapeutic Use Exemptions (TUEs) with the urinary concentrations observed in the nine confirmed contamination cases (Figure 1)
The cases described here demonstrate that prescription medications may be contaminated at levels high enough to cause a positive anti-doping test
Summary
Sport drug testing is the backbone of the anti-doping movement and the fight for clean sport. Pharmaceutical Contamination and Drug-Testing Analysis that was contaminated with ∼2.5 mg of HCTZ per tablet (Helmlin et al, 2016) This example, in addition to the observations in the present manuscript, suggest that medications pose an emerging anti-doping risk. Differentiating between intentional doping (that is, athletes that purposely use a prohibited substance or method with the aim to enhance their performance) and product contamination through anti-doping sample analysis alone is challenging, and compounded by the laboratories ability to detect trace amounts of prohibited substances. We present data to support a minimum reporting level (MRL), below which labs would not be required to report findings, or report them as atypical Implementing this MRL is a pragmatic solution that would effectively reduce the likelihood of unfairly sanctioning an athlete that has inadvertently consumed a medication contaminated with a diuretic
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