New Rules For Steroid Injections

On the 1st of January this year, WADA updated their Banned Substances List, as they do every year. Minor changes are usually made, such as varying the dosing allowances for asthma medications.

However, quite a significant change occurred this year…..glucocorticoid injections are now completely banned “in competition”. But what does this mean?

WHAT EXACTLY ARE GLUCOCORTICOIDS?

Glucocorticoids, or “steroids” for the sake of this post, are a form of strong anti-inflammatory medication. They are used for many different medical conditions, including asthma, arthritis and psoriasis….but they are also sometimes used to treat acute muscle injuries in sport.

Unlike anabolic steroids, these types of medications do not display any type of muscle building properties.

Up until now, steroid injections have been banned for use in competition when administered via intramuscular or intravenous routes (as well as oral and rectal administration).

However, local injections at a specific site of injury, into either a joint or around a tendon, have been permitted within periods of competition, in order to treat inflammation from injury or overuse. But this has now changed.

WHY HAVE THE RULES CHANGED?

The banning of steroids via oral, rectal, intravenous or intramuscular administration has always been in place. It is well established that these methods can lead to systemic absorption of the steroids, leading to an enhancement in performance, but there are also some possible health risks associated with these drugs.

As has been explained in the explanatory notes, local injections have now also been shown to be absorbed systemically, leading to the same issues………possible enhanced performance and a risk to an athlete’s health. Hence, the changes have been made, to ban the use of all forms of administration of steroids – other than via inhalation or topical application at therapeutic doses – for use while “in competition”.

WHAT DOES THIS MEAN?

“In competition” means exactly that. If these steroids are detected in therapeutic levels while an athlete is competing (usually tests are undertaken directly after competition), it is classed as a doping violation. Therapeutic levels of these drugs can be reached via oral and rectal administration, as well as all methods if injection. Hence, the change to the rules has been made.

But there are still many health conditions which require treatment with these types of medications, for a short period of time. As long as an athlete is not involved in competitive sport during these treatment periods, there are no issues.

It is possible that an athlete may be competing soon after requiring treatment with a steroidal medication though. For example, an athlete may need a steroid injection for an inflamed knee; or require a short course of steroid treatment for an asthma flare up. So what needs to be done?

Athletes can always apply for a Therapeutic Use Exemption (TUE). This does not automatically mean an athlete can compete while using these medications though. The TUE needs to be approved*^ to comply with the anti-doping regulations….and ultimately, if an athlete requires treatment with a steroid, chances are they should be having a period of rest to allow their body to recover from their injury/illness anyway!

The safest way to ensure there are no dramas is to follow WADA’s “washout period” guidelines. These allow a set number of days between receiving treatment with a steroid, and competing again, to let the drug be cleared from the body.

RouteGlucocorticoidWashout period
OralAll glucocorticoids;

Except: triamcinolone acetonide
3 days

30 days
IntramuscularBetamethasone; dexamethasone; methylprednisolone

Prednisolone; prednisone

Triamcinolone acetonide
5 days

10 days

60 days
Local injections (including
periarticular, intra-articular,
peritendinous and intratendinous)
All glucocorticoids;

Except: triamcinolone acetonide; prednisolone; prednisone
3 days

10 days
Table sourced from wada-ama.org

WHERE TO FROM HERE?

Quite simply, if you are an athlete in need of steroid treatment, or a sports doctor prescribing these types of medications, you need to familiarise yourself with the rules.

As long as you follow the guidelines, there should be no issues with the use of steroids for the treatment of acute medical conditions……and ultimately, if you are requiring treatment with these types of medications, you should probably be giving your body a bit of a rest anyway!

*Application for a TUE does not automatically mean one will be granted

^Retroactive TUEs can be sought under certain conditions


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