Professor

David GerrardDunedin School of Medicine

16:30 - 18:30 WS #80: Sports Medicine Updates: Clinical Vignettes and

Hot Tips (120mins, not repeated)

Dr Mark FulcherAxis Sports Medicine Specialists

Dr Bruce HamiltonDirector of Performance Health High

Performance Sport NZ / NZ Olympic

Committee

High Performance Sport NZ / NZ

Olympic Committee

Auckland

Dr Dan ExeterSport and Exercise Physician

Axis Sports Medicine Specialists

Dr Chris HannaSport and Exercise Physician

Axis Sports Medicine Specialists

Dr Graham

PatersonSport and Exercise Physician

Axis

PRESCRIBING FOR ATHLETES: TIPS FOR THE SPORTS GP

Professor David Gerrard

The process of Therapeutic Use Exemption (TUE)

“…using a prohibitedsubstance for justified

medical reasons…”

The Athlete Patient“Health and wellbeing remains the priority…”

The Elite professional athlete

“Bound to compliance with the World Anti-Doping Code…”

knowledge of:WADA Prohibited ListWADA TUE Guidelines

Ref: Drug-Free Sport New ZealandWADA website

TUE medical guidelinesnon-negotiable pre-requisitesAligned with clinical “best-practice”

1. Diagnostic confirmation (investigations)2. Trial of permitted alternatives3. Negative performance enhancement4. Prior drug misuse

PROCESSApplication to DFSNZStandard form completed (signatures)Supporting documentation availableConsideration by TUE CommitteeRapid turnaround (1 week)

Who needs a TUE?athlete/doctor joint responsibility

Registered testing poolNationally-ranked athletes

Who needs a TUE?If in doubt contact DFSNZKeep good clinical records

emergency treatment?anaphylaxissurgeryacute asthma crisissevere dehydration

Retroactive TUE applicationFull clinical records

Common clinical dilemmas

AsthmaHistory and clinical findingsRespiratory Function testing

Trial of permitted B2-agonistsInhaled glucocorticoids are PERMITTED

Specialist confirmation

GlucocorticoidsTested for in-competition ONLYAll systemic routes of administration require TUEInhalation/topical/intra-articular routes are PERMITTED

GlucocorticoidsUnpredictable excretion ratesGiven legally out-of-competition BUT may still be detectable in-competitionAllow 7-10 daysNotify DFSNZ in advanceKeep meticulous clinical records

ADHD

Diagnostic criteria in accordance with DSM-5Specialist input is criticalAccepted instruments of evaluationmethylphenidate

Probenecid

Prohibited ListCautionary use with athletesComplete TUE application

IV InfusionsIn excess of 100mls requires TUEExcept for medical investigations in hospital settingNot approved for “convenient rehydration”Keep precise clinical records eg… dehydration secondary to acute gastroenteritis

SUPPLEMENTSHigh risk of contamination Unproven efficacy Lack of scientific evidencePeer pressureCoach/parent influenceClinical justification??

SUPPLEMENTScaveat emptor“RIPPED”“TESTO-FUEL”“PREDATOR”“BEAST-GARGANTUA”

TAKE-HOME MESSAGES1. Athlete care requires knowledge of anti-doping code2. Keep full records3. Understand the TUE process