ADHD Medication and swimming

One of the main treatments for ADHD and ADD is methylphenidate in the form of Concerta or Ritalin (and a few other). Now this is an amphetamine so technically is a banned substance although it is used in small quantities. What are your thought on this when it is being used to treat a recognized condition?

Comments

  • IronMikeIronMike Northern VirginiaCharter Member

    Doctor prescribed? I'd think it would be ok.

    We're all just carbon, water, starlight, oxygen and dreams

  • ZoeSadlerZoeSadler Charter Member

    It depends if it is used in competition. A search for prohibited drugs can be carried out here http://www.globaldro.com/default.aspx

    The search here indicates that it is prohibited for use in competition, but I may have searched for the wrong drug http://www.globaldro.com/uk-en/search/BrandStatus.aspx?brandid=14267&countryid=2&sportid=94&exact=1&searchid=2017099&userid=1&show=All&search=ritalin&newSearch=false

    sharkbaitza
  • sharkbaitzasharkbaitza LondonMember

    So I guess, that means it's ok from a day to day point of view but you would have to abstain on the day of competition or event?

  • Leonard_JansenLeonard_Jansen Charter Member

    A couple things:
    I take Adderall (an amphetamine) and Effexor as treatment for bat-shit crazy levels of depression. The Adderall dosage is what would be given to a 70 lb child for ADD and I am about 3 of those kids. I don't consider that much of a performance boost, unless, arguably, not getting in a funk and deciding to drown myself in the middle of a race is a performance boost. However, if someone were to object to me taking it like I usually do in the AM before a race, I am more than happy to disqualify myself from any awards or the like - I just want the chance to swim and finish. Keep in mind, too, that suddenly not taking your meds can trigger such exciting things as excruciating headaches, tremors and even seizures. It's different for everyone, of course, but for myself, I can miss by up to about 6 hours, but then I get light-headed and a migraine that would kill a stone statue. Not good when swimming. Also, if you travel abroad to swim be VERY sure that your meds are legal in your destination country. For things like amphetamines, it is often the case that if it's considered a class 1 narcotic, you can't bring it into the country even with a prescription, doctor's note, or letter from the pope.

    -LBJ

    sharkbaitza

    “Moderation is a fatal thing. Nothing succeeds like excess.” - Oscar Wilde

  • SpacemanspiffSpacemanspiff Dallas, TexasSenior Member

    sharkbaitza said:
    What are your thought on this when it is being used to treat a recognized condition?

    I think the problem is with the very slippery concept of "recognized condition." In proportion to the ADD diagnoses, the use of amphetamines has exploded in the last 10 years, as has their social acceptance. In my profession, we even have adderall awareness/support groups sponsored by the local bar association. Everyone seems to think its OK, since "the doctor prescribed it." But, IMHO, doctors seem more "customer service" oriented these days when it comes to scrips, diagnoses, sick day excuses, etc. I just Googled "how easy is it to get Adderall" and got a list of local docs who would prescribe it, along a cheat sheet for the diagnosis questionnaire.

    The NFL won't disclose how many players have "medical exemptions" from amphetamine use for ADD, but Players claim "about half" of NFL players use adderall (about 10 times greater than the incidence of ADD in the general population). Is that because ADD sufferers are more likely to be world-class athletes? I suppose its possible. But I doubt it. It's far more plausible that NFL players want the amphetamines to improve their athletic performance and they find (or the team finds for them) a doctor to "diagnose" them with ADD.

    So the bigger question in my mind is not "do we allow amphetamine use for 'recognized conditions'?" but "how do we 'recognize' them?"

    JenA

    "Lights go out and I can't be saved
    Tides that I tried to swim against
    Have brought be down upon my knees
    Oh I beg, I beg and plead..."

  • JenAJenA Charter Member
    edited June 2015

    I have similar concerns, and have raised these issue to the MSF rules-drafting team.

    My concern is a bit more dramatic, though: if I rejected all substances identified on the World Anti-Doping Agency's list, I'd die. :) Insulin is officially performance-enhancing. (Since I have type 1 diabetes, I'd be enroute to coma/death within hours of turning off the ol' insulin flow.)

    WADA has a rigorous "therapeutic use exception" process. Perhaps MSF can consider something similar.

    https://wada-main-prod.s3.amazonaws.com/resources/files/WADA_TUE_Guidelines_V6.0_EN.pdf

  • IronMikeIronMike Northern VirginiaCharter Member

    We're not any of us (perhaps) Olympians or Olympian-wanna bes. I see this as similar to the caffeine debate some months (years?) ago. If your body is used to it, all of a sudden dumping it could have disastrous effects. Like @JenA states re: insulin.

    The last thing this world needs, or this sport needs, is someone awesome like @Leonard_Jansen not taking his Adderall and Effexor. I wouldn't want to compete in a race if he and Jen couldn't be there.

    And for the record, if either of these swimmers were to "chart a new course" in the open water somewhere, I'd loudly and vehemently defend their right to continue using the drugs that keep them alive and happy.

    JenA

    We're all just carbon, water, starlight, oxygen and dreams

  • JenAJenA Charter Member
    edited June 2015

    Not to jump on @IronMike (loads of respect to @IronMike), but the diabetes advocate inside me is begging to say: I don't think I'd say that my body is "used to" insulin. Insulin is like air: it's needed for basic survival.

    Without insulin, glucose can't enter your cells, and without glucose, it's all downhill from there. Ketosis. Coma. Death.

    Everyone needs insulin -- it's just that most people have insulin supplies that are "innies" (including most people with Type 2 diabetes), and mine is an "outie". :-)

    But, @IronMike, thanks for wanting me at your event! I'm touched. :D

    IronMikesharkbaitza
  • IronMikeIronMike Northern VirginiaCharter Member

    I'm not real big on science. I just know that w/o insulin, you'd die. I don't want that. ;)

    JenA

    We're all just carbon, water, starlight, oxygen and dreams

  • danswimsdanswims Portland, ORMember

    Isn't this all kind of a moot point anyway? I don't know the status of testing in the rest of the world but in the US the only drug testing in swimming that is being done is in the USA Swimming system and even there only at the higher levels of competition. So without testing if I choose to enhance my training with EPO the only thing that is required to get away with it is for me to keep my mouth shut and someone who is using a PED to boost performance is not likely to be saying much about it.
    The banned substances list is a long one and without a therapeutic use exception there are probably a number of people using medications for legitimate reasons who are technically out of compliance with the MSF rules, @JenA being the most striking example. A reality based bottom line is that if the medication you are taking is prescribed for a legitimate reason and you would be taking it regardless of whatever swims you are involved in it should be allowed and unless the rules committee is prepared and qualified to make case by case decisions on what is a legitimate use that judgement defaults to the swimmer's MD.

  • JenAJenA Charter Member

    The NFL statistic is fascinating.

    danswims said:
    Isn't this all kind of a moot point anyway?

    Well, the rules identify substances on the WADA list as performance-enhancing (http://marathonswimmers.org/rules/5_nonstandard-equipment/), which means every swim I do is technically performance enhanced. My insulin pump is also non-standard equipment. My wireless continuous glucose sensors, which aren't on the WADA list, could definitely be considered performance-enhancing equipment for anyone without diabetes. This is a relevant issue for me, which is why I previously raised it to the MSF rules team. I'm confident they'll tackle this topic fairly.

    danswims said:
    So without testing if I choose to enhance my training with EPO the only thing that is required to get away with it is for me to keep my mouth shut

    For me, this (and other 'is it still cheating if I don't get caught?' topics) is a 'spirit of marathon swimming' issue.

    Here's a straw man to beat: there's athletic advantage to taking insulin. Insulin, taken in large quantities immediately after a workout, helps restock glycogen. You recover faster. Someone could go to their doctor and whine, "But I feel so tired after workouts! Can you give me something to help restock my glycogen? My training partner/top competitor uses insulin, and I know it works really well for them. There's prize money on the line here, and my kid needs a kidney transplant...". Depending on the doc's attitudes/expertise, they could end up with advice or a prescription for insulin (it's often available over the counter).

    Insulin would probably make them feel better -- and then they'd have medical support and a reason to truthfully say, "Hey! If I go off this insulin stuff, I'm not going to function as well.".

    There are continuums between "medically necessary", "medically beneficial", and "purely performance enhancing".

  • danswimsdanswims Portland, ORMember

    @JenA of course it is still cheating if you don't get caught and this is a sportsmanship/spirit of the sport issue across all sports but for those inclined to cheat the rules are only as good as far as they can be enforced. That is why I suggested that what medications are or are not allowed within the MSF rules is moot as testing isn't being done so there is no way to enforce it beyond a given swimmer's integrity.

    As an aside, using insulin to improve recovery sounds like a pretty dangerous way to cheat. Too much insulin can kill you much more quickly that not enough.

    I understand your issue and why as a swimmer with integrity you want to have the things that you need to use to stay alive recognized as being acceptable within the rules, but only for those who need them. If the rule drafters take this up I wish them good fortune because that continuum from medically necessary to purely performance enhancing is full of gray areas.

    JenA
  • JenAJenA Charter Member

    @danswims, I think, at a certain point, all you have is honour and knowing that, in your heart and in your head, you followed the truest essence of the spirit of marathon swimming.. :) (I wasn't suggesting, at all, that cheating was OK as long as you didn't get caught. I meant performance-enhancing drugs "and other similar topics".)>

    danswims said:
    As an aside, using insulin to improve recovery sounds like a pretty dangerous way to cheat. Too much insulin can kill you much more quickly that not enough.

    I'm not suggesting overdosing. As I understand it, the energy can be stored in its usual locations in greater/lesser amounts when taken at different times post-exercise.

    You poor, poor folks without type 1 diabetes don't know what you're missing. ;-) (Actually, I have no idea how effective the technique is.)

    Personally, were I aiming for a world record or a "best in class" claim, I'd probably arrange for voluntary drug testing.

  • dpm50dpm50 PA, U.S.Senior Member

    I was prescribed Concerta some years back. Instead of my performance being enhanced, it was impeded. My normal resting heart rate is in the high 30s/low 40s. With the prescription drug, it shot up when I ran (I was at the time primarily a runner), so that it was uncomfortable in particular to run hard. I had to ease off to bring my heart rate down. So if this enhances performance, I'm missing something. I stopped taking the med b/c of this.

    sharkbaitza
  • Leonard_JansenLeonard_Jansen Charter Member

    IronMike said:

    >

    The last thing this world needs, or this sport needs, is someone awesome like @Leonard_Jansen not taking his Adderall and Effexor. I wouldn't want to compete in a race if he and Jen couldn't be there.

    Awww.... shucks.... this could be the start of a beautiful bromance... Thanks.

    As I said, I'm perfectly happy if someone wants me to disqualify myself from a share of the fabulous riches that 60 year old men regularly garner from marathon swimming, as long as I can swim, finish and maybe get a finisher's certificate.

    That said, I wouldn't have any objection to an MSF rule that said that people using medically necessary drugs had to declare it up front, couldn't win anything and couldn't set records, but could swim. However, that is the perspective of someone who isn't going to win much of anything anyway and is never going to set a record. A faster/younger person might feel differently.

    As to @JenA's case, it seems to me that diabetes qualifies as a handicap, if anything. Everyone I have every known with diabetes seems to have a 24 hr/day job with it. No thanks - being crazy is no box of chocolates, but managing it is easier than with diabetes.

    -LBJ

    IronMike

    “Moderation is a fatal thing. Nothing succeeds like excess.” - Oscar Wilde

  • msathletemsathlete Victoria, British Colubia, CanadaMember

    The use of any type of drug has been an interesting point of discussion for the Masters Swimming Association of British Columbia. We have had a number of lively discussions on this topic. What we are finding is that as one ages the use of prescribed drugs is more likely then when one was a teen our young adult. For example, there are a number of males over 50 who have been prescribed testosterone.

    My own feeling about this and many of the other topics I see on the forum is that we have to look for more ways to bring people into the sport rather than keep them out. In the case of those of us with disabilities it is hard enough for us to participate in this and other sports to begin with. We have a number of challenges that we face every day that can put us at a disadvantage - I would hope that our counterparts who do not have disabilities understand that there are things that we may need to do to put us on an equal playing field or in come cases just participate.

  • JenAJenA Charter Member

    msathlete said:
    I would hope that our counterparts who do not have disabilities understand that there are things that we may need to do to put us on an equal playing field or in come cases just participate.

    @msathlete presents an interesting perspective.

    I don't think an equal playing field would be fair -- we all have something that prevents us from swimming like Michael Phelps. (Well, except for Michael Phelps, that is.)

    I can't imagine what an equal playing field would look like for someone with type 1 diabetes. "You lost 4 minutes this half hour testing your blood glucose? Poor dear. Here, hold on to your feeding rope, and we'll drag you to where you would have otherwise been."?

    Much like @Leonard_Jansen, I just wanna swim. :-) Diabetes adds challenges, and sometimes it stops me, it's mostly not a barrier to participation (given freakish amounts of effort invested into managing it).

    I reflect on whether or not it would be unfair to use a wireless reader that predicts blood glucose from interstitial fluid. It's an newish technology that is becoming more common, more accurate, and less expensive. It could mean no more finger pokes while swimming. Finger pokes cost me 3-5 minutes per half hour, and take progressively longer with colder fingers.

    After all, we all experience dips and rises in blood sugar while swimming. Sure, my fluctuations can cause unconsciousness, coma, and death, but I could see it argued that I have an unfair advantage. What if my crew manages my blood glucose levels so carefully that they prevent 'glycemic excursions' from happening? Then, in terms of blood glucose management, I'm better off than those without type 1 diabetes. Real time wireless glucose readings may fall into the franken-watch category.

  • Leonard_JansenLeonard_Jansen Charter Member

    A bit of a nuclear explosion just occurred in the Track & Field world, with Alberto Salazar, the head coach of the Nike Oregon Project, being (credibly) accused of using PEDS on his athletes. You can see the BBC documentary here: https://youtube.com/watch?v=YbuAo6YQSHk
    The first half hour or so isn't about the NOP, but is still interesting, especially when the reporter takes PEDS to see what will happen.

    -LBJ

    “Moderation is a fatal thing. Nothing succeeds like excess.” - Oscar Wilde

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