The World Anti-Doping Code, published by the World Anti-Doping Agency (WADA), harmonises anti-doping regulations across all sports and in all countries. The Prohibited List of Substances and Methods is one of the International Standards that are mandatory for all signatories of the Code. The Prohibited List identifies the substances and methods prohibited in- and out-of-competition, and substances prohibited in particular sports. The updated 2024 Prohibited List has recently been published by WADA. Changes for prescribers to note for 2024 include:

• the prohibition of tramadol,  in-competition,  by  all  routes of administration and the addition of a minimum ‘washout period’ for athletes that use tramadol out-of-competition;
• the addition of minimum washout periods following rectal administration of glucocorticoids to the Glucocorticoid Washout Table and;
• the addition of several new examples to various sections of the WADA List.

S7. Narcotics

From January 1st 2024, tramadol will be prohibited in-competition. Athletes should allow a ‘washout period’ for tramadol of at least 24 hours. The ‘washout period’ refers to the time between the last administered dose and the start of the in-competition period (beginning from 11.59 pm on the day before a competition that the athlete is scheduled to participate in unless a different period was approved by WADA for a particular sport). For athletes currently taking tramadol, alternative permitted medications should be prescribed where possible. A Therapeutic Use Exemption (TUE) will be required to use tramadol in competition. Athletes must adhere to Sport Ireland’s TUE Policy and the Irish Anti-Doping Rules 2021 regarding Pre- and Post-test TUEs.

S9. Glucocorticoids

The ‘washout periods’ for rectal administration of glucocorticoids have now been included in the Glucocorticoid Washout Table (see below).

Athletes must adhere to Sport Ireland’s TUE Policy and the Irish Anti-Doping Rules 2021 regarding Pre- and Post-test TUEs. In all cases, if there are any reasonable permitted alternatives to GCs then the physician should document why the GC was the most appropriate treatment.