On Friday, the 2021 version of the World Anti-Doping Code takes effect, including the updated WADA list of banned substances and methods.
Along with other changes previously discussed, Vilanterol, a beta-2 agonist in inhalers used to treat asthma, has been approved for use “up to the manufacturer’s maximum recommended dose.”
That substance has triggered several doping cases in the last few years, including notably American swimmers Will Licon and Amanda Kendall in 2019 and 2018, respectively. Both athletes declared the use of Breo Ellipta inhalers on their anti-doping forms, which contains Vilanterol, and didn’t have TUEs, which triggered USADA proceedings. Licon was given a warning, while Kendall was given a 3 month suspension.
Vilanterol is one of 4 inhaled Beta-2 agonists (generally asthma medications) that are now listed as exceptions to the prohibited lists:
- Inhaled salbutamol: maximum 1600 micrograms over 24 hours in divided doses not to exceed 800 micrograms over 12 hours starting from any dose;
- Inhaled formoterol: maximum delivered dose of 54 micrograms over 24 hours;
- Inhaled salmeterol: maximum 200 micrograms over 24 hours;
- Inhaled vilanterol: maximum 25 micrograms over 24 hours.
The other 3 substances listed previously had those exceptions in place, with vilanterol being the only new addition. These substances don’t require Therapeutic Use Exemptions, if they are used within the manufacturer’s guidelines.
In 2019, across all sports, these substances were in aggregate responsible for 20 out of 153 adverse analytical findings of Beta-2 Agonists (11 for salbutamol, 9 for vilanterol).
The new changes will not retroactively impact athletes who were sanctioned under the prior rules.
WADA has also reformated the prohibited list in an effort to make it easier to read and more accessible as part of an information campaign to spread the word about the changes to the code. Infamously, Maria Sharapova claimed in 2016 to have been unaware that the substance meldonium was newly-banned by WADA after testing positive.
Other Major Changes
- While the prohibition of all injectable routes of glucocorticoids during the in-competition period was approved, the implementation of that new rule was delayed until January 1, 2022 to allow athletes and medical personnel to get a better understanding of the practical implementation and of the washout periods.
- Non-comprehensive examples were added to several categories of prohibited substances, including Nebivolol (Beta-blockers), several stimulants, and IOX2 – a new substance that broke into the doping conversation in 2020 via equine sport.
- New language regarding substances of abuse, including MDMA/ecstacy, cocaine, marijuana, and THC, in line with updates to the World Anti-Doping Code.
glucocorticoids are one of the drugs being used to combat the immune system overreaction that causes problems arising from Covid19 – suspect we will see a rash of “positives” from recovered Covid19 victims.
possible, yes
Systemic corticosteroids are not recommended for non-critical cases of covid-19. They actually increase mortality risk. Hopefully they are being used judiciously.