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Athlete Advisory: Explanation of Key Changes on 2023 WADA Prohibited List

2023 WADA Prohibited List cover image.USADA is a signatory to the World Anti-Doping Code established by the World Anti-Doping Agency (WADA), which means that USADA upholds and enforces WADA rules that govern sport around the world.

The WADA Prohibited List is among those rules, and identifies (by categories) which substances and methods are prohibited in-competition, out-of-competition, and in some cases, by specific sport. WADA conducts an annual review of the List and identifies if substances and methods should be added or removed, as well as if any categories and conditions should be modified or clarified.

WADA recently released the 2023 WADA Prohibited List, which will go into effect on January 1, 2023. While the Prohibited List is reviewed and updated, annually, significant changes may not always occur, which is the case for the 2023 Prohibited List.

For 2023, WADA only made clarifications to the List to help athletes and their support teams better identify and understand prohibited substances and methods. Some of those clarifications are highlighted and explained below, and a full list can be found here: Summary of Major Modifications and Explanatory Notes

While USADA has a team available to help answer your specific questions (contact info below), we also urge you to use GlobalDRO.com to search the prohibited status of your medications and ingredients.

S1 Anabolic Agents 

There were no changes to the status of any anabolic agent, but a few new examples were added to the Prohibited List. Several of these substances are illegally marketed in dietary supplements, which is among the many reasons that USADA reminds athletes to reduce their risk from supplements by using products that are third-party certified.

The new example include: 

  • adrenosterone (also known as Androst-4-ene-3,11,17-trione; 11-ketoandrostenedione; 11-oxoandrostenedione (11-OXO))
  • Epistane (17α-methylepithiostanol)
  • Ractopamine
  • S-23
  • YK-11

It’s important to remember that while the Prohibited List includes many examples, it is not exhaustive, and new examples may be added during the year. As always, the easiest way to check the prohibited status of medications is to visit GlobalDRO.com

S4 Hormone and Metabolic Modulators 

This section was updated to include antibodies against myostatin and myostatin precursors. 

In clinical trials, such antibodies promote muscle growth, and they are being explored to treat muscle wasting diseases. Apitegromab was added to the List as one example of a new myostatin inhibitor antibody.

S5 Diuretics and Masking Agents 

As in years past, WADA still requires athletes to have a Therapeutic Use Exemption (TUE) if they use a diuretic/masking agent AND a threshold substance at the same time, specifically formoterol, salbutamol, cathine, ephedrine, methylephedrine, and pseudoephedrine. For example, if you are on a diuretic medication (or on any other substance in the S5 category of the Prohibited List) for any reason and you are using an inhaler that contains salbutamol (albuterol) or formoterol, then you may need a TUE.

However, WADA has clarified that a specific class of diuretics called Carbonic Anhydrase Inhibitors, such as dorzolamide or brinzolamine, used in the eye in conjunction with a threshold substance does not require a TUE. This is because the local use of these substances in the eye won’t have an effect on other parts of the body. Dorzolamide and brinzolamine are sometimes prescribed as eye drops to reduce pressure in the eye such as in glaucoma.  

Similarly, WADA has clarified that the use of felypressin in dental anesthesia in conjunction with a threshold substance is also not prohibited. 

Lastly, torasemide (torsemide) was added as an example of a diuretic in the Prohibited List. The status of torasemide has not changed and it remains prohibited at all times. 

M1. Manipulation of Blood and Blood components 

Voxelotor was added as an example to this section. 

S6. Stimulants 

Solriamfetol was added as a non-specified stimulant as it improves wakefulness in adults with excessive daytime sleepiness due to obstructive sleep apnea.

Also, a few more names for methylhexanamine were added as examples to this section. 

WADA additionally clarified that tetryzoline is considered an imidazoline derivative, and therefore, like other imidazoline derivatives, it is not prohibited when used in the ear (otic), in the eye (ophthalmic) or in the nose (nasal). 

S7. Narcotics 

Tramadol will become prohibited in 2024, as WADA has identified potential patterns of misuse since tramadol has been in the monitoring program. Because the status remains not prohibited in 2023, athletes can continue to use tramadol both in- and out-of-competition in 2023 without a TUE. According to WADA, the addition of tramadol to the Prohibited List will be delayed until 2024 to allow for sufficient education of athletes and athlete support personnel about this new rule. 

 S8. Cannabinoids 

There were no changes in the cannabinoid section of the Prohibited List, but WADA published its conclusions from a recent assessment it conducted on whether THC specifically should be prohibited. WADA concluded that: 

  • “There is compelling medical evidence that Use of THC is a risk for health, mainly neurological, that has a significant impact on the health of young individuals, a cohort which is overrepresented in Athletes.” 
  • “The current body of objective evidence does not support THC enhancement of physiological performance, while the potential for performance enhancement through neuropsychological effects still cannot be excluded.”
  • “In consideration of the values encompassed by the Spirit of Sport as outlined by the Ethics EAG, and noting in particular that respect for self and other participants includes the safety of fellow-competitors, the Use of THC In-competition violates the Spirit of Sport.” 

Based on these three criteria, WADA determined that THC meets the criteria to remain on the List. More information about WADA’s decision on THC is available here.

S9. Glucocorticoids 

WADA has clarified that use of corticosteroids in the ear (otic) is not prohibited.   

P1. Beta-Blockers 

Under the 2023 Prohibited List, beta-blockers will be prohibited in-competition in the sport of mini-golf (World Mini-Golf Federation). 

Beta-blockers are already prohibited in-competition for all subdiscipline of freediving, spearfishing, and target shooting (World Under Water Federation CMAS). As of 2023, beta-blockers will also be prohibited out-of-competition. Athletes in these sports will need a TUE to use beta-blockers at any time, even if they are not competing. 

Monitoring Program 

All of the substances in the 2022 Monitoring Program are staying in the 2023 Monitoring Program. WADA is also adding the following: 

  • GnRH analogs in females under 18 (in- and out-of-competition)
  • Hypoxen (in- and out-of-competition)
  • Dermorphin and its analogs (in-competition)

Substances in the Monitoring Program are not prohibited. The WADA laboratories will be analyzing for the substances in the program to evaluate patterns of use, but athletes will not incur an anti-doping violation for using substances in the Monitoring Program.

More questions?

For questions about specific products, substances, and methods, contact USADA’s Drug Reference Line at drugreference@USADA.org or call (719) 785-2000, option 2.

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