High-performance sport, marijuana, and cannabimimetics.

The prohibition on use of cannabinoids in sporting competitions has been widely debated and continues to be a contentious issue. Information continues to accumulate on the adverse health effects of smoked marijuana and the decrement of performance caused by the use of cannabinoids. The objective of this article is to provide an overview of cannabinoids and cannabimimetics that directly or indirectly impact sport, the rules of sport, and performance of the athlete. This article reviews some of the history of marijuana in Olympic and Collegiate sport, summarizes the guidelines by which a substance is added to the World Anti-Doping Agency Prohibited List, and updates information on the pharmacologic effects of cannabinoids and their mechanism of action. The recently marketed cannabimimetics Spice and K2 are included in the discussion as they activate the same receptors as are activated by THC. The article also provides a view as to why the World Anti-Doping Agency prohibits cannabinoid or cannabimimetic use incompetition and should continue to do so.

The world anti-doping program and the primary care physician.

The presence of a prohibited substance in an athlete's urine (or blood, when applicable) or the use of a prohibited method constitutes a doping offense, even if the substance is a pharmaceutical and is properly prescribed. To avoid a doping offense for the therapeutic use of a prohibited substance or method the International Standard for Therapeutic Use Exemptions (TUE) must be followed. When the TUE is required, the appropriate process must be completed before testing under conditions where the substance or method is prohibited. This article describes the World Anti-Doping Code and the International Standards, which are part of the Code. In addition, the procedures for the proper preparation and submission of TUE requests are presented along with the manner in which the requests are considered by the Therapeutic Use Exemption Committees.

An update on regulatory issues in antidoping programs in sport.

Doping control for national- and international-level athletes has undergone major changes in the past few years, and will continue to change at an accelerated rate. National antidoping organizations (NADOs) such as the United States Anti-Doping Agency (USADA) are being established by major nations to work with national governing bodies of sport. The World Anti-Doping Agency has been established to coordinate worldwide antidoping efforts with the NADOs and international federations of sport, and to implement a recently drafted World Anti-Doping code, which clarifies the definition of doping and establishes procedures to harmonize international efforts in sample collection process, testing laboratory accreditation, result reporting, and result adjudication. A number of substances and methods currently used in doping present serious challenges to the scientific community, and are described briefly. In addition, brief descriptions of other issues of significance to doping control, including the role of physicians in doping and the operation of the USADA, are presented.