Don’t jump for joy yet, don’t open the champagne but all the same the news yesterday from the UCI that the Management Committee, its board, has announced it plans to test cortisol levels and ban Tramadol for 2019 and this is welcome news.
Cortisol is a hormone produced by the adrenal glands which sit on top of your kidneys. These glands produce adrenalin and also cortisol in response to stress. Skimming the medicine cortisol has two effects, one is anti-inflammatory and the other is to help the body access more energy. In both cases there are advantages to an athletem and doping with cortisone has existed for decades. Aching muscles hurt less and instead of a surge of adrenalin, the cortisone provides a more sustained boost. Abuse has a catabolic effort, first burning fat to help a rider get extra lean and then breaking down muscle and even joint and bone tissue. Several ex-riders from the 1970s and 80s have stated they had major problems, for example Tour de France winner Bernard Thévenet, the man who dethroned Eddy Merckx said “I was doped with cortisone for three years, I’m now unable to ride a bike.” Note the difference, cortisol and cortisone. When someone starts taking big doses of cortisone, perhaps via injection, the body stops producing its natural cortisol. This matters in the event of a crash when the body would respond to the shock by producing cortisol for the inflammation but a rider with low levels could not and therefore the body’s natural ability to recover is endangered. This is particularly worrying in the case of a head injury where the body cannot produce its own anti-inflammation response to a cranial injury. Cortisone use is permitted under the WADA Code and under the new plans for 2019 it will still be allowed but any riders with low cortisol levels, whether through ill health or cortisone abuse will be required to rest for eight days. It’s exactly what the MPCC group of teams does already and is a health check more than an anti-doping measure.
As for Tramadol, it is a powerful opiate drug, not something you’d reach for in case of a headache, instead it’s used for chronic and acute pain relief, often prescribed for back pain or post surgery. But as an opiate it can be addictive and by some measures prescription drugs, including Tramadol, are abused in greater quantities in the US than illegal drugs from heroin to cocaine. Back to cycling and it’s not banned by WADA although they have been monitoring it’s use, ie testing samples collected to see how often the molecules show up. Tramadol has been used for two reasons. First, as pain relief for injuries allowing riders to train or even race through an injury. Second it’s mixed into a “finish bottle”, a bidon consumed late in the race to provide a small “high” and numb the rider to an effort. Tramadol typically comes with warnings not to drive vehicles or operate machinery because of the side effects like drowsiness – let alone race a bike down a descent or into a farm track before a cobbled climb – and the finish bottles are often laced with caffeine to counter this. But it’s such a strong product that if a rider needs this kind of medicine because of injury then they really ought to be resting rather than racing and if they’re using it as part of their late race strategy then it’s dumb and dangerous. It’s lead to headlines of Tramadol causing crashes in the classics although the actual quote from the Lotto-Soudal team doctor was more nuanced, saying it could be one of many factors. Again it is legal under the WADA rules but MPCC teams ban it.
All this is beyond the WADA Code and until now this has been problematic for the UCI which hasn’t wanted to leave the legal and financial umbrella of WADA, although cycling’s governing body has done this already in adopting the “no needles” policy. It’s a win for the MPCC, the group of teams that have pioneered more stringent anti-doping methods than the WADA Code and which the UCI watches and then eventually copies, see the “no needles” policy of the MPCC: now incorporated into the UCI rules. Perhaps in future they’ll adopt the MPCC rule stipulating riders under investigation for a doping case mus be provisionally suspended. Quite why top teams don’t want to sign up to this group remains a mystery, from the outside it looks like they want to avoid pesky controls over cortisone and Tramadol use.
Nobody seems to have been sanctioned for breaching the no-needles policy so quite how much bite it has is unknown. Which is a question over the cortisol testing and Tramadol bans. Imagine if a rider presents low cortisol levels at the start of a grand tour, would a pro team accept this and bench the rider in question or seize the CAS? What if a rider presents a medical need for Tramadol during a race and the team doctor prescribes it, are we into the realm of TUEs here? Will the teams accept this, some like Lotto-Jumbo contest the MPCC cortisol testing. It’s hard to imagine the teams complaining too much, this is surely not a hill they want to die defending. But they may want input. There will be details to iron out, there’s a gap between the intention and the application.
There’s also the question of what next? If team doctors are prescribing Tramadol as part of legal “marginal gains” then if it is prohibited will they switch to an alternative opiate? If so this substitution may be no better, possibly worse. Similarly if teams or rider “coaches” are abusing cortisone will they adjust their timing and dosages to ensure cortisol levels rise; or what about injecting cortisol to beat the test? As such the move is welcome but it won’t solve everything, it just helps close off a couple of dubious avenues.
Good news but two cheers rather than three: let’s see what the rules are in black and white for 2019. UCI President David Lappartient promised to act on this so announcing the UCI is going to act is good but it’s still a communication strategy for now, an announcement ahead of any incorporation into the rules. It’ll be interesting to see how extensive the testing is and whether the measurement levels are set differently from the MPCC’s version.