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Sports medicine professionals and the drug testing process

This is an excerpt from Clinical Pharmacology in Athletic Training by Michelle A. Cleary,Thomas E. Abdenour & Mike Pavlovich.

The Drug-Testing Process

Typically, a drug-testing session can be scheduled with Drug Free Sport by the institution or the governing body during an athlete’s competitive season or in the off-season. Drug Free Sport furnishes the names of the athletes to be tested on the scheduled day to the institution or team, which is then responsible for contacting the athletes. Many institutions have their own versions of drug-testing programs—for example, for violations of team rules or in anticipation of testing prior to an NCAA event. Once testing is scheduled, Drug Free Sport assigns a trained doping control officer (DCO) to the screening site, which can be a college campus, an event venue, or the athlete’s home. The National Center for Drug Free Sport identifies approved laboratories for analysis and provides a consistent drug-testing program. This organization is unbiased and free of conflicts of interest with the institution or athlete involved in the screening. Selection for drug testing is random unless a specific athlete requires a follow-up test.

Drug-Testing Techniques

Current drug-testing techniques offer many advantages and some limitations. For example, urine specimens are relatively easy to obtain and are cost effective (table 21.2).^10,37,40 However, the presence of a witness during urine collection can be considered intrusive. Blood, hair, saliva, and sweat have also been used as drug-testing specimens in various settings, and each technique has advantages and drawbacks (table 21.3).^8,37 It is likely that mass drug screening conducted by the NCAA and U.S. professional sports leagues will continue to use urine specimens.

The AT’s Responsibility for Drug Testing

An AT designated by the institution or team is usually the point-of-contact person with the athletes during the drug-testing process. If the screening is announced in advance, the AT contacts each athlete with the specific logistical information for the test, including time and location. If the testing is unannounced, the AT is usually the person responsible for informing athletes of their selection for testing when they arrive at the venue. The AT has a series of responsibilities prior to and during the drug-testing process:

• Prior to drug testing, the AT secures the marshalling location, necessary restrooms, and the location where the Drug Free Sports representative will receive the specimen from the athlete and prepare it for shipment to the laboratory.
• During the drug-testing process, the AT may provide athletes with appropriate water or sports beverages in sealed individual containers to facilitate urination, if needed. This is particularly beneficial for dehydrated athletes. Individually wrapped snacks may also be provided if the urine is too dilute and the athlete has to produce another sample.
• The DCO, not the AT, accompanies the athlete to the restroom for specimen collection.
• Once drug testing is underway, the AT serves as the representative for the institution or team. The AT witnesses the documentation of the process and troubleshoots any problems that interfere with specimen collection.
• Occasionally, an athlete has trouble producing a specimen. In these instances, some light-intensity exercise may be beneficial. In these cases, the AT may escort and accompany the athlete to the necessary fitness equipment.
• After the athlete has produced a specimen, the AT accompanies him from the restroom to the specimen collection area to ensure there is no opportunity to introduce a masking agent or device into the specimen.
  
  

Ideally, ATs should not handle the specimen at any point during the collection process (table 21.4),^3,12,25 including specimen collection, analysis, or shipping to the testing laboratory. Testing at championship events is organized in a similar manner. Athletes are contacted at the first available time, such as once the event finishes, and they cannot leave the venue until the specimen is collected. In the event that an athlete is required to stay at the venue, the AT is usually the person who remains with the athlete. The steps of the NCAA drug-testing program specimen collection are similar to drug-testing protocols in other levels of international competition or professional sports.

Laboratory Testing

In early drug-screening programs, some intercollegiate ATs conducted point-of-care tests in their athletic training facilities. These tests are subject to many variables and unreliable, which prompted the recommendation that ATs use an outside source and limit their involvement in collecting or packaging specimens.^12,23 Current recommendations are that drug testing in the United States should be conducted by Drug Free Sport or a WADA-approved laboratory for international competition. There are 32 WADA-approved laboratories across the world, including in Africa, the Americas, Asia, Europe, and Oceania, with U.S. laboratories in Los Angeles, California, and Salt Lake City, Utah.⁴⁵

Although ATs are not responsible for analyzing specimens for banned substances, they should have a general understanding of the testing techniques. The enzyme-multiplied immunoassay technique (EMIT) is an immunoassay testing modality that is generally used to screen the A sample of a specimen. The EMIT test employs visible spectroscopy to measure the presence of certain chemicals or molecules in a substance by evaluating the interaction of those chemicals with specific antibodies or antigens. A positive result from an EMIT test indicates that the test subject has been exposed to the tested drugs, but does not indicate the exact measure of drugs in the athlete’s system. In most instances, when an EMIT test reveals possible drug use, the sample will then be followed by a more detailed confirmation test. An example of a substance that would merit a more detailed examination is poppy seeds, which contain morphine and may mimic the presence of an opioid; however, under normal circumstances, the amount present from eating a product with poppy seeds will be well below the level required for detection.

A positive test from sample A requires a separate confirmatory screening of sample B. In institutional testing by the National Center for Drug Free Sport and NCAA championship or year-round testing, the athlete can request that the B sample be tested. He can also personally request to witness the B sample test or have a representative witness it. This confirmation test is generally conducted via gas chromatograph–mass spectrophotometer (GC–MS), which can identify small quantities of a substance to confirm the presence of a specific drug. The gas chromatograph component separates the different drugs or metabolites in the specimen and the mass spectrophotometer component identifies the specific drugs or metabolites.³ The GC–MS analysis is generally used for testing anabolic steroids and confirming a positive A sample test.⁷ This technique is the most accurate and reliable testing method; however, it is the most time-consuming and expensive screening technique.

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