Lives in the Balance: Why Doping Control Matters

As the Tour de France rolls onto stage 7, few in the general public know of the story of 21-year-old Linas Rumsas, but they need to consider it. Especially on this day, July 13, 2018, the 51^st anniversary of cyclist Tommy Simpson’s death.

People ask us all the time why doping control matters. Some argue that it doesn’t and that we should just let folks use what they want. A doping free-for-all. Cynics might say that plenty of dopers have already escaped through the net in sports, at least for a time: Lance Armstrong, Tim Montgomery, Marion Jones, to name a few.

Linas Rumsas was an up-and-coming cyclist whose life was cut short after he abused performance-enhancing drugs. Photo: Team Altopack-Eppela

The story of young Linas, a promising cyclist whose life was cut short after abusing performance-enhancing drugs, reminds us that doping can kill. We would be wise to remember that it has happened before. Linas’ story is one of the saddest we have come across and it powerfully demonstrates why many of us who have chosen to pursue anti-doping continue to do so. This one story illuminates in no uncertain terms the realities of what we all face with the scourge of doping, and yet outside of Italy and frequent readers of Cycling News, few sports fans have probably heard of it.

There have been others who have perished from doping. According to ProCon, which provides a comprehensive historical timeline of doping in sports, the first modern athlete chronicled to have died from doping was the Danish cyclist Knut Jensen at the Summer Olympics in Rome in 1960. Heat was the initial culprit but his autopsy found traces of Ronicol. ProCon describes Ronicol as an amphetamine, but Ronicol would be described more accurately as a vasodilator and can be used as an anti-ischemia drug. Though it is not on the 2018 WADA Prohibited List, it is similar to meldonium in many ways.

Stop to consider that the first drug to have been implicated in the death of an athlete in the Olympics in 1960 is not banned today! Ronicol, otherwise known as nicotinyl alcohol, is not prohibited as confirmed by the Global DRO. Its cousin meldonium wasn’t prohibited by WADA until 2016, when it caused hundreds of athletes to test positive. Some might like to think that doping is behind the peloton, but we fear it may still be in the middle. Just in a form we don’t currently define as doping, like Ronicol.

Fifty one years ago today on July 13, 1967, Tommy Simpson infamously died on the slopes of Mount Ventoux during Stage 13 of the Tour at the age of 29. His death was one of the central moments in anti-doping history. Shortly thereafter that same year the International Olympic Committee (IOC) created the IOC Medical Commission and the first drug testing began at the Olympics in 1968, with narcotics and stimulants making up the initial prohibited list. Steroids were not added until 1975.

There have been other examples of athlete deaths that have been seminal. MLB pitcher Steve Bechler, of the Baltimore Orioles, died during drills in 2003. Ephedrine was indicated as a contributing cause in his premature death, which played a role in the regulation of ephedrine as a dietary supplement ingredient in the United States.

Steroids have played a role in the demise of many young athletes, including Taylor Hooton, Efrain Marrero, and just two days ago, a young 18-year-old Irishman in Limerick. Numerous stories exist of athletes who went too far with blood doping, or performed transfusions the wrong way, leading to dire consequences. Many stories are out there but few are known to the broader sporting public.

Linas Rumsas’ story reminds us that the scourge of doping is still present and that it is just as deadly today as it was in 1967 when amphetamines derailed the promising life and career of Mr. Simpson.

Linas Rumsas is the son of Raimondas Rumsas, who himself was a professional cyclist and took third place in the 2002 Tour de France. After Raimondas’ wife Edita was caught with a van full of drugs on the way home from that Tour, they both received four-month suspended sentences in 2006. Raimondas later tested positive for EPO during the 2003 Giro d’Italia. Sadly, this experience did not seem to deter them from apparently assisting their two children with doping.

Linas rode for the Altopack-Eppela squad in Italy and had already been a national road race champion. But in May 2017, he died at age 21 of a heart attack. It was nearly 50 years to the day after Mr. Simpson had died.

Upon Linas’ death, police searched his family’s home and seized a number of banned substances and medications. In September 2017, his older brother Raimondas Jr. tested positive for the prohibited substance GHRP-6, a peptide that produces natural growth hormone. It seems a cocktail of banned substances and other medications were being used at the family home.

The result of all this has been one family torn apart, again, from doping. Perhaps doping didn’t matter to the Rumsas family either until their son died. But Linas didn’t just die, if the allegations in this case hold true. He died as a result of family support and encouragement to dope.

It gets worse. In the course of the investigation, six people have been arrested in an apparent team-sponsored doping program including the team owner, directeur sportif, pharmacist, and trainer, who stand accused of providing drugs to riders. Seventeen other people are being investigated. Sadly, however, it is too late for Linas.

Unfortunately, the recent decision to allow Chris Froome to ride again with no sanctions after testing positive for elevated levels of salbutamol has called into question the validity and utility of the anti-doping system, again, at least in some people’s eyes. WADA has tried to explain the reasoning now, including clarifying the levels (1,428 ng/ml of urine, when adjusted for specific gravity, which is above the decision limit of 1,200 ng/ml). The reasons may not satisfy everyone, or anyone, but Froome’s case is certainly not a reason to give up on anti-doping.

Linas’ story personifies why giving up on anti-doping is simply not an option and should remind us all that doping is a significant matter. In fact, it is all the more reason to recognize that the failures of the anti-doping system are largely due to a lack of resources and money. For that to change, more people will need to truly understand what is at stake when athletes dope and to demonstrate the will to do more to combat the problem.

– Oliver Catlin

Response to Grigory Rodchenkov and Vladimir Putin on Russian Doping Debacle

Beijing Olympics Opening Ceremony – Photo by Oliver Catlin

We welcomed reading the Sept. 22 New York Times opinion piece from Grigory Rodchenkov on Russia’s state-sanctioned doping and the response to date by the Olympic community. Vladmir Putin has now added his voice to the discussion.

Grigory’s comments clarifying the direct involvement of the Russian sport minister in the country’s nefarious doping activities are very important, as that has been difficult to prove. Grigory also shares what our position has been for some time, that as a result of its state-directed doping Russia should be sanctioned and not allowed to compete as a nation in the upcoming 2018 Winter Olympics in PyeongChang but demonstrably clean Russian athletes should be allowed to compete under a neutral flag.

While we appreciate much of the perspectives Grigory shares, and also his apology to those he disappointed since we fall into that group, we still have some questions regarding his explanation and reasoning. The biggest question remains: Why did he participate in Russia’s fraudulent state-directed doping for so long without trying to expose it earlier on ethical grounds, and exactly how long was the activity going on?

Grigory begins his piece saying he escaped Russia to expose to the world the Russian doping activities in hopes of leading to change. He laments that his hope for change is fading due to a lax response. He notes that Russia has yet to admit to supporting the doping activities or provide evidence to demonstrate the specifics of what occurred, part of the recommended reforms the Olympic authorities have requested. He points out the oddity that none of the commissions investigating the case had sought comment from him until September. This is certainly unfortunate if true.

He then goes on to unequivocally explain that Vitaly Mutko, a deputy prime minister and former minister of sport, and other government officials were directly involved in the doping activities, saying Mr. Mutko “knew about, and was critical to the success of, Russia’s doping program.” The involvement of the state and the ability to demonstrate it has been debated by some to date and has made it easier to support a less stringent response for those so inclined. Grigory, as a key witness, adds important clarity as to the direct involvement of government authorities in the Russian doping agenda.

Grigory goes on to describe himself as the witch in the witch-hunt, and we agree with that notion in part as he was most likely not the mastermind behind this affair. Yet we are not ready to accept his absolution of guilt. After all, from an ethical standpoint there are still many questions remaining as to why Grigory did not come forward earlier to expose the truth behind the Russian doping activities and halt his own involvement in them. There are also big questions as to how long the state-sponsored doping has been ongoing that are of significant concern.

Grigory describes himself as a victim of the system suggesting that he did not have a choice but to be involved in the doping activities. He compares this to the clean athletes that also do not “have much choice but to cheat, even if some did so enthusiastically.” He suggests that the Russian system demands compliance and that people face serious consequences if they do not comply with directions from superiors or the state. He recounts the sudden, mysterious deaths of two of his colleagues that were involved in Russia’s doping system, saying that they were not coincidental.

We do not doubt, nor discount, the need to comply with the demands of the state in Russia or face dire consequences. We understand that careers, and in fact lives in certain circumstances, are at stake for non-compliance.

For Grigory, or for Russian athletes, a sad choice is suggested: Follow the directions of the state, sacrificing your ethics in the process, if you want to be successful in your career. The other option seems to be to leave the country to pursue your trade, whether it be science or athletics. Leaving ones country and life behind is perhaps a more difficult choice to make than sacrificing ones ethics, but that is a choice that some people in similar circumstances have made. What a horrible decision to have to make.

We noted recently in our commentary on the documentary “Icarus” that there are allegations of state-sponsored doping in the Soviet Union and Russia going back to 1988 and before, when Victor Uralets was the laboratory director from 1980 to 1992. Elliott Almond reminded us of this on May 13, 2016 in The Monterey Herald in his interview with Victor the week following the revelations of Russian doping in The New York Times. Grigory was hired by Victor and eventually succeeded him as director of the Moscow anti-doping laboratory.

A Russian magazine Smena had revealed allegations of 1988 pre-testing occurring on the ship ‘Mikhail Sholokhov,’ docked 60 kilometers from Seoul in an effort to explore whether Russian athletes would pass drug tests during the Olympics. As Elliott writes, this was “one of the most startling revelations that attracted little attention… after the 1988 Summer Olympics in Seoul, South Korea.” An L.A. Times piece from March 24, 1989 describes the Smena article and recounts a startling story told by the young anonymous Soviet athlete interviewed by the youth magazine.

“They knew what kind of ‘vitamins’ these were,” said the athlete, who asked not to be identified. “And that if you refused, you’d be thrown off the team. . . . Now I’m practically an invalid . . . constant pains . . . my whole hormonal system is destroyed, my health is ruined . . . and my life is still ahead of me. I would have liked to become a mother.” For those who question why we should fight against doping, this one personal story should provide a powerful answer.

Victor verifies the veracity of the pre-testing claims and the apparent purpose, in Elliott’s article and also importantly noted that he left his position and came to the United States because he did not believe what he was being asked to do was ethical or safe. “By the time I realized it is not ethical or safe, I decided to leave,” Victor is quoted as saying. “I have a similar job here but without that embarrassment involved with cheating.” He goes on to say, “It is repeating itself. It is a huge embarrassment. It is an embarrassment on a global scale.”

Is it repeating itself or did it never end?

As we pointed out in our earlier discussion on “Icarus,” Don, and others had concerns that doping activity was occurring going back to the Soviet era. Manfred Donike, one of the greatest anti-doping scientists in history, had become suspicious in 1988 of Soviet pre-testing during the Olympics in Calgary where on the street he ran into Victor, who was there unbeknownst to his international doping control lab colleagues. Later, Don and other colleagues became aware of the Smena allegations of pre-testing of Soviet athletes; Don even recalls a photo of Grigory coming off the boat.

While there was suspicion that these activities could be part of a larger Soviet doping strategy there was never anything actionable to address. There had been no proof presented that we can recall that could clearly demonstrate state-sanctioned doping was occurring in the 1980s, or in the years since. As Grigory points out, that proof has yet to be provided by Russia even for the most recent endeavors.

But Grigory, we must ask, why did you not opt to do the same thing that Victor did? Why did you not come out earlier to expose the scandal for the benefit of clean athletes? Why did you wait until your life was threatened? You could have come to us at any point and we would have done everything possible to help you expose whatever was occurring in the right way–and do what was possible to protect your family in the process. You chose not to take that path, and that is unfortunate. Now you want to wash your hands of any responsibility?

The New York Times article of May 12, 2016, “Russian Insider Says State-Run Doping Fueled Olympic Gold” by Rebecca Ruiz, described your activities as “the apex of a decade-long effort to perfect Russia’s doping strategy at international competitions.” You have admitted to not only allowing your testing to be used as a tool in the state-directed doping activities, but to actually providing the drugs involved! We would really like to know the extent of what was going on back to the 1980s and how you were involved since then.

For us to consider that you were complicit somehow in Soviet and Russian doping from the 1980s through recent years makes our spine tingle. We were your friends, your colleagues. We even worked on collaborative anti-doping efforts with you including a groundbreaking U.S. – Soviet partnership in 1988 described in the New York Times at the time as “the first major attempt by each country to eliminate the use of performance-enhancing drugs like anabolic steroids.”  All that seems like a fraud now, sadly.

In “Icarus,” Grigory briefly alludes to challenges we have faced in the United States with doping athletes. In the 1980s the USOC’s now infamous “education” program was used to explore how to dope athletes and beat the drug tests. When Don uncovered the reality behind the program, for which he was doing the testing, he immediately stopped the work and demanded change.

His career was potentially on the line, but thankfully his life was never threatened. We understand the ethical dilemma Grigory faced, but we can’t profess to truly understand the circumstantial dilemma that the threat of the state adds to the equation.

Courageous whistleblower athletes Yuliya Stepanova and her husband, Vitaliy, did understand the risk and nonetheless elected to come forward. They are to be lauded for helping to expose the sordid Russian doping affair. As we noted in our earlier statement on “Icarus,” the athletes courageously stepped forward to demand change themselves and took action. Their strength is a powerful force in confronting state corruption and impelling the system to change.

We share the opinion that the Olympic family must adequately respond to this demand for change and that it has yet to do so. Prohibiting Russia from achieving glory at the 2018 Winter Olympics in PyeongChang as a penalty for its involvement in the establishment of a doping program seems justified. We advocated for that step to be taken before Rio. Fines are not adequate and set a dangerous precedent. Allowing Russian athletes that are proven clean to compete under a neutral flag reinforces support of clean athletes while a Russian ban would enforce a deservedly harsh penalty on the state.

We remain hopeful the exposure of the Russian doping scandal will result in positive changes that will reinforce the protection that clean athletes deserve. Grigory could help further by explaining what was happening before Sochi and the mouse holes were drilled and the bottles tampered with and the positive test results covered up and the clean athletes denied their victories. He could help shed some light on the historical realities of the Soviet and Russian doping program going back to the 1980s and 1990s. This information might help us to avoid state-sponsored doping in the future, by Russia or some other country willing to ride roughshod over the integrity of Olympic sport.

Russia is now requesting that Grigory be returned home to face trial for his actions. If he is sent back he will surely be imprisoned, or worse, and his knowledge of what really happened will be lost. What he knows is important to the future of clean sport and he should be given the opportunity to finish telling his story.

On Nov. 9, Russian President Vladimir Putin commented on the Russian doping allegations, suggesting among other things that the doping scandal is a U.S. plot aimed at swinging the upcoming Russian presidential election against him. He is quoted in part as follows:

“Here is what worries me: the Olympics start in February, and when are our presidential elections? In March. There is a strong suspicion that this is all happening in order to create a situation useful to some, one of disappointment for sports followers and sportsmen in which the state allegedly participated in violations. Therefore, there is strong suspicion that in response to our alleged interference in their election they want to create problems in the election of the President of Russia, which, if so, is very bad, as it undermines the very meaning of the Olympic movement.”

President Putin, the eyes of the world have already been opened to the reality that there was high-level support for the doping that occurred in your country. Independent international parties under the auspices of the World Anti-Doping Agency carried out the process of investigating and reporting the reality of the abuses that occurred. The exposed Russian doping scandal is not a U.S. plot and the good people of the Lausanne laboratory were not part of the subterfuge. It is clear this was a systemic scheme perpetuated on sport by Russia to subvert Olympic competition. The worldwide reaction to this affront represents a global fight for the integrity of Olympic sport, led in part by Russia’s own athletes.

Indeed, part of the beauty of Olympic sport is that it transcends politics, which is all the more reason to protect it. In your own words, “sport as well as culture should be beyond politics, because it is a bridge that unites people”–yet you seek to politicize it. Doping degrades and destroys sport, it ruins the lives of talented athletes, and it undermines the unity and goodwill that international sport generates. As you point out, “a sports match should be honest, otherwise it loses all meaning. Interest in it disappears.”

President Putin, we appreciate your passion for sport and your aim to ensure Russia remains a global leader in sport. We hope you realize that in order to accomplish that goal a true embrace of the Olympic ideals and a real commitment to support clean sport are required.

DRUG TESTING RULES FOR NARCOTIC PAINKILLERS IN THE NFL, MLB, NCAA AND OLYMPIC SPORT

The world is focused once again on the NFL, after a DEA investigation into the possible illegal use of prescription painkillers in the sport, as first reported Sunday by Sally Jenkins and Rick Maese of the Washington Post.

The issue centers on how such drugs are used and dispensed within pro football. According to DEA regulations, controlled substances like narcotic painkillers, known as analgesics in the medical field, can only be monitored and prescribed by licensed medical personnel and only within states where the license applies.

Controlling the use and abuse of analgesics is not an isolated issue faced by the NFL. The problem is prevalent across sport and society. Alarmingly, the CDC reported deaths from prescription drug overdose had risen steadily through 2008 reaching the same level as deaths from vehicle accidents. Thankfully, the CDC reports this trend has slowed in recent years, but the issue remains present and acute.

To understand the issue better one needs to know what drugs we are talking about. Most of the concern is centered on narcotic opioid analgesics, substances that can be dangerous and addictive. These include morphine, heroin, codeine and their synthetic derivatives and analogs. Fentanyl, tramadol, meperidine (demerol), hydrocodone (vicodin), oxycodone are common examples of drugs in this category. Narcotic analgesics are to be distinguished from other drugs used to treat pain like muscle relaxers or non-steroidal anti-inflammatory drugs.

While controlled substance laws dictate how narcotic analgesics are managed in society, drug-testing programs in sport dictate how these drugs are treated within the sport in question.  We look deeper into the drug-testing policies and banned substance lists in sport to see how these drugs are governed and managed.

The World Anti-Doping Agency (WADA) Prohibited List governs international Olympic sport and is often used as a model by other sporting groups when considering what to ban. Some narcotic analgesics are on the WADA Prohibited List in the S7. Narcotics category, but not all the common ones mentioned above would be included.  The language for narcotics is shown below.

S7. NARCOTICS

The following are prohibited: Buprenorphine, dextromoramide, diamorphine (heroin), fentanyl and its derivatives, hydromorphone, methadone, morphine, oxycodone, oxymorphone, pentazocine, pethidine.

The language does not include the ‘similar chemical structure or similar biological effect’ language or the ‘including but not limited to’ language used in other categories to cover additional substances not listed. In the case of narcotics, the only substances not listed that are covered are fentanyl and its derivates. Codeine and derivatives like hydrocodone and tramadol are not covered by the WADA language. WADA prohibits the use of narcotics in-competition, but these agents are not tested for out of competition.

Interestingly, the language included on the WADA Prohibited List is different than that used by Olympic sport prior to WADA. In 2000, Olympic sport was still governed by the International Olympic Committee (IOC) and the rules in the Olympic Movement Anti-Doping Code. At the time, the narcotics section included ‘and related substances’ but a specific list of narcotic analgesics was permitted, as shown below.

1. NARCOTICS

Prohibited Substances in class (B) include the following examples: buprenorphine, dextromoramide, diamorphine (heroin), methadone, morphine, pentazocine, pethidine, … and related substances

NOTE: codeine, dextromethorphan, dextropropoxyphene, dihydrocodeine, diphenoxylate, ethylmorphine, pholcodine, propoxyphene and tramadol are permitted.

The issue is different when one evaluates how narcotic analgesics are treated in professional sport leagues and college. We review the NFL, MLB and NCAA policies here. A review of how other sport groups might deal with these drugs is more difficult as drug-testing policy language is not always publicly available.

The NFL covers narcotic analgesics under its Policy and Program on Substances of Abuse. The policy says that, “Players shall be tested only for the following substances.” Narcotic analgesics are covered as follows: “Opiates (total morphine and codeine) ≥ 300 ng/mL, Opioids (e.g., hydrocodone, oxycodone) ≥ 300 ng/mL.” The language is somewhat vague but it should broadly cover narcotic analgesics depending a bit on how the testing provider interprets the listing of opioids (are only hydrocodone and oxycodone included or all opioids?). Looking at how the testing policy is applied in the NFL, one discovers that testing for drugs of abuse only occurs Pre Season, Pre-Employment, during an Intervention Program or by Agreement. During the season, when narcotic analgesics would be expected to be used, the drugs are not typically included in the drug-testing parameters.

In the MLB, narcotic analgesics are covered under Drugs of Abuse in Major League Baseball’s Joint Drug Prevention and Treatment Program. The MLB language describing the compounds covered is broader and more inclusive than WADA’s or the NFL’s and includes: “Opiates (e.g., Oxycodone, Heroin, Codeine, and Morphine),” “…and their analogs,” and “any and all drugs or substances included on Schedules I and II of the Code of Federal Regulations’ Schedule of Controlled Substances.” However, the application of the testing in the MLB is more restrictive as testing is only done for drugs of abuse in the case of reasonable cause or if a player is in a treatment program. No other testing for drugs of abuse is allowed.

In college sport narcotic analgesics are covered still differently in the NCAA Drug Testing Program. The 2014-2015 NCAA Banned Drugs list includes one opiate, heroin, under Street Drugs. The entire list is governed by language stating, “any substance that is chemically related to the class, even if it is not listed as an example, is also banned!” In the case of narcotic analgesics it is unclear if this would be interpreted narrowly to include only drugs chemically related to heroin or whether it would be interpreted more broadly to include opiates or opioids. This language leaves it vague as to the analgesics that are or are not approved. Use of banned substances can be allowed by medical exception, but “no medical exception review is available for substances in the class street drugs.” As for application, testing for street drugs, and any narcotic analgesics interpreted to be included, can occur year round for selected athletes.

It is fascinating to review the treatment of narcotic analgesics and see the lack of consistency between sport drug-testing programs as to the substances that are banned and the application of the testing. This is an example of the challenges faced when considering what to ban and how.

Perhaps the realization that significant differences exist in the treatment of narcotics will prompt a larger review of other categories of banned substances and the differences that exist across sport in the management of performance-enhancing drugs in general. After more than three decades of modern drug testing, we should be able to achieve greater consistency and clarity in drug-testing policy and the protections afforded therein to the sports and the athletes represented.