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Infographic. Tramadol: should it be banned in athletes while competing, particularly in road cycling?
  1. Joao Gabriel Baltazar-Martins1,
  2. María del Mar Plata2,
  3. Jesús Muñoz-Guerra3,
  4. Gloria Muñoz4,
  5. Daniel Carreras4,
  6. Juan Del Coso1
  1. 1 Exercise Physiology Laboratory, Universidad Camilo Jose Cela, Villanueva de la Cañada, Spain
  2. 2 Department of Education, AEPSAD, Madrid, Spain
  3. 3 Jefe de Prevención y control del Dopaje, AEPSAD, Madrid, Spain
  4. 4 Doping Control Laboratory, AEPSAD, Madrid, Spain
  1. Correspondence to Dr Juan Del Coso, Exercise Physiology Laboratory, Universidad Camilo Jose Cela, Villanueva de la Cañada 28692, Spain; jdelcoso{at}ucjc.edu

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Tramadol is a synthetic opioid widely used for the management of pain in sport setting.1 Tramadol is considered an effective substance to reduce acute and chronic pain because it acts by binding to the μ-opioid receptor to induce analgesia and sedation. However, tramadol also inhibits serotonin and norepinephrine reuptake and thus, it might play a role in the regulation of mood. In the past years, tramadol has caught attention of media and antidoping authorities because this substance might be the subject of abuse in some sports, notably cycling.2 WADA determined that the use of some narcotics are prohibited in-competition but tramadol has never been banned, and it has not been included in the 2019 Prohibited List.3 Nevertheless, WADA has been monitoring the abuse of tramadol in all sports through the assessment of urine tramadol concentration in the samples obtained in-competition. WADA has established a cut-off point of 50 ng of tramadol per microlitre of urine to consider a ‘tramadol finding’.

Recently, the Union Cycliste Internationale (UCI) has prompted the banning of tramadol in cycling competitions, beginning on 1 March 2019. The UCI claims medical reasons for the ban of tramadol, as this substance might produce several drawbacks such as dizziness, loss of alertness, drowsiness and physical dependency that could affect cyclists’ safety.4 The UCI is the only international federation that has introduced a new regulation that allows for penalties to be imposed across all disciplines and categories of cycling. Unlike WADA, the UCI will obtain in-competition blood samples, and positive results will depend on the presence of the substance in the blood at any quantity.5

The current infographic presents information about the 2017 WADA Monitoring Program.6 Specifically, the distribution of tramadol findings in 122 706 urine samples obtained in-competition. All these samples were analysed in WADA-accredited doping control laboratories through liquid–liquid extraction followed by gas chromatography–mass spectrometry to detect those specimens with a urinary tramadol concentration above 50 ng/mL of urine. In 2017, only 900 samples surpassed the cut-off set for tramadol which represents an incidence of 0.7% respect from the total of samples analysed. Interestingly, 548 were detected in cycling which accounts for approximately 61% of all tramadol findings. These data confirm that tramadol might be overused in cycling and supports the concerns of the UCI regarding this opioid. Since WADA’s main objective is to guarantee the safety and equality of all athletes, it becomes imperative to provide evidence that clarifies the clinical benefits of tramadol in sport setting, the possible ergogenic effects in competition and the drawbacks derived from acute and chronic ingestion of this opioid.

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Footnotes

  • Contributors JGB-M drafted the infographics with the indications of JDC. All the authors reviewed the infographic and the accompanying text.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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