Risks of taking over the counter medications:

Last week I wrote about the potential risks of accidentally ingesting banned  substances when  using what appears to be a completely legal supplement.   You may think that you’ll never  have to deal with USADA,   but  the reality is that the potential for amateur athletes to be testing is growing every day.    They are already testing Gran Fondo Riders in NY.   Colorado and Florida already have plans to test racers  in 2013,  and  there is talk of  instituting amateur testing in Southern California.    So this week I’d like to go talk hat to do when you are legitimately taking a medication that is on the ban list.  

Basically the idea is that the substances on the list either confer an unfair advantage, or that they could potentially harm the athlete   But what about over the counter medications,  drugs  you are taking for a legitimate medical reasons and even  medications that are prescribed to you by your physician?   They can still  get you into trouble.

In 1999  skeleton slider Zach Lund began taking  the anti baldness medication finasteride, and it was perfectly  within the rules.   Lund was  tested many  times over the years, and each time he was tested, he disclosed his use of the medication.  Then in 2005, unbeknownst to Lund, finasteride was put on the banned list.    It was added not because  it gives a competitive advantage, but because WADA claims finasteride can be used to  mask other more sinister drugs.   Even though Lund had been using the medication for years, even though he  disclosed his use, and even though  he got no competitive advantage; he was kicked off the national team and missed the 2006 Winter Olympics.  As of this writing, finasteride is longer on the banned list.  So while Lund eventually went with a clean shaven pate, he could now choose to take finasteride without consequence.


The reality is that something as simple as an over the counter cold medicine could be on the banned list, and some medications are banned during competition but not out of competition.   You can see why  understanding   exactly what is allowed and what isn’t can be difficult.  Take Nyquil for example:   Nyquil  Cold and Flu, and Nyquil   Cough are just  fine, and won’t get you into any trouble.  But Nyquil D, Nyquil  Cold , and Nyquil Hot Therapy Powder all contain  small amounts of peudoephedrine, an  “ in competition” banned  substance.     So you can take any of these without penalty if you  aren’t  racing for several days.   So  Nyquil Cold and Flu  is  fine any time, but Nyquil Cold  can get you into big trouble on race day.      You can see how easy it can be to get ourself in trouble.    The best way to make sure you don’t test positive is to avoid taking any OTC medications, but that may not be realistic.    The best way to  check to see if your medication  contains a banned substance is to check the Gobal  Drug Reference Online(DRO).     The DRO allows you to search medications by country and by sport, and  puts drugs into essentially  three different classifications.  These classifications may be different for in competition vs out of competition ( as in  the Nyquil example above).  These classifications are:

  • Not Prohibited
  • Conditionally Prohibited (for example:  certain levels are not allowed)
  • Prohibited

Before you take any OTC medication, you should check the  DRO and know the USADA status of  any medication you are taking.     You may still be able  to take a medication containing a banned substance without fear of penalties, but  you’ll need to get a  Therapeutic Use Exemption(TUE).    A therapeutic Use exemption


What about   medications that are prescribed by your doctor for a legitimate medical condition?      You should check the DRO for those medications as well.   If you are subjected to a drug test and a banned substance is found in your system, a doctor’s prescription is not enough to get you off the hook.     You may still be able to take a medication containing a banned substance without fear of penalties, but you’ll need to get a  Therapeutic Use Exemption(TUE).    A therapeutic Use Exemption is essentially  pre approval to  use an otherwise banned substance because of a legitimate medical use.      Examples are situations such as:   insulin for Type 1  diabetics, some asthma medications,   and  some use of corticosteroids.      A physician’s prescription alone is not enough.   An athlete must have a TUE, and a Dr’s prescription is no guarantee that TUE will be approved.  It may not be difficult to get an anti-aging Dr to prescribe banned medications such as testosterone.  Those Androgel  commercials that seem ubiquitous  on television are constantly   pushing the stuff, and its easy to see how a masters athlete may be tempted  visit his doctor and ask to try it out.    USADA will, in some circumstances, give a TUE for testosterone. But the   level of documentation and the conditions present for a testosterone TUE to be approved are for more stringent that what many physicians require to give out a prescription.    A slightly below average testosterone level or   a testosterone level that falls with age   is not going to be enough to get a TUE for the stuff.   Back in  2003, journalist  and avid cyclist Stuart Stevens got a Dr to prescribe him  testosterone, growth hormone,  and even EPO.  While Stevens didn’t apply for  a TUE for any of these, I’m certain that not a single one would have been approved.


Bottom line is that   drug testing is now a concern for amateur athletes as well as professionals.     When you sign up for a racing license you agree to be subject to testing, and amateur testing is becoming more common every day.      Even the cleanest athlete out there is going to have some minor anxiety   when going through the testing process.    The banned list is large and sometimes confusing, and the possibility of innocently ingesting a banned substance is real.     Being conservative with supplement choices, and being educated about common medications goes long way towards staying safe.  But the best practice is probably to minimize your intake of supplements as well as medications whenever possible.




Sean Burke is the head coach for Crank Cycling in San Diego CA.     Is there a training  or coaching related question that you would like to see addressed in Cycling Illustrated?  Contact Sean  via his website, or Post  your suggestions on the  Cycling Illustrated Facebook page and tag Sean M Burke.


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