CHANGES TO GLUCOCORTICOIDS / CORTISON
Until December 31, 2021, glucocorticoids were prohibited in-competition when administered by all injectable, oral, or rectal routes.
With the 2022 WADA Prohibited List entering into force (from 01.01.2022):
All glucocorticoids are forbidden in-competition if they are administered by the following routes of administration:
- orally (by mouth). This also includes oromucosal (via oral mucosa), buccal (in cheek pocket), gingival (on gums) and sublingual (under the tongue) administration.
- rectally (by rectum),
- any injectable routes. These include intravenous (into a vein), intramuscular (into a muscle), intraarticular (into a joint), periarticular (around a joint), peritendinous (around a tendon), epidural (to the vertebral canal), or subcutaneous (under the skin) injections.
Out-of-competition, the above-mentioned types of application of glucocorticoids are permitted. Please note the corresponding washout times (see table below), which should be followed after using a glucocorticoid until the next competition.
All types of use that do not belong to the above are permitted at any time, i.e. in- and out-of-competition. These include dermal (on the skin), inhalative (by inhalation), nasal (in the nose) or ophthalmic (on the eye) application.
Washout times for glucocorticoids (source: WADA)
To assess the required time between a glucocorticoid application and the next competition, WADA has published so-called washout times.
Further information from WADA can be found in the document "Glucocorticoids and Therapeutic Use Exemptions".
Important questions and answers about glucocorticoids / cortisone in sports
Glucocorticoids, also called cortisone, corticosteroids or glucocorticosteroids, are active ingredients that are derived from the endogenous hormone cortisol and mimic its effects. In medicine, its anti-inflammatory and suppressive effects on the immune system are used to treat a wide variety of diseases. In Germany, most glucocorticoid medications require a prescription. Some types of application (e.g. as a tablet or as a syringe) are also listed on the Prohibited List of the World Anti-Doping Agency (WADA) and can constitute an Anti-Doping Rule Violation with serious consequences.
A high concentration of glucocorticoids in the body can not only have serious side effects, but also lead to an inadmissible increase in performance. For this reason, WADA's anti-doping regulations prohibit certain routes of administration within competitions that can lead to high glucocorticoid concentrations in the body.
The most commonly used glucocorticoids include: Beclomethasone, Betamethasone, Budesonide, Ciclesonide, Dexamethasone, Fluticasone, Hydrocortisone, Methylprednisolone, Mometasone, Prednisolone, Prednisone or Triamcinolone Acetonide. In addition, numerous other glucocorticoids are used as medication. If you are unsure whether a drug contains a glucocorticoid, ask your doctor or pharmacist.
Glucocorticoids can be used outside of competitions, regardless of the route of administration. However, depending on the route of administration, some glucocorticoids can be detected in the urine over a longer period of time after use. Evidence of glucocorticoids during a competition doping test can constitute a violation of anti-doping regulations!
For this reason, the administration of glucocorticoids that is prohibited in competition should be carried out in the competition-free period with sufficient distance to the next competition.
To assess the required time between a glucocorticoid application and the next competition, WADA has published so-called washout times, which should be followed after the last application of glucocorticoids until the next competition. If these washout times are followed, the probability of a positive competition doping test is very low. The washout times depend on the active ingredient used and the type of application (see table "Washout times for glucocorticoids (source: WADA)").
WADA has not specified any washout times for rectal and intravenous use. To be on the safe side, athletes should keep a sufficient time interval of several days between the last application and the next competition.
If a glucocorticoid has to be used outside of the corresponding washout time, the probability of positive detection in a doping test in competition is very low. In principle, however, we always recommend that you have the name of the medication, the dosage, the type of application, the time or period of application, as well as contact with the doctor treating you ready.
If a glucocorticoid has to be used within the corresponding washout time, a positive test result is possible during a doping test in competition.
If a glucocorticoid has to be used within the appropriate washout time, you should have the treating doctor prepare a detailed report on the treatment, which also contains information on why permitted alternatives could not be used. Please keep this report with you along with any other medical documents (e.g. x-ray results, laboratory diagnostics, etc.).
If you are subjected to a doping control during a competition, you should state the treatment on the doping control form. If glucocorticoids are detected in your doping sample, you must apply for a retroactive TUE after being requested to do so by NADA. To do this, you must submit the medical report mentioned above to NADA, among other things.
In ice hockey, football and handball, special TUE obligations must be observed for certain leagues (see information sheet on the NADA website at https://www.nada.de/en/medicine/when-athletes-fall-ill/therapeutic-use-exemptions-tue).
For athletes who are not part of any NADA test pool:
If a glucocorticoid has to be used within the corresponding washout time, you should have the treating doctor draw up a specialist medical certificate about the treatment, which contains the name of the drug, the dosage, type and frequency of administration, start and end of therapy. You can find a form for such a certificate here: https://www.nada.de/en/medicine/when-athletes-fall-ill/therapeutic-use-exemptions-tue
Please carry a copy of the specialist medical certificate with you during the competition. In the event of a doping test, you should state the treatment on the doping control form and present the medical certificate.
This regulation only applies to national competitions in Germany. For participation in international championships or competitions abroad, you should inquire in advance with your international federation whether other regulations apply there.
If you use glucocorticoids during long-term therapy via an administration route that is prohibited in competition and you want to take part in one or more competitions during this time, you must apply for a therapeutic use exemption (TUE) from NADA.
The complete application for a TUE should be submitted to NADA at least 30 days before the next competition. If the application is made less than 30 days before the next competition, it is possible that the application will not be approved in time of the competition. If you take part in competitions despite pending approval, you do so at your own risk and with the residual risk of violating anti-doping rules if your application is rejected.
With the help of the "TUE Physician Guidelines" of WADA (www.wada-ama.org) you can check in advance whether the treatment meets the conditions for a TUE for various clinical pictures.
You can also use WADA's TUE checklists to help you with the requirements for applying for TUEs for various conditions. These can be found at www.wada-ama.org.
In ice hockey, football and handball, special TUE obligations must be observed in certain leagues (see information sheet on the NADA website at https://www.nada.de/en/medicine/when-athletes-fall-ill/therapeutic-use-exemptions-tue).
For athletes who are not part of any NADA test pool:
If you use glucocorticoids as part of a long-term therapy via an administration route that is prohibited in competition and want to take part in one or more competitions during therapy, you should carry a copy of a specialist medical certificate with you during the competition. The certificate must not be older than 12 months and should contain the name of the drug, the dosage, the type and frequency of administration, as well as the start and end of therapy. You can find a form for such a certificate at www.nada.de > Service & Infos> Downloads> "Attestvorlage". In the event of a doping test, you should state the treatment on the doping control form and present the medical certificate.
This regulation only applies to national competitions in Germany. For participation in international championships or competitions abroad, you should inquire in advance with your international trade association whether other regulations apply there.
If you receive a glucocorticoid on the day of the competition due to an emergency treatment (e.g. an allergic reaction) by a prohibited type or administration, you must inform the responsible anti-doping officer of this at the latest before participation in the competition. If this person cannot be reached at the competition site, the emergency treatment must be reported to the judge panel. If the treatment takes place during the competition, this must be reported immediately after the end of the competition.
After emergency treatment with a glucocorticoid on the day of the competition, you must apply for a retroactive TUE from NADA within 7 days of the administration. This is regardless of whether you have been subjected to a doping test or not.
In the sports of ice hockey, football and handball, special TUE obligations must be observed in certain high leagues (see information sheet on the NADA website at https://www.nada.de/en/medicine/when-athletes-fall-ill/therapeutic-use-exemptions-tue).
In addition, the following applies to athletes who are not part of a NADA test pool:
If you are subjected to a doping test on the day of the competition after an emergency treatment with a glucocorticoid, you should state the treatment on the doping control form and submit a specialist medical certificate regarding the treatment during the doping test.
This regulation only applies to national competitions in Germany. For participation in international championships or competitions abroad, you should inquire with your international trade association whether other regulations apply there.
If you would like to apply for a TUE at NADA, you need to fill out the TUE application form together with your treating doctor and send the original to NADA by post. In addition, to assess a TUE application, a current specialist report must be submitted, which describes the previous and medical history in a complete and comprehensible manner and explains why permitted alternatives cannot be used. Further diagnostic findings, e.g. for the initial diagnosis, laboratory results, tests and reports complete the application.
You can also use WADA's TUE checklists to help you with the requirements for applying for TUEs for various conditions. This are under www.wada-ama.org also available in German.
Further changes in the individual classes of prohibited substances are presented below. Classes of the prohibited list that do not contain any changes in 2022 compared to 2021 are not mentioned below.
The peptide BPC-157, a substance from pharmacological research that is not approved for therapeutic use in humans, is included as an example.
The substance tibolone has been transferred from the sub-class "S1.2 Other anabolic agents" to the sub-class "S1.1 Anabolic androgenic steroids (AAS)". Tibolone is a synthetic steroid with estrogenic, gestagenic and androgenic partial effects. It is metabolized in the body to, among other things, delta-4-tibolone, a potent androgen, and acts on the androgen receptor.
The substance osilodrostat, an inhibitor of the enzyme CYP11B1, has been added to this class because it increases the levels of circulating testosterone.
The previous sub-class "S2.2.3 growth hormone (GH), its fragments and releasing factors" has been divided into two sub-classes "S2.2.3 growth hormone (GH), its analogs and fragments" and "S2.2.4 growth hormone releasing factors".
Lonapegsomatropin, somapacitan and somatrogon have been included as examples of growth hormone analogs.
Inhalative use of the beta-2 agonist salbutamol has been permitted up to a dose of 1600 μg (micrograms) over 24 hours since 2011. The dosage interval has now been adjusted. Until now a maximum of 800 μg salbutamol could be inhaled within 12 hours. From January 1st 2022 a maximum of 600 μg salbutamol can be inhaled within 8 hours.
In addition to salbutamol, other beta-2 agonists have been permitted for inhalative use for a number of years:
- Inhaled formoterol: delivered dose no more than 54 micrograms over 24 hours;
- Inhaled salmeterol: a maximum of 200 micrograms over 24 hours;
- Inhaled vilanterol: a maximum of 25 micrograms over 24 hours.
All other beta-2 agonists and their optical isomers are prohibited at all times, this also applies to the optical isomers of formoterol and salbutamol, namely the substances arformoterol and levosalbutamol.
All types of administration other than inhalation are prohibited for all beta-2 agonists at all times.
For several years it has been made clear that the dermatological, nasal and ophthalmic use of imidazole derivatives are exempt from the ban. The before used term has been replaced by “imidazole derivatives” in order to better distinguish between any chemical-structural imidazole derivative and sympathomimetic imidazolines.
In the footnote for cathine (D-norpseudoephedrine) it is now made clear that the limit value of 5 μg cathine per ml urine applies to both isomers, the D and L isomers.
Ethylphenidate, methylnaphthidate, (±) -methyl-2- (naphthalen-2-yl) -2- (piperidin-2-yl) acetate, and 4-fluoromethylphenidate have been included as examples of methylphenidate analogs. In contrast to methylphenidate, however, they are not approved as medicinal products in Germany.
Hydrafinil (Fluorenol) is included as an example of an analog of Modafinil and Adrafinil. It is not approved as a medicinal product in Germany.
The sub-disciplines of underwater sports (CMAS), in which beta blockers have been banned in competitions for several years, have been regrouped. This will not result in any changes to the existing ban for 2022.