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2017 HCHB_digital

Drugs in Sport Treating

Drugs in Sport Treating Athletes Medical professionals need to exercise caution when treating athletes because many medications are not permitted for use in sport. Athletes at any level may be subject to drug testing. Testing may be conducted at a competition or event or out-of-competition when an athlete is training, travelling or at home. Athletes have a responsibility to inform every doctor or specialist treating them that they are subject to drug testing in sport. Drug Free Sport NZ (DFSNZ) provides up-to-date information regarding medications to athletes so that they can alert medical professionals to their special needs. The Prohibited List Medications which are not permitted in sport are listed in the World Anti-Doping Agency’s Prohibited List which is published on January 1st each year. It is important to keep up-to-date with what’s included on this list. The list is available at www. drugfreesport.org.nz Checking Medications Medical professionals should always check the status of a medication before prescribing to an athlete. This can be done by: •• checking the New Zealand Formulary database (www.nzformulary.org.nz) for possible restrictions in sport •• visiting www.drugfreesport.org.nz/medication-check •• calling Drug Free Sport NZ on 0800 DRUGFREE (0800378437) •• texting the medication name or active ingredient to 4365 (texts cost 20c). Common Conditions If an athlete has one or more of the following conditions it is likely that prohibited substances will be part of the recommended treatment: •• ADHD •• asthma •• cardiovascular disease •• diabetes •• severe acne and other severe skin conditions •• severe hay fever or other allergic reactions. Athletes who require anaesthesia, surgery or dental work are also likely to require medication which is prohibited in sport. supporting the diagnosis in the event an adverse analytical finding results from testing. Please call Drug Free Sport NZ on 0800 DRUGFREE (0800 378 437) for further information. Supplements Drug Free Sport NZ advises athletes that they take supplements at their own risk. It warns athletes to be wary of supplements for the following reasons: •• supplements are not manufactured to the same rigorous standards as pharmaceuticals •• some supplements may be cross-contaminated with prohibited substances •• labelling laws are not the same in all countries meaning that some ingredients may not be listed •• manufacturing standards vary greatly around the world and some supplement manufacturers use phrases such as “pharmaceutical standards” or “approved by XXX sports league”. This does not mean they are safe for use in sports. Drug Free Sport NZ cannot determine the status of any supplement in sport, but can provide advice about the level of risk associated with particular brands or ingredients. Athletes should contact Drug Free Sport NZ for advice on supplements (0800 DRUGFREE) or use the organisation’s online supplement enquiry form at www.drugfreesport.org.nz/supplement-check Quick Reminders •• Ensure you check the status of all medications before administering them to athletes. •• If the medication is prohibited, check to see if there is an alternative that is permitted. If not, check that the athlete is aware a TUE may be required. •• If you have any queries, call 0800 DRUGFREE (378 437) for assistance •• Check Drug Free Sport NZ’s website for further information and advice on treating athletes: www.drugfreesport.org.nz Reviewed by Drug Free Sport NZ, March 2017. Therapeutic Use Exemptions (TUEs) If international or national level athletes (as determined by DFSNZ) are prescribed a prohibited substance they must obtain a TUE before using the medication. This form must be submitted to Drug Free Sport NZ (or the athlete’s International Federation if applicable). The athlete has to wait for TUE approval before using the medication unless the situation is deemed an emergency whereby the athlete’s health is at great risk. In these circumstances a TUE application should be submitted as soon as possible once the situation is resolved. TUE forms are available at www.drugfreesport.org.nz Note: Athletes who are not competing at a national or international level can apply for a TUE retrospectively; however, they will require a full medical file Page 206 HEALTHCARE HANDBOOK 2017-2018 References Charts

Common permitted and prohibited OTC medicines Cough, cold, flu, sore throat Diarrhoea or vomiting Hay fever Pain/inflammation/ headache Permitted Anaesthetic throat sprays Antihistamines (see hay fever below) Aspirin, benzydamine, or oral anti-inflammatories Cough medicines, eg: bromhexine, dextromethorphan, guaiphenesin, pholcodine Phenylephrine Electrolyte replacement therapies (eg, Enerlyte, Gastrolyte, Hydralyte) Loperamide (eg, Diamide, Imodium, Nodia) Prochlorperazine (eg, Antinaus), promethazine (Avomine), meclozine (Sea-Legs), scopolamine (Scopoderm TTS) All antihistamines (eg, Fexofast, Hayfexo, Levrix, Phenergan, Polaramine, Zyrtec) Glucocorticoid nasal sprays (eg, Beconase, Flixonase, Telnase) Oxymetazoline, xylometazoline (eg, Dimetapp, Otrivin) All non-steroidal anti-inflammatories (eg, aspirin, ibuprofen, diclofenac, naproxen) Paracetamol Tramadol Combination analgesics that include codeine with other permitted medicines (eg, Mersyndol, Nurofen Plus, Panadeine) Products containing caffeine (eg, Panadol Extra, Parafast Extra) Examples of prohibited medicines All pseudoephedrine products are prohibited in competition. DFSNZ recommends athletes consider using products that contain phenylephrine as a permitted alternative Products containing MORPHINE (eg, Gees Linctus) Alcohol is prohibited in-competition in certain sports – see Drug Free Sport NZ website for details All pseudoephedrine products are prohibited in competition Oral prednisone In-competition, all medicines containing morphine, pethidine, fentanyl, oxycodone, etc are prohibited Skin conditions Topical hydrocortisone preparations (eg, Derm-Aid) Oral glucocorticoids (eg, prednisone) are prohibited in-competition Note: Call 0800 DRUGFREE (378 437) for a full list of prescription medicines, or if unsure. A Guide To Commonly Prescribed Medicines And Their Status In Sport MEDICINE International athlete National athlete Other athletes Salbutamol by inhalation (eg, Respigen, Salamol, Ventolin)* Permitted Permitted Permitted Salmeterol by inhalation (eg, Meterol, Serevent)* Permitted Permitted Permitted eFormoterol by inhalation (eg, Oxis, Foradil, Symbicort, Vannair)* Glucocorticoids by inhalation (eg, Beclazone, Flixotide, Pulmicort) Permitted Permitted Permitted Permitted Permitted Permitted Terbutaline (eg, Bricanyl) TUE required from IF TUE required from DFSNZ TUE required retrospectively if a positive test occurs Systemic salbutamol (eg, Ventolin elixir) TUE required from IF TUE required from DFSNZ TUE required retrospectively if a positive test occurs Systemic glucocorticoids (eg, prednisone – oral, parenteral, intramuscular, rectal) TUE required from IF TUE required from DFSNZ TUE required retrospectively if a positive test occurs Nasal/eye/ear/topical corticosteroids Permitted Permitted Permitted Note: IF stands for the athletes’ International Federation – we advise International Level athletes to call 0800 DRUGFREE (378 437) for assistance when a TUE is required. *Thresholds exist for certain inhalers (for example, salbutamol has a threshold of 1600mcg per 24 hours or 800mcg per 12 hours. Once this threshold is exceeded, a positive test will be reported). Essentially, if inhalers are used as prescribed at standard prescription dosages, the threshold should not be exceeded. Page 207

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