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Olympic Games

Drug testing at the Sydney Olympics

With pre-Olympic and out-of-competition testing, as well as a new, validated test for erythropoietin, athletes will be exposed to more comprehensive drug testing at the Sydney Olympics

Brian Corrigan and Ray Kazlauskas

MJA 2000; 173: 312-313
See also, Kennedy

Drug screening - Sample collection - Analysis - Conclusion - References - Authors' Details
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  Testing for drugs used to enhance performance has been carried out at the Olympic Games since they were held in Mexico in 1968, when Australia's Ron Clarke became the first athlete to be tested. Doping at the Olympic Games is banned for two very good reasons: the use of drugs is cheating, and drugs have adverse effects on the health of athletes.1 The International Olympic Committee (IOC) has maintained a list of proscribed substances and methods for their detection since 1967, and this list is updated each year to form the basis for determining banned substances in all sport.2

In much the same way as random breath testing is used to deter drink driving, drug testing is intended as a deterrent rather than a method of catching all offenders. Thus, in Olympic final events, the competitors who gain the first four places, plus one other usually chosen at random, are subjected to a drug test. During Olympic heats, any athlete may be selected at random for testing.

In past Olympic Games, athletes were not tested for drugs until after they had competed in their events. At the Sydney Olympics, for the first time, many athletes will be subject to pre-Olympic, out-of-competition testing, as it is during this period that some drugs, such as anabolic steroids, may be best detected. This represents a huge change in the IOC position and has occurred after much lobbying by, among others, the Drug Committee of the Sydney Organising Committee for the Olympic Games (SOCOG).


Drug screening
Although blood testing has been performed in a limited fashion at Winter Olympics since 1994, screening for drugs at the Summer Games has, until these Sydney Games, been restricted to urine testing. Urine samples are generally preferable to blood samples for testing for most substances banned by the IOC, as it is easier to collect adequate volumes of urine, and collection of urine is not so invasive. Also, drug and metabolite levels are much higher in urine than in blood, so their detection has greater retrospectivity.3 However, there is a subset of drugs -- the peptide hormones such as erythropoietin (EPO) and human growth hormone (hGH) -- for which establishing a reliable urine test has proved a major obstacle. However, a validated test for EPO has just been accepted by the IOC and will be available for use at the Sydney Games. It involves both a blood test perfected by Australian scientists, and a urine test perfected by the French.


Sample collection
The procedures of urine collection for doping control are rigorously controlled.1 First, a chaperon meets the chosen athlete at the conclusion of the event, provides documentation of his or her selection, and obtains the athlete's signature for verification. The chaperoned athlete attends the doping control station, where forms are filled in to document all prescribed, complementary and other medicines he or she may be taking. The athlete selects his or her own container and provides a urine sample under the observation of the chaperon, and possibly a team representative.

Athletes are required to provide a specimen of approximately 75 mL. This can take some time if the athlete is dehydrated, and athletes are permitted to attend press conferences or receive medals in the interim, provided they are always accompanied by their chaperons. Fluids (not containing caffeine) are provided in the waiting room. The urine sample is checked for volume, pH, and specific gravity (SG). A low SG (< 1.010) could indicate an attempt to dilute the urine by taking a diuretic or drinking litres of water. Athletes may have taken sodium bicarbonate to prevent the build-up of lactic acid and so delay the onset of fatigue. While it is difficult to detect sodium bicarbonate, its use markedly elevates the pH (normally about p H 5-6 post-exercise).4 Also, at high pH, basic drugs such as the amphetamines are very poorly excreted,5 so, if a urine sample is dilute or has a high pH, the athlete will be asked to remain in the collection area and to produce further samples.

Athletes divide their own 75 mL urine specimens into two aliquots in bottles labelled A and B, which have the same unique identifying number. These are secured for shipment to the laboratory. There are at least three copies of the associated paperwork -- one for the athlete, one for the testing authority (the IOC) and a third, abbreviated version (that does not identify the athlete) for the laboratory. The athlete verifies that the process was satisfactory.

The information recorded at the doping control station initiates a chain of custody, which identifies the custodian of the sample at every stage. This extends from urine collection through storage, transport, delivery to the drug-testing laboratory, testing and then the final report sent to the appropriate authority.

Correct storage of the urine sample is important and refrigeration is essential to inhibit bacterial growth and endogenous steroids, which can be modified under some conditions to produce, or, more usually, break down, testosterone.6

Analysis State-of-the-art technology and quality control are integral to the whole analytical procedure. The 27 laboratories around the world currently accredited by the IOC are subjected to rigorous reaccreditation testing each year.7 The IOC-accredited laboratory in Sydney has been accredited since 1990 and performs about 4000 tests within Olympic sports each year as part of the Australian program to eliminate doping in sport (Australian Sports Drug Agency, annual report, 1998). Medical practitioners cannot request testing for competing athletes outside this system unless the athletes have bona fide medical conditions and proper documentation is supplied. During the two weeks of the Sydney Olympic Games, up to 2000 samples will be analysed (some 10 000 individual drug tests).

Samples are screened for banned substances by means of sophisticated instruments such as gas chromatography mass spectrometers. Such instruments can provide unambiguous identification of drugs or metabolites to confirm a positive result. To obtain higher sensitivity for anabolic steroids, and hence longer detection periods of banned substances that may have been used during training but not at event time, the IOC has introduced the use of high-resolution mass spectrometry. This technique can detect smaller quantities and was made compulsory by the IOC for the Atlanta Olympics. The techniques have been refined and extended and will play an integral part of the testing protocol at the Sydney Olympics.

The most common method of detecting exogenous testosterone, rather than natural testosterone, is the testosterone/epitestosterone (T/E) ratio.8 Epitestosterone is normally secreted as an epimer of testosterone, and testosterone is not converted to epitestosterone, so the population mean for the T/E ratio is approximately one.9 An elevated T/E ratio remains an excellent indicator of exogenous testosterone abuse,10 and the IOC has determined that values above six indicate doping. However, a very small group of individuals have a naturally elevated T/E ratio. An endocrinological investigation must be performed to detect individuals with an elevated T/E ratio due to either a medical condition or low normal epitestosterone production.9 More recently carbon isotope ratio mass spectrometry has been used11 and this technique may also assist in deciding these cases.

All testing is carried out on one of the duplicate samples from each athlete (the A sample). The presence of a banned substance or its metabolites is sufficient to constitute a positive test -- it is not the responsibility of the testing authorities to determine how that substance got into the body. However, positive results are further investigated by the IOC Medical Commission. This may require analysis of the second (B) sample, during which the athlete or his or her representative may be present.1 If this analysis supports the initial result, a hearing is held to determine if a doping offence has occurred. The IOC Code clearly specifies the penalties that apply for doping offences.

Conclusion Use of performance-enhancing drugs demeans both sport and the athletes who use them. Now that sport is a multi-billion dollar business, antidoping programs must be correctly undertaken so as not to allow evasion by the use of legal arguments and loopholes. This requires constant research into doping practices and programs. It goes without saying that the whole drug-testing process has to be, like Caesar's wife, beyond suspicion.

References
  1. Olympic Movement Anti-Doping Code. Lausanne, Switzerland: International Olympic Committee, 1999.
  2. Kicman AT, Cowan DA. Peptide hormones and sport: misuse and detection. Br Med Bull 1992; 48: 496-517.
  3. Donike M, Geyer H, Gotzmann A, et al. Blood analysis in doping control. Advantages and disadvantages. In: Hemmersbach P, Birkeland K, editors. Proceedings of the Second International Symposium on Drugs in Sports. Towards the use of blood samples in doping control? Lillehammer, Norway, 1993. Oslo, Norway: On Demand Publishing, 1994: 75-92.
  4. Tiryaki GR, Atterbom HA. The effects of sodium bicarbonate and sodium citrate on 600m running time of trained females. J Sports Med Physical Fitness 1995; 35: 194-198.
  5. Mottram DR. Drugs in sport. 2nd ed. London: Spon, 1996: 8-9.
  6. Ayotte C. Evaluation of elevated testosterone epitestosterone values in athlete's urine samples. IAAF Quarterly 1997; 2: 87-94.
  7. Doping. An IOC white paper. Lausanne, Switzerland: International Olympic Committee, 1999.
  8. Anguilera R, Becchi M, Casabianca H, et al. Improved method of detection of testosterone abuse by gas chromatography combustion isotope ratio mass spectrometry analysis of urinary steroids. J Mass Spectrom 1996; 31: 169-176.
  9. Dehennin L, Matsumoto AM. Long-term administration of testosterone enanthate to normal men: alteration of the urinary profile of androgen metabolites potentially useful for detection of testosterone misuse in sport. J Steroid Biochem Biol 1993; 44: 179-189.
  10. Catlin DH, Hatton CK, Starcevic SH. Issues in detecting abuse of xenobiotic anabolic steroids and testosterone by analysis of athletes' urine. Clin Chem 1997; 43: 1280-1288.
  11. Becchi M, Anguilera R, Farizon Y, et al. Gas chromatography/combustion/isotope-ratio mass spectrometry analysis of urinary steroids to detect misuse of testosterone in sport. Rapid Commun Mass Spectrom 1994; 8: 304-308.


Authors' Details
Institute of sport, Concord Hospital, Sydney, NSW.
Brian Corrigan, AM, FRACP, FRCP, Director.

Australian Sports Drug Testing Laboratory, Pymble, NSW.
Ray Kazlauskas, PhD, Director.

Reprints will not be available from the authors.
Correspondence: Dr B Corrigan, 1 Lookout Avenue, Dee Why, NSW 2009.
abcATsouthernx.com.au

©MJA 2000
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