TRANSCRIPT

NCAA Banned Drugs and Medical Exceptions Policy: A stricter application – August 2009

HI – My name is Jerry Koloskie, and I am the chair of the NCAA competitive safeguards committee. 

As you know, the NCAA bans classes of drugs because they can harm student-athletes, and because they can create an unfair advantage in competition.  Some legitimate medications contain NCAA banned substances, and student-athletes may need to use these medicines to support their academics and their general health.  We have in place a procedure to review and approve legitimate use of medications that contain NCAA banned substances.

Our committee has the responsibility to oversee the banned drug list and review medical exception requests.  Physicians on the committee determine whether the use of a banned medication is warranted, and weigh the medical need vs the potential for abuse and for unfair performance enhancement.  This review protects not only the health and safety of the student-athlete, but the liability of the institution.  Banned substances should not be allowed unless there is sufficient evidence of medical need.

We’ve received a number of requests to grant medical exceptions in which the institution or student-athlete did not provide adequate documentation to show the student-athlete had undergone a diagnostic evaluation.  Most commonly this occurs in cases of ADHD – Attention Deficit Hyperactivity Disorders.

We often get asked what documentation is needed in order for the committee to grant a medical exception, so let’s consider these question:

Question. What types of medications fall under the NCAA medical exception policy?
Answer.  First, there is no medical exception for the use of street drugs.  The use of any medication that contains a banned substance must be approved.  For stimulants, diuretics, and anti-estrogen use, a request for review and approval should be made following the notice of a positive NCAA drug test.  For anabolic agents and peptide hormones, the request must come prior to the use of the medication. 

Question.  What documentation does an institution need to keep on file?
Answer.  The institution should keep on file a record of the student-athlete’s evaluation, diagnosis, the history of treatment, and a copy of the most recent prescription.  This documentation can be compiled in the form of a dictated letter from the prescribing physician if the letter includes the details previously mentioned.  There is no need to keep records of all testing, but rather to demonstrate that an evaluation has been conducted to achieve the diagnosis. 

Question.  What type of assessment is used to diagnose ADHD?
Answer.  There are a variety of tools used by clinicians to reach a diagnosis of ADHD.  Many children are diagnosed soon after they begin their formal schooling, and school psychologists and child psychiatrists use behavioral assessments such as the Conners Rating Scale or the DSM-IV ADHD Survey.  When a student-athlete is not diagnosed until they have already matriculated to your institution, the institution’s student support services or disability services can provide an assessment, using such tools as the Conners Adult ADHD Rating Scales (CAARS) or the Adult ADHD Self-Report Scale (ASRS) .  In any case, a student-athlete may go through their family physician for a referral for an assessment.

Question. Will an assessment conducted more than 5 years ago be acceptable?
Answer. Yes, if the student-athlete has been followed-up recently to confirm that continuing treatment is appropriate.  On the other hand, if a student-athlete has a history of treatment with stimulant medications for ADHD but has not undergone a diagnostic assessment for this condition, the sports medicine staff should refer the student-athlete for an assessment.

The important criteria is:  an evaluation has been conducted, the student-athlete is under ongoing medical care for the condition, and the student-athlete is being treated appropriately. 

Question.  Some athletes are embarrassed and don’t reveal that they are taking medication for ADHD, so the institution is unaware.  How is this handled when a student-athlete tests positive for using the medication?
Answer.  Of course, all medications should be reported to the sports medicine staff, so they can be informed in the event a student-athlete experiences any illness or injury while under their care.  Incoming student-athletes should be educated on the importance of this policy, and specifically advised of the need to share information about medications that may contain banned substances, such as Adderall or Ritalin.  Many new student-athletes are unaware they may be using banned substances.  Making it a requirement to report all medications as a part of the routine care, and naming a variety of examples, the sports medicine staff can help diminish embarrassment. The NCAA will also include information about this issue as it sends out information to prospective student-athletes.

If a student-athlete tests positive for a medication and has not provided documentation to the institution, an appeal hearing may be scheduled so that the student-athlete and the institution can gather that information.  Until the hearing takes place, the student-athlete must be withheld from competition as in any other positive drug-test case.

Question.  Do student-athletes need to be prescribed a non-stimulant medication for ADHD before using stimulant medications?
Answer.  The NCAA Medical Exception policy requires that a non-banned medication be used if available, but the medical community has generally accepted that with this age group, the non-stimulant medications are not as effective to treat ADHD.  The committee will approve the use of stimulant medications for ADHD without a prior trial with non-stimulant medicine.

For other medical issues, student-athletes need to provide documentation that non-banned medications indicated for the condition have been prescribed before using the banned medication.

These are the most common questions we have heard about the NCAA Medical Exception policy, but your institution may have a unique question or circumstance involving student-athlete use of banned medications.  For these, contact the NCAA Health and Safety Staff, at www.ncaa.org/health-safety .  Together we can assure that our student-athletes are able to compete in a healthy and safer athletics environment.