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Anti-doping efforts have again kicked into high gear as nearly 600 disabled athletes from around the world compete over the next nine days in the Vancouver Winter Paralympics.
Experts in the fight against doping in sport say that while there are some unique challenges in doping control for the Paralympics, in most ways doping practices among Paralympians are the same as those employed by their Olympic counterparts.
Same drugs. Same goals.
Dr. Don Catlin, a veteran of the anti-doping wars, says he used to think Paralympians would be less likely to dope - until he started analyzing samples collected from this pool of elite athletes.
"I was pretty much aghast because I found anabolic steroids and other stuff like I was finding in the regular (Olympics)," he says, harkening back to the 1980s before crackdowns on steroids began.
"What was surprising to me was that these people would take the regular doping drugs," says Catlin, founder of Anti-Doping Research Inc. and the man who ran the testing labs for the Los Angeles, Atlanta and Salt Lake City Olympics.
"I had sort of hoped, I guess, that because of whatever their disability, that they would have a different outlook towards sport and competition."
But the drive to win at any cost isn't exclusive to the Olympics or professional sports. And if Paralympians set out to cheat, they often do it the same way their Olympic counterparts do, says Don MacQuarrie, director of ethics and doping for the Canadian Centre for Ethics in Sport.
The centre is the body that oversees Canada's anti-doping efforts for both Olympic and Paralympic athletes. In the months leading up to the Paralympics, the organization tested about 86 per cent of the Canadians competing in Vancouver.
"Paralympic athletes have the same bodily systems," says MacQuarrie, who notes no Canadian athletes are sitting out these Games because of pre-Paralympic testing.
"In terms of the endurance sports, it's typically blood boosting technologies that are more likely to be the subject of abuse. In other sports where power is an issue, we'd be looking for substances like (anabolic steroids)."
Blood boosting refers to the use of drugs like EPO - erythropoeitin - which stimulate production of oxygen-transporting red blood cells and blood transfusions, where athletes are given transfusions of their own blood before competition.
Just as weightlifting has one of the worst track records of Olympic sports, powerlifting is the Paralympic sport with the highest rate of positive cases. At the Athens Paralympics in 2004, all 10 athletes who tested positive for performance enhancing drugs were powerlifters.
Athletes who compete in both the Paralympics and Olympics are subject to the same prohibitions when it comes to drugs and technologies that have been determined to be performance enhancing.
"We both are world anti-doping code compliant," says Dr. Peter Van de Vliet, medical and scientific director of the International Paralympic Committee.
"That means that the list of prohibited substances is exactly the same. The procedures to be followed is exactly the same."
But many drugs on the list can be used by athletes, if they have a legitimate medical need, so long as they obtain a waiver in advance. That waiver is called a therapeutic use exemption or TUE.
For example, asthma inhalers are banned for non-asthmatics, but athletes who have asthma are entitled to use them, as long at they document their condition and are granted a TUE. Athletes who wanted a TUE for the Vancouver Games had to apply for one by March 5.
One might think Paralympians, some of whom have complicated medical conditions, would require more drug exemptions. But in fact, a recently published study looking at data from the 2004 Athens Paralympics and Olympics pointed to more waivers among Olympic athletes, Van de Vliet says.
Still, there are some differences and some unique challenges for those trying to police cheating in Paralympic sport.
For one thing, athletes who are partially paralyzed can take advantage of a side-effect of their condition to give themselves a competitive edge. In the Paralympic world, it's a technique called boosting.
Certain stimuli that would cause pain in people who aren't paralyzed can trigger what's called autonomic dysreflexia, a situation where the blood pressure rises sharply. That can give athletes a significant edge in events which involve distance racing, for instance.
"The reason why we monitor boosting is we know from clinical investigations that autonomic dysreflexia impacts on your capacity to excel in performance," says Van de Vliet.
At the Winter Paralympics, the sport where boosting might be used is cross-country skiing. At the Summer Games, it's sometimes seen in rowing, cycling, athletics and swimming, he says.
Some of the techniques used to trigger autonomic dysreflexia can't be detected easily. So medical officers at events where it may be in use can ask to check an athlete's blood pressure before an event.
If the systolic blood pressure reading (the higher figure) is above 180, the athlete is informed he or she will be tested again in a few minutes. If the second test shows the systolic blood pressure reading is still over that threshold, the athlete isn't allowed to compete, Van de Vliet says.
There are other challenges, including special testing procedures for athletes who urinate via a catheter. To ensure they give a fresh urine sample for testing, they must first drain their existing equipment and where possible, use a new catheter to produce the sample.
Another difference relates to the fact that some of the sports allow visually impaired athletes to use guides. Where there is a guide, he or she must also pass doping control. For the purposes of the sport, the athlete and the guide are a single unit, MacQuarrie says.
Van de Vliet says the International Paralympic Committee plans to conduct about 425 drug tests at the Vancouver, a roughly 42 per cent increase over the number done at the last Games, in Turin. There were no positive doping cases at the Turin Paralympics.
