1. IAIN HIGGINS COMPANY LAWYER, ICC INTERNATIONAL SPORTS MEDICINE SCIENCE & PERFORMANCE CONFERENCE 20 & 21 JULY 2010, LEEDS THE ROLE AND RESPONSIBILITY OF SPORTS PHYSICIANS IN ADVISING ON ANTI-DOPING MATTERS

2. CONTEXT: RECENT NEWS STORIES…

3. A SPORTS PHYSICIAN’S ROLE … Diagnosis and treatment of injuries Injury management Emergency treatment Surgery Rehabilitation Physiotherapy / treatment

4. A SPORTS PHYSICIAN’S ROLE …(cont) Advising on general health and well-being Over-the-counter medication Food / nutritional supplementsHerbal remedies / natural supplements

5. A SPORTS PHYSICIAN’S ROLE …(cont) Sample collection process / paperwork Advising on Prohibited Substances ADAMS – ‘whereabouts’ filings Use of social drugs Detection Administration / supply of banned substances Possession of banned substances

6. THE RELEVANT RULES Primary source - WADA regulations Secondary sources – international federations; national federations; national anti-doping organisations

7. “ATHLETE SUPPORT PERSONNEL” “Athlete Support Personnel” Coach / trainer Manager Agent Team staff / official Medical personnel Parent Any other person working with, treating or assisting an Athlete participating in or preparing for sport

8. KEY OFFENCES UNDER THE WADA CODE Presence of a Prohibited Substance in a Sample (WADA Code Article 2.1) Possession of a Prohibited Substance or Method (WADA Code Article 2.6) Trafficking or Attempted Trafficking in a Prohibited Substance or Method (WADA Code Article 2.7) Administration or Attempted Administration of a Prohibited Substance or Method (WADA Code Article 2.4)

9. THERAPEUTIC USE EXEMPTIONS (TUEs) WADA Code permits athletes to apply for Therapeutic Use Exemptions, ie permission to use prohibited substances or methods where documented medical conditions require such use Criteria: -Significant impairment to health if substance or method was withheld -No additional performance enhancement effect other than by returning athlete to normal state of health following treatment of legitimate medial condition -No reasonable therapeutic alternative to use of prohibited substance or method -Necessity for use cannot be a consequence of the prior use without a TUE Cancellation / expiry Retroactivity where emergency or exceptional circumstances Application process

10. POTENTIAL SANCTIONS Banned for a specified period of time from participating in any competition or other relevant activity Disqualification – means results are invalidated, including forfeiture of medals, ranking points, annulment of records etc Disqualification – forfeiture of prize money Damage to reputation Potential for further consequences beyond the scope of the WADA Code

11. MITIGATING SANCTIONS Specified SubstancesNo Fault or Negligence No Significant Fault or Negligence

12. DEGREE OF FAULT Increasing degree of fault on the part of the athlete = greater the sanction Decreasing degree of fault on the part of the athlete = lower the sanction What about fault on the part of the physician? (See Edwards v IAAF and USATF – athletics)

13. CASE STUDIES Specified Substance (accepted) Glucocorticosteroid for wrist injury Sought assurance from doctor ITF v Koubek (Tennis) No Fault or Negligence (accepted) Nandrolone metabolite in injection of Retabolil Emergency treatment for heart failure on ice rink Pobyedonostsev v IIHF (Ice Hockey) No Significant Fault or Negligence (accepted) Hydrochlorothiazide (diuretic) in Co-Diavan TUE granted after the sample collection WADA v Stauber (Handball)

14. EXERCISING UTMOST CAUTION If in doubt, do not take the medication / supplement Utilise any other facilities available to them (eg 24-hour hotline; on-line drug information database Check with their NADO and/or national/international federation Read the packaging and drug information leaflet enclosed with the medication Check the medication against the Prohibited List and/or ask the physician to do the same Carry a copy of the Prohibited List at all times Explain to the physician that they are subject to drug-testing regulations Use a sports-specialist physician

15. THE FUTURE…

16. TEN TIPS FOR PHYSICIANS 1.Familiarise yourself with the WADA Code, Prohibited List and the International Standard for TUEs 2. Ensure access at all times to a current Prohibited List 3.Check medication (including all of its ingredients) against the substances on Prohibited List before prescribing / recommending use 4. Do not make a prescription or recommendation unless you are 100% certain that the medication (including all of its ingredients) does not contain any of the substances on the Prohibited List 5. Be diligent when advising in a foreign country where: (a) there may be language difficulties; and/or (b) common ‘brand names’ may contain different ingredients

17. TEN TIPS FOR PHYSICIANS… 6.Undertake further research if necessary 7. Explain to an athlete that it is his/her personal responsibility to ensure that no substances on the Prohibited List are present in his/her sample and that he/she should take independent steps to verify the medication 8.Be careful with nutritional / dietary supplements 9. When prescribing medication pursuant to a TUE, ensure that the substance and dosage is consistent with the conditions set out in TUE 5. Document clearly and concisely the circumstances of any prescription of medication to an athlete subject to any anti-doping regulations

18. THANK YOU