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Tackling the issue of sports anti-doping and ADHD drug therapies

Lisdexamfetamine is an FDA-approved treatment for attention deficit hyperactivity disorder (ADHD), and it is marketed worldwide under different brand names. According to the Centers for Disease Control and Prevention, 11 percent of school-aged children in the U.S. have received a medical diagnosis of ADHD, making drugs such as lisdexamfetamine increasingly more popular – and controversial.

One area where controversy reigns are athletics, where the World Anti-Doping Agency (WADA), the NCAA, and the NFL, for example, all prohibit the use of performance-enhancing substances. So how can treatment for ADHD come under scrutiny as a performance-enhancing drug? The human body converts lisdexamfetamine into the active component dextroamphetamine, which is in the amphetamine class and is therefore banned by all established sports. Lisdexamfetamine fits into a broader set of ADHD therapeutics containing a “psychostimulant” that could lead to a positive drug test for an athlete.

In recent years, two forces have started clashing in sports – real concern for treating diagnosed cases of ADHD and attacking the widespread and growing abuse of performance-enhancing drugs. Drugs such as lisdexamfetamine are now caught up in this clash. That’s what makes the recent work of researchers at the Institute of Biochemistry - Center for Preventive Doping Research, German Sport University in Cologne, Germany, so important. Their work attempts to differentiate legitimate therapeutic use from abuse so that viable treatment options are not being foreclosed for physicians and their patients.

The research team in Germany recently evaluated a quantitative assay for the identification of urine-excreted lisdexamfetamine using liquid chromatography–high-resolution, high-accuracy tandem mass spectrometry (LC-MS/MS) (read more about the method and technology here). Its goal was to show how rapid, sensitive protocols can be widely used to differentiate between actual amphetamine doping and “false” positives that can result from the administration of lisdexamfetamine and other ADHD medications to athletes.

Although the team in Germany advanced the science of sports doping considerably, the researchers acknowledge the need for follow-up studies that clearly delineate typical ratios of amphetamine, lisdexamfetamine, and metabolic products to establish standards for the differentiation of therapeutic use from drug abuse. This would set the stage for a widespread roll-out throughout the amateur and professional sports worlds, using advanced instruments and methods to draw clearer distinctions between two real health issues – ADHD and drug abuse – so that each can be addressed more directly and decisively.

ADHD CONCEPT Printed Diagnosis Attention deficit hyperactivity disorder

“The human body converts lisdexamfetamine into the active component dextroamphetamine, which is in the amphetamine class and therefore banned by all established sports."


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