WADA Prohibited List and ADRV Principles

Anti-doping is governed globally by the World Anti-Doping Agency (WADA) through the World Anti-Doping Code, usually just called the Code. The Code harmonises anti-doping rules across sports and countries, so that the same core rules apply to a cyclist in France and a swimmer in Australia. Each country has a national anti-doping organisation that implements the Code, and in the United Kingdom this is UK Anti-Doping (UKAD). International federations and event organisers apply it within their own sports and competitions.

Underneath the Code sit a number of international standards, and the one clinicians meet most often is the Prohibited List, which sets out exactly what is banned. Others govern testing and investigations, therapeutic use exemptions, and the handling of results. The system rests on the idea of clean sport, protecting both the health of athletes and fair competition, and it applies to far more people than elite internationals, reaching any athlete who competes under the rules of a sport that has adopted the Code, which in practice includes many amateur and club competitors.

The Prohibited List is published by WADA and updated at least once a year, with the new list coming into force on the first of January. A substance or method is considered for the List if it meets any two of three criteria: that it has the potential to enhance performance, that it poses an actual or potential risk to the athlete's health, or that it violates the spirit of sport. A substance can also be listed if it has the potential to mask the use of other prohibited substances.

The List is organised by when substances are banned. Some are prohibited at all times, both in and out of competition, and these include anabolic agents, peptide hormones such as erythropoietin (EPO) and growth hormone, certain hormone and metabolic modulators, diuretics and masking agents, and prohibited methods such as manipulating blood or samples and gene doping. Others are prohibited in competition only, including stimulants, narcotics, cannabinoids and glucocorticoids, reflecting substances that mainly matter around competition. A few are prohibited only in particular sports, such as beta-blockers in precision sports like archery and shooting. The List also flags specified substances, those more likely to have been taken inadvertently rather than to dope, a distinction that affects how a case is judged rather than how serious it is, and substances of abuse such as cocaine and cannabis, which carry particular provisions when taken out of competition and unrelated to performance.

An anti-doping rule violation (ADRV) is any breach of the Code's rules, and there are eleven of them. The one most people picture is the presence of a prohibited substance in an athlete's sample, which operates on strict liability, meaning the athlete is responsible for what is found regardless of how it got there or whether they intended it. Closely related are the use or attempted use of a prohibited substance or method, and possession of one. Several violations concern the testing process itself: evading, refusing or failing to provide a sample, whereabouts failures for athletes in a registered testing pool, usually three within a twelve-month period, and tampering with any part of doping control. Others target the wider network around doping, including trafficking, administering a prohibited substance to an athlete, complicity in a violation, prohibited association with banned support personnel, and acts that discourage or retaliate against someone reporting to the authorities. The breadth matters, because a clinician can be exposed through administration, possession or complicity, not only an athlete through a positive test.

Because clinicians prescribe and inject, safe prescribing is where anti-doping becomes a daily concern rather than an abstract one. The first habit is to check: before giving any medicine to an athlete, confirm its status using a reference such as Global Drug Reference Online (Global DRO), which shows whether a substance is prohibited and in what circumstances. This matters for everyday MSK practice, since a glucocorticoid injection for a painful tendon or joint is prohibited in competition and carries a washout period, so timing and documentation matter.

Where an athlete genuinely needs a prohibited substance to treat a medical condition, a Therapeutic Use Exemption (TUE) may allow it. A TUE is granted only when four conditions are met: the substance is needed to treat a diagnosed condition, it is highly unlikely to enhance performance beyond a return to normal health, there is no reasonable permitted alternative, and the need is not the result of previously using a prohibited substance without a TUE. The clinician's role is to recognise when a treatment is prohibited, to consider a permitted alternative first, and, where none exists, to support a properly documented TUE application in good time rather than after the event. Treating athletes therefore means keeping the Prohibited List and the TUE process in mind as routinely as any drug interaction.

• •The World Anti-Doping Code and its international standards, including the Prohibited List and the standard for Therapeutic Use Exemptions, set the global rules and are published by the World Anti-Doping Agency (WADA).
• •UK Anti-Doping (UKAD) implements the Code in the United Kingdom and provides guidance for athletes and support personnel, including on medications and supplements.
• •Global Drug Reference Online (Global DRO) allows medicines to be checked against the Prohibited List for the relevant country and sport.
• •Faculty of Sport and Exercise Medicine (FSEM) and British Association of Sport and Exercise Medicine (BASEM) resources support clean-sport practice and safe prescribing for athletes.

• •The World Anti-Doping Agency publishes the Prohibited List, which is updated at least yearly and comes into force each first of January.
• •A substance is listed if it meets any two of three criteria, performance enhancement, health risk, or breach of the spirit of sport, or if it can mask other substances.
• •The List is grouped into substances prohibited at all times, in competition only, and in particular sports.
• •There are eleven anti-doping rule violations, and presence of a prohibited substance operates on strict liability.
• •A Therapeutic Use Exemption needs a diagnosed condition, no meaningful performance gain, no permitted alternative, and the need not arising from prior prohibited use.
• •Check every athlete's medicine against a resource such as Global Drug Reference Online, remembering that injectable glucocorticoids are prohibited in competition.