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A painful dilemma? Analgesic use in sport and the role of anti-doping
  1. Alan Vernec1,
  2. Andrew Pipe2,
  3. Andrew Slack1
  1. 1 Department of Science and Medicine, World Anti-Doping Agency (WADA), Montreal, Quebec, Canada
  2. 2 Faculty of Medicine, University of Ottawa, Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

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How clinicians should address the use and abuse of analgesics in sport has been a focus of debate for many years. Concern for an athlete’s health and a desire to prevent unfair distortion of performance underlie any discussion of this issue. In 1967 the original IOC list of prohibited substances specifically identified ‘Narcotic Analgesics’ as being prohibited in sport. The 2017 WADA Prohibited List (List) mandates that ‘Narcotics’ and ‘Cannabinoids’ are prohibited ‘In-Competition’. More commonly used analgesics, including non-steroidal anti-inflammatory drugs, paracetamol, local anaesthetics, and some weak opioids such as tramadol and codeine are not prohibited. No well-defined boundary separates either the health risk or ergogenic potential of cannabinoids and narcotics versus the more commonly used analgesics.

Should more analgesics be added to the List or should narcotics and cannabis be removed? Is the use of pain medication doping? As defined by Article 2 of the World Anti-Doping Code (Code),1 doping is defined, inter alia, as the presence, use, possession or trafficking of a prohibited substance. This leads one to query: what are the key determinants for inclusion …

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  • Competing interests None declared.

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

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