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Running Clean: The Pharmacist's Role in Athletics

by Douglas Page,  2000
 
While the Olympic flame blazes brightly over the 2000 Summer Olympics at Sydney this month, the burning issue of drugs and athletes never goes out. 
 
In August, for instance, the International Olympic Committee (IOC), responding to international pressure, approved a new test in August to detect the use of the performance-enhancing drug erythropoietin (EPO) by Olympic athletes.
 
The IOC intends to use an Australian-developed blood test in combination with a urine test developed by French researchers.

EPO, the center of a Tour de France drug scandal in 1998, is produced naturally by the kidneys to stimulate production of red blood cells, a synthetic version of which is prescribed for certain chemotherapy patients. World-class athletes, however, use it illicitly, having discovered EPO increases the blood's oxygen-carrying capacity, in endurance sports such as cycling, distance running and swimming.

Elite athletes may not be found in every neighborhood, yet local pharmacists can nevertheless influence those amateur and professional athletes they do find as patients.

"Pharmacists should ask their patients whether they're competitive athletes subject to drug testing by a sports-governing body," said Peter J. Ambrose, Pharm.D., associate clinical professor, School of Pharmacy, University of California, San Francisco, and International Olympic Committee doping control technical officer in Sydney. "If so, pharmacists should take responsibility in helping the athlete avoid banned substances considered ergogenic and performance-enhancing."
Also, even drugs not considered performance-enhancing may be banned for other reasons, such as diuretics, which are banned as ‘masking agents'.

Pharmacists can obtain information on questionable substances by referring to the Athletic Drug Reference (ADR), published annually by Glaxo Wellcome and Clean Data, Inc., a reference book of banned, restricted and permitted drugs for athletes. To be absolutely safe, however, the sport's governing body should be consulted., or professional sports organization.
 
"A drug's current status can be verified by contacting the National Collegiate Athletic Association (NCAA) or U.S. Olympic Committee," said Jack Rosenberg, Pharm.D., Ph.D., professor of pharmacology at the College of Pharmacy, Long Island University, and ADR co-author. "This is the most reliable way since the ADR is published yearly and a drug's status may change."
 
In either case, the list of banned substances is substantial, containing over 24,000 entries, according to Rosenberg, including ingredients in many OTC products, such as antihistamines and decongestants.

"Pharmacists should become knowledgeable about banned substances," said Frank D. Uryasz, president, National Center for Drug Free Sport, which administers the NCAA's drug-testing program. "Generally, any stimulant, anabolic agent (androgens, etc.), diuretics, beta blockers (in some sports), and narcotic analgesics will be banned or limited."
Physicians tend to believe if the substance is prescribed, then it is permissible for an athlete to use.  This is not the case, and pharmacists can provide a final check for their athlete-patients.
Moreover, a relatively new problem in recent years is the proliferation of popular dietary supplements and "natural" or herbal products, many of which contain banned substances such as ephedrine.
 
These compounds are problems because ingredients may be listed by the botanical name and it may not be obvious they're prohibited, Ambrose said.
These dietary supplements for the most part are not listed in the ADR.
 
"‘Natural' does not mean ‘safe'," said Uryasz.
 
Dietary supplements also lack the regulations that apply to other products dispensed in a pharmacy. This can be confusing to consumers since pharmacies seem to be carrying these products more and more.
 
Nevertheless, supplement products pose a serious threat to an athlete's eligibility, Uryasz said. A significant number of recent positives from NCAA drug tests were attributed to the OTC dietary supplements containing the banned steroid 19-norandrostenedione (commonly referred to as nor-testosterone or nandrolone).
According to the NCAA, the number of nandrolone positives increased 58 percent in 1999 to an all-time high of about one percent of all student-athletes tested.
 
"All sports has seen an increase in nandrolone positives, almost all due to use of products containing 19-norandrostenedione," Uryasz said.

Some experts believe neighborhood pharmacists can make a difference by counseling their athlete patients on what substances they should and shouldn't take.
"Pharmacists can really help here," said Linda Tyler, Drug Information Director for the University of Utah Hospitals and Clinics (UUHC). "Frequently, student-athletes think OTC products are not a big deal, then they're ruled ineligible because they took something as simple as a cold remedy containing pseudoephedrine." 
Frequently, student-athletes will load up on pseudoephedrine and use it like an amphetamine, believing it boosts their performance.
 
"They read about pseudoephedrine, think it's a good idea, then try it,"  said Jim Jorgenson, Pharm.D., UUHC director of pharmacy, and Utah's hockey coach. "That's not good for the cardiovascular system. This is where the community pharmacist can have a big impact."
Pharmacists should also understand if substances are banned all the time or only during competition, particularly important since many governing organizations test out-of-competition athletes randomly, on short notice, Ambrose said. If a medication is restricted and medically necessary, pharmacists can instruct the athlete to contact their sports organization to get information on the procedure for medical exceptions.
 
"Inadvertent use of a banned substance can have devastating consequences for a class athlete, and pharmacists can help them avoid such problems," Ambrose said.
-end-
 
Comments? Questions? Corrections? Assignments? douglaspage@earthlink.net
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