Tramadol test is a big deal but there are still loopholes in the system, says expert

The introduction of a tramadol test within professional cycling has been welcomed by leading doctor Prentice Steffen, though the American has warned that the test is just one element in the ongoing fight against doping and that there have been several recent reality checks to prove that doping is still a factor.

Steffen was the first doctor to raise concerns over the abuse of tramadol, which is a powerful painkiller. In 2012 he brought the drug to the attention of Roger Legeay at the Movement for Credible Cycling (MPCC) and the Frenchman petitioned for a complete ban on the substance.

Riders have used the substance in both training and racing, with a consensus that it reduces pain, while also delaying reactions. It has been blamed for causing crashes, as a result.

Although tramadol has been on WADA's 'monitoring list' for a number of years, the UCI took measures to bring in tests for the drug from March 1, with the first batch of controls taken at Paris-Nice earlier this week.

Riders and teams will face punishment if any trace drug is detected, though the levels of punishment are far less severe than if a rider tests positive for a drug such as EPO or testosterone. If a rider tests positive for tramadol they face disqualification from the race they are participating in and a fine. For a second offence, they could be handed a five-month ban. A third positive would result in a nine-month suspension.

"I think this is a big deal. We looked at three areas: Is it dangerous? Is it performance enhancing? And is it against the ethics of the sport? As a group, the MPCC doctors and directors, we all agreed that it was a yes in all three areas. It was clear cut that it should be on the WADA list," Steffen told Cyclingnews after the first tests for tramadol were carried out.

Teams have admitted to using the drug in the past. In December 2013 Team Sky told Cyclingnews that the painkiller had been prescribed 'minimally'. In 2014 former Team Sky rider Michael Barry admitted to The Times that, "Tramadol made me feel euphoric, but it's also hard to focus. It kills the pain in your legs, and you can push really hard."

Steffen has been consistent in his stance since 2012, calling for the drug to be banned both in and out of competition.

"I think that it really is a problem. It dulls the senses, however slightly. I think reaction time has to be slightly delayed. You know what it's like in the peloton, if one rider has a delayed reaction time of a tenth or a hundredth of a second, it could lead to disaster.

"The research is also being done but it stands to logic that if it is hard to go hard on the bike, that if you can decrease the pain a bit, then you can go a bit deeper and perform a little better. Those were the primary concerns."

Other drugs and other methods

One concern in both the present and the future is that those seeking an advantage from painkillers will simply identify a stronger substance that isn't banned or on WADA's monitoring list. Steffen, who worked for several years at Slipstream Sports and is now part of the Rally Cycling team, stressed that tramadol's strength was that it could neatly balance out the need to subdue pain while keeping athletes on the edge of high performance.

"Tramadol gently stimulates the opioid receptors. In doing so only gently, the side effect profile is favorable for a cyclist. So, if you take something heavier like codeine then it's going to dull your senses even more and it might be detrimental to performance," he said. 

"I understand the theory that there are other medications being used but I don't think they'd be as advantageous. We do think about that, though; that we make tramadol illegal and the guys look for something else. Tramadol is almost in a special category, pharmacologically, I would say.

"People are looking to smaller drugs for smaller advantages. This is just one piece in the puzzle and it's about closing another loophole in a system that has a few holes in it."

The introduction of the tramadol test has taken several years but, like the no-needle policy - another element that Steffen and the MPCC called for before the UCI adopted the position - it only represents a small piece of the puzzle in the fight against doping.

The manipulation and abuse of the Therapeutic Use Exemption (TUE) system that members of the British parliament highlighted in the wake of the Team Sky, Bradley Wiggins Jiffy bag affair, along with the more damning revelations of a blood doping ring that was recently uncovered within Austria, provide clear evidence that the sport still has work to do. Steffen described both as "good reality checks that the problem isn't solved", before adding: "Despite all the news from Austria it does feel like we've made some real headway with the hard drugs or heavy drugs."

The case in Austria, which is not yet concluded but has prompted two doping admissions in the last fortnight, has raised questions over the Biological Passport. The blood monitoring system was introduced just under a decade ago with five cases immediately opened.

However, since then only nine riders have been successfully banned directly as a result of the passport, although more have been subject to targeted testing and eventual bans as a result of the blood profiles. That said, the recent case in Germany involving sports doctor Mark Schmidt and several athletes from Austria has raised old questions regarding the effectiveness of the passport and whether micro-dosing and other factors can facilitate doping without triggering warning signs.

"I'm a little shocked that people are still trying to do that," Steffen said in relation to the Schmidt case. "The passport certainly hasn't proved to be what we thought it might. Some of us who are maybe not experts in that area had higher hopes that more cases would be generated and that it would be more bulletproof than it appears to be. That said, there's probably some dissuasive value that I wouldn't want to underestimate."

According to Steffen, the biggest threat to clean cycling isn't perhaps one substance or rule, but that individuals and groups are willing to still take risks.

"What immediately comes to mind is the Dr. Schmidt situation. People are still going to pretty extreme and desperate measures, against all the safeguards that we've put in place," he said. 

"It's still much, much better. The safeguards that have been put in place, such as the whereabouts programme and out of competition testing, really are effective. From the teams that I've worked with and people that I know, the culture really is changing. Riders never really wanted to dope, and they still don't want to, and I think there's now a culture that thinks it's not necessary."