Knowledge and Perceptions of Pharmacy Students in Qatar on Anti-Doping in Sports and on Sports Pharmacy in Undergraduate Curricula

Competence in Sports Pharmacy among Pharmacy Students in Norway

Pharmacists are competent to promote the proper use of medicines. According to the International Pharmaceutical Federation, pharmacists must develop competence in sports pharmacy and the contents of the World Anti-Doping Agency code. This explorative study aimed to identify the status of sports pharmacy in pharmacy education in Norway and competence in sports pharmacy among Norwegian pharmacy students. The study curricula of pharmacy education were examined for the content of sports pharmacy. An online questionnaire was also developed and distributed among pharmacy students. The anonymous survey collected demographic information and data on competence in sports pharmacy. Data from 122 participants were analyzed. Only 22.5% of pharmacy students had acquired a form of training in sports pharmacy and 91.7% wished to gain higher competence. In total, 40.2% of respondents were uncomfortable in advising athletes and trainers on medication use in sports. Study year was found to correlate with competence level with a significant difference between the 3rd year (bachelor) and 5th year (master) students. Age, institution, and number of years engaged in sports were not associated with competence level. The inclusion of sports pharmacy in pharmacy programs holds practical relevance for enhancing competency levels. This implementation can be realized through the integration of sports pharmacy modules and/or the incorporation of research-based activities.

Pharmacy professionals' knowledge, attitude and practice towards doping in sports: A Cross-sectional study in Ethiopia

Background

Doping is appearing as a major problem in Ethiopia, a country decorated with medium and long-distance runners. To protect athletes from doping, pharmacists can be the first port of call for advising athletes on drug treatment. Hence, to fuel the anti-doping movement, it is crucial to explore the knowledge, attitude, and practice of community pharmacy professionals. Therefore, this study aimed to assess the community pharmacy professionals' knowledge, attitude, and practices towards doping in sports in Addis Ababa, Ethiopia.

Materials and methods

A cross-sectional survey, involving 336 study participants, was conducted in selected community pharmacies of Addis Ababa, Ethiopia from April to May 2018.

Results

Of 336 study participants, most of them knew the word "doping" and out of these, 51.9 % of them wrote the definition of doping correctly. Most respondents classified narcotics, hormone modulators, growth factors, and β-2 agonists correctly. Almost one-third of the professionals agreed that they have adequate information about doping and that doping is a public health problem. Among the participants, only 33.4 % were confronted with "suspicious of doping substance" without a prescription over the last 12 months.

Conclusions

Although most pharmacy professionals lack doping-specific knowledge and adequate training required to be operative in doping prevention, most of them perceive doping as a public health problem although the curriculum does not have good coverage about doping.

Knowledge gaps of medical and pharmacy students with respect to performance enhancing drugs in sport: a pilot study

BACKGROUND

Central to the work of medical and pharmacy practitioners is the provision of pharmaceutical support for patients, who may also be competitive athletes. This study aimed to assess the knowledge gaps of medical and pharmacy students at the University of Malta regarding World Anti-Doping Code and the Prohibited List.

METHODS

All medical and pharmacy students studying at the University of Malta were invited to participate in an online questionnaire devised by the research team. This questionnaire assessed knowledge regarding the prohibited status of 19 substances, as well as knowledge regarding therapeutic use exemptions. The questionnaire was prepiloted with local experts in the sports doping field to test face validity, and then tested for content clarity and easy of use by 20 medical and pharmacy students. Total scores were used to compare medical student vs. pharmacy student and athlete vs. non-athlete using the Mann-Whitney U Test.

RESULTS

A total of 242 students answered the questionnaire, 58% of which were female. 86% of respondents were medical students. From of the cohort of respondents, 22% identified themselves as athletes as per definition provided in the questionnaire. A number of substances, such as diuretics, morphine, cocaine and ecstasy, were incorrectly classified by the majority of participants. Paracetamol, caffeine, vitamins, NSAIDs, and antihistamines were mostly correctly classified. Pharmacy students had better knowledge when compared to medical students (U value =2734.5, P value =0.034). Student athletes did not have more knowledge than non-athletes (U value =4810.5, P value =0.659).

CONCLUSIONS

Medical and Pharmacy students have significant knowledge gaps when it comes to performance enhancing drugs in sport. Sports pharmacy should be included as part of the undergraduate curriculum for both medicine and pharmacy, but especially for medical students who will be future prescribers.

Anti-Doping Knowledge of Students Undertaking Bachelor's Degrees in Sports Sciences in Spain

In Spain, students pursuing a career in athletic training, physical education, or scientific evaluation of sports enroll in a bachelor’s degree in sports sciences. This degree provides knowledge and skills in a broad array of sports settings and promotes research-based interdisciplinary knowledge. However, the student’s syllabus rarely includes specific academic training on anti-doping regulations or doping prevention. The purpose of this study was to assess the anti-doping knowledge of the students undertaking a bachelor’s degree in sports sciences in Spanish universities. One thousand two hundred and thirty-three bachelor students in sport science (907 males, 322 females, and 4 participants with non-binary sex) from 26 Spanish universities completed a validated questionnaire about general anti-doping knowledge. The questionnaire is an adapted version of the Play True Quiz of the World Anti-Doping Agency and contains 37 multiple-choice questions. The score obtained in the questionnaire was transformed into a 0−100-point scale. The questionnaire was distributed among students within each university by a faculty member and it was filled out online. Students obtained a score of 65.8 ± 10.10 points (range = 32−92 points). There was an effect of the course in the score obtained (p < 0.001). Students of the first course (63.6 ± 9.5 points) had lower scores than the remaining courses (p < 0.037) while the students of the fourth course obtained the highest scores (68.7 ± 9.5 points; p < 0.019). The students with an itinerary on sports performance were the respondents with the highest anti-doping knowledge (67.2 ± 10.2) points, followed by the students with an itinerary on health (66.7 ± 9.5 points). The knowledge of basic anti-doping rules and doping prevention strategies of the bachelor students in sports sciences in Spain was suboptimal. Increasing doping prevention information in the syllabus of the bachelor’s degree in sports sciences is essential as these future professionals will directly work with populations at risk of doping.

Engaging community pharmacists to eliminate inadvertent doping in sports: A study of their knowledge on doping

This study aimed to evaluate the community pharmacists’ knowledge of tackling the issue of inadvertent doping in Malaysia. A cross-sectional survey was conducted among 384 community pharmacists working in Malaysia using a self-administered questionnaire. All the respondents were pharmacists fully registered with the Pharmacy Board of Malaysia and had been working in the community setting for at least one year. Of the 426 community pharmacists approached, 384 community pharmacists participated in this study, giving a response rate of 90.14%. The majority of the respondents were females (63.5%), graduated from local universities (74.9%), with median years of practising as a community pharmacist of six years (interquartile range, IQR = 9 years). The respondents were found to have moderate levels of doping-related knowledge (median score of 52 out of 100). Anabolic steroids (95.8%), stimulants (78.6%) and growth factors (65.6%) were recognised as prohibited substances by most of the respondents. Around 65.9% did not recognise that inadvertent doping is also considered a doping violation. Most of them (90%) also have poor levels of knowledge of doping scenarios in the country. Community pharmacists in Malaysia have limited knowledge in the field of doping. More programmes and activities related to doping and drugs in sports should be held to enhance the community pharmacists’ knowledge on the issue of inadvertent doping.

A Comprehensive Assessment of Knowledge, Attitudes, and Practicalities Related to Doping Agents use among Jordanians

Background

People perform sports for better health and wellbeing. However, the use of doping agents is emerging among young adults. This study investigated aspects related to doping agents.

Methods

A reliable self-administered questionnaire (Cronbach's alpha =0.72, Pearson's r = 0.89) was used to assess knowledge, attitudes, and practicalities related to the use of doping agents. Results for pharmacists as health care providers (HCP, n=550) were compared with non-healthcare providers (Non-HCP, n=319).

Results

Among pharmacists, 82.9% knew the definition of doping agents vs. 72.4% of non-HCP (P<0.001). However, 36.7% of pharmacists vs. 39.6% of non-HCP incorrectly classified doping agents (P=0.02). The majority of responders (89.8%) supported having an anti-doping authority, yet, only 15% were aware of the anti-doping organizations. The majority of responders (83%) did not receive an official education related to doping agents. Enhancing physical performance was perceived as a leading driver (82.1%) to use doping agents. More than 90% of responders supported awareness in the community. The perceived best tool for awareness was social media and TV sites, as suggested by pharmacists (95.0%) and non-HCP (92.1%, P=0.312). A total of 6.1% had ever used doping agents (3.6% pharmacist vs. 9.8% non-HCP, P<0.001). Almost half of the users utilized a diet or medication to counteract the side effects of doping agents. Within pharmacists, males received more requests to provide doping agents (41.9%) compared with females (23.8%, P<0.001).

Conclusion

It is crucial to enhance professional and legal knowledge and public awareness about doping agents, not only for non-HCP but also for HCPs. Applying more restrictions on doping agents is strongly recommended.

Doping Knowledge, Attitude and Practice of Pharmacists in Dessie, Northeast Ethiopia

Background

Doping includes tampering, possession; trafficking; administration, assisting, encouraging, aiding, conspiring a prohibited substance, and an anti-doping rule violation. Doping in sports is increasing and diversifying involving physiological, mechanical, and pharmacological techniques and becoming a serious public health problem. Pharmacy professionals have a vital role in the fight against doping. This study assessed the knowledge, attitude, and practice of pharmacists on the use of doping agents by sportsmen and women.

Methods

A community-based cross-sectional descriptive study was done targeting community pharmacists of Dessie city, Northeast Ethiopia. Structured questionnaires were distributed and collected between April and March of 2018. Data were analyzed using SPSS version 20.0. Linear regression was used and the level of statistical significance was set at a p-value <0.05.

Results

Of the 61 pharmacy professionals who participated in the study, 46 (75.4%) were males and 15 (24.6%) were females. Only 25 (41.0%) and 13 (21.3%) of the respondents said they watch and play sport regularly, respectively. The majority of the participants, 50 (82%), supported the prohibition of performance-enhancing drugs in sport. The majority of the respondents, 55.7%, agree that pharmacists are a potential source of doping agents. Only 27.9% of them mentioned World Anti-doping Agency (WADA) as the source of information about doping agents. Regarding identifying the WADA status of 13 agents, the average score out of 13 was 4.95, while 80.3% of them scored less than or equal to seven. Factors associated with knowledge of participants were being male (β = 4.48, p= 0.02) and regularly watching sport (β = 2.64, p= 0.01).

Conclusion

Even though the pharmacists' low knowledge score revealed that they need further specialized training on doping and anti-doping, majority of them support banning doping substances from sport. Pharmacy curriculum developers should consider incorporating specific topics or courses about doping agents.

Rebooting a sports pharmacy advanced pharmacy practice experience: Utilizing medicinal chemistry as a foundational approach to get pharmacists back in the game

BACKGROUND AND PURPOSE

To implement a sports pharmacy advanced pharmacy practice experience (SP-APPE) utilizing medicinal chemistry as a foundational approach.

EDUCATIONAL ACTIVITY AND SETTING

A student-pharmacist and medicinal chemistry faculty member collaborated to reboot a SP-APPE. Approached from a medicinal chemistry perspective and tailored to the infrastructure of the university, three fourth-year student-pharmacists piloted the SP-APPE (fall 2017 to fall 2018). Various performance enhancing drugs (PEDs) and supplements were investigated. Student-pharmacists evaluated general knowledge of PEDs along with the perceived value of pharmacists in sports among student-athletes, athletic personnel, and pre-APPE students.

FINDINGS

By demonstrating how legitimate medications were chemically similar to substances banned by sports governing agencies, comparing chemical structures/pharmacophores of PEDs to those of various prescription drugs, and comprehending athletes' misuse of PEDs, student-pharmacists educated student-athletes and athletic personnel on pertinent topics spanning pharmacy and sports (e.g., marijuana, medication sharing, deciphering supplement labels). Laboratory analytical methods that detect PEDs and educational points regarding potential adverse health risks posed by PED usage were also reviewed. Survey participants (approximately 75%, n = 134) perceived pharmacists as valuable to student-athletes and athletic personnel. Student-pharmacists indicated that medicinal chemistry knowledge was strengthened by completing the APPE and relevant to their pharmacy careers.

SUMMARY

Based on medicinal chemistry principles, the SP-APPE provided a venue for student-pharmacists to interact with athletics, assist with drug information education, and identify drugs or supplements as chemically related to those banned by sports governing agencies. Confident in medicinal chemistry concepts, student-pharmacists translated their expertise to benefit the patient/student-athlete.

Medication information and supply behaviours in elite and developing athletes

OBJECTIVES

To investigate the behaviours of elite and developing athletes in obtaining medications and medication information, and to identify the role of pharmacists in athlete care.

DESIGN

Cross-sectional survey.

METHODS

An electronic, 39-item questionnaire was developed, piloted and distributed to elite and developing athletes aged 18 years and above at a state-based sporting institute. Quantitative data was analysed using descriptive statistics and free text comments were analysed using an inductive reasoning approach.

RESULTS

A total of 98 responses were analysed. Ninety (n=90/98, 91.84%) participants obtained medications in the six months prior to survey completion. Pharmacies were the most common source of both prescription (n=67/69, 97.10%) and non-prescription medications (n=64/75, 85.33%). Forty-five (n=45/98, 45.92%) participants also attended pharmacies when they had a minor ailment. Sixty-two (n=62/98, 63.27%) participants 'sometimes' consulted pharmacists for medication information. Only 11 (n=11/98, 11.22%) knew, according to their sporting institute medication policy, that athletes were required to consult a medical practitioner before taking anti-inflammatory, pain-relieving or sleep-inducing medications. Forty (n=40/98, 40.82%) participants believed pharmacists could play a role in their medication management.

CONCLUSIONS

Many elite and developing athletes visited pharmacies for medication supply and treatment of minor ailments. Doping regulatory agency websites were the most commonly used and trusted sources for medication information, although some athletes believed pharmacists could also contribute to their medication management. Future research should consider whether pharmacists are ready for a role in sports pharmacy.

Current and Potential Roles in Sports Pharmacy: A Systematic Review

(1) Background: The objective of this systematic review was to evaluate current and potential roles for pharmacists in sports medicine and to identify key themes in outcomes reported in studies. (2) Methods: EMBASE, MEDLINE, CINAHL, Scopus and the Cochrane Library were searched in January 2019. Peer-reviewed, original research articles were considered for inclusion. Articles published in a language other than English were excluded. Quality appraisal was performed independently by two authors. (3) Results: Findings of 11 eligible articles (10 observational and 1 experimental study design) were grouped into three themes: (i) doping prevention and control, (ii) injury management and first aid, and (iii) educational and curricular needs. Pharmacists were perceived as a good potential source of information about doping and are enthusiastic about counseling athletes, but lack knowledge and confidence in this area. While pharmacists were frequently consulted for advice on managing sprains and strains, their advice was not always guided by current evidence. Pharmacists and pharmacy students recalled limited opportunity for education in sports pharmacy. (4) Conclusion: Pharmacists showed a willingness and an aptitude to counsel athletes. However, lack of knowledge and confidence, and limited educational opportunities, were key barriers. More research is necessary to support pharmacists in this role.

Instructional design and assessment of an elective course on the use of drugs in sport

BACKGROUND AND PURPOSE

The use and misuse of drugs in sport is becoming increasingly important globally, and the role of pharmacists is evolving in this regard. This paper describes the design and implementation of an elective course "Drugs in Sport" in an undergraduate pharmacy curriculum.

EDUCATIONAL ACTIVITY AND SETTING

The elective course was designed to introduce BSc pharmacy students to an evidence-based approach to safe, effective, and legal use of drugs in sport. The course covered why athletes take drugs, evolution of doping in sport, the international regulations regarding doping and anti-doping in sport including the World Anti-doping Agency Prohibited List, as well as testing and monitoring for drug use in sport. It also included the role of athlete support personnel (ASP) in preventing the use of prohibited substances by athletes. A web-based survey was conducted at the end of the course to assess the students' perspectives of the course.

FINDINGS

Students provided an evaluation of the course in terms of its content, methods of delivery, and assessment. Overall, the students demonstrated competence. They gained insight into international and national regulations regarding doping and anti-doping in sport and the potential role of pharmacists as ASP in providing support and advice for athletes and the public.

SUMMARY

Designing and implementing an evidence-based course on the use of drugs in sport customized for pharmacy students was achieved successfully. Such courses could provide an opportunity to advance the scope of pharmacy practice and possibly provide a new career path for future pharmacists.