The use of substances or methods to enhance performance is cheating, unfair and is contrary to the spirit of fair competition. Drug misuse can be harmful to the athlete's health or to other athletes competing in the sport. It severely damages the integrity, image and value of sport, whether or not the motivation to use drugs is to improve performance.

Substances and methods are prohibited in sport for various reasons including performance enhancing effects, health of the athlete and legality. 

STIMULANTS
DIURETICS
PEPTIDE HORMONES, MIMETICS AND ANALOGUES
ANABOLIC ANDROGENIC STEROIDS
NARCOTIC ANALGESICS
NON-STEROIDAL ANTI INFLAMMATORY DRUGS
CLASSES OF SUBSTANCES SUBJECT TO CERTAIN RESTRICTIONS
PROHIBITED METHODS

The information on these pages should be used as a guide only. It has been compiled using 
"The Competitors and Officials Guide to Drugs and Sport, UK Sports Council, March 1998 and the
"IOC List of Prohibited Classes of Substances and Prohibited Methods" 1st January 2000.

What is a stimulant?
Stimulants are substances that act on the brain to stimulate the body both mentally and physically.

What do stimulants do? 
Stimulants:

increase alertness

decrease the feeling of tiredness

increase competitiveness and aggression

Why might competitors use stimulants to improve performance?
Artificial stimulation of the mind and body may give a competitor an unfair advantage by increasing the competitor's ability to exercise at maximal levels as well as reducing feelings of fatigue. Some stimulants will suppress the appetite, therefore competitors may use them to reduce weight. This is clearly contrary to the rules of sport and is not acceptable.

What harm can stimulants cause?
The misuse of stimulants can result in harmful side effects such as;

increased blood pressure and body temperature  increased and irregular heart beat addiction

aggression and anxiety  loss of appetite

Increased competitiveness and aggression can result in a loss of judgment which can put both the competitor and other competitors at risk of injury especially in contact and team sports.
The misuse of stimulants can also make it difficult for the body to cool down, especially when a competitor has been exercising for long periods of time. A body that is overheated and unable to cool down can result in dehydration and reduced blood circulation - the body cannot cool down by sweating as there is little or no fluid to sweat and the blood thickens due to a reduction in the amount of fluid in the body. This results in the heart having to beat harder to circulate the thickened (and reduced volume o~ blood. Eventually the heart and other organs will stop working normally which could result in stroke, cardiac arrest or even death.
Over stimulation can make it more difficult for a competitor to relax and sleep, which may lead to a further need for medication to calm the competitor. The use of `uppers' and 'downers' in this way is a very damaging cycle for competitors to get into and in the long term certainly does not improve performance.
Death can occur when taking normal doses of stimulants and exercising at maximal levels.

What types of medications contain stimulants?
Stimulants can be found in prescription and over-the counter medications (i.e. medications that can be purchased in pharmacies and other retail outlets without a prescription) as well as in various herbal and nutritional supplements. They are often found in cough and cold and hay fever medications, as well as some pain relieving medications.

Over-the-Counter Products
Many cold and hay fever medications contain prohibited stimulants, in particular from the group called sympathomimetic amines (e.g. ephedrine, pseudoephedrine, phenylpropanolamine and norpseudoephedrine). Care should be taken when purchasing these types of products. Competitors should tell the pharmacist and/or doctor that they may be subject to drug testing and that they must not take any preparations containing prohibited stimulants.

Examples of cold and hay fever medications that contain prohibited stimulants include:

Benylin Day and Night Cold Treatment (phenylpropanolamine) Contac 400 (phenylpropanolamine) Sudafed (pseudoephedrine)

Lemsip powder (phenylephrine) Dimotane Plus (pseudoephedrine) Haymine (ephedrine)

Caffeine
Caffeine is a stimulant that is prohibited when used in large quantities. The concentration of caffeine in the urine sample may not exceed 12 micrograms per millilitre. Coffee, tea, chocolate products and some soft drinks including cola drinks as well as some over the counter cough and cold and pain relieving medications and herbal/nutritional supplements contain caffeine.
The normal taking of products containing caffeine prior to a competition should not cause a positive result, however, as everybody is individual be aware that it could cause a positive result. Your weight, bulk, metabolic rate and what you have eaten recently has an effect on what the level of caffeine in your body will be, so care is required. You should be aware of all sources of caffeine that you are ingesting, e.g.. food, drink, medications, supplements, etc. You should also be aware that the amount of caffeine in each product can vary, for example the type of tea leaves and the length of time it is infused can effect the level of caffeine in a cup of tea (i.e. the longer it is infused the greater the caffeine content), whilst different types of coffee contain different amounts of caffeine.

Approximate Caffeine Concentrations in Common Foods and Drinks

To obtain a urine concentration of caffeine greater than 12 micrograms per millilitre you would need to consume approximately 3-10* cups of coffee or tea (depending brand and brewing method), or 9* cans of soft drink, in a short period of time and then be tested soon after consuming these products.

Commonly used products that contain caffeine include:

Coffee Feminax Tea

Pro-plus Chocolate Red Bull / Red Kick

Some soft drinks (e.g. colas) Panadol Extra or Hedex Extra

You should always take caution when taking any product containing caffeine.

Guarana 
Another name for caffeine is guarana. This substance is frequently found in herbal or nutritional supplements. Guarana is reported to contain up to 5% caffeine whereas other sources of caffeine, such as coffee, tea and chocolate contain between 1-4% caffeine.

Herbal and Nutritional Preparations In addition to caffeine (guarana), other stimulant substances can be found in herbal and nutritional preparations.

Amphetamines 
Amphetamines and related substances such as methamphetamine and Ecstasy (MDMA) are also prohibited stimulants. Amphetamines are classified under the Misuse of Drugs Act 1971 and possession without a prescription is against the law.

Medically, amphetamines have been used as an appetite suppressant, to treat narcolepsy (a condition where the person has a tendency to fall asleep during the day for no reason), hyperactivity in children as well as epilepsy, Parkinson's Disease, depression and severe tiredness. Due to a history of problems with addiction and development of tolerance to the substance amphetamines are not prescribed very ' much by doctors today.

Amphetamines are often referred to as speed or uppers. There is no medical justification for their use in sport.

In small doses amphetamines increase alertness, speed up breathing and heart rate and decrease appetite. Large doses can cause:

tremors sweating

anxiety headache

palpitations  chest pain

Long term amphetamine use can result in side effects such as weight loss, constipation, dehydration and unstable emotional states. Continued large doses may reduce the body's resistance to infection, or even result in damaged blood vessels and heart failure.

Amphetamines do cause both physical (addiction) and psychological dependence. Amphetamines and related substances continue to be available illegally and are still used in the social drug scene.

Examples of prohibited stimulants include:

amineptine  amiphenazole  amphetamines  bromantan carphedon cocaine   fencamfamine  mesocarb pentylentetrazol  pipradrol phentermine  strychnine	caffeine*      * For caffeine the definition of a positive is a concentration in the urine greater than 12 micrograms per millilitre.	ephedrines** methylephedrine** phenylpropanolamine**  pseudoephedrine ** ** For cathine, the definition of a positive is a concentration in the urine greater than 5 micrograms per millilitre. For ephedrine and methylephedrine, the definition of a positive is a concentration in the urine greater than 10 micrograms per millilitre. For phenylpropanolamine and pseudoephedrine the definition of a positive is a concentration in the urine greater than 25 micrograms per millilitre.	salbutamol***  salmeterol***  terbutaline***    ***These beta2 agonists are classed as stimulants and anabolic agents. They are permitted by inhaler only to prevent and/or treat asthma and exercise induced asthma. Written notification of asthma and/ or exercise-induced asthma by a respiratory or team physician to the relevant medical authority.
. . . . and related substances

NOTE: All imidazole preparations are acceptable for topical use, e.g. oxymetazoline. Vasoconstrictors may be administered with local anaesthetic agents. Topical preparations (e.g. nasal, ophthalmological, rectal) of adrenaline and phenylephrine are permitted.

What are peptide hormones, mimetics and analogues?
Peptide and glycoprotein hormones are substances produced by glands in the body to control specific bodily functions. Analogues are man-made drugs that have similar effects as the naturally occurring hormones,

What do peptide hormones, mimetics and analogues do?
Peptide and glycoprotein hormones carry messages around the body to stimulate specific functions such as:

increase growth

influence sexual and general behaviour stimulate red blood cell production

control pain

Analogues mimic the actions of the naturally occurring hormones.

Why might competitors use peptide hormones, mimetics and analogues to improve performance? 
Competitors may misuse these substances for various reasons depending on the substance and the desired result.

to stimulate the production of naturally occurring hormones to increase muscle size and strength

to help repair body tissue which will promote quicker recovery from injury and from training to improve the blood's ability to carry oxygen

What harm can peptide hormones, mimetics and analogues cause?
Everyone is individual therefore it is very difficult to specify how much harm can be caused by misusing peptide hormones, mimetics and analogues. As they mimic hormones that are naturally occurring in the body, they can interfere with the normal hormone balance in the body as well as their actions.

Examples of prohibited peptide hormones, mimetics and analogues include chorionic gonadotrophin (prohibited in males only), pituitary and synthetic gonadotrophins (prohibited in males only), corticotrophin, growth hormone, erythropoietin, insulin-like growth factor and insulin.  All the respective releasing factors (and their analogues) of these substances are also prohibited.

What about insulin?
Please note that insulin is permitted only to treat athletes with certified insulin-dependent diabetes. Written certification of insulin-dependent diabetes must be obtained from an endocrinologist or team physician.

1 Chorionic Gonadotrophin (HCG - Human Chorionic Gonadotrophin)
HCG is a hormone produced by the placenta in pregnant women to maintain the pregnancy. It is found in small quantities in the urine of pregnant women. HCG is used medically in the treatment of female infertility. It has also been used to prevent miscarriage in women who have a history of miscarriage, to treat undescended testes in young boys and to increase sperm production in men.
The administration of HCG, or other compounds with similar action, to males results in an increased production of testosterone and so is considered to be the same as the administration of testosterone. The use of HCG or similar compounds is prohibited in males athletes only. All the respective releasing factors of this substance are also prohibited.

3 Growth Hormone (HGH - Human Growth Hormone, Somatotrophin)
Growth hormone is a polypeptide hormone produced by the pituitary gland to stimulate the growth of bones, muscles and tissues, Medically it is used to treat children who's pituitary gland does not produce enough growth hormone to allow normal growth to occur. It is usually only given to children who's growth centres of their bones have not yet closed.
HGH may be misused by competitors in an attempt to stimulate muscle and tissue growth (i.e. for its anabolic effect).

The administration of growth hormone in large doses over a prolonged period of time can cause many harmful side effects such as:

allergic reaction

cardiomyopathy

high blood pressure

diabetes

Excess growth hormone in adults can result in acromegaly (abnormal growth of the hands, feet and face, and enlarged internal organs). Excess growth hormone in children can cause gigantism (excessive growth of the skeleton).
The administration of these hormones also increases the risk of transmission of infectious diseases through sharing of needles. There is also potential for contamination of some growth hormone preparations of human origin such as Creutzfeldt Jacob disease. All the respective releasing factors of this substance are also prohibited.

What are Anabolic Androgenic Steroids? 
Anabolic androgenic steroids are natural or man-made compounds that act in a similar way to the hormone testosterone. Testosterone is a male sex hormone that is produced by the testes. It is also found in women in small quantities and is produced by the ovaries and the adrenal gland.

Anabolic steroids have been used medically for the treatment of some forms of anaemia (to stimulate blood cell production), osteoporosis and to promote recovery after a serious illness or major surgery. They have also been used in the treatment of breast cancer and for boys/men who are deficient in the naturally occurring male sex hormones.

In the UK, anabolic steroids are classified as a Class C drug under the Misuse of Drugs Act 1971 . It is an offence to produce, supply, possess or import/export anabolic steroids with intent to supply. However, it is not an offence to possess them when in a form of a medicinal product for personal use.

 There are many different anabolic steroids available throughout the world, Some examples include Nandrolone, Stanozolol, Testosterone, Boldenone, Androstenedione, Androstenediol, 19-nor androstenedione, 19-nor androstenediol and DHEA. 

Some of the anabolic steroids used have been designed for veterinary use. Anabolic steroids are available in tablet form or for intra-muscular injection, under trade names such as Dianabol, Durabolin, DecaDurabolin, Winstrol and Anavar. Some substances prohibited under the anabolic agents class may be found in nutritional products such as androstenedione and DHEA.

Why Might Competitors Use Anabolic Androgenic Steroids To Improve Performance?
Competitors use anabolic androgenic steroids to improve sporting performance, and in particular to:

increase muscle size, strength and power

to train harder and for longer

to increase aggression and competitiveness

The androgenic effects of anabolic steroids (increased aggression and competitiveness) helps the competitor to train harder and to recover more quickly, resulting in increased strength.

There is little evidence to support the belief that anabolic steroids alone can increase muscle strength in adult males - development is dependent on an appropriate diet and exercise programme. When anabolic steroids are used without training, muscles tend to look bigger, but this is probably due to water retention. Because of their ability to promote the quality and quantity of training, anabolic steroids became known as 'training drugs', taken during training before a competition. To reduce the risk of being caught by a drug test, the competitor comes off the drugs several weeks before a competition and may retain some of the benefits. However, anabolic steroids have always been detected during competition testing as well as during out of competition testing, showing the extent of the risk that some competitors are prepared to take.

What Harm Can Anabolic Steroids Cause? 
Anabolic steroids mimic hormones that are naturally occurring in the body, and therefore can interfere with the normal hormone balance in the body as well as their actions. This interference can cause adverse side effects ranging from development of male features in females, loss of fertility and eventual impotence in males to acne and kidney damage. They can also increase blood pressure, cause hardening of the arteries and increase the risk of heart disease. Anabolic steroids also increase the risk of liver disease and certain forms of cancer.

Potential harmful side effects of anabolic steroid misuse include:

NARCOTIC ANALGESICS
What are narcotic analgesics?
Narcotic analgesics are painkillers. They are used in medicine to relieve pain. Narcotic analgesics are the strongest form of pain killers.

What do narcotic analgesics do?
 Narcotic analgesics act on the brain and spinal cord to reduce the amount of pain felt.

What harm can narcotic analgesics cause?
Narcotic analgesics may produce a feeling of euphoria as well as reduce mental capacity. This could result in a false feeling of invincibility and that the competitor's ability is better than it actually is, or the perception of dangerous situations as safe and therefore put themselves and other competitors at risk.

The misuse of narcotic analgesics may cause:

drowsiness decreased breathing rate nausea and vomiting constipation sweating

loss of concentration, balance and co-ordination fainting, palpitations, sedation, restlessness and mood changes are also side effects of narcotic analgesics narcotic analgesics are highly addictive.

Overdose of narcotic analgesics can result in coma and breathing difficulties that often results in death. Long term abuse often results in reduced mental and physical capacity.

Some of the substances prohibited under this category may be administered intravenously which can increase the risk of serious health problems including transmission of infectious diseases such as hepatitis and HIV

What types of medications contain narcotic analgesics?
Narcotic analgesics can be found in both prescription and over-the-counter medications. Medications used for moderate to severe pain relief, such as morphine, diamorphine (heroin) and pethidine are available on prescription only.

Preparations for mild pain relief as well as cough/cold and stomach disorders such as diarrhoea may contain mild analgesics such as codeine. They are often found in combination with aspirin (permitted), paracetamol (permitted) or caffeine (restricted). These can be purchased over the counter without prescription.

Some examples of medications containing prohibited narcotic analgesics include:

Diocalm Dual Action (morphine hydrochloride)  Palfium (dextromoramide)

Pethidine Sevredol (morphine sulphate)

Examples of narcotic analgesics include:

buprenorphine  dextromoramide diamorphine (heroin)

hydrocodone methadone  morphine

pentazocine  pethidine ....and related substances

Please note that aspirin, codeine, dextromethorphan, dextropropoxyphene, dihydrocodeine, diphenoxylate, ethlymorphine, pholcodine, propoxyphene, paracetamol and tramadol are permitted.

Cannabis
Cannabis (marijuana and hashish) is prohibited in some sports such as association football, swimming, motor cycling and rugby league. Cannabis is generally not considered performance enhancing, and could even be detrimental to performance. The use of cannabis may not be intended to improve performance. However, irrespective of the intention behind the use, if it is prohibited by a governing body's regulations an offence has been committed and therefore will be subject to disciplinary action.
The use of cannabis may be damaging to the image of sport and as elite competitors can be influential role models for young people the use of an illegal substance also sends inappropriate messages to them. For this reason some sports have prohibited the use of social drugs such as cannabis. The action taken by governing bodies who specifically test for social drugs may include rehabilitation and/or counseling to assist competitors to overcome their drug problems.
Cannabis is a hallucinogen. In small amounts it causes a feeling of relaxation, reduces inhibitions and results in a loss of perception of time and space. It also can result in impaired co-ordination and reduced ability to perform complex skills. Large amounts can impair mental functioning. These effects could obviously be detrimental to a competitor's ability to perform complex skills as well as place other competitors at risk. Cannabis could be used to reduce apprehension and to steady the nerves. Cannabis is illegal in the UK, therefore the production, supply, possession and use of this substance is against the law.
Tests may be carried out for the presence of cannabinoids. Check your governing body's anti-doping regulations to determine whether cannabis is prohibited in your sport. At the Olympic Games, tests will be conducted for cannabinoids - a concentration in the urine greater than 15 nanograms per millilitre constitutes doping.

Local Anaesthetics

What are local anaesthetics?
Local anaesthetics are substances that produce the temporary loss of feeling. They are used medically for the control of pain.

Why might competitors use local anaesthetics to improve performance? 
Competitors might use local anaesthetics to reduce or eliminate the pain felt from injury or illness so they can continue to compete or train.

What harm can local anaesthetics cause?
The use of local anaesthetics can result in the competitor continuing to train or compete when injured. The competitor may not realise the extent or severity of the injury and make the injury worse or cause permanent damage.

What types of medications contain local anaesthetics?
Local anaesthetics can be found in both prescription and over-the-counter medications. They may be found in creams, sprays, ear drops and eye drops as well as some sore throat products. These are permitted in sport.

Local anaesthetics are also administered by injection. Injectable local anaesthetics are only permitted under the following conditions:

• that bupivacaine, lidocaine, mepivacaine, procaine can be used but not cocaine. 
• Vasoconstrictor agents may be used in conjunction with local anaesthetics
• only local or intra-articular injections may be administered
• only when medically justified

Where the rules of a responsible authority so provide, notification of administration may be necessary.

Glucocorticosteroids 

What are corticosteroids? 
Corticosteroids are drugs derived from the corticosteroid hormone that is produced by the adrenal gland. Synthetic corticosteroids are also available.

What do corticosteroids do?
Corticosteroids are primarily used for their anti inflammatory properties. However, when administered systemically they can produce a feeling of euphoria (increased feeling of well being).
Corticosteroids are commonly used to treat asthma, hay fever, tissue inflammation, rheumatoid arthritis and inflammatory bowel disease.

Beta Blockers 

What are beta blockers?
Beta blockers block the transmission of stimuli through the beta receptors. They stop the actions of noradrenaline (increased heart rate, dilation of blood vessels - getting the body ready to act). Beta blockers are used medically to treat angina, high blood pressure, and heart disease. They may also be used in the treatment of migraines and to reduce the symptoms of anxiety.

What do beta blockers do?
Beta blockers reduce the heart rate and the force at which the heart contracts as well as preventing dilation of the blood vessels. Preventing dilation of the blood vessels contributes to reducing the work load of the heart.

Why might competitors use beta blockers to improve performance? 
Competitors may misuse beta blockers to decrease heart rate, steady nerves and stop trembling. Decreasing heart rate would increase the amount of time between each beat of the heart which in turn could allow a competitor to perform their skill without the heart beat compromising accuracy. This would be an advantage in sports requiring a great degree of accuracy such as shooting and archery.
Beta blockers could also be used to reduce anxiety of a competitor.

What types of medications contain beta blockers?
Beta blockers can be found in medications used to treat angina, high blood pressure, heart disease and migraine and are only available on prescription only.

PROHIBITED METHODS

The following procedures are prohibited:

• Blood doping
• Administering artificial oxygen carriers or plasma expanders
• Pharmacological, chemical and physical manipulation

BLOOD DOPING

What is blood doping?
Blood doping is the administration of blood, red blood cells artificial oxygen carriers and related blood products to a competitor to artificially increase the number of red blood cells in the body. Increasing the number of red blood cells means the body's oxygen carrying capacity is increased, Medically, red blood cells are administered for the treatment of severe anaemia or blood loss following surgery or severe injury,

How is blood doping carried out? 
A competitor has an amount of their own blood removed 2-3 months prior to competition.' The blood is stored while the competitors body naturally produces more blood to return it to a normal state. The blood is then reinjected into the competitor approximately one week before the competition. The injection of extra blood increases the number of red blood cells and therefore improves the competitor's oxygen carrying capacity. Alternatively the competitor may be injected with someone else's red blood cells. .

Why might competitors use blood doping to improve performance? 
Increasing the number of red blood cells increases the body's oxygen carrying capacity. This is an obvious advantage for competitors participating in endurance sports such as running, cycling and cross country skiing, whose performance relies on this ability.

What harm can blood doping cause? 
Blood doping can have serious health risks including:

allergic reactions  (ranging from rash or fever to kidney damage if the incorrect blood type is used)

transmission of infectious diseases (eg. hepatitis, AIDS)

overload of the circulatory system blood clots

Blood doping contravenes the ethics of medicine and sport and is prohibited in sport.

PHARMACOLOGICAL, CHEMICAL AND PHYSICAL MANIPULATION

Pharmacological, chemical and physical manipulation is the use of substances and/or methods which alter, attempt to alter or may reasonably be expected to alter the integrity and validity of a urine sample such as:

administration of diuretics catheterisation sample substitution and/or tampering	inhibition of renal excretion (e.g. by probenecid and related compounds) epitestosterone* or bromantan administration
* Epitestosterone can be used to mask the use of testosterone and therefore is a prohibited substance. The presence of an epitestosterone concentration in the urine greater than 200 nanograms per millilitre will be reported to ~he appropriate governing body. The governing body will then investigate its presence as outlined for T/E ratio in the Anabolic Agents Class.

Probenicid is a drug that reduces the excretion of certain drugs into the urine. This could be used to mask the presence of a prohibited substance. Pharmacological and chemical masking agents could be used to try to hide the use of a prohibited , substance. Competitors could also try to substitute untainted urine or avoid a test altogether.

The use of any of these substances or methods is prohibited.