According to the Prohibited List, certain strong painkillers are prohibited whereas other forms of pain relievers are permitted. Alongside the prohibited status, the side effects of painkillers should not be overlooked and improper use should therefore be avoided. In the case of the therapeutic use of strong painkillers (narcotics), banned by the Prohibited List, the provisions governing Therapeutic Use Exemptions (TUE) must be observed.
Prohibited status for painkillers
There are different types of painkillers. They differ in terms of their effect, strength, application and prohibited status. According to the Prohibited List, strong painkillers (narcotics), legally classified as narcotics, are prohibited. These include, for example, morphine, fentanyl, oxycodone and, from 2024, tramadol. Weaker painkillers such as paracetamol and non-steroidal anti-inflammatories (e.g. ibuprofen or diclofenac) are not banned according to the Prohibited List. However, even these medicines should not be used carelessly due to potential health risks.
Check the prohibited status of your medication with the Medication Inquiry Service Global DRO.
Misuse of painkillers
Various reports reveal an increased use of painkillers in mass and competitive sports. Various sports are mentioned, such as soccer, cycling and marathon running. A study by the German National Anti-Doping Agency indicates that around one third of footballers regularly take painkillers.
By taking painkillers as a preventive measure, athletes hope to be able to stave off potential injuries and sore muscles. Another reason for the use of painkillers may be to suppress pain in order to remain pain-free during sporting activities. Athletes sometimes take painkillers and participate in training and competitions, in spite of injury. Many athletes rely on taking painkillers to avoid missing valuable play time. However, there is no evidence that the preventive use of painkillers and use of painkillers to suppress pain achieves the desired effects. These drugs cannot heal underlying injuries. On the contrary, the painkillers can lead to overuse and this in turn can cause serious long-term damage.
Regular and long-term use or misuse of painkillers can present significant health risks. Athletes and their support personnel should therefore inform themselves and seek information from professionals about the potential side effects and the correct dosing regimen. Painkillers should only be used if necessary and if recommended by a healthcare professional. If necessary, a break from sport may be required.
Risky side effects
The use of paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) can be associated with risky side effects. Paracetamol is a pain-relieving and antipyretic drug. Excessive and regular use of paracetamol can damage the liver. NSAIDs are used to relieve pain and inflammation. However, regular use of NSAIDs can cause gastrointestinal problems, including bleeding of the stomach, kidney dysfunction and cardiovascular disease.
In addition to the standard painkillers such as NSAIDs and paracetamol, opioids are used to treat very severe pain, for example after a serious injury or operation. Opioids are listed in the category of narcotics in the Prohibited List. Typical drugs in this class include fentanyl, morphine, oxycodone and tramadol. Possible side effects include constipation, dizziness, drowsiness or respiratory depression. These painkillers also have a high addiction potential, which can lead to physical and psychological dependency.
Therapeutic Use Exemptions (TUE)
If athletes require narcotics prescribed by a doctor but which are prohibited in accordance with the Prohibited List, the provisions for Therapeutic Use Exemptions (TUE) must be observed.
The TUE Wizard helps to ascertain if, when, and to whom a TUE application should be submitted.
The TUE procedure varies depending on the time of use of the narcotic and competition planning: for use “in competition” (23:59 on the day before the competition, up to and including the competition and possible doping controls), a different procedure applies than for use outside of the competition.
TUE pool and international-level athletes require a prospective TUE for the use of narcotics in competition (or, if applicable, an emergency TUE application). For the use of medically prescribed narcotics out-of-competition only, all athletes may apply for a retrospective TUE after receiving a potential positive doping test result in competition.
This procedure also applies to the glucocorticoids prohibited in competition. More detailed information can be found under the corresponding special topic. There are two differences: the World Anti-Doping Agency does not specify washout period for narcotics, except for tramadol. The washout period for tramadol will be communicated by WADA before the End of 2023. If a treatment using other narcotics is only required outside of competition, the washout period for these narcotics must be calculated in collaboration with the physician administering the treatment. In addition, separate TUE application criteria apply for pain therapy.
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