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Anti-doping

WADA publishes updated Prohibited List for 2022

WADA publishes updated Prohibited List for 2022 main change is the inclusion of all injectable routes of glucocorticoids (S9 category) as prohibited in the in-competition period, effective January 1

WADA publishes updated Prohibited List for 2022

The World Anti-Doping Agency (WADA) has published the updated Prohibited Substances List, effective January 1, 2022. The main change is the inclusion of all injectable routes of glucocorticoids (S9 category) as prohibited, as of 01/01/2022. Until 12/31/2021, only oral, rectal, intravenous and intramuscular routes of administration are prohibited; all other routes being permitted, which include, for example, peritendinous or intra-articular injections. But from 2022, all injectable routes will be considered breaking the rules. It is worth noting that the S9 category is prohibited only in competition. For Dr. José Kawazoe Lazzoli, President of the Pan American Confederation of Sports Medicine and of the Commission for Therapeutic Use Exemptions (CAUT) of the Brazilian Doping Control Authority (ABCD), the update is positive.

“Glucocorticoids have performance-enhancing potential and may pose health risks. Studies have shown that many of the injectable routes that were permitted ended up resulting in plasma concentrations consistent with the systemic routes that are prohibited. In addition, peritendinous or intra-articular injections would sometimes inadvertently end up becoming intra-muscular,” he explained.

The WADA Executive Committee during its September 2020 meeting proposed a ban on all injectable applications of glucocorticoids in competition. While this modification was approved, the Executive Committee asked WADA Management to implement the ban only as of January 1, 2022, to allow sufficient time for stakeholders to learn and adapt to this change.

“The change makes the rule clearer, safer, and avoids wearing down the athlete's image with a positive test. The athlete's health will always be the priority and, if there is a proven need, a TUE must be requested, complying with the requirements indicated by the World Anti-Doping Code. The athlete remains responsible for what is found in his sample, and the medical team also has a duty to know and respect the rule”, said Dr Christian Trajano, manager of Education and Doping Prevention at the COB.

“It will be necessary for team doctors to be aware that they will now need to request TUEs for their athletes for the routes of administration that were allowed and will be prohibited from 2022. This will naturally imply an increase in requests for TUE. Doctors will need to keep up to date and attentive to avoid prohibited procedures from 2022 onwards”, analyzed Dr. Kawazoe.

If there is a medical need to use the substance, the athlete can apply for a Therapeutic Use Authorization (TUE), provided that the WADA international standard for granting TUEs is followed. And the international standard includes: a) That there is a clinical indication, based on scientific evidence, for the use of the prohibited substance; b) That the objective is, in fact, therapeutic; and c) That there are no valid therapeutic alternatives with permitted substances or routes of administration to consider the use of the prohibited substance.

“There is a forecast from CAUT that there will be an increase in TUE requests because glucocorticoids are substances contained in many drugs used by recovering athletes. To request a TUE, the athlete must fill out the specific form available on the ABCD website and send it to the e-mail aut@abcd.gov.br. The granting of a TUE can take up to 21 days according to the international standard. So, it is very important to plan and place the order in advance”, said Luisa Parente, national secretary of ABCD.

“The ABCD TUE Commission always acts under the strictest technical and ethical precepts, authorizing when the international standard of requests is contemplated, in order to allow correct treatments, from an ethical and scientific point of view, when the athletes' diagnoses are consistently documented and justified,” added Kawazoe.

Each year, WADA conducts an extensive consultation process on the Prohibited List, which involves some of the most qualified experts in the fields of science and medicine from around the world. This allows WADA to review the latest trends and scientific research to ensure that any new or existing substances or methods that may meet the criteria for addition to the List are considered in a timely manner to protect the athlete's health and maintain a level playing field for all.

“The deadline for making information available in Portuguese for the entire Olympic Movement in Brazil is January 1, 2022, the day the 2022 List comes into force. But the sooner the sports community in Brazil can have information about all the changes in the list, the more beneficial it will be for athletes. I understand that ABCD and COB are working together to make the translated information available and facilitate the access of the Olympic Movement of Brazil to all changes to the 2022 Prohibited Substances List,” said Maria José Pesce, WADA Regional Director for Latin America.

“We always work in partnership with the COB, which is a member of the Brazilian Forum on Doping Control, a very intrinsic partnership, in cooperation according to the International Anti-Doping System”, explained Parente.

“The Anti-Doping page on the COB website is an excellent source of information and there you can find more information on this topic and many others. If there are still doubts, we will respond to everyone through Contact Us”, said Dr Christian Trajano, manager of Doping Prevention and Education at the COB.

To assist athletes, technical committees and doctors, the COB, through its area of Doping Prevention and Education, will make available on the portal all WADA documentation and guidelines on updating the List of Prohibited Substances. Just access the links below.

+ Learn about the Prohibited Substance List update

+ Monitoring Program 2022

+ Glucocorticoids and Therapeutic Use Exemptions - Guide for doctors and athletes

Other changes

In addition to banning all injectable routes of glucocorticoids during the competition period, WADA made other changes to the list. See below:

S3. Beta-2 Agonists - Salbutamol Dosage

With respect to salbutamol, daily dosing intervals are modified to 600 micrograms over eight hours from the time any dose is administered (previously 800 micrograms over 12 hours). The total allowable daily dose remains at 1,600 micrograms over 24 hours. A TUE must be requested for doses that exceed these limits.

S0. Unapproved substances

For the first time, a substance has been included by name as an example in the S0 (Unapproved Substances) section of the List. This substance, BPC-157, is an experimental peptide sold as a supplement and was added to the 2022 List following a recent reassessment of its status.

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