UCI to Introduce Cortisol Testing and Ban Tramadol

Friday, 22 June 2018

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.

Medical Explainer
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.

Questions…
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.

Conclusion
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.

KevinK June 22, 2018 at 11:35 am

Very nice summary article, as always. Two cheers for sure. Even if it doesn’t close off these two forms of dangerous abuse, it at least highlights that it’s dangerous and a form of doping.

not yoda June 22, 2018 at 12:55 pm

Agreed. Quite surprised by the finish bottle contents here. Missed this in all the cycling controversies.

Handmade Cyclist June 22, 2018 at 4:58 pm

It was Taylor Phinney who I think brought awareness of finish bottles more into the mainstream: http://www.velonation.com/News/ID/13076/Taylor-Phinney-Interview-Getting-the-pill-culture-out-of-the-sport.aspx

The Inner Ring June 22, 2018 at 6:49 pm

It’s an ancient practice, pulling out a mystery vial to ostentatious down in front of rivals as a magic potion or being passed up a magic bottle from the team car with for the placebo effect. Over the years there are reports of strychnine, cocaine, amphetamines, champagne and more with Tramadol and caffeine still legal today although caffeine was banned in recent years.

wallers June 23, 2018 at 12:04 am

Like this you mean. not drugs but the same culture.
https://www.overstims.com/COUP-DE-FOUET-LIQUIDE-gel-energetique-boite

Anonymous June 23, 2018 at 1:46 pm

Finish bottles existed long before Taylor Phinney was even born.

Anonymous June 23, 2018 at 7:49 pm

You don’t say?!

Please re-read. *No one* said otherwise,

PS “Mainstream” here is, of course, the English language mainstream.

Anonymous June 24, 2018 at 5:05 pm

Must have missed the unwritten law that we have to discuss everything her only in and for of course, the English language mainstream. Anglos, you’re not the center of the world. Especially after Brexit and Trump, you’re merely sideline, get used to it.

AP June 24, 2018 at 5:14 pm

Hi, Vladimir.

Anonymous June 24, 2018 at 6:10 pm

Anonymous at 5:05 pm: No wonder you’ve missed the unwritten law you mentioned because there is and has never been such an unwritten law – and to the best of my knowledge you are the first and the only commentator who has suggested that there are commentators who are under the belief that such an unwritten law exists…

It may well be that the Joe Blow (or whatever his or her name is) who follows cycling only through “mainstream” (whatever that may include) in his own language had never read or heard about FBs before TPh mentioned them, explained them and voiced his opinion about them in the interview linked above.

I made a point of the obvious for the simple reason that apparently that are readers who read to fast to comprehend or who are too keen to misinterpret what they have read.

Let’s respect each other just a little bit and at least make an effort to understand what a commentator has said or tried to say before writing and submitting a quick reply!

dude June 25, 2018 at 4:50 pm

Hilarious that an anon forced to write in English says that “Anglos” are not the centre of the world. You ain’t reading this in Swahili son.

Anonymous June 25, 2018 at 10:09 pm

Neither your son nor is the fact that that someone communicates in an international language a premise to be
Anlgo. But thanks for proofing my center of the world point.

Davo June 25, 2018 at 11:17 pm

Perhaps it was Finnish bottles?
Different thing altogether.

Anonymous June 22, 2018 at 12:02 pm

From a cursory glance: It sounds like the cortisol testing is a bit in its infancy? Any danger of Semenya-like controversies, where the science neglects to account for the fact that some people are just different?

KevinK June 22, 2018 at 2:34 pm

From a medical standpoint, adrenal gland function, and the role and action of cortisol within the body, has been fairly well understood for a relatively long time by the standards of modern medical research. Cortisol was isolated in the 1930s, along with many other adrenal hormones, which immediately led to an explosion in basic and clinical research.

Anonymous June 22, 2018 at 3:07 pm

There was nothing wrong with the science in the Semenya controversy. It is just that the sporting rules about people being different (i.e. male or female and there competing in two different categories) had not covered for all possible cases (know to science) of people being different (i.e. some females being hormonally different in a manner that is highly relevant for sports from most other females).

RQS June 22, 2018 at 9:19 pm

I think the question is whether Semenya is actually, genetically speaking, ‘male’.
I agree that it is not Semenya’s fault that male hormones have not developed her body according to her sexual genetics but equally it’s not exactly fair on genetically female women that have to compete against her. It would almost be fairer to put Semenya up against those she matches genetically I.e. men. The likelihood is that her results would not qualify her for international races. So what is fair?

Tom June 23, 2018 at 10:41 am

Gender is genetic and is black or white? You better let the world know. This is a breakthrough moment.

Anonymous June 25, 2018 at 1:59 am

Who mentioned gender? Clearly it’s biological sex that is in question here – and yes, that is entirely genetic.

Anonymous June 22, 2018 at 2:01 pm

“is a health check more than an anti-doping measure.”

Anything that stops riders becoming addicts or suffering from long term issues is to be applauded. As you point out later though, for some it will only move the goal posts because there will be teams/riders who are more interested in results than possible future problems.

As for why some teams don’t sign up for this already, I can only imagine that black and white rules for colourful scenarios aren’t always welcomed. A rider with very low pre race cortisol levels is probably not too much of an issue (unless you’re Jumbo and George Bennett for example…). A strong opioid to get your GT GC podium guy through the last two stages might offer a different perspective though.

KevinK June 22, 2018 at 3:27 pm

“…for some it will only move the goal posts because there will be teams/riders who are more interested in results than possible future problems.”

This (that athletes will eagerly accept tremendous short term risks, and even the certainty of real damage/shortened lifespan/future chronic disability, in exchange for short-term glory) is well known to be true throughout sports. The history of anti-doping, as well as the institution of basic safety measures, has always been one of goal-post shifting. That doesn’t mean it isn’t worthwhile.

Sam June 27, 2018 at 9:04 am

I recall back in the post Ben Johnson controversy they was a survey of elite athletes which revealed a very high percentage (don’t recall exactly what) which hypothetically were prepared to take a drug which would guarantee them a gold medal but kill them within 10 years….

KevinK June 28, 2018 at 11:25 am

Yes, I looked it up – it’s known as the Goldman Dilemma, and it was actually a gold metal in exchange for certain death in 5 years. About 50% of elite athletes are hypothetically willing to take this deadly bargain. We’ve known for years that even when used appropriately (chronically ill patients with anemia), EPO substantially raises the risk of heart attacks, strokes, and tumor growth. We know that wanton use of EPO has apparently caused multiple deaths in young athletes, and it’s medically logical that microdosing puts riders at substantially increased risk of heart attacks/strokes/tumors. Likewise, using cortisone and cortisol analogues has well known and substantial negative side effects, and the risks of opiates are abundantly clear.

Athletes won’t make choices based on their long-term well being. That is clear. The fact that the sport of cycling has glamorized these bad choices in the past seems to me a poor reason to continue the nonsense.

On a related note, the fact that human physiology (blood count, cortisol levels, etc.) are rarely completely black and white is not a reason not to have strict rules and enforcement.

Larry T June 22, 2018 at 3:16 pm

Two hearty cheers from me! At least now someone can ask WHEN rather than IF and it now seems no more hiding behind WADA when it comes to making the rules. Next they can nix TUE’s entirely and ditch the “adverse analytical finding” weasel-speak. Would this have happened with C(r)ookson at the helm?

RonDe June 22, 2018 at 4:25 pm

We need a new sport of “how many innuendos can Larry string together in one post” methinks! Verbruggen, McQuaid and now C(r)ookson! One wonders why Lappartient is to be regarded any differently. It was Cookson who actually changed the rules on TUEs a couple of years back so they became a committee decision rather than getting pally with Dr Zorzoli to get you one. How quickly we forget.

PS Larry no TUEs at all means goodbye Novo Nordisk team who all need TUEs!

The Inner Ring June 22, 2018 at 4:47 pm

Cookson did this but he had to, the UCI was in breach of the shared standards for TUEs which said you needed a committee to decide etc (http://www.cyclingnews.com/news/uci-to-strengthen-anti-doping-programme/), so it was a matter of time rather than foresight and in the gap between a review on what to do and enacting it the story of Froome’s Romandie TUE and Zorzoli came out and the UCI reacted to this rather when it could have prevented the criticism.

Larry T June 22, 2018 at 5:23 pm

I think C(r)ookson will go down in history as mediocre and hapless at best, though I think he was far worse, though better than McQuaid. Faint praise for sure, but I have no doubt plenty of Anglo-Saxons will defend C(r)ookson just as they skewered his replacement, spewing BS claims about how he would sell the whole works somehow to ASO.
How quickly we forget, indeed.
But let’s not fight about that, let’s share the hearty two cheers and hope we can soon add a third as someone finally grabs the wheel of the UCI ship and starts to turn away from the iceberg. 🙂

RonDe June 22, 2018 at 7:08 pm

You don’t strike me as a Leonardo DiCaprio aboard the Titanic Larry! 🙂

Ruby June 22, 2018 at 3:25 pm

Thanks for noticing the nuances of the UCI’s approach rather than the hot-take “UCI bans glucocorticoids” approach of most twitterati and cycling media. The UCI are selling low cortisol levels as a medical/health risk to the athlete rather than a straight-up indicator of PED glucocorticoid use.

As a physician I also have a few points to add that may be helpful:

Cortisol is a naturally occurring hormone whos excretion is subject to a pronounced circadian rhythm. Medically, a random cortisol level is virtually useless. The test is usually taken in a starved patient in the early morning between 07.00 and 0.800 hours.

Secondly, if the athlete is administering exogenous “cortisol” in an attempt to fool the test this can only be done using hydrocortisone. This is actually slightly chemically different to natural cortisol and I presume would therefore be easy to differentiate during blood testing.

Thirdly, complete shutdown of natural cortisol secretion usually only occurs after prolonged (more than several weeks) administration of exogenous glucocorticoid. It is this situation that is dangerous as the body cannot increase cortisol secretion in response to illness, injury or surgery. This can lead to catastrophic and fatal cardiovascular collapse. Episodic administration of glucocorticoid may suppress natural cortisol secretion but is unlikely to cause complete shutdown.

Finally, natural cortisol levels are affected by many factors other than exogenous administration of glucocorticoid. Concurrent illness can be a factor as well as things like sleep deprivation, jet lag and even caffeine.

I understand what the UCI is trying to do here and appreciate the fact that they are couching things in terms of athlete health but I think using random cortisol tests to determine a rider’s fitness to compete as well as a proxy for exogenous glucocorticoid use, may not be as straightforward as it initially appears.

As for Tramadol, well yeah about time, M. Lappartient.

Easy cortisol primer:
https://www.chemistryworld.com/podcasts/cortisol-and-hydrocortisone/8647.article

P.S I hope I didnt post this twice.

The Inner Ring June 22, 2018 at 4:08 pm

Thanks for sharing this, the MPCC test and so presumably the UCI test involves testing between waking and before breakfast (0630-0900am) but doesn’t have to involve a fasting athlete.

Ruby June 22, 2018 at 7:09 pm

Thanks…that makes sense.

Lanterne_Verte June 22, 2018 at 3:39 pm

A blanket rule that any medication that advises against driving or using machinery is forbidden in bike races would seem entirely reasonable to me, if its there in black and white in the patient information leaflet then not allowed, simple. Also make it forbidden to exceed recommended doses. Trouble is Tramadol doesn’t explicitly advise against driving/machinery, PIL just says that it *may* cause drowsiness. An option would be that if drowsiness or dizziness are listed as Common or Very Common side effects then do not use. That excludes Tramadol but I think Co-codamol is ok. I would have thought that a rule allowing NSAIs and Co-codamol within recommended doses but nothing stronger would be legally defensible on grounds of personal and public safety for riders/colleagues/spectators who are all at risk if an individual rider is not fully compos mentis.

Davo June 22, 2018 at 6:21 pm

I am not a physician, and I know that my experiences do not offer a case for continuing to allow the use of Tramadol within the pro peleton , but I would offer a word of caution. I have been prescribed Tramadol for chronic back pain, an undiagnosed problem that appeared out of nowhere in my early-forties. It is the only effective pain relief I have found in the last 10 years. I am able to live a relatively normal life, including cycling 15-20 hours a week, something I could not do before Tramadol use. I have suffered no side effects, can drive, operate machinery, drink alcohol with no worries. I would also say I am not addicted but it helps me live my life.
Before Tramadol I was prescribed several different pain killers which were ineffective and in the case of co-codamol, actually dangerous. I suffered dramatic and unpredictable drops in blood pressure which could happen at any time having taken even a low dosage. On one occasion I collapsed and lost consciousness. I am not absolutely certain but I believe co-co-codamol does not have the same warnings on its packaging as Tramadol.
Now I don’t expect anyone to take notice of the relative effects of an amateur in their 50s, afterall, I am unlikely to have to worry about a change in stance by the UCI but I would urge caution when describing the side effects of pain killers and anti inflammatories.
I dislike the idea of finishing bottles like most people but we do ask a lot of pro cyclists. I can’t think of another sport where an athlete after having an accident at 60 km/h is asked not only to carry on but to keep going for up to anther 3 weeks.
I am not sure that a blanket ban on a single type of painkiller is the solution some might think it is.

Will June 22, 2018 at 8:04 pm

I was prescribed tramadol following an open fracture in my hand when I was 20. My experience of it was very different to yours, I suffered from nausea, dizziness and regularly felt on the edge of passing out.

That is not intended to discredit your experience with it at all, but the idea that someone could be riding a bike at 40+km/h, surrounded by 180 other riders suffering from those side-effects should be a huge cause for concern. I’d suggest that if you require that level of pain relief, you really should not be competing in a bike race.

Davo June 22, 2018 at 9:39 pm

Will,
I agree totally, in fact it furthers my point, which is different people react in different ways to different painkillers. However, in my opinion if you want an
injured rider to continue riding in a stage race, they should have recourse to pain relief.

J Evans June 23, 2018 at 2:50 am

If you’re in too much pain to ride, you don’t ride.
Pain is your body’s way of telling you to ‘stop doing that’.
What’s needed is a change to cycling’s pill-popping culture, as well as sport’s win at all costs mentality.

RolandDennis June 23, 2018 at 10:46 am

As usual, J Evans pops up with his sport-ending nonsense. Over to you Ayrton Senna:

If you no longer go for a gap, you are no longer a racing driver.

J Evans June 23, 2018 at 11:14 am

I don’t think it’s ‘sport-ending’ to suggest that if as a professional cyclist you are in so much pain that you require an opioid painkiller, rather than being allowed to take that drug it would be better that you don’t ride.

Will Luck June 24, 2018 at 12:50 pm

@Davo, as mentioned, I didn’t mean to discredit your experience in anyway whatsoever. I do strongly feel though that if there is a serious risk of those side effects then the drug should be banned.

@J Evans, I agree entirely. I was prescribed tramadol because a bone was sticking out of my hand. The last thing on my mind was to get back on a bike.

What RolandDennis is on about, I’m not entirely sure. Equating this to a Senna quote on overtaking is somewhat bizarre, especially considering it was said in the context of him deliberately crashing into a rival! I can only assume that it was being transcribed to “If you no longer go for an advantage within the rules, you are no longer a sportsman.” If that’s the case, then even more reason to create stricter rules to govern substance abuse!

Larry T June 23, 2018 at 11:19 am

Painkillers of any sort have no place in this sport. Isn’t one of the key things to results the infliction of pain on your competitors by “putting the hurt on them”? “Feeling no pain” whether it’s due to amphetamines, opiates, alcohol or anything else changes the sport’s challenge as much as letting a competitor ride a motorcycle.
TUE’s should simply no longer exist. If you require a medication or substance (that in any way can be a PED or danger to others) to be able to compete, you simply should not be competing.
This includes things like diabetes, a medical condition that can be treated – but so can low testosterone, low hematocrit and gawd knows what else with substances we don’t even yet know about. Before someone starts crying about Novo-Nordisk, tell me you’d be OK with a team sponsored by Amgen who supplied EPO to their riders – all of whom seemed to be suffering from low hematocrit they blamed on genetics or Allergan sponsoring a “Low-T” team with Androderm patches.

J Evans June 23, 2018 at 11:34 am

If this were to happen, I’d have great sympathy for Novo Nordisk riders (for instance).
However, there are I suspect far more riders gaming the system than there are genuinely in need of it, and if this can’t be prevented then I think overall it would be better to get rid of the TUE system altogether.
It would be unfortunate for some, but that’s life: many people have many reasons (health and otherwise) why they cannot be elite cyclists – you just have to deal with it (being a professional sportsperson is not a right).
A point that cannot be refuted is that PEDs, regardless of the motives behind taking them, enhance the performance (outside of the required therapeutic effect).
No-one can say where the therapeutic effect ends and where the performance-enhancing effect begins – nor the amount of crossover involved.
So I can’t see how it can ever be truly fair to allow people to take them.

Tom June 25, 2018 at 5:01 pm

Its hard to take people seriously who say “it would be unfortunate for some, but thats life” when you know it doesn’t include them.

When the same person goes on to say “No-one can say where the therapeutic effect ends and where the performance-enhancing effect begins – nor the amount of crossover involved” when that is exactly the point of the testing regimes and the rules and regs of the sport it makes the speaker seem a total joke.

This same person sometimes complains that some teams have more money than others too. You just hate competition in any form Mr Evans.

J Evans June 26, 2018 at 2:22 am

Tom, to take Wiggins as an example – can it be said where the therapeutic effect of the drug he took just before the Tour ended and how much performance-enhancing effect there was?
I think that would only be possible if he’d been in a lab.
The testing regimes of most drugs are positive/negative. In the case of things like Froome’s AAF, the level is not set by where any PE effect begins, it’s set at a level that they think is considerably above that which could be attained by using the drug for its therapeutic effect. It’s basically a guesstimate.
Yes, ‘that’s life’ – you can’t be a professional cyclist. It’s really not that bad and not a concept to get terribly emotional about.
‘You just hate competition in any form Mr Evans’ – this is as ludicrous as it is baseless.
‘makes the speaker seem a total joke’ – this is laughable.
So, I won’t even bother refuting those too – you’ve made a fool of yourself, I don’t need to.

Anonymous June 23, 2018 at 1:30 pm

Tramadol is a surely black and white case and banning it is a no-brainer. But more generally: we can’t even seem to get consensus about what is and what isn’t a PED. I’ve even seen claims that EPO isn’t a PED. And when does a natural substance become an unacceptable PED anyway? Relentless pursuits for purity don’t usually end well.

AP June 22, 2018 at 4:23 pm

“will they switch to an alternative opiate?”

Hopefully cycling won’t reclaim its white working-class roots by embracing fentanyl.

Anonymous June 22, 2018 at 8:26 pm

So this is just an in-competition Tramadol ban, right? If so, I don’t see how this addresses the longer term dangers of its use.

Also, do we know how often the tramadol “molecules show up”? Or are those WADA findings not for public consumption (no pun intended)?

Ruby June 22, 2018 at 9:23 pm

The WADA monitoring program shows Tramadol detection rates of 4.4% in elite competitive cyclists. This is reported as the highest detection rate when compared to other endurance sport athletes. So basically, almost 1 in 20 of the peloton is likely to be under the influence of an opioid at any particular time.

https://www.wada-ama.org/sites/default/files/2017_wada_monitoring_statistics_summary_total_final.pdf

The Inner Ring June 22, 2018 at 9:25 pm

We need to be careful with these numbers, WADA is typically getting the test results from the podium and three random picks at best so there’s a selection bias risk here, no?

Ruby June 22, 2018 at 11:47 pm

The Tramadol monitoring sample size of 12554 is inclusive of both In-Competition and Out-of-Competition samples but as you say there will certainly be a degree of selection bias if you assume that the presence of Tramadol in the athlete’s urine provides some amount of competitive advantage.

Ruby June 22, 2018 at 11:48 pm

My mistake – Tramadol monitoring is IC as you stated…my bad.

Watts June 22, 2018 at 8:49 pm

This is great news.
I ride in the Cat2 or something similar in my country, and I’ve heard how people just love riding on Tramadol. Even in local sportifs I hear they’re used. And the worst part is, some of those who abuse it don’t even feel ashamed to talk about it. It’s just normal to them. They take pride in sometimes not even knowing how they got to the line. It’s like seeing the old images of Simpson and others during the Amphetamine phase of the late sixties again. Zombies on a bike.

When having “the talk” with younger riders I always say that you don’t have to use anything. And you should especially never take anything you don’t know what is. But even 15-16 year olds have been getting finish bottles in weekend races they tell me, so what are they supposed to believe? They’re not even grown up and already they see that riders who take something are faster.

I really hope that our sport can be a place where you can get to the top without anything other than some supplementing vitamins. But when a product like Tramadol which is a huge grey area is allowed to exist, it will bend some people’s morals and set them down a path.

Anonymous June 22, 2018 at 11:29 pm

“What if a rider presents a medical need for Tramadol during a race and the team doctor prescribes it…?”

Then they should be withdrawn from the race, if you have a medical need for Tramadol you also have a medical need to not be racing a bike.

J Evans June 23, 2018 at 2:33 am

Absolutely. Same goes for corticosteroids.
Ideally, you’d get rid of team doctors – it’s hard to see how these doctors are working for the good of their patients’ health.
There should be a body entirely separate from the UCI – and any other sporting body – that provides medical assistance.

RolandDennis June 23, 2018 at 10:49 am

If you are ill Mr Evans and you need medical attention do you want a doctor who personally knows you and your history or do you want some guy drafted in from anywhere who is on a list?

I think we both know the answer.

J Evans June 23, 2018 at 11:10 am

Your medical history can be stored. Any of the group of doctors would have access to this history. They wouldn’t know you personally.
This is precisely the situation I have with my GP surgery.

Utah June 23, 2018 at 7:14 am

I lean towards this line of argument as well. Cycling may then become not just about the person who is the best by the numbers but also the one that is able to keep themselves the healthiest, and I’m fine with that.

J Evans June 23, 2018 at 2:28 am

How many people, for years, have been saying that the UCI cannot ban drugs if WADA does not do so? And now, if it can ban tramadol without WADA, the UCI can bad corticosteroids out-of-competition – where they’re just as dangerous and just as performance-enhancing.

As I’ve said before, where drugs are not banned by WADA, the UCI can publicly state that they are testing for these drugs and the teams have to accept it. The teams who will not accept this are named and shamed – bad PR.

If the UCI cannot ban riders for being positive – e.g. because of legal challenges – they can name the riders who are positive: the bad PR alone would work to stop most.

If it would be legally difficult to name the riders who are positive – i.e. if the teams/riders challenged this – the UCI could name the riders/teams who are ‘refusing to comply with our testing regulations’.
The sponsors are there for good PR, so they won’t tolerate this.

J Evans June 23, 2018 at 2:57 am

Then you add a rule that says that race organisers have a right not to invite riders/teams (including World Tour) who have been noted as refusing to comply with UCI testing regulations in that year, as it could be seen as bringing the race into disrepute.
Refuse to be tested = no TdF = no sponsor.

RolandDennis June 23, 2018 at 10:52 am

Welcome to J Evans’ kangaroo court where innuendo can achieve what objective testing cannot.

J Evans June 23, 2018 at 11:09 am

How is it innuendo?
You test for the PED, you find the PED.
If WADA’s rules are so poor that you cannot ban people for taking this PED, then this way you still have transparency (without being dragged to CAS every time).
And if there’s a medical reason, you make it known that there is a medical reason (without saying that the medical reason is).
No-one’s privacy infringed (same as it isn’t with any other drug-testing).
Or maybe you prefer omerta, not knowing who is taking what, and the ongoing abuse of dangerous drugs by cheats?
There is no innuendo, just facts.

omerta June 25, 2018 at 5:09 pm

I’m not sure you understand what omerta means J Evans. Or medical privacy. I do not believe your job should dictate that members of the general public should know medical details about you. (Professional ruling bodies and their medical departments is a different matter, of course.) All through this thread and many others like it you always play fast and loose with other people’s rights. I can only imagine you wouldn’t be so free with your own. I think the word for that is “hypocrisy”.

Anonymous June 26, 2018 at 2:30 am

They already have drug-testing; this would be no different.
The ‘right’ of someone to be a professional cyclist is not one I would fight for. I’d leave that for pseudo-liberals looking to make themselves look like good people.

Anonymous June 23, 2018 at 11:29 pm

But J Evans hates Rupert Murdoch and all his works. He can’t use innuendo. Rupert Murdoch and all his nasty news outlets use innuendo. Not J Evans. Innuendo is only used by bad people. Not by him. Never. J Evans is a good person. J Evans only uses facts. Every time. Yes, sir. And those facts are always so simple. So easy. As he’s said before. Many times. Over and over and over and over and over and over and over. Again.

J Evans June 24, 2018 at 2:15 am

Some are here to discuss cycling issues, some are here to insult people they don’t know.
Those people presumably manage to delude themselves that they have any knowledge about the person they’re insulting and that anyone is interested in what they think about that person, but of course they’ve been encouraged in this by being told what to think about that person by the figure of authority.
In short, stop being a pillock mate, no-one cares.

The Inner Ring June 24, 2018 at 11:24 am

We don’t even know what form the UCI’s ban will take, eg thresholds, TUE / permitted use etc so try not to lose your tempers over this or use up precious bandwidth.

Anonymous June 23, 2018 at 2:29 am

From a short while ago:
Tramadol – This week’s WADA report shows the scale of the drug’s abuse somewhat declined over the past two years. In 2015, 730 out of 12358 doping controls had more than 200ng/mL of Tramadol (5.9 per cent). In 2017, out of 12,554 samples tested, 548 were positive for more than 50ng/mL of the painkiller, a rate of 4.4 per cent.
WADA also monitored glucocorticoids – steroids that are used to treat inflammation. Cyclists also showed the highest incidence of positive samples of any sport for this class of drug, in competition, with 3.8 per cent of samples positive. Out of competition, cycling was third to skiing and triathlon with 4.38 per cent of cyclists’ samples positive compared with 4.7 percent of triathletes and 5.5 per cent of skiers.

Davo June 23, 2018 at 2:27 pm

I don’t understand what the UCI trying to achieve with an in competition ban on Tramadol.
I think it is conflating 2 or probably 3 separate issues. They are as I see it:
1.Genuine pain relief, I realise that I seem to be in the minority here but I believe pro riders have the right to properly prescribed pain relief, especially those riding in stage races. For those who disagree I offer the case of Jimmy Hoogerland 2011 tdf.
2. Finishing bottles, if this is as prevalent as some would imply then I agree fully but the UCI should state this is the reason and back it up with some fully researched statistics.
3. Long term addiction and it’s associated problems. In competition testing is not the solution and will do nothing for opioid abuse. Like all addictions, some people are more susceptible than others and education and welfare programmes are normally the only long term solutions.

KevinK June 23, 2018 at 6:00 pm

1. There are hundreds of other medications that can be used for pain relief, many of which have minimal potential for causing impaired consciousness, a sense of well being, and addiction.
2. Is the UCI able to get comprehensive information on what exactly all the riders are eating and drinking, either in competition or out of competition? I suspect they have neither the wherewithal or the authority to do this, and I don’t expect the teams will willingly provide such info.
3. A substantial proportion of people addicted to pain meds are introduced to the drug by their physician. The liberalization of the medical use of opiates over the last couple of decades is a (or perhaps THE) major factor in the current opiate drug crisis the world is experiencing.

IanPa June 24, 2018 at 11:02 am

Why include Novo Nordisk in this conversation, that’s bad form. Diabetes is a genuine medical complaint and has a real need for drugs just to live a normal life, a TUE gets them racing, but these guys bodies are already compromised. The injections are helping talented athletes achieve their goals, we should applaud them.

As for everything else that is banned or about to be banned, i don’t believe there is a good enough or valid enough reason for a fit/ healthy athlete to take a product for any other reason than performance enhancement.

Larry T June 24, 2018 at 4:24 pm

That is exactly the problem with TUE’s. You say “diabetes is a genuine medical complaint…” while someone like say, Chris Froome might say his asthma is pretty much the same. While some would say it would be a shame if diabetics or asthmatics could no longer compete at top levels in cycling, I say that would be a small price to pay to rid the sport of the massive and widespread abuse of various TUE’s and substances that can be used only up to a certain level, especially when the certain level is being argued back and forth as in the Froome scandal.
Sure, a small number of perfectly innocent (but ill) people might lose the ability to ride a bike and get paid for it, but since the cheats will take any and every advantage (genuine medical complaint or not) and use these PED’s otherwise, a line must be drawn. Harsh? Yes, just as harsh as the fact that a guy with a VO2 max of 58 and a hematocrit of 39 can’t get paid to ride his bike on a World Tour cycling team either. Life’s not fair and it can’t be made fair with PED’s.

Anonymous June 24, 2018 at 6:24 pm

It is always easier to demand sacrifices when one is not among those who would have to make them!

But the problem with the virtue of being harsh in this matter “for greater good” is that I don’t think there is any quarantee that the doping problem in sports would become any less if we got rid of TUEs. Sure, *some* methods could no longer be used – but wouldn’t it be only a matter of time before the “doping industry” would find alternative (and equally or possibly more harmful or dangerous) methods?

There is not much worse than making sacrifices for wrong reasons and completely in vain.

PS XC skiing is a sport with very much similar problems with TUEs and fake or genuine cases of asthma, but I haven’t encounted any serious opinions for eliminating TUEs and banning asthma medication. For some reason, the desire and the demand for “completely clean” or “pure” sport seems to be much greater and a lot more acute among cycling fans.

Ferdi June 25, 2018 at 3:53 pm

At least it would simplify the enforcement of the rules. We have to get rid of the many-months-long legal-biological discussions, so that any adverse analytical finding is a positive, it is immediately sanctioned, end of story, and on to the next race.

Tom June 25, 2018 at 5:12 pm

Froome “scandal”? When did it achieve scandal level? 🙂

Whats next, Froome DEFCON 1?

Larry T June 26, 2018 at 7:57 am

Scandal – an action or event regarded as morally or legally wrong and causing general public outrage. I know a few casual cycling fans who’d qualify as “general public” and they have been outraged at the idea of a man caught with almost twice the allowable level of a PED being allowed to compete in all the races he likes while his case is argued back and forth in the media. They also think it scandalous that this would all be secret if the parties involved had their way.
What would you call the Froome case if not a scandal?

gastro george June 24, 2018 at 12:23 pm

The up and down sides of cortisone are well known in football back to the 60s, IIRC (and before)? Many old pros ended up with destroyed joints after too many injections.

Anonymous June 25, 2018 at 2:47 am

“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.”

I think the first sentence answers the second. In any other instance than cycling, it seems, we recognise that people being sentenced without trial to be highly immoral. Why should a rider miss the biggest race of his career because of an accusation? Despite later being shown to have done nothing wrong? Why should a team have to put up with that?

I think cycling fans have a tendency to immediately assume riders are doping before due process has taken place. That might be understandable, given cycling’s past, but that’s all the more reason why the authorities should be careful about this kind of thing. Bowing to mob rule, and committing injustice in the name of justice has never been a successful formula in anything. What’s worse: waiting until the evidence is in, or ruining an innocent man or woman’s career? Strip away everything else, and that is the basic choice here. As it’s the most pertinent example, here, does anyone think that were Froome to be exonerated once the process has completed his reputation could ever recover? Might as well at least have the opportunity to do something which would be a highlight of any rider’s career which could not be achieved at any moment other than this one.

Let’s not forget, also, that the MPCC has at times contained teams with sordid illegal drug abusing pasts. It’s been used ostentatiously as good PR. It’s not exactly an organisation that is beyond reproach. If we’re going to suggest that teams don’t want to be in it because they want to exploit legal drugs loopholes, then let’s all bear that in mind, too.

Don’t know why, but that innuendo just left a sour taste in my mouth. This has become virtually the only cycling site I visit, precisely because it strives to be as even handed as possible. I’m well aware of cycling’s past, it’s just nice to be able to talk and read actual ‘cycling’ once in a while!

Anyway, pet peeve ranted about, keep up the good work, Inrng. You’re one of the few voices I consider worth coming to for information upon cycling without having to wonder what agenda (in whichever direction) they may have hidden.

As for the announcement itself, cautiously good news – rider safety should always be considered paramount. For the same reason, though, I would hope it remains a TUE. Aside from everyone reacting differently to different types of medication, there can be allergies at play too, which prevent athletes being able to take certain medication. It may well be that for some riders, in some situations, Tramadol (or any banned drug) is the best thing for their health.

Also, about the need to protect riders from themselves, I’m reminded of Goldman’s dilemma. Whilst later study’s have reported a dramatic reduction amongst people who would do it nowadays, it still arguably points to a certain part of a makeup for a top competitor’s psyche. What price are people willing to take for victory when that thought consumes them? Or, perhaps even worse, when their contract for next year may depend upon them getting this ride right?

Anonymous June 25, 2018 at 7:52 am

Catching up with the comments over the weekend it is obvious that some people will never be happy. I’d like to add to yours if I may as I agree with much of what you say.

The insistence by some that all drugs that are considered PEDs should be banned fascinates and irritates equally. WADA endeavours to classify those drugs that have only performance enhancing properties when used by elite athletes differently to those that may be used in that way. Total ban versus partial/TUE/none. This would seem to be a most sensible practice. Just because Larry, Johnny and Mo believe that athletes should be assumed to be guilty of cheating if they require a drug that could possibly, if used the ‘right’ way, under the right conditions, may also, possibly, give them some sort of unfair advantage, possibly, maybe,… doesn’t make it so. Then the argument against painkillers seems to be “if you’re sick enough to need pain relief you shouldn’t compete” or some similar phrase. I’m going out on a limb but they’ve probably not been paid to perform… Not that I am a cheerleader for opioids. I’m of the strong opinion sports teams/owners/administrators etc have a duty of care that should include making sure their athletes aren’t being set up for later health issues or becoming addicted so the less these drugs are used the better but a blanket ban as argued by some is ridiculous. Why should an athlete, especially a cyclist on the last week of a GT, be unable to take medication to help them sleep because they’ve had a nasty abscess appear behind a tooth? Something that may not be able to be righted till after the race or on the next test day. Will a strong painkiller really be unfair to their competition? Should those years of training and sacrifice be seemingly wasted to satisfy the sensibilities of a random fan or even worse just some person that will always believe “they’re all cheats”? I think not.

Well anyway, you inspired me to a little rant of my own so thanks for that.

Will June 27, 2018 at 10:48 pm

Anon, you speak a fair amount of sense, but I disagree entirely on the painkillers comments.

“Why should an athlete … be unable to take medication to help them sleep?” Because the side effects of said medication make them a danger to both themselves and those around them. I think that’s a fairly common sense position to take and probably stands somewhat apart from the morally ambiguous right/wrong discussion.

The Inner Ring June 25, 2018 at 9:38 am

There are many professions where people can be suspended pending a review, from teachers to surgeons, commercial pilots etc. There are concerns over the justice of this, especially in a sport where competing brings you experience, condition etc. I’m not sold on this precautionary suspension idea but can see the arguments for and against and given the UCI has picked up all of the MPCC’s policies so far you have to wonder.

As for the MPCC, yes it was exploited by teams looking for a veneer but that only makes some squads look bad with their Saint Augustine calls for chastity (when signing up)… but just not today (when in a situation when they had to uphold the rules).

Anonymous June 26, 2018 at 11:04 am

Although I have a different opinion to doping (I think it is ridiculous to say: „Doping is bad, because it is not a level playing field“ to then be totally fine with a team, that has n-times more budget than all others. Where is the level playing field in that?), I can understand the feeling of some, that cycling showed clear enough, that it can‘t deal with anything responsible.

Why I understand these people? I just say one thing: team sky trying out which pills could give them an advantage and using for example viagra on their riders. If it is so far, that human beings are used as guniea pigs in the quest for supremacy you can only react with taking all medication away from riders and teams. Not because of doping, but to shield the riders from themselves and their teams.

When you are young, you never think things can change, you can notvimagine, that your body doesn‘t do, what you tell it to do. It is normal to be dismissive of caution, when you are young. But when you are older and you pay for everything you did to your body (being sceleton like thin for example is not only ugly, but unhealthy physical and psychological) you can‘t undo these things again, you have to live with the choices you made. And I think, if you ask the former athletes, who live in constant pain or those, that fight dpression and adiction, because of the pill-taking culture in cycling (which are a lot), if they would be ok with no medication for riders, they would take it within a second (just to be clear: No medication for riders doesn‘t mean they get no medication per se, just that if they need medication, they can‘t race. Simple as that). Unfortunately all those, whose life ended earlier because of the pills they took as athletes can‘t be asked anymore for their opinion. They are gone forever.

Ferdi June 25, 2018 at 3:46 pm

This is all very interesting news, thanks for the post.
I would like to suggest politely one subject for research and discussion, inspired by Froome’s salbutamol case. Who is accountable for the fact that the anti-doping system is not in a position to deliver swift decisions on such cases, and thus prevent interference with the races in which the rider under proceedings participates (the interference being that the rider’s results in those races may be invalidated by a sanction, which constitutes an undesirable uncertainty). Something is not right in the system if this can happen, and I honestly don’t know who to hold accountable.

Davo June 25, 2018 at 11:27 pm

I think the answer to your question is …….Lawyers, on both sides.
It is not a criticism but in most disputes, it is normally the legal profession who have most to gain.
Not just in terms of their fees, but also increasing their expertise in a given area.

Ferdi June 26, 2018 at 9:00 am

But the lawyers are only doing what they’re supposed to do. The blame must go somewhere else: who is responsible for making it possible for proceedings to take so long?

Ecky Thump June 25, 2018 at 4:30 pm

There’s a strange paradox around the issue of riders’ health and well-being in cycling.
On the one hand there’s the concerns laid out in Inner Ring’s article and the problems of doping for performance gain.
But on the other, there’s the celebration of the “hard man” and the admiration for riding through injury.
Take the aftermath of the horrendous crash in Stage 3 TdF 2015; Matthews limped around the remainder of the Tour, I recall.
What pain killer/s, if any, did he require? Was he on a TUE? Should he have pulled out / been forced to pull out?

Bernard Hinault’s Niege-Bastogne- Neige epic; if his cortisol was tested the following morning, I wonder what the level would have been?
Could he have subsequently been asked to take an eight day voluntary rest?

If the sport is to go down the full MPCC route, there are wider implications.
As well as being a punitive measure, it can be used for proactive rider health management.
The end of the “hard man”?

Kavan June 25, 2018 at 6:14 pm

Also Thomas who is not from Gwent riding from Corsica to Paris with a broken bum.

KevinK June 26, 2018 at 10:25 pm

The veneration of the “hard man” and bans on opiate drugs and PEDs isn’t a paradox at all. Imagine if we had actual transparency about what riders were taking, now and in the past. Imagine if we as fans found out that a particularly amazing “hard man” performance came because the rider had a blood bag, a handful of tramadols, and a bit of speed to keep him on the bike – somehow, I don’t think it would be that impressive or worthy of being honored. In such a case, it’s actually an act of deception, and takes away from the true amazing performances that were accomplished without doping.

Frankly, I’m confident that there will always be hard men. There is too much variation in pain tolerance, and there will always be riders whose greatest strengths are that they can endure more than their cohort. And I suspect the true hard men would celebrate the faux hard men being denied their in-race opiates.

noel June 25, 2018 at 5:16 pm

who leaked Froome’s AAR in the first place? It’s hard to see anyone getting an advantage of this being played out in public – the UCI/WADA look toothless, Sky look like their usual ruthless selves… it sells newspapers I suppose…

Anonymous June 25, 2018 at 6:30 pm

This idea that the professional media have that there is no such thing as a problematic leak is starting to wear thin for me. (Even more so in the internet age, where journalists can be easily manipulated by carefully selected leaks.)

J Evans June 28, 2018 at 5:05 am

Casting a critical eye on corruption in sport: Q&A with anti-doping expert Robin Parisotto

Robin Parisotto has played an important role in anti-doping during his career, with his work including the development of the first-ever tests for EPO, which were introduced in time for the Sydney Olympics in 2000. He was awarded the Australian Sports Medal for these efforts. He was also one of the founding members of the UCI’s biological passport programme, which was a revolutionary system of assessment of blood values to detect doping use.

(It’s from cyclingtips – link can’t be posted.)

‘It is always the same response in any enquiry, and it’s just a joke. If people are legitimate about, let’s say TUEs or medical problems or medical diagnoses and supposed treatments, then show us the records.

Unless you have a communicable disease or a disease that the athletes have that’s embarrassing for them. But, if I’m an asthmatic, I don’t really care if someone else knows that I’m an asthmatic. Or if I have diabetes, I don’t care too much if someone else knows I have got diabetes.

And this thing of hiding behind the wall of privacy…it should be part of the athlete’s appointment charter, almost. That if you are going to go down the road of TUEs, be aware that you are going to have to make a public announcement that you are required to take these drugs because of this reason.’

plurien June 23, 2018 at 12:56 pm

Or maybe not like this: FFC are? / were sponsored by Overstim, like it says on their bidons. This is royal jelly and superfood fruits extracts with potassium sorbate if you please.

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