Safe prescribing in sport combines the ordinary principles of good prescribing with issues specific to athletes and to working away from a hospital, chief among them the anti-doping rules. Every prescription should be the right drug, at the right dose, for the right patient, with interactions, storage and record-keeping handled properly. For the sport and exercise medicine (SEM) clinician, medicines management also means checking each drug against the anti-doping rules, handling supplies at events and while travelling within the right governance framework, and keeping clear, confidential records. This page covers the principles of safe prescribing and drug interactions, medicines governance and storage, travelling with medicines, and the athlete-specific checks that prevent an inadvertent anti-doping violation.
What are the principles of safe prescribing?
Safe prescribing starts with the basics that apply to any patient. The drug should be clinically indicated and matched to the person, taking account of allergies, other conditions, pregnancy and breastfeeding, and kidney or liver function, which often change the choice or the dose. Interactions matter: common examples in this setting include non-steroidal anti-inflammatory drugs (NSAIDs) with anticoagulants or with antihypertensives, and any combination that affects the heart's rhythm, and polypharmacy raises the risk. Prescriptions should be clear and unambiguous, with the dose, route, frequency and duration specified, and the patient given enough information to take the medicine safely. In the UK, this sits within professional standards such as the General Medical Council guidance on good practice in prescribing and managing medicines.
Safe prescribing means the right drug at the right dose for the right patient, checking allergies, comorbidities and organ function, watching interactions and polypharmacy, prescribing clearly and conservatively, and in sport adding an anti-doping check of the exact product.
Good prescribing is also about restraint. Using the lowest effective dose for the shortest appropriate time, reviewing continued need, and avoiding medicines that are unnecessary all reduce harm. In sport there is a particular temptation towards medicalising normal training discomfort or reaching for injections and supplements, and part of good practice is recognising when the best answer is not a prescription at all but rest, rehabilitation or reassurance.
Medicines governance, storage and travelling with medicines
Away from a clinic, medicines still have to be handled within a clear governance framework, and who is responsible depends on the employing organisation, who owns the stock, the standard operating procedures in place, the relevant legal authority and the named accountable staff; the clinician remains responsible for their own prescribing, supply, administration and records. Medicines must be stored correctly, keeping to the cold chain for drugs that need refrigeration, protecting them from heat and light, checking expiry dates, and keeping an accurate log of what is held, given and disposed of. Emergency drugs for the pitchside bag need to be present, in date and familiar to the team.
Controlled drugs carry extra legal requirements around storage, records and who may lawfully possess them, and these are not set aside when a team travels. A personal controlled-drug licence covers an individual carrying their own prescribed medicine and is not the right mechanism for a doctor carrying stock for a squad; taking squad supplies across borders may require Home Office import or export licensing, appropriate custody arrangements, and permission from every destination and transit country, with rules that vary between countries. Records carried while travelling should be a secure, minimum-necessary clinical record accessible only to authorised healthcare staff, maintaining each athlete's confidentiality at borders, hotels and venues, rather than an openly shared list. Planning ahead and taking sufficient but not excessive quantities reduce problems and make safe treatment easier in an unfamiliar setting.
Prescribing for athletes: the anti-doping check
The step that sets sports prescribing apart is checking every medicine against the anti-doping rules before it is given, though this check must never delay emergency or clinically necessary care: where treatment is urgent, the clinician treats first, documents fully, and addresses the anti-doping process as soon as practicable. For non-urgent prescribing, a resource such as Global Drug Reference Online is used to check the exact UK product against the current World Anti-Doping Agency (WADA) Prohibited List; the search reference is recorded, and the check is repeated after any change of product, route, dose or competition timing and when the annual rules change. Global Drug Reference Online checks medicines, not supplements, and a product sold under a similar name in another country may have a different formulation, so nothing is assumed from the name alone.
The anti-doping prescribing check: never delay urgent care, then for non-urgent prescribing verify the exact product against the current WADA Prohibited List and record the reference; if prohibited, seek a therapeutic use exemption where required. This reflects the rules at the time of writing; always check the current WADA Prohibited List, which changes.
Two principles are essential. First, a doctor's prescription alone does not permit an athlete to use a prohibited substance; where a prohibited drug is genuinely the right treatment and a therapeutic use exemption (TUE) is required, it is applied for prospectively, with retrospective applications allowed only where the applicable anti-doping rules permit, such as emergency or insufficient-time circumstances, and a retrospective application is not guaranteed to be approved. Second, supplements are a real hazard, because they are poorly regulated and can be contaminated with prohibited substances; recognised batch-testing schemes reduce, but cannot eliminate, this risk, and they do not certify that a supplement works or guarantee that an athlete avoids an anti-doping rule violation. Under the principle of strict liability, an athlete is generally responsible for whatever is found in their sample. Clear records of what was prescribed, why, and the checks performed protect both the athlete and the clinician.
Exam Tips
•Match the drug to the patient, checking allergies, comorbidities, pregnancy, and kidney and liver function, and screen for interactions such as NSAIDs with anticoagulants; reduce risk from polypharmacy.
•Who is responsible for team medicines depends on the organisation, stock ownership and standard operating procedures; the clinician remains responsible for their own prescribing, supply and records.
•Store medicines correctly (cold chain, heat, light, expiry) and keep secure, confidential, minimum-necessary records; controlled drugs carry extra legal requirements even when travelling.
•A personal controlled-drug licence is for an individual's own medicine; carrying squad stock abroad may need Home Office import or export licensing and permission from every country involved.
•Anti-doping checks must not delay urgent care; treat first when needed, document, and check the exact product on Global Drug Reference Online, recording the reference.
•A prescription alone does not permit a prohibited substance; retrospective therapeutic use exemptions are allowed only where the rules permit and are not guaranteed, and batch-tested supplements reduce but do not remove contamination risk.