To go further: three questions for Doctor Jacomet

Three questions to Dr. Jacomet about the 2019 prohibited list and the monitoring of certain products, including caffeine.

A member of the Monegasque Anti-Doping Committee, Dr Jacomet has agreed to deepen the analysis of the 2019 Prohibited List, which entered into force in January 2019, which places new products, such as Bupropion, under surveillance and which puts them under fire. well-known old spotlights, like caffeine.

Hospital biologist
Pharmacologist-Toxicologist at the CHU de Nice
Head of department of the biological addictology and toxicology laboratory at Arcchet 2 hospital
Head of the Doping Prevention Medical Unit (AMPD) in the PACA region

Expert at the Aix-en-Provence Court of Appeal
Why does caffeine remain on the watch list? What are its effects on the body and to what extent it can be considered as a doping product?

Caffeine has been a known stimulant for centuries. We even know with certainty nowadays that it is both psychic and physical stimulant. But, given its extensive use by humans, it seems impossible to ban it completely in sport. Especially since it would be necessary to ban the consumption of coffee, tea and chocolate which contain all three.

The first bans in sport logically focused on stimulants and it is even they who feed the longest list of prohibited substances. WADA specifies that “All stimulants are prohibited” and that all analogues, by chemical structure or biological effect, of a listed stimulant molecule are also prohibited. So there is no other solution than to keep caffeine under surveillance since it cannot be authorized or prohibited as the World Sport Code would like.

Nicotine is also one of the substances under surveillance, alongside products such as Bupropion, often used in the context of smoking cessation. What can you tell us about these products, their links and their presence in the monitoring program?

Nicotine :

Nicotine is a paradoxical stimulant. It instantly produces relaxation (parasympathomimetic effect) but the body reacts just as instantly to adrenergic stimulation (sympathomimetic) exactly the opposite. This paradoxical effect leads to a powerful addiction in humans who find twice their happiness there.

In the athlete, nicotine can be dangerous because the heart needs to know in which direction it must make an effort. It cannot be both more and less of the risk of causing a heart rhythm disorder. Therefore, the expected benefit is above all predictable before physical effort and to prevent stress from entering the stadium, track, courts, etc.

As with caffeine, given its extensive use by humans, it seems impossible to ban it completely. So there is no other solution than to keep it under surveillance since it cannot be authorized or prohibited as the World Sport Code would like.

Bupropion :

Smoking cessation is mainly done by direct substitution with nicotine, in particular in a much more effective patch, although the success is quite limited (20% maximum success at 1 year).

Bupropion is considered a stimulant because its chemical structure is derived from amphetamine and its effect at the cellular level increases circulating dopamine and norepinephrine. However, WADA specified that any molecule having a structural relationship or an effect comparable to another stimulating molecule (here amphetamine) should be banned. In other words, in the doubt of a clearly demonstrated doping effect, they are all prohibited.

If the stimulating molecules had all the same effects and were really comparable to amphetamine or any other reference molecule, there would not be as many molecules available that differed from each other in structure or effect. So, what is punishable with molecules like bupropion is the search in itself for a doping effect, even without demonstrated success. The search for a doping effect is contrary to the ethics of sport, one of the three items set by the World Sports Code. But, in doubt of a demonstrated effect on performance, WADA has chosen for the moment to put it only under surveillance.

The 2019 List ultimately brings few changes. Do you think there are any products that should have been included or included in the monitoring program?

The role of WADA is to ban all substances: 1- which have an effect on performance, 2- which endanger the health of athletes or 3- which are unethical in sport. Consequently, all drugs and substances likely to have an effect on the body are intended to be banned. Which is all in all logical.

The difficulty is then to be able to identify them in the laboratory without being mistaken in eliminating the false positives. The search for a fair sanction would also require taking into account a demonstrated effect on performance and therefore on obtaining a place or an unjustified gain. As for the effect on health, it goes without saying that the risk is never zero to obtain an undesirable effect more or less serious in the short, medium or long term on an organism launched at full physiological speed as required. the high sporting level.

To achieve this, it is essential to monitor all substances to better understand them before including them in a prohibited list.