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Background: Nicotine is a psychostimulant drug with purported use in sports environments, though the use of nicotine among athletes has not been studied extensively., Objective: The aim of this study was to assess the nicotine positivity rate in 60,802 anti-doping urine samples from 2012 to 2020., Methods: Urine samples obtained in-competition at different national and international sports events held in Italy during the period 2012-2020 were analysed. All samples were from anonymous athletes that were collected and analysed at the WADA-accredited antidoping laboratory in Rome, Italy. Samples were analysed by gas chromatography coupled with mass spectrometry, with a cut-off concentration for nicotine of > 50 ng/mL. Results were stratified by year, sport and sex., Results: An overall mean of 22.7% of the samples (n = 13,804; males: n = 11,099; females: n = 2705) showed nicotine intake, with male samples also displaying higher positivity rates than female (24.1% vs 18.5%). Sample positivity was higher during 2012-2014 (25-33%) than 2015-2020 (15-20%). Samples from team sports displayed a higher positivity rate than those from individual sports (31.4 vs 14.1%)., Conclusions: The current data demonstrates that one in five samples from a range of 90 sports test positive for nicotine in-competition. There is a lower positivity rate in endurance versus power/strength athletes and higher positivity rate in team versus individual sports, probably accounted for by differences in physiological and psychological demands and the desire for socialisation. WADA, international and national sports federations should consider these findings with concern, proactively investigate this phenomenon and act in order to protect the health and welfare of its athletes., (© 2023. The Author(s).)

The detection of clostebol misuse in sports has been growing recently, especially in Italy, due to the ample availability of pharmaceutical formulations containing clostebol acetate (Trofodermin®) and the use of more sensitive instrumentation by the antidoping laboratories. Most of these cases have been claimed to be related to a nonconscious use of the drug or through contact with relatives or teammates using it. We have investigated, through the application of the well-known and currently used gas chromatographic mass spectrometric procedures, the likelihood of these allegations and have demonstrated that after a single transdermal administration of 5 mg of clostebol acetate and a transient contact with the application area, it is possible to generate adverse analytical findings in antidoping controls. We have reviewed the Phase I and Phase II clostebol metabolism in order to generate evidences that may help the sport authorities reviewing these cases. The main clostebol metabolite (4-chloro-androst-4-en-3α-ol-17-one, M1) generally used at the screening level as well as other three metabolites (M2-M4) are mainly excreted as glucuronides, whereas M5 (4ζ-chloro-5ζ-androstan-3β-ol-17-one) is predominantly excreted as sulfate. Neither the 5α-reductases activity (impaired by the presence of the chlorine in C4) nor specific sulfotransferases present in the skin allowed a clear distinction of the administration route. Studies with a larger number of volunteers and probably investigating another physiological fluid allowed in antidoping such as blood are needed for a deeper investigation. It is not unreasonable to establish a reporting level for M1, maybe creating some false negatives but excluding nonintentional doping scenarios., (© 2020 John Wiley & Sons, Ltd.)

The objective of this study was to assess the prevalence of illicit drugs use among young adults, in particular elite athletes. This study considers the data obtained from anti-doping analyses performed on nearly 100,000 urine samples from 2000 to 2009 by the World Anti-Doping Agency accredited Italian Anti-Doping Laboratory. The percentage of adverse analytical findings varies on a yearly basis, but it is in the range 1.0-1.8% (not considering atypical findings, such as an altered endogenous steroid profile). Among positive results, there is a high prevalence of stimulants and drugs of abuse. The drug of abuse found most frequently is the tetrahydrocannabinol (cannabis) metabolite, accounting for 0.2-0.4% of the total samples analysed (18% of the positive results). The second most frequently encountered drug is cocaine, as detected from cocaine metabolites, accounting for 0.1% of the total samples analysed (7% of positive results). Other stimulants found included amphetamines, ephedrines, carphedon, modafinil, and anorexic compounds. No amphetamine-like designer drugs were detected. These data are indicative of the widespread prevalence of cocaine and cannabis use among the young adult population. However, due to the particular population studied, it must be considered an underestimation of the phenomenon among elite athletes with respect to the general population.

Competitive sports eligibility, mandatory for the Italian law in all age classes, from young to master athletes, involves millions of subjects, who are at risk during their sport career both for prescription and illicit drugs (or banned substances included in the World Anti-Doping Agency list, annually updated). These drugs may interfere with adrenergic hyperactivation related to athletic activity and can bring to unfavorable cardiovascular effects, such as arrhythmias, coronary artery disease, myocarditis, pericarditis, heart failure, ion channel disease. Moreover, numerous compounds may reduce athletic performance. Cardiovascular side effects are more frequently reported when drug co-administration is performed, which occurs frequently. Drug co-administration may have a higher risk when a common metabolic pathway is used (i.e. P450 hepatic cytochrome), and inhibition or induction effects modify plasma drug levels. One of the most important problems remains for combination of drugs that might be torsadogenic. Therefore, it is mandatory to be aware of pharmacokinetic properties, mechanisms of action, side effects and interactions between drugs and competitive sports activities; moreover, possible clinical, instrumental (i.e. ECG) or laboratory markers should be pointed out in order to recognize a possible toxic effect and subsequently interrupt or modify drug administration and/or assumption.

The incidence of the abuse of illicit drugs in sport may be a useful indicator of the extent of the phenomenon among the youth population. Many drugs of abuse are included in the WADA (World Anti-Doping Agency) Prohibited List, and are therefore routinely tested for in antidoping controls. This study presents the data obtained in tests carried out in the period 2003- 2007 at the Antidoping Laboratory of Rome, on 44781 samples analysed. The methods used are those developed by the Laboratory for routine antidoping analyses. The percentage of positive test results ranges from 1.1 to 2%, with a high incidence of stimulants and drugs of abuse. The substance most frequently found is THC metabolite, which accounts for 0.2-0.4% of the total, followed by cocaine metabolites, accounting for 0.1%. Other stimulants found are ephedrines, carphedon, modafinil, and anorexic compounds such as phendimetrazine and norfenfluramine. No amphetamines or amphetaminelike designer drugs have been detected. These data may be indicative of the widespread incidence of cocaine and cannabis abuse among the young Italian population, bearing in mind that the phenomenon is underestimated in this study, due to the fact that drugs of abuse are investigated only in samples involved in competitive sport, and especially to the fact that people doing such activities take more care of their health and are subject to greater control in their behaviour and habits with respect to the 'normal' population.

The use of natural supplements, included herbal supplements, by athletes has become an habit which often lacks any valid scientific rationale. It appears evident that this habit may entail health risks (including more or less serious adverse effects), consequent either: 1) to the pharmacodynamic effects of the drugs at high doses; or 2) to the occurrence of accumulation especially when their administration is not justified by a reduced synthesis or an increased demand; or 3) to the occurrence of intolerance; or, finally, 4) to the presence of unlabelled ingredients. The abuse of this kind of products always entails risks to the consumer, not only to the elite athlete, that can incur an adverse analytical finding on the occasion of anti-doping tests, but also to the amateur sportsman, for the possible occurrence of adverse drug reactions (ADR).