Drugs and the law
Drugs and the law; use and abuse of drugs in sport; drugs in common use
Drugs and the law
The main acts governing the use of medicines in the UK in relation to sport and exercise are the Medicines Act 1968, the Misuse of Drugs Act 1971 and the Medicinal Products: Prescription by Nurses Act 1992.
The Medicines Act 1968
This act identifies doctors, dentists and veterinary surgeons as the only appropriate practitioners to prescribe medicines and deals with drugs in three groups.
Prescription Only Medicines (POM): includes most of the potent drugs in common use, supplied or administered to a patient on the instructions of the appropriate practitioner.
Pharmacy Only Medicines (P): licensed drugs supplied under the control and supervision of a registered pharmacist. Examples include ibuprofen, antihistamines and glyceryl trinitrate.
General Sales List Medicines (GSL): commonly used drugs such as aspirin and paracetamol, available through many retail outlets such as supermarkets.
The Medicines Act 1968 also makes provision for various other substances such as potent herbal medicines (not available for unrestricted sale to the public) used in complementary therapies. However, many homeopathic preparations, food supplements, herbal and traditional medicines from non-European countries are not presently covered by the licensing process.
The Misuse of Drugs Act 1971
This act imposes controls on those drugs liable to produce dependence or cause harm if misused. It prohibits certain activities in relation to controlled drugs (CD). Only doctors and dentists can prescribe CDs, which are divided into three classes (A, B and C) that reflect the level of harm caused by each drug if misused.
Further to the 1971 act, the Misuse of Drugs Regulations 1985 identify those who may supply and possess controlled drugs while acting in their professional capacity and ordain the conditions under which these activities may be carried out; they also further subdivide drugs into five schedules, each detailing the requirements for import, export, production, supply, possession, prescribing and record keeping.
Further reading and information sources
British Medical Association and the Royal Pharmaceutical Society of Great Britain, London. British National Formulary (revised twice yearly - March and September). www.bnf.org.uk
Use and abuse of drugs in sport
Drug use in sport was first recorded around 300 bc. Prior to this sport was considered to be part of a balanced lifestyle but as mass spectator sport grew, it became 'professionalized', with greater rewards for success. A variety of substances were used, many of which contained alcohol. It has been suggested that the breakdown of the ancient Olympic Games was in part due to drug use and abuse to gain 'unfair' advantage. In the modern era, drug use in sport first arose as the Industrial Revolution led to a structure in sport, which became more commercial and professional.
The early 1900s saw some high-profile drug-related deaths in sport, including that of the runner Hicks during the 1904 London Olympic marathon as a result of a combination of brandy and strychnine. The 1930s brought the use of stimulant drugs (short-acting drugs such as amphetamines) to improve performance on the day, and the 1950s saw the introduction of anabolic steroids, used largely during training to allow the athlete to train 'harder, faster and for longer' (both now banned). The 1960s saw a more liberal approach to drug use in general in society, coinciding with a major expansion of drug development within the pharmaceutical industry and thus the opportunity to enhance performance beyond that achieved by hard work and training alone. Modern legislation concerning drug use in sport is based on the harmful effects on the athlete, potential performance-enhancing effects and legality.
Formal restriction and control of the use of drugs in sport were first introduced by the International Olympic Committee (IOC) in the 1960s and resulted in the production of their list of doping classes and methods. This covered not only certain drugs which were prohibited but also areas such as blood doping and pharmacological, chemical and physical manipulation. In recent years, increasing public concern about the use of drugs has led to the formation of the World Anti-Doping Agency (WADA). This body reflects a joint effort by governments, international federations and governing bodies to work together in the fight against drugs. WADA has produced its anti-doping code, which upholds sport's 'strict liability' policy whereby athletes are responsible for any banned substance found in their body, regardless of how it got there. The burden of proof is now placed on athletes to contest positive drug findings. A single list of banned substances, which is intermittently updated, has been created, with exemptions granted for therapeutic reasons only.
For further information see www.wada-ama.org.
Drugs used (or banned ) in sport and of general relevance to sportsmen and women
See table facing .
|Drug groups and subgroups||Examples||Indications|
|Anabolic steroids||Nandrolone, stanozolol||Banned in sport|
|Non-opioids (see also NSAIDs)||Aspirin, paracetamol||Mild to moderate pain, e.g. simple headache; pyrexia|
|Opioids||Diamorphine, dihydrocodeine, fentanyl, morphine, etc.||Banned in sport|
|Angiotensin-converting enzyme (ACE) inhibitor||Captopril, ramipril, etc.||Heart failure and other clinical cardiovascular problems|
|Antacids||Aluminium hydroxide, magnesium trisilicate||Dyspepsia|
|Antibiotics (antibacterials) include:||Infections, by many different bacteria, at various sites|
|Antidiarrhoeals||Codeine phosphate, loperamide (antimotility drugs)||Adjuncts to rehydration in acute diarrhoea|
|Antiemetics||Nausea and vomiting in: gastrointestinal disorders|
|Dopamine (D2)-receptor antagonists||Metoclopramide|
|H1-receptor antagonists||Cinnarizine||Motion sickness|
|Muscarinic antagonists||Hyoscine||Motion sickness|
|Antiepileptic (anticonvulsant)||Phenytoin||Epilepsy control|
|Antihistamine||Chlorphenamine (H1-receptor antagonist)||Hay fever, emergency treatment of anaphylactic reactions|
|Corticosteroids||Banned in sport|
|Antivirals||e.g. Aciclovir||Herpes simplex|
|Benzodiazepines||Diazepam||Short term for anxiety and insomnia, acute alcohol withdrawal, etc.|
|Beta-adrenceptor antagonists (beta blockers)||Banned in sport|
|Decongestant||Pseudoephedrine (oral), ephedrine hydrochloride (nasal drops), etc.||Nasal congestion|
|Diuretics||e.g. Furosemide, bendroflumethiazide||Banned in sport|
|Alpha (α)-glucosidases inhibitor||Acarbose|
|Insulin||Short-, intermediate-or long-acting preparations||Diabetes|
|Bulk-forming laxatives||Ispaghula, methylcellulose|
|Faecal softeners||Arachis oil (enema)|
|Nitrates||Glyceryl trinitrate (sublingual, transdermal)||Angina|
|Fenamates||Mefenamic acid||Pain relief, antipyretic, reduction of inflammation and stiffness in arthritis, etc.|
|Salicylates and paracetamol||Aspirin, paracetamol|