Physician-prescribed medication use by the Finnish Paralympic and Olympic athletes

Para sport and anti-doping: a study of Swedish Para athletes' experiences and perceptions

Introduction

A well-functioning anti-doping system relies on being perceived by athletes as effective, fair, and practically feasible to implement. While research has highlighted the views of Olympic athletes on anti-doping over the past decade, the experiences and perceptions of Para athletes have not been extensively explored. The purpose of this study was to examine Swedish elite Para athletes' experiences and perceptions of the policy and practice of the anti-doping system.

Methods

A quantitative cross-sectional approach was used, with a web survey elaborated from a survey with Olympic athletes adjusted for Para athletes with physical, visual, and intellectual impairments. The sample consisted of 66 active Para athletes competing at national or international level (response rate 71%). Data were analyzed using descriptive statistics and differences between subgroups were examined Fisher's exact test. Thematic analysis was employed to analyze open-ended questions.

Results

Most of the respondents expressed a positive outlook on the anti-doping system, advocating for comprehensive efforts. A significant portion (35%) had not received anti-doping education, with those who did reporting increased confidence in avoiding unintentional doping. Despite their elite status, half of the respondents had not undergone doping control. Mistrust regarding the system's effectiveness and fairness was identified, with over half of the participants emphasizing the need for new technical solutions to enhance procedures specifically tailored for Para athletes.

Discussion

The athletes in this study advocate for a Para sports-focused approach in the anti-doping system, emphasizing equal testing opportunities, procedural adjustments for independence and privacy, and increased access to education. The findings illuminate the unique conditions faced by athletes with impairments within the anti-doping system, offering valuable insights for policymaking in the development of anti-doping strategies tailored to Para athletes and their various impairments.

Antimicrobial Resistance and Sports: The Scope of the Problem, Implications for Athletes' Health and Avenues for Collaborative Public Health Action

Antimicrobial resistance (AMR) poses a global threat, leading to increased mortality and necessitating urgent action-however, its impact on athletes and the world of sports has hitherto been neglected. Sports environments (including athletic and aquatic) exhibit high levels of microbial contamination, potentially contributing to the spread of resistant microorganisms during physical activities. Moreover, the literature suggests that travel for sports events may lead to changes in athletes' gut microbiomes and potentially impact their antibiotic resistance profiles, raising questions about the broader implications for individual and public/global health. The prevalence of Staphylococcus aureus (S. aureus) among athletes (particularly those engaged in contact or collision sports) ranges between 22.4% and 68.6%, with MRSA strains being isolated in up to 34.9% of tested individuals. Factors such as training frequency, equipment sharing, delayed post-training showers, and a history of certain medical conditions are linked to higher colonization rates. Moreover, MRSA outbreaks have been documented in sports teams previously, highlighting the importance of implementing preventive measures and hygiene protocols in athletic settings. In light of the growing threat of AMR, there is a critical need for evidence-based treatment guidelines tailored to athletes' unique physiological demands to ensure responsible antibiotic use and mitigate potential health risks. While various initiatives-such as incorporating AMR awareness into major sporting events-aim to leverage the broad audience of sports to communicate the importance of addressing AMR, proactive measures (including improved AMR surveillance during large sporting events) will be indispensable for enhancing preparedness and safeguarding both athletes' and the general public's health. This narrative review thoroughly assesses the existing literature on AMR and antibiotic usage in the context of sports, aiming to illuminate areas where information may be lacking and underscoring the significance of promoting global awareness about AMR through sports.

Use of pharmaceuticals amongst athletes tested by Anti-Doping Norway in a five-year period

Introduction

The aim of the study was to map the use of pharmaceuticals by Norwegian athletes registered on doping control forms (DCFs) in a five-year period to examine general and some class specific use of pharmaceuticals across sports and athlete levels.

Method

Anonymous data from DCFs collected in 2015-2019 were manually entered into a database using the Anatomical Therapeutic Chemical (ATC) system for classification of the pharmaceuticals. Variables entered were year of control, gender, age group, athlete level, sport, test type, nationality, and pharmaceuticals (and dietary supplements) used.

Results

Pain killers in the ATC groups M01 A (Nonsteroidal anti-inflammatory drugs - NSAIDs) and N02 B (other analgesics), and anti-asthmatics in ATC groups R03 A and R03 B were the most frequently used pharmaceuticals. National level athletes reported more use of pharmaceuticals (1.4 ± 1.7 pharmaceuticals per form) than recreational level athletes (0.9 ± 1.2). The highest proportion of DCFs containing information about at least one pharmaceutical were found in speed skating (79.1%), alpine skiing (74.0%), rowing (72.4%) and cross-country skiing (71.7%). Painkillers were most frequently used in muscular endurance sports (30.4% and 21.2 % for M01A and N02 B, respectively) and ball and team sports (17.9% and 17.0%). Use of hypnotics was reported from ice-hockey players and alpine skiers in around 8% of the cases.

Coclusion

Use of anti-asthmatics was most often reported amongst athletes specially exposed to cold, chemicals and heavy endurance training. Athletes in specialized sports requiring high levels of strength and/or endurance reported a higher use of pharmaceuticals out-of-competition compared to in-competition, while there was no such difference in complex sports, such as team, gymnastic, aiming and combat sports.

Analgesic Use in Sports

BACKGROUND

Consumption of medication to alleviate pain is widespread in Germany. Around 1.9 million men and women take analgesics every day; some 1.6 million persons are addicted to painkillers. Analgesic use is thought also to be common in sports, even in the absence of pain. The aim of this study was to assess the extent of painkiller use among athletes.

METHODS

In line with the PRISMA criteria and the modified PICO(S) criteria, a systematic literature review was registered (Openscienceframework, https://doi. org/10.17605/OSF.IO/VQ94D) and carried out in PubMed and SURF. The publications identified (25 survey studies, 12 analyses of doping control forms, 18 reviews) were evaluated in standardized manner using the Newcastle Ottawa Scale (NOS) and AMSTAR (A MeaSurement Tool to Assess systematic Reviews).

RESULTS

Analgesic use is widespread in elite sports. The prevalence varies between 2.8% (professional tennis) and 54.2% (professional soccer). Pain medication is also taken prophylactically in the absence of symptoms in some non-elite competitive sports. In the heterogeneous field of amateur sports the data are sparse and there is no reliable evidence of wide-reaching consumption of painkillers. Among endurance athletes, 2.1% of over 50 000 persons stated that they used analgesics at least once each month in connection with sports.

CONCLUSION

Analgesic use has become a problem in many areas of professional/ competitive sports, while the consumption of pain medication apparently remains rare in amateur sports. In view of the increasing harmful use of or even addiction to painkillers in society as a whole, there is a need for better education and, above all, restrictions on advertising.

Antibiotic Therapy and Athletes: Is the Mitochondrial Dysfunction the Real Achilles’ Heel?

It is widely recognized that athletes consume oral antibiotics almost twice as often as observed in the non-sports population in order to reduce as much as possible the period of inactivity due to bacterial diseases. However, increasing evidences have demonstrated the ability of some classes of antibiotics to induce muscle weakness, pain, and a feeling of fatigue upon resuming physical activity conditions that considerably limit the athletic performance of athletes, ascribable to alterations in the biochemical mechanisms underlying normal musculoskeletal activity, such as mitochondrial respiration. For this reason, tailoring a treatment plan for effective antibiotics that limit an athlete’s risk is paramount to their safety and ability to maintain adequate athletic performance. The present review illustrates and critically analyzes the evidence on the use of antibiotics in sports, deepening the molecular mechanisms underlying the onset and development of muscle–tendon alterations in athletes as well as delineating the pharmacological strategies aimed at counteracting such adverse events.

Chronic prescription medication use in endurance runners: a cross-sectional study in 76,654 race entrants - SAFER XV

OBJECTIVE

To determine the prevalence of chronic prescription medication (CPM) use in distant runners (by age and sex) and to compare CPM use in 21.1 km vs. 56 km race entrants.

METHODS

A cross-sectional study of 76,654 race entrants who completed a pre-race medical screening questionnaire during race registration, which included questions on the use of CPM and CPM use in eight main categories of CPM. Prevalence (%, 95%CIs) and prevalence ratios (PR) are reported.

RESULTS

The prevalence of any CPM use was 12.5% (12.2-12.8). CPM use was higher in older age categories vs. the youngest age category (31-40 yrs vs. ≤30 yrs: PR = 1.4; 41-50 yrs vs. ≤30 yrs: PR = 2.1; >50 yrs vs. ≤30 yrs: PR = 3.4) (p < 0.0001) and females vs. males (PR = 1.1; p < 0.0001). The use of any CPM was significantly higher in 21.1 km vs. 56 km race entrants (PR = 1.2; p < 0.0001). Prevalence of CPM use in main categories was: blood pressure lowering medication (3.7%), cholesterol lowering medication (3.6%), asthma medication (3.1%), and medication to treat anxiety/depression (2.6%). The pattern of CPM in the main categories differed between 21.1 km and 56 km race entrants.

CONCLUSIONS

One in eight race entrants use CPM, with a higher prevalence of use among older race entrants, female vs. males, and 21.1 km vs. 56 km race entrants. Frequent CPMs used are blood pressure lowering medication, cholesterol lowering medication, asthma medication, and medication to treat anxiety/depression. The use of CPM medications may increase the risk of medical complications during exercise, and these data help identify subgroups of entrants that may be at higher risk for race medical encounters.

Patterns of Athlete Medication Use at the 2018 PyeongChang Paralympic Games: A Descriptive Cohort Study

OBJECTIVE

Medication use among elite athletes has received growing attention over the past decades. However, only limited studies have focused on para athletes, and trends in medication use among this cohort remain unclear. The aims of this study were (1) to describe the pattern of medication use in elite Paralympic athletes, with a particular focus on analgesics, (2) to analyze whether medications declared by athletes were included in the 2018 World Anti-Doping Agency's prohibited list and monitoring program, (3) to report on a variety of novel supplements, and (4) to review whether athlete analgesic needs will be met by the new Olympic & Paralympic Model Formulary.

DESIGN

This is a retrospective, descriptive cohort study.

RESULTS

Of all athletes who underwent doping control, 21% declared the use of an analgesic medication. Athletes with limb deficiency and para snowboarders declared the most analgesic medications in their respective categories. It was determined that 84% of the athletes' analgesic medication needs were provided from the new Olympic & Paralympic Model Formulary.

CONCLUSIONS

Analgesic use among athletes who participated at the 2018 PyeongChang Winter Paralympics was high. Para snowboarders and athletes with limb deficiency declared the most analgesics. The new Olympic & Paralympic Model Formulary adequately addressed the medication needs of the athletes attending the 2018 games.

Analgesic Management of Pain in Elite Athletes: A Systematic Review

OBJECTIVE

To identify the prevalence, frequency of use, and effects of analgesic pain management strategies used in elite athletes.

DESIGN

Systematic literature review.

DATA SOURCES

Six databases: Ovid/Medline, SPORTDiscus, CINAHL, Embase, Cochrane Library, and Scopus.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Empirical studies involving elite athletes and focused on the use or effects of medications used for pain or painful injury. Studies involving recreational sportspeople or those that undertake general exercise were excluded.

MAIN RESULTS

Of 70 articles found, the majority examined the frequency with which elite athletes use pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, anesthetics, and opioids. A smaller set of studies assessed the effect of medications on outcomes such as pain, function, and adverse effects. Oral NSAIDs are reported to be the most common medication, being used in some international sporting events by over 50% of athletes. Studies examining the effects of pain medications on elite athletes typically involved small samples and lacked control groups against which treated athletes were compared.

CONCLUSIONS

Existing empirical research does not provide a sufficient body of evidence to guide athletes and healthcare professionals in making analgesic medication treatment decisions. Based on the relatively robust evidence regarding the widespread use of NSAIDs, clinicians and policymakers should carefully assess their current recommendations for NSAID use and adhere to a more unified consensus-based strategy for multidisciplinary pain management in elite athletes. In the future, we hope to see more rigorous, prospective studies of various pain management strategies in elite athletes, thus enabling a shift from consensus-based recommendations to evidence-based recommendations.

Pain Management in Athletes With Impairment: A Narrative Review of Management Strategies

OBJECTIVE

To review the literature related to different treatment strategies for the general population of individuals with amputation, spinal cord injury, and cerebral palsy, as well as how this may impact pain management in a correlated athlete population.

DATA SOURCES

A comprehensive literature search was performed linking pain with terms related to different impairment types.

MAIN RESULTS

There is a paucity in the literature relating to treatment of pain in athletes with impairment; however, it is possible that the treatment strategies used in the general population of individuals with impairment may be translated to the athlete population. There are a wide variety of treatment options including both pharmacological and nonpharmacological treatments which may be applicable in the athlete.

CONCLUSIONS

It is the role of the physician to determine which strategy of the possible treatment options will best facilitate the management of pain in the individual athlete in a sport-specific setting.

Medication and Supplement Use in Disability Football World Championships

BACKGROUND

Individuals with an impairment comprise more than 15% of the world's population, many of whom can benefit greatly from participation in sport. The provision of medical services in disability sport is a challenging area with a lack of scientific evidence. Given the positive impact that sport can have on the people with an impairment, it is vital that measures are taken to better understand the medical issues posed by disability sport. It is well established that medications and supplements are overused in sport, particularly within professional football, but there is no current evidence on medication or supplement use in elite disability football.

OBJECTIVE

To examine and describe the use of medication and supplements in disability football, before and during international tournaments, and to identify the profile of substances used by category.

DESIGN

Prospective, descriptive, cohort study.

SETTING

International Blind Sport Association Football World Cup 2015 and the International Federation of Cerebral Palsy Football World Cup 2015.

PARTICIPANTS

Two hundred forty-two elite-level disability footballers, classified with B1 visual impairment or cerebral palsy.

METHODS

Team clinicians were asked to document all medication and supplements taken in the 48 hours before each match.

RESULTS

This study recorded the use of 1648 substances in 242 players, with more than one half (53.1%) classified as supplements. There was an overall rate of 1.26 substances used per player per match and a medication use rate of 0.59 medications per player per match. Seventy percent (170/242) of players reported using at least one substance per tournament, with 57.9% (140/242) using at least one prescribed medication (63.6% of players at International Blind Sports Association World Games and 57.7% of players at International Federation of Cerebral Palsy World Cup). The most commonly prescribed category of medications was nonsteroidal anti-inflammatory drugs, representing 39.3% of all reported medications.

CONCLUSION

This study highlights the potential overuse of medication and supplements in disability football, particularly in the use of nonsteroidal anti-inflammatory drugs. These trends are comparable to previous research in Fédération Internationale de Football Association World Cup competitions.

LEVEL OF EVIDENCE

Not applicable.