Study suggests Tramadol enhances TT performance by ~ 5%

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Re: Re:

fmk_RoI said:
Ripper said:
If you think of doping tests as a form of random sampling, then the 4% might represent the whole population. But I am not so sure you can consider doping like a random sample, as there is some selectivity to doping controls. My guess would be overall Tramadol use is greater than the 4.4% identified.
But as the selectivity is tilted toward those assumed to be most likely to be doping, you could also guess that overall Tramadol use is less than the 4.37% identified.
you can't make any conclusions about what this means without knowing the glow time and use patterns for Tramadol. It could very well be that 100% of cyclists use it, but each is only glowing 4% of the time.
 
Re: Re:

fmk_RoI said:
Ripper said:
If you think of doping tests as a form of random sampling, then the 4% might represent the whole population. But I am not so sure you can consider doping like a random sample, as there is some selectivity to doping controls. My guess would be overall Tramadol use is greater than the 4.4% identified.
But as the selectivity is tilted toward those assumed to be most likely to be doping, you could also guess that overall Tramadol use is less than the 4.37% identified.
You could guess that. The main point being, I don't know if the number is representative of the population, so to speak. It all depends on what kind of targeting is being done, etc. Given Tramadol is not banned, it could easily be used by lots of riders who are not 'suspect', per se.

Overall, it's an interesting finding. It's not a drug I am comfortable having in the peloton, as I would not want someone crashing into me or getting overly agro. :p But the click bait of "rife" was a bit funny.
 
Mar 31, 2009
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Not sure if this was already pointed out, but it seems to me it is 4% of all controls, including out of competition controls.
This means either 4% of riders use tramadol so often that it shows up outside competition, or if riders do not use it outside competition, the percentage using it in competition is higher.
 
samhocking said:
Agreed, the winning riders always give a sample, so the 4.37% is likely to be less in the winning riders as diluted by the non-winners also giving their random samples. Hard to say how much. It's top 3 finishers of the stage, overall GC leader and then random 3 from bunch over the line give urine I believe? Samples include out of competition too I think.
Or maybe it is higher in winning riders & diluted by non-winning riders' samples?
 
Re:

hmronnow said:
Not sure if this was already pointed out, but it seems to me it is 4% of all controls, including out of competition controls.
This means either 4% of riders use tramadol so often that it shows up outside competition, or if riders do not use it outside competition, the percentage using it in competition is higher.
I have already stated that the 2017, 2015, and 2013 figures all relate solely to IC testing. Tramadol is not monitored OOC.

It is interesting to see how much effort is being made to discredit a figure that is far below what many want to believe the figure is.
 
Re: Re:

fmk_RoI said:
It is interesting to see how much effort is being made to discredit a figure that is far below what many want to believe the figure is.
That's one way of viewing it. I've actually taken it that there is simply a fair bit of curiosity of whether this figure is representative, lower, or higher than the larger peloton. Of course, most folks are not statisticians, so there's lots of unknown there. I'd love to hear what a statistician with expertise in this sort of sampling would have to say. We also don't have a clear idea of the impact of targeted testing. So I highly doubt we'd ever be fully clear on how this exactly compares with the larger pro racing community - but those with expertise in the matter may totally have different thoughts! :)
 
LaFlorecita said:
samhocking said:
Agreed, the winning riders always give a sample, so the 4.37% is likely to be less in the winning riders as diluted by the non-winners also giving their random samples. Hard to say how much. It's top 3 finishers of the stage, overall GC leader and then random 3 from bunch over the line give urine I believe? Samples include out of competition too I think.
Or maybe it is higher in winning riders & diluted by non-winning riders' samples?
Perhaps. Although the winners to losers being tested is still about 50:50 split. Every winner contributes along with every podium finisher to that 4.37% and 3 other random losers each race.
So, if every winner is on tramadol, and every loser isn't the figures would be around 50%. To get down to 4.37% is not possible if even 1 in 3 winners are on tramadol. The lowest that could be is 33.333%.
 
Re: Re:

Ripper said:
fmk_RoI said:
It is interesting to see how much effort is being made to discredit a figure that is far below what many want to believe the figure is.
That's one way of viewing it. I've actually taken it that there is simply a fair bit of curiosity of whether this figure is representative, lower, or higher than the larger peloton. Of course, most folks are not statisticians, so there's lots of unknown there. I'd love to hear what a statistician with expertise in this sort of sampling would have to say. We also don't have a clear idea of the impact of targeted testing. So I highly doubt we'd ever be fully clear on how this exactly compares with the larger pro racing community - but those with expertise in the matter may totally have different thoughts! :)
Curiosity is to be encouraged. Stating that the reported figure is distorted by OOC testing is not, not when the report is clear on this and it has been stated that the 4% refers to IC testing. Nor should we encourage those saying we don't know Tramadol's glow time. They may not have looked for it but it is known. And easily found.
 
Some points about that tramadol report:

1) Cycling includes all kinds of racing, including track, e.g., where I would think that analgesics would be less common, though if someone more familiar with the sport wants to argue that's not the case, I'll certainly listen. It may also be relevant that in the "impaired" category in that same report, the proportion of positives was much lower, about 1%.

2) The 50 ng/ml threshold seems pretty high. Detection limits of 10 ng/ml are common, and I've seen one report claiming a limit as low as just 0.2 ng/ml.

3) Tramadol has a short half-life, and most studies report that it's not detectable 24-48 hours after a single typical dose, though some of its metabolites may persist longer.

Putting these points together, I wouldn't be at all surprised if the actual prevalence of tramadol in road cyclists is much higher than 4-5%. Since the drug is not banned, WADA is not going to make a major, no-expense barred, effort to detect users.
 
Re: Re:

fmk_RoI said:
Curiosity is to be encouraged. Stating that the reported figure is distorted by OOC testing is not, not when the report is clear on this and it has been stated that the 4% refers to IC testing. Nor should we encourage those saying we don't know Tramadol's glow time. They may not have looked for it but it is known. And easily found.
I'm presuming you're stating this aloud for others, as did not state any of these things.
 
Re: Re:

Ripper said:
fmk_RoI said:
Curiosity is to be encouraged. Stating that the reported figure is distorted by OOC testing is not, not when the report is clear on this and it has been stated that the 4% refers to IC testing. Nor should we encourage those saying we don't know Tramadol's glow time. They may not have looked for it but it is known. And easily found.
I'm presuming you're stating this aloud for others, as did not state any of these things.
You can get a pretty good representative picture of the IC testing from this control form after a typical stage in tour de france.



So overall GC leader is tested by default
Winner of stage is tested by default
7 random riders tested (I believe one of these 7 will be an '1 numbered rider. On this days control, Nibali is also part of the random 7 for example along with the Cofidis leader). I think in most other races it's 6 random riders, not 7.

So 28.6% of the controls come from the known winner and overall leader and 71.4% are from random riders anywhere on GC.

If Tramadol was making a significant difference to who could win overall or a stage, you would clearly expect the positives for Tramadol to be more than 4-5%, given the winners contribute 28.6% of the samples WADA tested for Tramadol.

Clearly to get down to 4-5% you not only need most winners to not be positive, you also need most random riders not to be positive. Given the random nature for 7, you would expect at least 1 in 190 or more to also come from other GC leaders. e.g. if we look at that control form. Nibali is one of the random 7 simply from being selected randomly (or targeted of course ; ))

Someone better at maths could probably work out how many of the 28.6 samples would need to be positive for Tramadol and how many of the 71.4% negative in order for the overall Tramadol found to be 4-5%. I'm crap at maths.
 
Merckx index said:
3) Tramadol has a short half-life, and most studies report that it's not detectable 24-48 hours after a single typical dose, though some of its metabolites may persist longer.
A dose of 100mg taken no more than six to seven hours before the control - ie just ahead of or during the race - will likely be below the 50ng/mL reporting threshold when? Ballpark it - before or after the test?
 
Surely if you wanted the performance enhancement benefit of Tramadol, you need it most-effective at the end of the race in the last 20km. Given Tramadol is perfectly legal, why would you use it anyother way or be bothered about half-life? You wouldn't take it before going to bed the night before, you would take it within the race, probably at the feed.
 
fmk_RoI said:
Merckx index said:
3) Tramadol has a short half-life, and most studies report that it's not detectable 24-48 hours after a single typical dose, though some of its metabolites may persist longer.
A dose of 100mg taken no more than six to seven hours before the control - ie just ahead of or during the race - will likely be below the 50ng/mL reporting threshold when? Ballpark it - before or after the test?
From what i've read, I believe 6 hour half life. Substance is effective 1 hour after ingesting.
Tramadol will show up on urine screens for 2-4 days after use. However, Tramadol may show up a for a few days after last dose with heavy or chronic use. But in most cases, if someone hasn't taken the drug within 48 hours, the levels are undetectable
 
Merckx index said:
1) Cycling includes all kinds of racing, including track, e.g., where I would think that analgesics would be less common, though if someone more familiar with the sport wants to argue that's not the case, I'll certainly listen. It may also be relevant that in the "impaired" category in that same report, the proportion of positives was much lower, about 1%.
WADA's 2016 report shows cycling had 12,840 IC urine tests in 2016. If we exclude all identified as not road, we get 8,017 tests. That's a fairly steady figure year to year, so let's use it to play math. Let's pretend that no other cycling discipline uses Tramadol, despite the evidence from paracycling. That gives us 548 samples showing Tramadol in excess of 50ng/mL from about 8,000 tests. 6.85%. One in fifteen. Still a notable figure. But rife? Prevalent?

We can all agree that Tramadol is being used. And we can all just about agree Tramadol should probably not be used. But these WADA figures show a problem that is declining - the reported number is down one third in four years - and not as widespead as some would like to believe.
 
I would agree with declining obviously. I would also add, perhaps given it is legal for all teams to use, either the peloton doesn't think it's that great a PED or their medical team along with the riders are making ethical decisions to not use it simply because it is legal.
 
fmk_RoI said:
A dose of 100mg taken no more than six to seven hours before the control - ie just ahead of or during the race - will likely be below the 50ng/mL reporting threshold when? Ballpark it - before or after the test?
After, almost certainly. I’m having trouble finding human studies where they looked at urine levels over time, but one I did see gave subjects 50 mg, and their urine levels were > 100 ng/ml even after 48 hours. This seems to be an unusually slow decline, other researchers say it’s below detection limit at this time, but don’t provide actual data. The half-life is supposed to be about six hours.
 
Merckx index said:
fmk_RoI said:
A dose of 100mg taken no more than six to seven hours before the control - ie just ahead of or during the race - will likely be below the 50ng/mL reporting threshold when? Ballpark it - before or after the test?
After, almost certainly. I’m having trouble finding human studies where they looked at urine levels over time, but one I did see gave subjects 50 mg, and their urine levels were > 100 ng/ml even after 48 hours. This seems to be an unusually slow decline, other researchers say it’s below detection limit at this time, but don’t provide actual data. The half-life is supposed to be about six hours.
A study I'd looked at before asking the question suggested a 100mg dose would be below the 50ng/mL reporting threshold in 20-24 hours. But that was using blood.

What does seem clear, to both of us, is that glow time is not really a factor here: if you're using Tramadol on the day of a race and are tested at the end of that race, it will show up in the test.

We can argue whether there is a major difference in drug usage between World Tour events and the conti/pro-conti circuits and I think we could argue both sides: some will say that the lower level riders have more to gain from a drug like Tramadol (a pro contract) while some will say that the abuse is highest at the World Tour level because it's the World Tour. Personally, I'm not sure how much this really matters: we all care about cycling in general, not just the top riders at the top races.

Which really only leaves us the testing spread to query. Sam has posted how that's done (though I would take the word random out, as it confuses: since the Index of Suspicion story, we've had a fairly clear idea of how testing strategies for races are developed, and it involves evidence-based targeting). How that impacts the reported figure, that's open to discussion. But I think it will be quite difficult to argue it has a material negative impact on the result.
 
fmk_RoI said:
.A study I'd looked at before asking the question suggested a 100mg dose would be below the 50ng/mL reporting threshold in 20-24 hours. But that was using blood.
Yes, there are a lot of published human studies of serum levels. Urine, not so much. I think the emphasis on not being detectable in urine fairly quickly is because the greatest interest is not the pro peloton, of course, but non-athletes who use it and are worried about testing positive by their employers. If the drug is not detectable in 24-48 hours, that's very relevant to their situation.

What does seem clear, to both of us, is that glow time is not really a factor here: if you're using Tramadol on the day of a race and are tested at the end of that race, it will show up in the test.
Yes, from what I've now seen in the literature, I agree with that.I don't know if tramadol would be useful in training, though.
 
Merckx index said:
Yes, from what I've now seen in the literature, I agree with that.I don't know if tramadol would be useful in training, though.
I think it's a pretty safe bet that some riders use it in training: we know amphetamines were used in training as well as races (Laurent Fignon probably has one of the best anecdotes about using amphetamines in training). If nothing else it'd dull the pain on those days when you can't quite face the grind of it all. I think Prentice Steffen has been quoted saying some use it in training. That said, Michael Barry - who's claim that "some riders took Tramadol every time they raced" helped fuel the fear over the extent of Tramadol's use - said he never saw Tramadol being used in training at Sky, only in racing there. And it is the IC use of it that has been focused on: the performance benefit it (allegedly) gives during a race and the greater risk of crashing in a race it (allegedly) causes. It is IC where its use is believed to be most widespread, both in finishing bottles at the front of the race by those going to for the win and as a Mother's Little Helper at the back of the race by those just trying to hang on. It is IC where its use is most feared, because of the many claims it causes crashes.
 
fmk_RoI said:
It is IC where its use is believed to be most widespread, both in finishing bottles at the front of the race by those going to for the win and as a Mother's Little Helper at the back of the race by those just trying to hang on. It is IC where its use is most feared, because of the many claims it causes crashes.
LOL, I had forgotten how relevant that song is to the peloton:

What a drag it is getting old
"Racing’s different today,"
I hear ev'ry rider say
They need something today to make them fast
And though they’re not really ill
There are lots of little pills
They go running for the shelter of a rider’s little helper
And it helps them on the pace, gets them through the biggest race

"Things are different today, "
I hear ev'ry domest’ say
Riding in front of the pack’s just a drag
So they buy some instant cells, and they ride like bloody hell
And go running for the shelter of a rider’s little helper
And it help them on the climbs, they get a faster time

Doctor please, some more of these
Inside the bus, give to us
What a drag it is getting old

"Sponsors aren't the same today"
I hear ev'ry rider say
They just don't appreciate that you get tired
But they’re not hard to fool, you can raise your V02
So go running for the shelter of a rider’s little helper
And it helps them sure as fate, helps to minimize lactate

Doctor please, some more of these
Inside the bus, give to us
What a drag it is getting old

"Life's just much too hard today, "
I hear ev'ry rider say
The pursuit of results just seems a bore
And if they take more of those, they will get an overdose
No more running for the shelter of a rider’s little helper
They just helped them till they can’t, through their final jour sans
 
Merckx index said:
fmk_RoI said:
It is IC where its use is believed to be most widespread, both in finishing bottles at the front of the race by those going to for the win and as a Mother's Little Helper at the back of the race by those just trying to hang on. It is IC where its use is most feared, because of the many claims it causes crashes.
LOL, I had forgotten how relevant that song is to the peloton:

What a drag it is getting old
"Racing’s different today,"
I hear ev'ry rider say
They need something today to make them fast
And though they’re not really ill
There are lots of little pills
They go running for the shelter of a rider’s little helper
And it helps them on the pace, gets them through the biggest race

"Things are different today, "
I hear ev'ry domest’ say
Riding in front of the pack’s just a drag
So they buy some instant cells, and they ride like bloody hell
And go running for the shelter of a rider’s little helper
And it help them on the climbs, they get a faster time

Doctor please, some more of these
Inside the bus, give to us
What a drag it is getting old

"Sponsors aren't the same today"
I hear ev'ry rider say
They just don't appreciate that you get tired
But they’re not hard to fool, you can raise your V02
So go running for the shelter of a rider’s little helper
And it helps them sure as fate, helps to minimize lactate

Doctor please, some more of these
Inside the bus, give to us
What a drag it is getting old

"Life's just much too hard today, "
I hear ev'ry rider say
The pursuit of results just seems a bore
And if they take more of those, they will get an overdose
No more running for the shelter of a rider’s little helper
They just helped them till they can’t, through their final jour sans
At last - we've got a Clinic theme tune. I say we petition CN to get it recorded.

Well played.
 
https://www.velonews.com/2018/09/news/uci-to-start-tramadol-testing-in-january-2019_479553
Dope testers will start screening for the painkiller tramadol in January 2019, International Cycling Union President David Lappartient announced on Saturday.

Tramadol, an opiate, is not yet on the World Anti-Doping Agency (WADA) banned list, but cycling will start imposing bans from 2019.

“We tried to get WADA on board to get a second test specifically for tramadol, but there has been no real will on their part to do so,” Lappartient said. “So we are taking it forward on our own and have found a finger pin-pick test that detects the presence, or not, of tramadol and its level of concentration.

“Two-thirds of the tramadol detected in tests of athletes is found in cyclists,” he said. “And five percent of cyclists tested show positive results for it.

“Tramadol is a problem in cycling, we needed to do something about it.”

The medication tramadol is comparable to codeine in that it has around ten percent the power of the painkiller morphine.
How many appeals to CAS. WADA etc will follow though?
 
Re:

Robert5091 said:
https://www.velonews.com/2018/09/news/uci-to-start-tramadol-testing-in-january-2019_479553
Dope testers will start screening for the painkiller tramadol in January 2019, International Cycling Union President David Lappartient announced on Saturday.

Tramadol, an opiate, is not yet on the World Anti-Doping Agency (WADA) banned list, but cycling will start imposing bans from 2019.

“We tried to get WADA on board to get a second test specifically for tramadol, but there has been no real will on their part to do so,” Lappartient said. “So we are taking it forward on our own and have found a finger pin-pick test that detects the presence, or not, of tramadol and its level of concentration.

“Two-thirds of the tramadol detected in tests of athletes is found in cyclists,” he said. “And five percent of cyclists tested show positive results for it.

“Tramadol is a problem in cycling, we needed to do something about it.”

The medication tramadol is comparable to codeine in that it has around ten percent the power of the painkiller morphine.
How many appeals to CAS. WADA etc will follow though?
I doubt there will many appeals - Many sports ban substances/treatments etc above and beyond the WADA Code.
 

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