New rules around glucocorticoid injections
From 1 January 2022, all glucocorticoid injections will be prohibited in-competition. This is a new ruling making their classification consistent with oral glucocorticoid preparations.
Athletes may require a glucocorticoid injection for legitimate medical purposes, in which case they’ll need to check the Sport Integrity app for their Therapeutic Use Exemption (TUE) requirements and keep good medical records to enable a TUE application if required.
Glucocorticoid injections are permitted out of competition. However, the World Anti-Doping Agency (WADA) advises that the most commonly used glucocorticoid injections have a wash-out (clearance from the body) period of between three and five days, but some are longer (up to 60 days for intra-muscular injection.) This means that some injections given before competition can be detected in an in-competition sample.
Sport Integrity Australia Chief Science Officer Dr Naomi Speers reminds athletes to discuss their status with a doctor and to ensure good medical records are kept.
“Some glucocorticoids have longer washout periods and may remain in the athlete's system for up to 10 weeks,” Dr Speers says.
“It might be difficult to identify the exact injection that contributed to an atypical in-competition test, which makes it even more important for physicians to practice good medicine with appropriate clinical record keeping.”
The following opportunities will be made available for doctors in sport to discuss the WADA 2022 glucocorticoid injection changes with the members of the Australian Sports Drug Medical Advisory Committee:
- SMA Symposium (online), Saturday 9 October
- Sport Integrity Australia is also hosting a live webinar to discuss this change on at 7pm on October 26.
- ACSEP annual scientific conference (online), December 3 and 4
- High Performance Sport Medical Officers Group (AIS Chief Medical Officers meeting)
- Sport specific meetings on request from National Sporting Organisations/Chief Medical Officers.
Resources for athletes and medical practitioners have been shared with National Sporting Organisations and are available on the Sport Integrity Australia resources page.
This article appeared in the Sport Integrity Matters magazine.
Update 31 October 2021
Sport Integrity Australia hosted a webinar on Tuesday 26 October 2021 for medical practitioners to discuss the WADA changes to the in-competition status of injectable Glucocorticoids (iGC) which comes into effect on 1 January 2022.
Over 120 medical professionals attended the online webinar with Dr Susan White, Chair of the Australian Sports Drug Medical Advisory Committee, and Dr Larissa Trease, Medical Advisor for Sport Integrity Australia, explaining the changes in detail.
Dr Trease summarised the WADA changes and explained how they will impact sports, athletes and medical practitioner requirements. The presentation included information relating to Glucocorticoid Injections, wash-out periods, Therapeutic Use Exemptions (TUEs) and the importance for good medical practice with good medical documentation.
Dr White presented a number of case studies which highlighted the changes from medical diagnosis and treatments, through to being able to justify the use of an iGC in-competition to the TUE Committee (including the wash-out period) and reiterated the critical need for solid record keeping.
The Question-and-Answer session allowed for further discussion around specific technical questions and sporting examples provided by our medical colleagues.
If you’d like to better understand the new GC rulings coming into effect on 1 January 2022, catch-up on the status of Glucocorticoid medication in sport.
