Glucocorticoids given In-Competition
All Glucocorticoids (GC) given via oral, any injectable route (i.e. joint/soft tissue, IV, IM etc) and rectal routes are prohibited in-competition.
In-competition period begins from 11:59pm the day prior to the commencement of competition.
Athletes who require an in-advance Therapeutic Use Exemption (TUE) will need to apply prior to receiving a GC in the in-competition period. If the treatment is urgent however, then the athlete should be treated, and a TUE application can be made retroactively.
Glucocorticoids given prior to competition
If an athlete is prescribed a GC prior to competition, they should discuss the wash-out period with their doctor to determine if the GC may be detected in their urine if they are tested in competition.
If the GC was given in the wash-out (pre-competition) period and is detected in the athlete urine sample, the athlete will be notified and can the apply for a retroactive TUE.
The athlete and their doctor should ensure that there is a medical record kept with details of the diagnosis and treatment that would satisfy a TUE request.
See below the WADA GC Washout Table:
| Route | Glucocorticoid | Washout period |
|---|---|---|
|
Oral* *Oral routes also include e.g. oromucosal, buccal, gingival and sublingual. |
All glucocorticoids: Except: triamcinolone; triamcinolone acetonide |
3 days 10 days |
| Intramuscular |
Betamethasone; dexamethasone; methylprednisolone Prednisolone; prednisone Triamcinolone acetonide |
5 days 10 days 60 days
|
| Local injections (including periarticular, intra-articular, peritendinous and intratendinous) |
All glucocorticoids: Except: prednisolone; prednisone, triamcinolone acetonide, triamcinolone hexacetonide |
3 days 10 days |
| Rectal |
All glucocorticoids: Except: triamcinolone diacetate, triamcinolone acetonide |
3 days 10 days |
Ref: WADA Glucocorticoids and Therapeutic Use Exemption [PDF]
Applying for a TUE
When applying for a TUE, the medical record should include (whether in advance or retroactive):
- a typed clinical letter from the doctor
- an application form signed by the athlete and the doctor.
- a medical diagnosis where a GC injection is the recognised treatment.
- information that a permitted alternative was tried, not available, or not considered the best treatment option.
- the GC type given, dose and by what means (such as a copy of the radiologist's report if the injection is given under ultrasound or X-ray guidance).
If the athlete is eligible to apply for a retroactive TUE, they need to prepare a medical file (as above) in case they are required to complete doping control and subsequently apply for a retroactive TUE.
Resources
More detailed information regarding GC injections is available in the following resources.
Sport Integrity Australia hosted a webinar on Tuesday 26 October 2021 targeting 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, you can catch-up on the medical practitioner's webinar here: