For many, professional cycling and doping will always be linked, the past ‘misdemeanours’ of Lance Armstrong and numerous others tarnishing the sport forever.
But as anyone who follows the professional road side of the sport will be aware, it’s remained relatively free from doping headlines over the past few years, save for Operation Aderlass in 2019 where endurance athletes including cyclist Stefan Denifil doped under German physician Mark Schmidt.
Does that mean the sport’s generally cleaner than ever? Are the testers winning the battle? What drugs do riders look to to ride higher, faster and stronger with? Cyclist has delved deep into the world of doping and anti-doping…
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Why do riders dope?
Why do riders dope? In many ways it’s an obvious answer with many layers. The obvious is that they want to win, that their personality and ego cannot face defeat, no matter what the costs.
There was certainly a time in the 2000s where illegal drug abuse was so rampant that a rider’s defence would be that they wouldn’t stand a chance of earning a living if they didn’t dope and level the playing field. Scottish rider Graeme Obree, who broke the hour record in the 1990s, said he couldn’t become a professional road rider because he wouldn’t dope.
However, physiologist Michael Joyner scratches a little deeper. Joyner wrote a piece in 2013 suggesting that one of the reasons why sports(wo)men dope is down to game theory, that athletes are in a game with one another with each vying for the best result and highest salary.
If the athlete feels testing and enforcement are lax, the risk of being beat by a doper is perceived to be larger than the risk of getting caught. In short, doping becomes the optimal strategy for victory.
And that’s even taking into account the health risks. There’s a well-known survey in sport known as the Goldman Dilemma where researcher Bob Goldman asked elite athletes in the 1980s whether they would consume a drug that guaranteed them a gold medal but would also kill them within five years.
More than half of the athletes responded ‘yes’. Goldman repeated the survey biannually for the next 10 years and the results were always the same.
In 2009, researchers asked non-elites the same question in the British Journal of Sports Medicine. Only two of 250 people surveyed said they would take a drug leading to success but premature death, which shows that not only an elite athlete’s desire to win is different than the general population, but also that recreational athletes would dope, even if a minor percentage.
That’s certainly the case in cycling, where a 2017 survey came back that one in 20 amateur cyclists had doped.
Why would they with no money and livelihoods on the line? There’s certainly an argument that it’s down to ego and pride, which can be just as strong a motivator as money. Men especially are motivated by status and honour in their tribes, going back to our Palaeolithic ancestors. Even just being top dog in a local cycling club can be a real ego boost to a lot of cyclists.
Who makes the rules?
WADA, the World Anti-Doping Agency.
Cycling, as you can imagine, played a pivotal role in its formation after the Festina Affair of 1998 rocked the world of sport. Many fans will be well aware of the Festina Affair but it warrants a reminder.
On 8th July 1998, soigneur Willy Voet was stopped by customs at the French border near the city of Lille. On opening Voet’s boot, officers found steroids, erythropoietin (EPO), syringes and other doping products.
His team, Festina, had their hotels searched, along with many other teams. Festina were ejected from the Tour, leaving main rider Richard Virenque in tears. The repercussions of the Festina Affair rippled for years as riders and doctors from a number of teams, including ONCE and TVM, were prosecuted for doping.
It proved a watershed moment for sport. In February 1999, the International Olympic Committee (IOC) convened the First World Conference on Doping in Sport in Lausanne, Switzerland, which brought together all parties involved in the fight against doping.
The Conference resulted in the Lausanne Declaration on Doping in Sport, a document that provided for the creation of an independent international anti-doping agency to be operational for the XXVII Olympiad that were to be held in Sydney, Australia in 2000. The organisation would be called the World Anti-Doping Agency (WADA) and would be charged with promoting, co-ordinating and monitoring the fight against drugs in sport.
How is doping defined? Is it black and white?
Very simply, a substance or method is placed on WADA’s prohibited list if it’s deemed to meet two of the following three criteria:
- It has the potential to enhance or enhances sporting performance.
- Use of the substance or method represents an actual or potential health risk to the athlete.
- Use of the substance or method violates the spirit of sport.
The latter is described in the introduction of the WADA Code. It’s a belter of a read.
Are there grey areas? You only have to read Fifty shades of grey? On the concept of grey zones in elite cycling, as published in Science Direct, to answer that one.
The authors conclude that there are many grey areas of the code including that point three. ‘The use of certain PEDs was seen as a form of cheating not because they were on the banned list, but because they allegedly went against what was deemed morally acceptable, that is the “spirit of sport”,’ the authors wrote. ‘For that there is no legal or uncontested basis.’
Academic Andy Miah says of the strong ethical argument to support something like genetic doping, ‘The concepts of health and illness are more blurry, as is the way we define quality of life today.
'Take laser eye surgery: is that therapy or enhancement? If you undertake laser eye surgery, you can end up with better than perfect vision.
‘So, many forms of therapy – as they improve – are now taking us beyond just normal and making us superhuman. This broader cultural shift in how we use biotechnology and other sciences is why the anti-doping industry will fall on its knees in due course.
‘Quite simply, nobody will care about an athlete using a nasal decongestant, when everybody’s biological systems will be reinforced against illness and optimised for performance in what is an increasingly toxic world.
‘I bet that the average human in 100 years from now will be able to run as fast as Usain Bolt does today. I may even be around to win that bet, if what I am saying about science and technology is right.’
Arguably the greyest area is the Therapeutic Use Exemption (TUE) programme, which is designed to allow an athlete to race if they have a legitimate medical reason for using a prohibited substance on the WADA list.
Team Sky attracted criticism for their perceived abuse of TUEs after Bradley Wiggins’ TUEs for the powerful corticosteroid triamcinolone became public knowledge. He injected triamcinolone before his most important races of 2011, 2012 and 2013.
Since 1st January 2021, all requests for TUEs are managed by the International Testing Agency (ITA, more on them below) on behalf of the UCI. The athlete’s get-out-of-jail-free card continues to be abused, according to Thibaut Pinot, with the Frenchman telling L’Équipe in 2021 that it’s one of the reasons the ‘peloton races at two speeds’.
In short: yes, there are grey areas.
How does testing work?
In January 2021, cycling’s governing body, the UCI, delegated its operational anti-doping programme to the ITA, which is an independent organisation that implements anti-doping programmes for international sports federations.
It was created in 2018 under the supervision of WADA and the International Olympic Committee (IOC). Its task is to not only undertake testing of riders but also manage intelligence, which includes tip-offs from whistleblowers. The ITA also manage the Athlete Biological Passport (ABP), which we elaborate on below. They will conduct in-competition urine tests and in- and out-of-competition blood tests.
Each country also has its own anti-doping organisation who complement the work done by the ITA. In the United Kingdom, the organisation responsible for ‘protecting sport in the UK from doping’ is UKAD (United Kingdom Anti-Doping). We asked a spokesman for UKAD to talk us though how the tests work…
‘The procedures are in accordance with the ISTI and WADA have supporting guidelines that detail what steps should be undertaken for sample collection. You can also watch a video with all the details on the testing process here.
‘It’s exactly the same with blood tests. As above, the procedures are in accordance with the ISTI and WADA have supporting guidelines that detail what steps should be undertaken for sample collection.’
So, a fair few links to read. However, they did then kindly give us more of an overview of the urine test… ‘As you’ll see from the video above, an athlete will be required to give a 90ml sample. If they do not reach this minimum sample amount, then they will be required to remain with the Doping Control Officers until they can provide the minimum amount.
‘Urine samples are also required to meet a minimum specific gravity for the lab to analyse the sample. If a sample does not meet the requirement – eg, too dilute due to overhydration – the athlete is required to provide an additional sample until one is collected in range. All samples will be sent to the lab.’
When it comes to what happens next? ‘The samples are placed in a security seal transit bag and are sent to a WADA-accredited laboratory for analysis.
‘Blood samples are required to be temperature controlled and so are transported within a temperature control box to ensure the sample does not freeze and is maintained in a cool environment. Urine samples do not need to be sent via temperature-controlled devices. A secure chain of custody is maintained during the transport.
‘Along with the sample, the laboratory receives an anonymised copy of the doping control form that has been filled out with the athlete during the test, which contains information only relevant to the analysis.
‘Once the sample arrives at the lab the A sample is opened, and the B sample is stored securely and is only used later if necessary (a B sample can be stored for up to 10 years). The laboratory conducts its analysis and then reports the results to UKAD or the relevant testing authority.’
These samples are divided into A and B. If A comes back positive, this is deemed an adverse analytical finding (AAF). Sample B is then tested and if that comes back positive, the athlete is then informed and a case brought against the athlete begins.
What are the penalties for doping in cycling?
Again, the answer’s not as simple as the question would have you believe. But according to Anti-Doping Rule Violations (ADRVs), this is a good start…
| Offence | Sanction |
|---|---|
| Presence: Presence of a prohibited substance or its metabolites or markers in an athlete’s sample | Up to 4-year sanction |
| Use: Use or attempted use by an athlete of a prohibited substance or a prohibited method | Up to 4-year sanction |
| Use: Use or attempted use by an athlete of a prohibited substance or a prohibited method | Up to 4-year sanction |
| Whereabouts failure: Any failure to file whereabouts information, any failure to be available for testing at the declared Whereabouts. Any combination of three filing failures and/or missed tests committed within a 12-month period by an athlete in a registered testing pool | Up to 4-year sanction |
| Tampering (or attempted tampering): Conduct that subverts the doping control process but that would not otherwise be included in the definition of prohibited methods. Tampering shall include, without limitation, intentionally interfering or attempting to interfere with a doping control official, providing fraudulent information to an anti-doping organisation or intimidating or attempting to intimidate a potential witness | Up to 4-year sanction |
| Possession: Possession by an athlete/athlete support person of any prohibited substance or prohibited method | Up to 4-year sanction |
| Trafficking: Trafficking or attempted trafficking of any prohibited substance or prohibited method | From 4-year to a life sanction |
| Administration: Administration or attempted administration to any athlete of any prohibited substance or prohibited method | From 4-year to a life sanction |
| Complicity: Assisting, encouraging, aiding, abetting, conspiring, covering up or any other type of intentional complicity involving an anti-doping rule violation | 2-year to a life sanction |
| Prohibited association: Association by an athlete or other person in a professional or sport-related capacity with any athlete support person who is: serving a period of ineligibility; has been convicted or found in a criminal, disciplinary or professional proceeding to have engaged in conduct which would have constituted a violation | Up to 2-year sanction |
| Acts by an athlete or other person to discourage or retaliate against reporting to authorities: Acts that threaten or seek to intimidate another to discourage them from sharing information about doping (also referred to whistleblowing) or retaliating against another for doing so | From 2 years up to a lifetime sanction |
Are things better than they used to be?
The 1998 Festina Affair catalysed global sport into action, leading to the creation of WADA. A brave new world had arrived… until the case of Lance Armstrong and his next-level doping routine.
EPO abuse and blood transfusions were rife with some suggesting they improved performance by 15%. The testers were losing the battle. Until they bolstered their defences in the form of the Athlete Biological Passport (ABP) in 2009.
Cycling was the first sport to adopt the ABP with WADA adopting it later that year. Unlike many previous doping tests that focussed on direct markers of abuse, the ABP focusses on indirect markers over time with WorldTour riders tested a minimum three times each year in and out of competition.
How does it work? Well, it’s down to reticulocytes (young red blood cells) and haemoglobin (protein that carries oxygen).
Take the haematological module. Injecting yourself with EPO (erythropoietin) stimulates your body to produce more red blood cells, increasing the percentage of reticulocytes.
The other primary method of doping, blood transfusion, requires removal of your blood before re-infusion. Your body compensates for that initial drop by making more red blood cells, again leading to a higher-than-normal percentage of reticulocytes.
But this is where things become complicated and why the ABP is so effective. While reticulocytes rapidly skew upwards after doping, when you re-infuse your blood, your actual percentage of reticulocytes then drops because the 'older' blood effectively dilutes the new blood. Haemoglobin, on the other hand, plummets when you first extract blood but increases on re-infusion.
Together, reticulocytes and haemoglobin produce what’s called an OFF-score, which is the ratio of the two numbers. Analysis by a panel of three experts is triggered by any atypical value. This can be an abnormal haemoglobin, haematocrit level (percentage of red blood cells) or OFF-score.
Riders also have to sign up to the Whereabouts Programme, telling the authorities where they’ll be at certain times of the day for testing purposes.
The ABP certainly seems to have cut down heavy EPO abuse. Since 2014, the Mouvement Pour un Cyclisme Credible (MPCC), a voluntary cycling organisation set up in 2005 to fight doping, has published its annual doping barometer, which takes into account cases revealed by federations, anti-doping agencies, the justice system and the press. This covers all sports.
For 2021, weightlifting and track and field endured the ignominious honour of heading the table with 54 doping convictions apiece with cycling in seventh on 19. Of these, 12 were on the road, albeit for the first time in MPCC history, none of these positives were from the WorldTour.
Reasons to celebrate? Not according to the MPCC, who commented, ‘On the field, some stakeholders and managers are not delighted about this news. Testimonials from emblematic riders once again point out a ‘two-speed cycling’ and the UCI director said in a recent interview that anti-doping tests are no longer enough to catch cheaters.
‘According to Amina Lanaya [UCI director general], more radical methods of investigation should be considered. The MPCC fully supports this approach and is therefore encouraged to put the flattering reality of the figures in this table into perspective.’
One of the main concerns remains focussed on EPO, with Dr Reid Aikin, the deputy director of the ABP, conceding in October 2022 that micro-dosing of EPO can still be hard to detect via the ABP, though at least reduced the dangerous amounts athletes might take.
‘If you have a lower dose of a substance, the effect will be lower,’ Aikin said. ‘So as athletes go to lower doses or micro-doses or reduced timing of the use, that’s a win for anti-doping. It’s not beating the system but having less effect.’
So, all in all, it seems the situation’s brighter – certainly safer for the rider – than the 2000s, but the war on doping continues.
How do you dope?
Here’s a snapshot of the most popular doping products over time and that are (probably) still being used today to some degree [this is not a how-to guide].
Amphetamines
A psychostimulant that works by modulating the levels of numerous neurotransmitters in the brain. These include dopamine and serotonin, which then produces feelings of happiness and well-being.
How is it used in cycling?
Cyclists will use it in pill form. Amphetamines have been shown to increase stamina, beat fatigue and increase alertness. They’re also an appetite suppressant, meaning they can help a cyclist lose weight.
Notable cases
- Laurent Fignon: Two-time Tour de France winner (1983 and 1984) Fignon tested positive in both 1987, after the Grand Prix de Wallonie where he was disqualified, and 1989, after finishing second in the Grand Prix de la Libération, when he was suspended for three months.
- Paul Kimmage: In his book Rough Ride, published in 1990, the Irish rider-turned journalist admitted using amphetamines at post-Tour criteriums. There was no punishment for the retired rider.
Blood transfusion
Blood transfusion remains a common medical practice when an individual suffers heavy blood loss.
How is it used in cycling?
Arguably the most high-profile method of illegal performance enhancement in cycling, this involves the infusion of blood to increase the amount of oxygen-carrying red blood cells.
An athlete may either extract their own blood, wait for the body to naturally stimulate more red blood cells to return to the original level, before reinfusing their own blood for that extra hit. The advantage of this is detection is difficult; on the downside, it weakens the athlete so infusion can’t be near competition.
Or an athlete can endure a blood transfusion of someone else’s blood. This homologous method dispenses of the need of original extraction so there’s no weakening, but it is easier to detect. The ABP is the key defence against transfusion.
Notable cases
- Lance Armstrong: Blood transfusion was just one doping product Armstrong confessed to when interviewed by Oprah Winfrey after a federal investigation. The American is banned for life and had all results accrued from 1st August 1998 scrubbed from the record books.
- Jan Ullrich: The German confessed to doping with Dr Eufemiano Fuentes in 2013. He had a retrospective two-year ban and all results from 1st May 2005 were annulled.
Clenbuterol
Clenbuterol is commonly taken in pill form and belongs in a group of drugs known as beta-2-agonists. Drugs in this category, which includes salbutamol, dilate the bronchial muscles.
How is it used in cycling?
Although its primary role is to assist breathing, it also accelerates weight loss, which is why cyclists use it. It’s why clenbuterol is used with livestock – to increase the proportion of meat – which has caused several issues over the years…
Notable cases
- Alberto Contador: Two-time Tour de France winner Alberto Contador (2007 and 2009) tested positive for clenbuterol in 2010 after the final rest day of the 2010 Tour de France (which he later won). He was suspended for a year. The Spanish authorities then lifted the suspension on the grounds of no intentional negligence on Contador’s defence that he ate contaminated meat. WADA and the UCI appealed the decision. Finally, the Court of Arbitration for Sport ruled against the rider, handing him a two-year ban until August 2012 and stripping him of all victories since his 2010 positive including that Tour victory.
DHEA (Dehydroepiandrosterone)
DHEA is one of the most abundant naturally circulating steroids in the body. It’s produced in the adrenal glands of the kidneys, the gonads and the brain. Its therapeutic use includes the treatment of adrenal deficiency, sexual dysfunction and ageing.
How is it used in cycling?
Cyclists consume the pill form of DHEA to strengthen muscles and improve alertness. Too much leads to hair loss and potential heart irregularities.
Notable cases
- Tom Danielson: The American tested positive for DHEA and testosterone in an out-of-competition test in 2015. This was his second doping violation, which could have resulted in an eight-year or even lifetime ban. But it was reduced to four years after Danielson provided evidence of having taken a contaminated supplement.
EPO (erythropoietin)
EPO is a naturally occurring hormone that tells bone marrow to produce more red blood cells. The synthetic version was originally developed to treat patients with anaemia.
How is it used in cycling?
EPO was used and abused in huge doses by many riders of the 2000s. Why? Because it raises an athlete’s haemotocrit levels (proportion of oxygen-carrying red blood cells) beyond natural levels, giving a clear endurance advantage. Injection is the most common method. It’s hard to detect as EPO levels drop relatively swiftly with red blood cells peaking around two weeks after injection.
Notable cases
- Bobby Julich: The American admitted to taking EPO from August 1996 to August 1998 in 2012. At the time of his confession, he was a coach at Team Sky. As the British team had a zero-tolerance approach to drugs, Julich had no choice but to leave.
- David Millar: The British rider was banned for two years in 2004 after he admitted taking EPO. This was soon after the police raided his French home and found empty phials of Eprex, a brand of the blood-booster EPO. Upon his return from suspension, Millar became a vocal anti-doping campaigner and won a stage of the 2011 Tour de France.
Human growth hormone (HGH)
Human growth hormone is secreted by the anterior lobe of the pituitary gland. It stimulates the growth of essentially all tissues of the body.
How is it used in cycling?
Injecting HGH for athletic means is associated with lean body mass, decreased fat mass, plus increased carbohydrate and fat metabolism – all favourable adaptations for an endurance cyclist.
Notable cases
- Floyd Landis: The American tested positive for testosterone during his victorious Tour de France of 2006. He denied it but was officially stripped of his title in 2007. In 2010, he finally admitted to doping with HGH on his medicinal list.
Nandrolone
Nandrolone is the common name for 19-nortesterone. It’s related to the hormone testosterone and is naturally created in the body in small quantities, especially pregnant women. There’s no evidence that nandrolone naturally occurs in men. In its lab-based form, it’s used for the treatment of conditions like osteoporosis and breast cancer.
How is it used in cycling?
Nandrolone’s appeal to cyclists stems from its ability to accelerate recovery from injury.
Notable cases
- Malcolm Elliott: One of Britain’s finest ever cyclists tested positive twice on Stages 3 and 5 of the 1992 Vuelta a Andalucia, albeit a single positive was recorded because of the proximity of the two tests. He was stripped of his Stage 3 win, despite the team blaming the positive on an eyewash.
Probenecid
Probenecid, also sold under the name Probalan, is a medication that increases uric acid excretion in urine. It’s primarily used in the treatment of gout.
How is it used in cycling?
Probenecid is banned because it has been shown to reduce the urinary excretion of anabolic steroids in the urine; in other words, it’s a masking agent.
Notable cases
- Daryl Impey: The South African tested positive after winning the 2014 South African time-trial national championships but was later cleared after he successfully proved supplement contamination.
Strychnine
Strychnine is a toxic, colourless alkaloid used as a pesticide, particularly for killing rodents. At high levels, it can cause death if inhaled, swallowed or absorbed through the eyes or mouth.
How is it used in cycling?
Strychnine was popularly used as a performance-enhancer in the late 19th and early 20th century as, in small doses, it can apparently help an athlete ride longer without feeling fatigued.
Notable cases
- Adri van der Poel: Mathieu’s dad was a fine cyclist in his own right but in 1983 tested positive for strychnine after winning the Grand Prix of Frankfurt. He was disqualified but blamed his pigeon-racing father-in-law, who apparently made him eat doped-up pigeon pie.
Testosterone
Testosterone is a steroid hormone produced in the body. It stimulates bone and muscle development. The synthetic version is primarily administered to treat conditions associated with hormonal deficiency.
How is it used in cycling?
Testosterone’s anabolic effects have appealed to many cyclists over the years. Testosterone accelerates the synthesis of proteins for muscle, forging a stronger cyclist.
Notable cases
Kim Anderson tested positive an incredible seven times during his career (1980-1992). One of those times including a positive for testosterone after winning stage four of the 1987 Tour du Limousin.
Main photo: Wikimedia Commons, license 3.0
