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Dietary supplement use is very popular among athletes, to enhance performance, speed recovery or ease pain. Many of these products contain numerous ingredients that are not prohibited substances in sport, such as amino acids, proteins, creatine and caffeine. However, unscrupulous manufacturers also use these nutritional supplements as cover-ups to sell prohibited substances, such as synthetic psychoactive drugs. These substances are commonly undeclared on the supplements label or identified with names of natural products, pretending to be harmless. The inclusion of novel psychoactive substances (NPS) in supplements is even more problematic because neither the parent compound nor the metabolites are detected in routine drug tests. This chapter describes the historic evolution of the use of dietary supplements containing psychoactive substances (PS) for sports doping and proposes means to curb their availability and consumption.

The systemic effect of glucocorticoids (GCs) following injectable routes of administration presents a potential risk to both improving performance and causing harm to health in athletes. This review evaluates the current GC antidoping regulations defined by the World Anti-Doping Agency and presents a novel approach for defining permitted and prohibited use of glucocorticoids in sport based on the pharmacological potential for performance enhancement (PE) and risk of adverse effects on health. Known performance-enhancing doses of glucocorticoids are expressed in terms of cortisol-equivalent doses and thereby the dose associated with a high potential for PE for any GC and route of administration can be derived. Consequently, revised and substance-specific laboratory reporting values are presented to better distinguish between prohibited and permitted use in sport. In addition, washout periods are presented to enable clinicians to prescribe glucocorticoids safely and to avoid the risk of athletes testing positive for a doping test.

The list of prohibited substances and methods (the List) is the international standard that determines what is prohibited in sport both in- and out-of-competition. Since 2004, the official text of the List is produced by the World Anti-Doping Agency (WADA), the international independent organization responsible for promoting, coordinating, and monitoring the fight against doping in sport. Originally based on the prohibited lists established by the International Olympic Committee, the List has evolved to incorporate new doping trends, distinguish permitted from prohibited routes of administration, and adjust to new analytical and pharmacological breakthroughs. In this chapter, the elements that compose the List as well as the updates over the years are presented.

Psychoactive substances have a long history of use as doping substances in sport, usually constituting the second most used drug class behind anabolic steroids. In addition to classic stimulants, a more disturbing problem is the increasing availability of novel psychoactive substances (NPS). The challenges faced by anti-doping authorities regarding these NPS are of the same kind as those experienced by public health authorities and law enforcement agencies. These include easy access to raw material for synthesis, rapid and worldwide dissemination of the products and difficulty to analytically characterize these unknown chemical entities and their metabolites. Information and resource sharing between the different parties concerned in detecting and curtailing the production, distribution and use of NPS, either from a health or anti-doping fields, should be encouraged to effectively counteract the use of NPS in society and sports.

The list of prohibited substances and methods (the List) is the international standard that determines what is prohibited in sport both in- and out-of-competition. Since 2004, the official text of the List is produced by the World Anti-Doping Agency (WADA), the international independent organization responsible for promoting, coordinating, and monitoring the fight against doping in sport. Originally based on the prohibited lists established by the International Olympic Committee, the List has evolved to incorporate new doping trends, distinguish permitted from prohibited routes of administration, and adjust to new analytical and pharmacological breakthroughs. In this chapter, the elements that compose the List as well as the updates over the years are presented.

The List of Prohibited Substances and Methods (the List) is the International Standard that determines what is prohibited in sport in- and out-of-competition. The official text of the List is produced by the World Anti-Doping Agency (WADA), the international independent organization responsible for promoting, coordinating and monitoring the fight against doping in sport. The drafting of the annual List is a highly interactive and consultative process involving scientific and medical experts in anti-doping, sport federations and governments. In this article, the elements that compose the List as well as the process behind its annual revision and update are presented.

The List of Prohibited Substances and Methods (the List), an International Standard published yearly by the World Anti-Doping Agency (WADA), determines which substances and methods are prohibited in sport in- and out-of-competition. Stimulants are included within drug class S.6 under the in-competition testing section of the List. Athletes may be tempted to use stimulants as ergogenic aids in-competition in order to temporarily improve their mental and/or physical functions by increasing alertness, aggressiveness, motivation, locomotion, heart rate, and reducing fatigue. The Prohibited List Expert Group, responsible for the maintenance of the List, approved WADA funding for a two-year study to determine whether athletes were also using stimulants to benefit from their performance-enhancing effects during the training phase between competitions (i.e., out-of-competition). This study, involving 11 WADA-accredited laboratories, found that the use of stimulants by athletes during training was not significantly prevalent (0.36% of positive findings), suggesting that this issue does not, at the moment, pose a further challenge to the fight against doping in sport. In addition, the study supports the current structure in the Prohibited List that differentiates banned substances into the in- and out-of-competition classifications.

Since 2004, when the World Anti-Doping Agency assumed the responsibility for establishing and maintaining the list of prohibited substances and methods in sport (i.e. the Prohibited List), cannabinoids have been prohibited in all sports during competition. The basis for this prohibition can be found in the World Anti-Doping Code, which defines the three criteria used to consider banning a substance. In this context, we discuss the potential of cannabis to enhance sports performance, the risk it poses to the athlete's health and its violation of the spirit of sport. Although these compounds are prohibited in-competition only, we explain why the pharmacokinetics of their main psychoactive compound, Δ(9)-tetrahydrocannabinol, may complicate the results management of adverse analytical findings. Passive inhalation does not appear to be a plausible explanation for a positive test. Although the prohibition of cannabinoids in sports is one of the most controversial issues in anti-doping, in this review we stress the reasons behind this prohibition, with strong emphasis on the evolving knowledge of cannabinoid pharmacology.

Due to its stimulatory effects on the central nervous system, and its structural similarity to banned stimulants such as ephedrine and methamphetamine, pseudoephedrine (PSE) at high doses is considered as an ergogenic aid for boosting athletic performance. However, the status of PSE in the International Standard of the Prohibited List as established under the World Anti-Doping Code has changed over the years, being prohibited until 2003 at a urinary cut-off value of 25 µg/ml, and then subsequently removed from the Prohibited List during the period 2004-2009. The re-consideration of this position by the World Anti-Doping Agency (WADA) List Expert Group has led to the reintroduction of PSE in the Prohibited List in 2010. In this manuscript, we present the results of two WADA-sponsored clinical studies on the urinary excretion of PSE and its metabolite cathine (CATH) following the oral administration of different PSE formulations to healthy individuals at therapeutic regimes. On this basis, the current analytical urinary threshold for the detection of PSE as a doping agent in sport has been conservatively established at 150 µg/ml

Since ancient times, unethical athletes have attempted to gain an unfair competitive advantage through the use of doping substances. A list of doping substances and methods banned in sports is published yearly by the World Anti-Doping Agency (WADA). A substance or method might be included in the List if it fulfills at least two of the following criteria: enhances sports performance; represents a risk to the athlete's health; or violates the spirit of sports. This list, constantly updated to reflect new developments in the pharmaceutical industry as well as doping trends, enumerates the drug types and methods prohibited in and out of competition. Among the substances included are steroidal and peptide hormones and their modulators, stimulants, glucocorticosteroids, beta2-agonists, diuretics and masking agents, narcotics, and cannabinoids. Blood doping, tampering, infusions, and gene doping are examples of prohibited methods indicated on the List. From all these, hormones constitute by far the highest number of adverse analytical findings reported by antidoping laboratories. Although to date most are due to anabolic steroids, the advent of molecular biology techniques has made recombinant peptide hormones readily available. These substances are gradually changing the landscape of doping trends. Peptide hormones like erythropoietin (EPO), human growth hormone (hGH), insulin, and insulin-like growth factor I (IGF-I) are presumed to be widely abused for performance enhancement. Furthermore, as there is a paucity of techniques suitable for their detection, peptide hormones are all the more attractive to dishonest athletes. This article will overview the use of hormones as doping substances in sports, focusing mainly on peptide hormones as they represent a pressing challenge to the current fight against doping. Hormones and hormones modulators being developed by the pharmaceutical industry, which could emerge as new doping substances, are also discussed.