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Doping Prevalence in Competitive Sport: Evidence Synthesis with “Best Practice” Recommendations and Reporting Guidelines from the WADA Working Group on Doping Prevalence

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Abstract

Background

The prevalence of doping in competitive sport, and the methods for assessing prevalence, remain poorly understood. This reduces the ability of researchers, governments, and sporting organizations to determine the extent of doping behavior and the impacts of anti-doping strategies.

Objectives

The primary aim of this subject-wide systematic review was to collate and synthesize evidence on doping prevalence from published scientific papers. Secondary aims involved reviewing the reporting accuracy and data quality as evidence for doping behavior to (1) develop quality and bias assessment criteria to facilitate future systematic reviews; and (2) establish recommendations for reporting future research on doping behavior in competitive sports to facilitate better meta-analyses of doping behavior.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to identify relevant studies. Articles were included if they contained information on doping prevalence of any kind in competitive sport, regardless of the methodology and without time limit. Through an iterative process, we simultaneously developed a set of assessment criteria; and used these to assess the studies for data quality on doping prevalence, potential bias and reporting.

Results

One-hundred and five studies, published between 1975 and 2019,were included. Doping prevalence rates in competitive sport ranged from 0 to 73% for doping behavior with most falling under 5%. To determine prevalence, 89 studies used self-reported survey data (SRP) and 17 used sample analysis data (SAP) to produce evidence for doping prevalence (one study used both SRP and SAP). In total, studies reporting athletes totaled 102,515 participants, (72.8% men and 27.2% women). Studies surveyed athletes in 35 countries with 26 involving athletes in the United States, while 12 studies examined an international population. Studies also surveyed athletes from most international sport federations and major professional sports and examined international, national, and sub-elite level athletes, including youth, masters, amateur, club, and university level athletes. However, inconsistencies in data reporting prevented meta-analysis for sport, gender, region, or competition level. Qualitative syntheses were possible and provided for study type, gender, and geographical region. The quality assessment of prevalence evidence in the studies identified 20 as “High”, 60 as “Moderate”, and 25 as “Low.” Of the 89 studies using SRP, 17 rated as “High”, 52 rated as “Moderate”, and 20 rated as “Low.” Of the 17 studies using SAP, 3 rated as “High”, 9 rated as “Moderate”, and 5 rated as “Low.” Examining ratings by year suggests that both the quality and quantity of the evidence for doping prevalence in published studies are increasing.

Conclusions

Current knowledge about doping prevalence in competitive sport relies upon weak and disparate evidence. To address this, we offer a comprehensive set of assessment criteria for studies examining doping behavior data as evidence for doping prevalence. To facilitate future evidence syntheses and meta-analyses, we also put forward “best practice” recommendations and reporting guidelines that will improve evidence quality.

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Notes

  1. There is not a universal definition of doping. However, this study builds upon [1] definition where doping “refers to the set of prohibited substances and/or methods as identified by the ruling body of the particular sport”, which, “means that the term ‘doping’ in […] does not reflect other doping violations mentioned in the World Anti-Doping Code, such as whereabouts failures or trafficking.” We have also differentiated between therapeutic and unintentional use of prohibited substances to more clearly describe the phenomenon.

  2. The connection between controlled substances in sport (doping) and in general is a complicated one. First of all, not all substances prohibited in sport are controlled substances for the general population, and this varies from one country to another. One example for this is anabolic steroids (AS). AS are prohibited in sport both in- and out-of-competition for all athletes around the globe under WADA regulations. However, whilst using AS is also illegal in some countries (e.g., Australia, US, Norway, Saudi Arabia), in other countries (e.g., UK, Canada, South Africa, Turkey) personal use is not illegal but production and supply without license are, regardless of who uses it. In countries where doping is a criminal offence (e.g., Austria, Germany, France, Italy, Israel), AS use is only illegal and can carry a prison sentence for athletes if they are subject to doping control, but not for the general population. AS is not a controlled substance in some countries (e.g., Japan, Bulgaria, Russia, Mexico).

  3. Gender is the term used in official documents and reporting throughout sport governing bodies such as the International Olympic Committee, the Court of Arbitration for Sport, and the World Anti-Doping Agency to classify competition categories for men and women. As this evidence synthesis only related to competitive sport, the manuscript reflects the categorizations used by the competitive sport governing bodies.

  4. A multitude of indirect estimation models exists. In the applied literature, these are often referred to as ‘randomized response technique’, even though not all models rely on randomization. For simplicity and to avoid confusion, we accepted this terminology for the review while noting its inaccuracy.

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Acknowledgements

The work was conducted as part of the Working Group on Doping Prevalence of the World Anti-Doping Agency (WADA). The authors thank Tony Cunningham, Marcia MacDonald, and Olivier Rabin for their critical review and constructive comments on the manuscript; and Annie Bachman for her assistance in extracting and compiling data.

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Authors and Affiliations

  1. Department of Kinesiology, California State University Fullerton, 800 N State College Blvd, Fullerton, CA, 92834, USA

    John Gleaves

  2. Kingston University London, Kingston upon Thames, UK

    Andrea Petróczi & Dirk Folkerts

  3. University of Münster, Münster, Germany

    Dirk Folkerts

  4. Doping Authority Netherlands, Capelle aan den IJssel, The Netherlands

    Olivier de Hon

  5. Penn State University, State College, USA

    Emmanuel Macedo

  6. University of Lausanne, Lausanne, Switzerland

    Martial Saugy

  7. University of Utrecht, Utrecht, Netherlands

    Maarten Cruyff

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  1. John Gleaves
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Correspondence to John Gleaves.

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Funding

No sources of funding were used to assist in the preparation of this article.

Conflicts of interest

This paper represents part of the work by the World Anti-Doping Agency Working Group on Doping Prevalence conducted between September 2017 and December 2019, but WADA had no control over the drafting or content of this manuscript. John Gleaves, Andrea Petróczi, Olivier De Hon, Martial Saugy and Maarten Cruyff served as members of the Working Group (2017–2019) and they prepared this paper in their capacity as Working Group members, in collaboration with DF and EM. The Working Group members receive no salary for their work but expenses related to the travel for work were covered. Andrea Petróczi received grant funding from WADA previously as part of the Social Science Research Program, served as a member of the first Working Group on Doping Prevalence (2011–2012); and is currently involved in providing analysis and evaluation support for WADA’s Outreach Program in an unpaid advisory role. Martial Saugy worked at the Swiss Laboratory for Doping analyses (LAD, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland) until 2016 and received funding from WADA Science Department prior to his involvement in this project. Olivier De Hon works for the National Anti-Doping Authority Netherlands. Dirk Folkerts and Emmanuel Macedo declare they have no conflicts of interest relevant to the content of this review.

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Not applicable.

Availability of data and materials

The definitions, questions, and rater criteria for the Quality Assessment of Doping evidence—Self-Reported Prevalence (QUAD-SRP) and the Quality Assessment of Doping evidence—Sample Analysis of Prevalence (QUAD-SAP) are available in Electronic Supplementary Material Appendix S1 and S2, respectively. All extracted data from the studies are available in Electronic Supplementary Material Appendix S3. The complete scoring for all studies is available in Electronic Supplementary Material Appendix S4. All other datasets generated during and/or analyzed during the current analysis are available from the corresponding author on reasonable request.

Authorship contributions

AP served as senior author on the project, conceptualized the study, led the development of quality assessment criteria, contributed to collating and synthesizing the independent quality assessments, contributed to the literature search, supervised DF and contributed to drafting the manuscript. JG drafted the manuscript, contributed to the development of quality assessment criteria, contributed to collating and synthesizing the independent quality assessments as well as the literature search and supervised EM. DF conducted the initial literature search, contributed to developing the quality assessment criteria and conducted independent quality assessment for all included studies under the supervision of AP. OH conducted independent quality assessment, contributed to developing the quality assessment criteria and literature search. EM conducted independent quality assessment under the supervision of JG. The best practice recommendations were formulated by AP, JG, OH, MS, and MC. All authors read and critically commented on the manuscript and approved the final version of the manuscript.

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Gleaves, J., Petróczi, A., Folkerts, D. et al. Doping Prevalence in Competitive Sport: Evidence Synthesis with “Best Practice” Recommendations and Reporting Guidelines from the WADA Working Group on Doping Prevalence. Sports Med 51, 1909–1934 (2021). https://doi.org/10.1007/s40279-021-01477-y

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