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WSJ article on Tramadol

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#1 Kracko


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Posted 15 October 2016 - 08:04 AM

Some light reading on this fine Saturday morning:

Oct. 14, 2016 10:43 a.m. ET


When the World Anti-Doping Agency published its 2017 list of banned substances last month, it was most notable for a drug that wasn’t on the list: a powerful painkiller called tramadol.

More surprising, perhaps, is the group lobbying for it to be banned: professional cycling, a sport wracked by doping for more than two decades.

Since 2011, cycling authorities have begged WADA to add tramadol to the list of prohibited substances, but their concern isn’t rooted in any potential performance-enhancing benefits. They’re far more worried that tramadol’s side effects, which can include drowsiness and dizziness, might be putting dozens of riders in danger every time they race.

“It potentially makes you a little bit loopy and you’re racing in a pack of 200 guys,” said Jonathan Vaughters, the manager of Team Cannondale-Drapac. “It’s like when you read the bottle, [and it says] ‘Do not operate heavy machinery’ or whatever. Maybe don’t race a bike either.”

​Tramadol illustrates ​the ​challenge anti-doping officials face in distinguishing, and regulating, grey areas between legitimate therapy and perceived abuses of pharmaceuticals, particularly when a drug is so strongly tied to a single sport.

Tramadol, a narcotic, is similar to other drugs of that class which are already banned, including morphine, oxycodone, heroin,​ and fentanyl. Nick Wojek, head of science and medicine at U​.K. Anti-Doping,​ which has also called for banning the drug,​ pointed out that “narcotics are heavy duty, and the majority of athletes shouldn’t be taking these all the time, only on the rare occasions that they’re needed.” Asked what sort of occasion might qualify, he said, “The exception would be for surgery.”

Cyclists use it to help them endure the constant punishment dished out by races like the Tour de France, which sees riders cover 2,200 miles in three weeks with only two rest days.

“Stage racing and Grands Tours at this level are really the hardest sporting event,” said Team Dimension Data rider Ben King, who says he does not use tramadol. “One day is enough, but to get up and do it for 21 days, the toll it takes is insane.”

The evidence for tramadol’s role in dramatic accidents is mainly anecdotal, but fears are growing on the professional scene, which is gathered this week in Qatar for the road cycling world championships. Cyclists ride with their wheels mere inches away from each other at speeds north of 30 miles per hour. A single false move can bring down dozens of bikes without warning.


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“I don’t enjoy competing against guys who are taking it,” said King, a veteran of the Tour de France and the Vuelta a Espana.

Tramadol use has been common in the professional peloton for at least a decade. In three-week stages races like the Tour de France, for instance, riders often use it after a heavy crash simply to survive on the road the following day. King said he also knew of riders also taking it mid-stage to “numb them for the finish.”

Rider Jonathan Tiernan-Locke told the BBC this month that tramadol was “offered freely around” by British Cycling’s doctor at the 2012 world championships, an allegation British Cycling has denied.

Yet WADA has been reluctant to ban it, because tramadol has legitimate therapeutic purposes, according Dr. Olivier Rabin, the organization’s head of science.

He added that the painkiller merely served to restore physical ability rather than to increase it, a position WADA has argued to the UCI. WADA maintains that for a substance to be prohibited, it must meet two of three criteria: ​it enhances performance, it presents a health risk, and/or it violates what they describe as “the spirit of sport.”​

‘I don’t enjoy competing against guys who are taking it.’

—Team Dimension Data rider Ben King
Still, in response to the UCI’s lobbying, WADA has monitored the use of tramadol since 2012. During that time, the organization found that 80 to 85% of cases occurred in cycling, which raised another issue: WADA is reluctant to deprive other athletes of a useful drug for the sake of a single sport.

WADA is currently awaiting further conclusions of a symposium on pain management in sports, according to Rabin. The organization will discuss tramadol use again in January.

Inside the peloton, many teams already operate under self-imposed tramadol bans as members of the Mouvement Pour un Cyclisme Crédible, a cycling union that attempts to hold riders to higher standards than those required by anti-doping authorities.

Tramadol isn’t only substance stirring up controversy in professional cycling. But the difference between it and most others, such as corticosteroids, is that tramadol is tricky to legislate. Because it isn’t banned by WADA, it doesn’t require riders to apply for a therapeutic use exemption from cycling or anti-doping authorities, nor does a team doctor have to sign off on it.

  The peloton rides during the 119th stage of the 2016 Tour de France. ENLARGE  
The peloton rides during the 119th stage of the 2016 Tour de France.  Photo:  Getty Images  
“If you can get your hands on tramadol, you could just take it, never tell anyone and that’s that,” Vaughters said. “To me, it would just be far easier to ban it.”

So far, UKAD has led the charge by national anti-doping authorities in calling for a ban. Among 16 pages of comments and recommendations submitted ​to WADA ​by ​UKAD this year, the agency specifically highlighted tramadol’s misuse in cycling, its potential for dependence, and dangerous side effects including “sedative properties [which] have been used to suggest that its use puts other athletes at risk, particularly when the sport occurs at high speeds,” according to a copy reviewed by The Wall Street Journal.

Other sports officials say they ​question the rationale for keeping tramadol off the banned substances list because it’s a niche interest.

Sebastian Coe, president of track and field’s global governing body, said “I guess that would run counter to one of my principle propositions here, which is that standardization cannot sacrifice the need of athletes. If standardization is helpful, fine,


with a hammer I can fix anything