Clean Sport Red Flags

Red Flag #1: A Win-At-All Costs Attitude

A win-at-all costs attitude can be revealed through various behaviors and by various members of the sports community, from athletes, to coaches, to parents. A red flag stemming from this mentality might look like an athlete who pushes teammates to use an unidentified substance for recovery, or a coach who encourages an athlete to use a substance without telling anyone else. A red flag could also be a physician who offers ‘experimental’ treatment options, or proposes a treatment that pushes the limits of best medical practice in hopes of performance gains.

Weightlifter David Bayer, who accepted a sanction in 2017 after testing positive for prohibited substances, describes the win-at-all costs environment that led to his positive test:

Red Flag #2: Medical practitioners who don’t consider anti-doping obligations

Athletes should always tell their treating physician that they are subject to anti-doping rules since compliance is ultimately the athlete’s responsibility. Due to these strict liability principles, athletes risk an anti-doping rule violation and sanction, including a possible period of ineligibility, even if they received poor guidance from their primary care providers.

Once a medical practitioner has been informed of an athlete’s anti-doping obligations, it is a red flag if practitioners aren’t discussing anti-doping rules with athlete patients or accounting for those requirements during treatment.

Medical professionals who treat athletes need to be aware of the Prohibited List and how to determine if a substance or method is prohibited in sport, which is easily done using GlobalDRO.com. Moreover, physicians should know that athletes can apply for Therapeutic Use Exemptions (TUEs) before using a prohibited substance or method, but that strict criteria exist for approval, meaning that the physician’s assistance is often vital to the application process. A prescription or a doctor’s note is not enough.

In addition, athletes should consider it a red flag if medical personnel aren’t aware of the risks surrounding the supplement industryand aren’t challenging the reasons for using a dietary supplement. It’s important for athletes and their support personnel, including health professionals, to question if there is a clear nutritional benefit from a supplement and if there are food alternatives. If the medical practitioner is receiving a financial benefit for prescribing or offering a product, this is a red flag.

Red Flag #3: Thinking supplements are as safe as medications

While athletes should consult health professionals about the use of supplements, it’s equally important for athletes and their support personnel to understand that supplements and medications are very different in terms of regulation and safety. Subject to a comprehensive evaluation process, medications must list every ingredient on the Drug Facts label, and these ingredients are confirmed through rigorous quality control procedures implemented and enforced by the Food and Drug Administration (FDA).

Unlike medications, supplements are regulated post-market, which means that no regulatory body evaluates the contents listed on the Supplement Facts label for accuracy, product efficacy, or safety before they are sold to consumers. Only the manufacturers and distributors of dietary supplements are responsible for making sure their products are safe before they go to market, not the government. Unfortunately, supplements are sometimes sold without question or assessment until it becomes evident from voluntary consumer reports of adverse health events that the product is harmful. Even then, supplements with harmful or illegal ingredients may remain on shelves for years despite FDA consumer warnings.

It’s also important to realize that supplement manufacturers may misidentify prohibited substances on labels, or they may fail to list prohibited substances altogether. Also unlike medications, supplements are not permitted to be marketed for treating, diagnosing, preventing, or curing diseases. If claims sound too good to be true, they probably are.

Given these disparities and the regulatory issues, it’s a major red flag if supplements are touted to be safe alternatives to medications or free of side effects. Be aware that the term natural doesn’t always mean safe either. Using supplements is AT YOUR OWN RISK.Red Flag #4: High Risk Dietary Supplements

When it comes to supplements, there is a spectrum of risk for a positive anti-doping test or adverse health event. Supplements that advertise unrealistic health claims or fit into specific categories, such as weight loss, tend to be riskier than others, such as vitamins (but not always). There are numerous red flags to look out for as an athlete or consumer considering the use of supplements. High-risk supplements for athletes are typically:

• Supplements for muscle-building, weight-loss, sexual enhancement, and energy.
• Supplements that claim to treat or prevent a disease.
• Supplements that claim to be an alternative to prescription medication.
• Supplements with ingredients ending in -ol – diol or –stene, or ingredients that contain a lot of numbers.

Always keep in mind, however, that any supplement can pose some risk due to the lack of pre-market regulatory standards, even supplements that seem low risk or claim to be all natural. More information on supplements can be found at Supplement411.org.

Red Flag #5: Clinics or Travelling IV Infusion Providers

Under the World Anti-Doping Agency (WADA) Prohibited List, there are very specific rules governing the use of IV infusions. Under the 2018 Prohibited List, all IV infusions and/or injections of any substance, prohibited or permitted, in excess of 100 mL per 12-hour period are prohibited at all times, except for those legitimately received in the course of hospital treatment, surgical procedures, or clinical diagnostic investigations. In all other circumstances, an approved TUE is required in advance of an IV infusion above the limit and/or involving a prohibited substance.

The specificity of the IV rules mean that there is very little room for error, so athletes should only use IVs when medically necessary under the care of a physician. Athletes should be wary of IV infusions received through home visits, urgent care offices, after-hours clinics, doctor’s office visits, and boutique IV and rehydration services, as they are not considered hospital treatments under the WADA rules. As IV infusions and injections are considered “non-Specified” under the WADA Prohibited List, the minimum sanction for a violation is a one-year period ineligibility, regardless of the circumstances.

Athletes are also reminded that normal rehydration can usually be achieved by eating normal meals and drinking beverages like water and sports drinks. If rapid recovery from dehydration is required, medical best practices indicate ingesting 1.5 L (50 fluid oz.) of fluid for each kilogram (2.2lbs) of body weight lost. More information on IVs can be found on the USADA Explanatory Note.