Anabolic Steroids, Substances and Methods Prohibited in Sport
Policy Category: Drug/Prescribing
Under Review: No
Approved by Council: October 1988
Reviewed and Updated: February 2000, December 2010
Publication Date: Dialogue, Issue 4, 2010
College Contact: Physician Advisory Service
Downloadable Version(s): Anabolic Steroids, Substances and Methods Prohibited in Sport
In recent decades there has been an increase in the use of drugs and other substances at all levels of sport for the purpose of performance enhancement and cheating. This practice is often referred to as doping. The number and types of doping agents continue to grow, as do the methods by which performance is enhanced. In addition to anabolic steroids and other doping agents, masking agents and performance enhancing “methods” are also used.
Many substances used as doping agents have a legitimate medical application. When used as clinically indicated, these substances can be safe and effective. However, when used inappropriately for doping, they can pose serious threats to athletes’ health and safety.
Governments, medical regulators and sport organizations worldwide view doping as dangerous and unethical. Not only does it have serious harmful side effects, it violates the core values of sport, namely fair play and honesty, loyal competition, healthy activity, respect for rules and laws, and respect for self and other participants.
Doping is a concern for physicians because they could be a potential avenue for athletes to access doping agents. As such, physicians play a key role in efforts to curtail doping in the interest of patient safety.
This policy articulates the College’s expectations of physicians regarding the use of anabolic steroids and other substances and methods for the purpose of performance enhancement in sport (i.e., doping).
Patients’ health and safety must always be physicians’ main concern.
Ethical conduct is a fundamental component of medical professionalism.
Physicians demonstrate professional competence by prescribing in an appropriate manner as clinically indicated in accordance with relevant guidelines.
Active communication is essential to the physician-patient relationship. This involves educating patients to ensure that medical knowledge is appropriately conveyed to facilitate health promotion and disease prevention.
Physicians must not prescribe, administer or provide assistance relating to the use of substances or methods prohibited in sport for the purpose of enhancing performance, even when pressured to do so by their patients or by others.
Physicians should be aware of the use of drugs in sport and should educate their patients about the possible dangers of this practice.
Physicians may prescribe and administer anabolic steroids and other substances commonly used in sport, including those contained in the Prohibited List maintained by the World Anti-Doping Agency (WADA), 1 only if clinically indicated for a medical purpose and in accordance with relevant clinical guidelines. This includes the provisions under WADA’s Therapeutic Use Exemptions. 2
Physicians who contravene this policy may be found guilty of professional misconduct pursuant to section 1(1)6 of the Professional Misconduct Regulation under the Medicine Act. 3
Physicians are encouraged to consult the following websites for additional information about complying with anti-doping standards and initiatives:
As doping occurs at all levels of sport, including high school, physicians should ensure that their communication and education is tailored to their patients’ level of understanding. Local public health boards may have brochures or websites with relevant information appropriate for different audiences, which can provide assistance.
Appendix: Established Anti-Doping Standards and Initiatives
The international and Canadian sport communities have well established anti-doping standards and initiatives that apply to all levels of sport. The College’s policy on doping is intended to reflect the position of international anti-doping standards and initiatives. They include information that is relevant to physicians, and as such, physicians are advised to consult them as an additional resource.
WADA, an independent international agency dedicated to research, education, monitoring and the promotion of anti-doping in sport, maintains the World Anti-Doping Code. 4 The World Anti-Doping Code is the fundamental and universal document upon which WADA’s World Anti-Doping Program is based. The Code harmonizes international anti-doping policies for all levels of sport. Canada is a signatory to the Code.
The World Anti-Doping Code works in conjunction with five International Standards 5 published by WADA, which are mandatory for signatories to the Code. The International Standards include the Prohibited List and the Therapeutic Use Exemptions. The Prohibited List sets out banned substances and methods. It is updated every year effective January 1. The Therapeutic Use Exemptions set out criteria for permitting an athlete to take particular medications contained in the Prohibited List.
The World Anti-Doping Code and International Standards are observed by the International Olympic Committee in its own Code of Ethics. 6
The United Nations Educational, Scientific and Cultural Organization (UNESCO) further promotes anti-doping efforts through its International Convention against Doping in Sport. 7
The Canadian Centre for Ethics in Sport oversees the Canadian Anti-Doping Initiative, which came into force January 1, 2009. 8 It integrates the World Anti-Doping Code and International Standards, the Canadian Policy Against Doping in Sport, 9 the Physical Activity and Sport Act, 10 and the Canadian Strategy for Ethical Conduct in Sport – the True Sport Strategy. 11
1 WADA is recognized as the world leader in promulgating anti-doping standards. For further information, see the section on Anti-Doping Standards in this document.
2 The Therapeutic Use Exemptions are available at www.wada-ama.org.
3 Medicine Act, 1991, O. Reg. 856/93. The section states that prescribing, dispensing or selling drugs for an improper purpose are acts of professional misconduct for the purpose of clause 51(1)(c) of the Health Professions Procedural Code.
4 Available at www.wada-ama.org.
5 Available at www.wada-ama.org.
6 Available at www.olympic.org.
7 Available at http://portal.unesco.org/en/ev.php-URL_ID=31037&URL_DO=DO_TOPIC&URL_SECTION=201.html
8 For general information, see http://www.cces.ca/en/antidoping/cadp.
9 Available at: www.pch.gc.ca/pgm/sc/pol/dop/index-eng.cfm.
10 Available at http://www2.parl.gc.ca/HousePublications/Publication.aspx?pub=bill&doc=C-12&parl=37&ses=2&language=E.
11 For general information, see http://www.cces.ca/en/antidoping/cadp.
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