You follow all the rules, check your medications against the prohibited list, and even obtain a Therapeutic Use Exemption when necessary. Then, despite your diligence, you receive the devastating news of a positive test for a banned substance.
At Global Sports Advocates, we've represented numerous athletes who faced anti-doping violations due to contaminated medications they received from reputable pharmacies. The issue of pharmaceutical contamination has become so significant that the World Anti-Doping Agency (WADA) recently implemented special reporting thresholds for certain contaminants.
Understanding Pharmaceutical Contamination
Pharmaceutical contamination occurs when medications contain trace amounts of substances not listed on their labels. Even medications from well-established pharmacies can be affected by this problem. The contamination typically happens during manufacturing, where equipment used to produce multiple medications may retain residue despite cleaning procedures.
Under the World Anti-Doping Code's strict liability principle, athletes are responsible for everything found in their system regardless of how it got there. However, under Article 10.6.1 of the World Anti-Doping Code, if an athlete is able to successfully establish they bear No Significant Fault or Negligence for their Article 2.1 (presence), Article 2.2 (use), or Article 2.6 (possession) anti-doping rule violation, their period of ineligibility can be reduced based on their “degree of fault”. Further, under Article 10.5, if an athlete is able to successfully establish they bear No Fault or Negligence, their period of ineligibility is eliminated.
How WADA Technical Letter TL24 Affects Athletes
WADA's Technical Letter TL24, effective as of April 1, 2024, represents a significant step in addressing the reality of pharmaceutical contamination. This document specifically targets six diuretics that are known to appear as contaminants in legitimate pharmaceutical products.
- Acetazolamide. Commonly prescribed for glaucoma, altitude sickness, and epilepsy, acetazolamide poses a contamination risk because it's frequently manufactured in facilities that also produce other medications, increasing the chance of cross-contamination during production.
- Bumetanide. A potent loop diuretic used to treat congestive heart failure and edema, bumetanide requires careful manufacturing controls as its high potency means even trace contamination can be detected in anti-doping tests.
- Furosemide. One of the most widely prescribed diuretics for treating hypertension and fluid retention, furosemide's prevalence in pharmaceutical facilities makes it a common contaminant due to its widespread production and potential residue on shared manufacturing equipment.
- Hydrochlorothiazide. Frequently prescribed for high blood pressure and often included in combination medications, hydrochlorothiazide has been identified in numerous contamination cases due to its extensive use in pharmaceutical manufacturing and resulting in equipment exposure.
- Torasemide. Similar to furosemide but with longer duration of action, torasemide's molecular properties make it particularly susceptible to transfer between production batches.
- Triamterene. Oten used in combination with other diuretics to treat hypertension and edema, triamterene presents contamination risks due to its distinctive chemical structure that makes it easily detectable even at the minimal concentrations typically associated with inadvertent exposure.
WADA has established a Minimum Reporting Level (MRL) of 20 ng/mL for these substances. This means when found at concentrations equal to or below this threshold, laboratories should report the finding as negative—with one important exception.
For athletes competing in sports with weight classes (like boxing, wrestling, weightlifting, and various martial arts), even levels below 20 ng/mL must be reported as an Atypical Finding since diuretics can be abused to achieve rapid weight loss to meet competition weight requirements. This triggers a mandatory investigation by the Results Management Authority to determine whether an anti-doping rule violation should be asserted.
Protective Measures for Athletes
Taking proactive steps can help reduce your risk of testing positive due to contaminated medications.
- Inform your healthcare providers about your status as an athlete subject to anti-doping testing. Many physicians aren't familiar with anti-doping regulations, so clear communication is essential.
- When possible, obtain medications from pharmacies that specialize in serving athletes. Some pharmacies offer testing services for medications to ensure they don't contain prohibited substances.
- Keep detailed records of all medications you take. Your records should include prescription information, dosage, frequency, and the pharmacy where they were filled. This documentation can prove invaluable if you face an anti-doping charge related to contamination.
- For medications you take regularly, consider having samples independently tested for prohibited substances. While expensive, this extra precaution provides an additional layer of protection against unintentional violations.
What to Do If You Test Positive
If you receive notification of a positive test result despite your precautions, don't panic—but do act quickly. You’ll want to contact an experienced anti-doping attorney right away. The timelines for responding to anti-doping charges are strict, and proper legal guidance from the start can significantly impact your case outcome.
At Global Sports Advocates, we understand that your career, reputation, and livelihood are at stake. Our comprehensive approach addresses not just the legal aspects of your case but the scientific, procedural, and personal dimensions as well. With our experienced team on your side, you can focus on what you do best—competing at the highest level of your sport.
