So what is the fuss around using glucocorticoids? With high profile athletes hitting the headlines for their Therapeutic Use Exemptions (TUE) for using glucocorticoids (cyclist Bradley Wiggins, Mahe Drysdale and Dan Carter to name a few), we thought it timely to give a quick run-down on what a glucocorticoid is, why athletes may (mis)use them and when a TUE is needed for their use.
Glucocorticoids are a specific group of steroids produced in the body from the adrenal gland. They can also be made synthetically and used for treatment of pain and inflammation. They are one of the more commonly prescribed families of drugs. Examples of synthetic glucocorticoids include Prednisone taken orally, Kenacort injections into joints (eg.shoulder or knee), Hydrocortisone cream applied topically and inhaled glucocorticoids such as Pulmicort or Flixotide.
They are most commonly used as anti-inflammatories but can have other purposes and can affect such things as central nervous system function, the activity of other endogenous hormones and red blood cell production. High doses frequently have undesirable side effects. While they have multiple legitimate medical uses it is clear that athletes in a variety of sports and, in particular, cycling misuse them because they believe they will enhance performance. Some studies give support to this. Consequently, they have been added to the Prohibited List as there is potential for glucocorticoids to be performance enhancing and a potential health risk to the athlete if misused.
Currently the World Anti-Doping Agency requires a TUE for glucocorticoids when they are used systemically in-competition. Systemic routes include oral, rectal, injected into the vein (IV) or muscle (IM). Topical use of glucocorticoids (eg. anti-rash cream), injections of glucocorticoids around tendons and into joints and inhalation of glucocorticoids (eg. for asthma) is permitted. Athletes may take glucocorticoids out-of-competition without submitting a TUE, but must be certain that the prohibited medication has cleared their system prior to the time defined as 'in-competition'. Only athletes classified as 'national' or 'International' level need to apply for a TUE before use, others may apply 'retroactively'.
For more details, please contact DFSNZ's TUE and Medical Liaison, Sarah Lawson at Drug Free Sport NZ on 0800 DRUGFREE