Background Doping incidence has been increased in sports at all levels. Therefore a need for alternative approaches to address the doping concerns has arisen because doping not only threatens the health of athlete but also the true spirit of sport.

Objective To assess knowledge, attitudes and usage regarding doping among national level Sri Lankan athletes and to identify reasons for doping and to plan better doping prevention strategies were the objectives.

Design Cross sectional descriptive study in which self-administered questionnaire was used to assess knowledge and usage of doping drugs. A modified version of Performance Enhance Attitude Scale was used to assess attitudes.

Setting 20 national teams/pools of Sri Lanka for the years 2018/2019

Patients (or Participants) 347 national athletes recruited through stratified and random sampling

Results The majority of athletes (66.6%) could not define the term WADA. Not more than 38% of athletes were aware about any given drug. Though attitudes regarding doping were positive in general, 8.3% of athletes admitted they would dope if they got a chance while athletes of individual sports had negative attitudes. According to Randomized Response Technique used, 8.4% of athletes had admitted usage of doping drugs. Doping was highest among athletes in individual sports (18.2%). Lack of knowledge, lack of self confidence and pressure to win were the main reasons for doping. Younger age, less experience, professionally being only an athlete, negative attitudes and knowing fellow athletes who used doping drugs were significantly associated(p<0.05) with doping.

Conclusions Younger inexperienced athletes and athletes of individual sports were more prone to doping and authorities should take special care of them. Actions should be taken to fill the knowledge gaps regarding doping. Special attention should be paid to improve positive attitudes regarding doping because negative attitudes were associated with doping than poor knowledge.