Glucocorticosteroids, such as cortisone, prednisone, and dexamethasone, are commonly prescribed to treat injuries or to manage chronic inflammatory conditions like arthritis. The anti-doping status of each glucocorticosteroid depends on several factors, including the route of administration (in other words, how you take it).
Keep reading to learn more about this class of substances, while keeping in mind that the World Anti-Doping Agency (WADA) Prohibited List is updated every year and these rules are subject to change.
What are glucocorticosteroids?
Glucocorticosteroids are a class of medications that resemble cortisol, a hormone produced naturally by the adrenal glands. Cortisol is involved in regulating metabolism and immune responses.
What are they used for in medicine?
Glucocorticosteroids generally reduce inflammation in the body, and are used medically to treat asthma, arthritis, lupus, allergies, injuries, pain, rashes, and many other maladies.
These substances are available as:
- inhalers (inhaled route of administration)
- pills or tablets (oral route of administration)
- creams or lotions (topical route of administration)
- rectal suppositories (rectal route of administration)
- eye drops (ophthalmic route of administration)
- many injectable formats, such as: intramuscular injections (into the muscle), intravenous injections (into a vein), subcutaneous injections (into or under the skin), intra-articular injections (into joints), and epidural (into the spinal column)
There are some glucocorticosteroid preparations that are available as over-the-counter medications, such as hydrocortisone cre ams, and there are many prescription-only glucocorticosteroid medications.
Are glucocorticosteroids prohibited in sport?
Under Section 9 of the WADA Prohibited List, the anti-doping status of glucocorticosteroids depends on several factors, including the exact substance in question, how it is administered (by mouth, by injection, used topically, etc.), and whether you are competing.
In 2021, glucocorticosteroids are prohibited in-competition when administered:
- orally (e.g., swallowing a pill or used topically in the mouth or under the tongue)
- by intramuscular injection
- by intravenous injection
These routes of administration result in a significant level of glucocorticosteroids circulating in the blood.
In 2021, glucocorticosteroids are permitted both in and out-of-competition when administered by:
- inhalation (e.g., glucocorticosteroid inhalers)
- intranasal (e.g., nasal sprays for allergic rhinitis)
- ophthalmic (e.g., eye drops)
- perianal (e.g., hemorrhoid creams)
- dermal (e.g., topical creams to treat rashes or allergic reactions)
- injections* into joints, bursa, or the epidural space
Since there are so many factors that impact whether a corticosteroid is prohibited, USADA strongly recommends you check your medication and route of administration on Global DRO.
*Injections by these routes are permitted in-competition only until January 1, 2022. In 2022, glucocorticosteroids will be prohibited in-competition by ALL injectable routes, including the routes listed here. USADA will provide further information as it becomes available.
What do you mean by in-competition?
Under the 2021 rules, in-competition is defined as the period commencing at 11:59 p.m. on the day before a competition in which the athlete is scheduled to participate, through the end of the competition and the sample collection process related to the competition.
What if I need to use a prohibited corticosteroid in-competition?
If you need to use a corticosteroid in-competition by a prohibited route of administration (orally, by intramuscular or intravenous injection, or rectally) you may need a Therapeutic Use Exemption (TUE) depending on your level of competition.
Any athlete in the Registered Testing Pool (RTP) or the Clean Athlete Program (CAP) who needs to use a prohibited glucocorticoid must apply for a TUE. All other athletes should submit a TUE Pre-Check Form to determine if a TUE is necessary. If you’re unsure if you are an RTP or CAP athlete, please submit a TUE Pre-Check Form.
For questions about specific products, substances, and methods, contact USADA’s Drug Reference Line at email@example.com or call (719) 785-2000, option 2.