WADA Executive Committee approves 2023 Prohibited List

The World Anti-Doping Agency’s (WADA’s) Executive Committee (ExCo) held its second meeting of the year in Sydney, Australia. ExCo members, some of whom attended in person and others virtually, were updated on WADA’s progress on key priorities, took a number of decisions – the main ones being summarized below – and made certain recommendations to the Agency’s Foundation Board (Board) for its next meeting in November.

After the meeting, WADA President Witold Bańka, said: “I was very pleased today with the high level of discussion and collaboration among members of the Executive Committee. After full consideration of the relevant experts’ recommendations, a number of important decisions were made, including approval of the 2023 Prohibited List, which will come into effect on 1 January 2023. I would like to thank our colleagues from the Government of Australia for graciously hosting the meeting in Sydney and to all those who participated in the meeting for their ongoing commitment to clean sport, including Australia’s Sports Minister, the Hon. Anika Wells.”

LIST OF PROHIBITED SUBSTANCES AND METHODS 

The ExCo approved the 2023 List of Prohibited Substances and Methods (List). Updated annually, the List designates the substances and methods that are prohibited under the World Anti-Doping Code (Code). There will be limited modifications to the List, which will be published before 1 October 2022 and come into effect on 1 January 2023.

Tramadol

Of particular note, the ExCo endorsed the recommendation by the List Expert Advisory Group (LiEAG) to prohibit the narcotic tramadol in competition, effective 1 January 2024. The delay in implementation is to provide an additional year for broad communication and education of athletes, their entourage and medical personnel so that there is a better understanding of the practical implementation of tramadol prohibition in competition. It will also give time to the scientific community to adjust the exact procedural details so that fairness can be ensured for athletes. In addition, it gives sports authorities time to develop educational tools for athletes, and for medical and support personnel to address the safe use of tramadol for clinical purposes within anti-doping.

Tramadol has been on the WADA Monitoring Program and data gathered through that program have indicated significant use in sports. Tramadol abuse, with its dose-dependent risks of physical dependence, opiate addiction and overdoses in the general population, is of concern and has led to it being a controlled drug in many countries. Research studies funded by WADA have also confirmed the potential for tramadol to enhance physical performance.

Cannabis

As it relates to cannabis (delta9-tetrahydrocannabinol, THC), the ExCo endorsed the LiEAG recommendation that the status of THC on the List should remain unchanged.

In September 2021, following requests from a small number of stakeholders, the ExCo agreed to initiate a review of the List status of cannabis, a substance which is prohibited in competition only. Since then, the LiEAG, which is composed of independent, experts in pharmacology, forensic toxicology, substances of abuse, analytical science, pharmacy, sports medicine, chemistry, endocrinology, internal medicine, regulatory affairs, peptides and growth factors, and hematology, from nine countries around the world, embarked on a full and thorough review of the status in sport of THC, the main psychoactive component of cannabis.

This review focused on the three criteria set forth by the Code for inclusion of any substance or method on the List, namely:

  1. It has the potential to enhance sport performance;
  2. It represents a health risk to the athlete; and
  3. It violates the spirit of sport (as defined by the Code).

Under the Code, a substance or method must meet at least two of these criteria to be considered for inclusion in the List.

All existing scientific and medical publications related to THC were reviewed by the LiEAG, as well as testimonials from athletes who were/are cannabis users, and published surveys from around the world. This scientific literature review was subsequently discussed with four world-renowned independent, external experts specialized in the pharmacology, toxicology, psychiatry and behavioral properties of THC and cannabinoids, to ensure that all relevant publications had been included and that all relevant scientific and medical aspects had been appropriately evaluated.

With respect to the spirit of sport criterion, the LiEAG consulted with WADA’s Ethics Expert Advisory Group, which continues to consider cannabis use, at this time, to be against the spirit of sport across a range of areas as listed in the Code.

THC is prohibited in competition only, and only when the urinary concentration exceeds a threshold of 150 ng/mL. This threshold was increased in 2013 from 15 ng/mL. As such, the high level of cannabis required to trigger an Adverse Analytical Finding in competition today would be consistent with a significantly impaired athlete or a frequent user. Further, the inclusion of the ‘Substance of Abuse’ provision in the Code from 2021 significantly reduced the length of suspension from a potential two (or even four) years previously to as low as one month today for athletes who can establish that the THC use occurred out of competition and was unrelated to sport performance.

WADA Director General Olivier Niggli said: “The question of how THC should be dealt with in a sporting context is not straightforward. WADA is aware of the diversity of opinions and perceptions related to this substance around the world, and even within certain countries. WADA is also mindful that the few requests for THC’s removal from the Prohibited List are not supported by the experts’ thorough review. We are also conscious that the laws of many countries – as well as broad international regulatory laws and policies – support maintaining cannabis on the List at this time.

“WADA plans to continue research in this area in relation with THC’s potential performance enhancing effects, its impact on the health of athletes and also in relation to perceptions of cannabis from athletes, experts and others around the world.”

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