The Grey Zone in Doping

Anti-doping programs seek to preserve what is intrinsically valuable about sport. This intrinsic value is often referred to as “the spirit of sport”, which is the celebration of the human spirit, body and mind and is characterised by values such as ethics, fair play, honesty, health, fun, team work, courage and many others. Doping, which is not only the detection of prohibited substances but also its possession and use, failing or tampering a doping test or refusing a control, is considered as fundamentally against the spirit of sport. As a result of this definition, lists of prohibited substances and methods have been developed to keep the spirit of sport as pure as possible. Since the introduction of the first doping test in the early 1960’s and the development of anti-doping rules by the UCI in the same period, doping rules have been extensively revised by the IOC and currently by WADA. These rules are very extensive and include numerous classes defined as doping agents, such as anabolic steroids, stimulants, diuretics and EPO, and also prohibited methods as blood doping. Doping control generally operates a strict liability principle. In other words, the presence of a banned substance, or its metabolite, in a urine or body fluid constitutes and doping offence. In a refinement of this principle, several substances now have a requirement for laboratories to report their presence only above a specified urinary concentration. Some of these substances are regulated by a urinary threshold level because they are, or may be, endogenous. Examples of those substances are testosterone and 19-norandrosterone, the major metabolite of nandrolone. Other substances can be present as a constituent in the daily diet, such as caffeine and ephedrine, and are only restricted when large urinary concentrations indicate the deliberate intake of this substance to enhance performance. In an attempt to run faster, jump higher or throw further athletes are always seeking for means to accomplish this goal. Since the mid 1990’s the use of diverse types of nutritional supplements has become very popular in an attempt to optimise performance. The most important factor behind the explosive growth of the supplement market was the passage of the Dietary Supplement Health and Education Act (DSHEA) which makes it possible to market numerous products as nutritional supplements as long as no statements are made that these products prevent, treat or cure a specific disease. Other factors behind the growth of this market is the easy access through the internet and the ever-improving results and record performances of top-level athletes who are promoting the use of supplements. However, the uncounselled use of these dietary supplements by athletes is not always without risk as some cases have proven that positive doping tests can be obtained as a result of the use of (deliberately) contaminated nutritional supplements. Seven professional tennis players for instance, tested positive for the nandrolone metabolite norandrosterone. This positive doping test was attributed to the use of a nutritional supplement which was distributed among those players by ATP-accredited physicians. As a result, all seven athletes were acquitted from a doping offence. Similar stories can be found in athletics where a female marathon runner tested positive for anorexic agents after the use of a contaminated nutritional supplement and in cycling where an improperly prepared supplement seemed to contain methadone. Following these facts, it can be concluded that a zone can be situated between uncontested doping products, such as injectable anabolic steroids, diuretics and growth hormone, and products with doubtful effects on the performance or products not listed on the WADA list of prohibited substances. This area is defined as “the grey zone” in this thesis. The substances situated in this “grey zone” are in most cases substances with a urinary threshold level, or compounds that are allowed if a proper medical cause justifies their use, such as corticosteroids. Nutritional supplements (un)intentionally contaminated with doping substances are also considered as part of this area if the supplement label does not specifically mentions the presence of the contested agent. The aim of this work is an evaluation of the “grey” area in doping control. In this thesis, some substances that are situated at the borderline, i.e. substances with urinary threshold levels, will be discussed as well as the complex situation that arises from contaminated nutritional supplements and their influence on the outcome of a doping test. In addition, the declared use of medication, i.e. substances allowed as a result of a proper medical cause, on the doping control forms filled out during a doping control will also be considered.