New resources are now available to help institutions prepare for stricter application later this year of NCAA drug-testing exceptions for banned stimulant medications used to treat Attention Deficit Hyperactivity Disorder (ADHD).

The NCAA recognizes that some banned substances are used for legitimate medical purpose, and allows exceptions to a positive drug test for those student-athletes with a documented medical history demonstrating the need for regular use of such a drug.

Guidelines established by the NCAA Committee on Competitive Safeguard and Medical Aspects of Sports for documenting legitimate use of ADHD stimulant medications via the medical-exception process now are available on the Association’s Web site.

Those and other resources are intended to help institutions and their sports medicine staffs prepare for a stricter application of the medical-exception policy that goes into effect August 1, 2009 – and in the process, become better equipped to monitor the health of student-athletes who are being treated for ADHD.

Stimulant medications commonly prescribed to treat ADHD, such as Adderall and Ritalin, are among banned substances for which a medical exception for a positive drug test may be granted, provided a student-athlete’s institution presents documentation that those substances have been prescribed by a physician and is supported by a clinical assessment for educational or health reasons.

“The student-athlete should provide the documentation to their sports medicine staff, to file and keep at the institution,” said Mary Wilfert, NCAA associate director of educational affairs. “It only is presented to the NCAA when there is a positive drug test.”

In order to process a medical exception for a banned stimulant, an institution must be prepared to submit documentation at the time of confirmation of a positive drug test. Otherwise, the institution will have to submit an appeal for the positive test.

Under the stricter application of medical exceptions, documentation for stimulants prescribed to treat ADHD must include evidence that the student-athlete has undergone a clinical assessment to diagnose the disorder, is being monitored routinely for use of the stimulant medication, and has a current prescription on file.

“It is all written documentation, and what basically has to be included is documentation supporting the diagnosis, the course of treatment, and the current prescription,” Wilfert said. “The documentation of the diagnosis can’t simply be, ‘I’m Dr. Smith and I say he has ADHD.’ It has to present the formal assessment that produced the diagnosis.”

The NCAA Web site also offers such aids as a list of criteria to include in the reporting physician’s submission and a sample evaluation format for a clinical assessment for ADHD.

The stricter application of the policy stems from a recent increase in requests received by the Committee on Competitive Safeguards and Medical Aspects of Sports (CSMAS) for medical exceptions, following positive drug tests resulting from use of stimulant medications.

“We increasingly have been receiving requests for medical exceptions that do not contain a lot of historical treatment information, nor do they contain documentation of a formal assessment,” Wilfert said.

Physicians serving as CSMAS members want to ensure that ADHD medication is prescribed with a clinical assessment that could reveal other reasons why a student-athlete may be experiencing focus or attention issues. In addition, they believe a student-athlete using a stimulant medication should be monitored for health effects associated with stimulant use.

“There may be an underlying medical issue, such as depression, that hasn’t been identified through a formal assessment,” Wilfert said. “The concern is that a student-athlete may not be treated appropriately for the condition.”

Diagnosis of ADHD should be clinically based, Wilfert said – including such tools as physical examinations, interviews and symptom-rating scales. Treatment of ADHD also may include education and psychological treatment, as well as prescription of medications.

The NCAA bans stimulants not only because they may enhance athletic performance, but because they pose a health risk by potentially contributing to heat illness or placing stress on the heart.

 “(CSMAS) is concerned about two issues,” Wilfert said. “It is concerned first about the health of the student-athlete. Second, it is concerned about situations where student-athletes may be using stimulants to gain an unfair advantage, though it also wants to ensure that student-athletes are able to use these medications when they are needed for education reasons.”

ADHD has been reported to affect approximately 5 percent of the United States population, and as adults increasingly are being diagnosed with the disorder, more college students – not just student-athletes – are using prescribed medications.

However, with more of these medications present on campuses, they sometimes may be obtained by students who do not have a prescription, or prescribed without fully investigating whether students are affected by other disorders that may co-exist with ADHD.

Although CSMAS is concerned about misuse of stimulant medications, the primary thrust of the more stringent application of the medical-exception policy is to help institutions prepare documentation for a response to a positive drug test of a student-athlete with a documented medical need.

“We know many sports medicine staffs already are doing this, but some are not getting all the information they need from student-athletes about all the medications and supplements they are using,” Wilfert said. “It’s important to do so, for student-athletes’ general health. If an incident occurs, they’ll know how to treat it, or be in a position to report what a student-athlete is using if he or she can’t report it.”

Wilfert acknowledged that some may be reluctant to reveal they are being treated for ADHD, but noted that schools can reassure student-athletes that they need the information only for two reasons – to safeguard the student-athlete’s health and to be prepared to respond to a positive NCAA drug test.

“We do hear from time to time, ‘I have kids who just don’t want to tell me they’re taking ADHD medication,’ ” she said. “Sports medicine staffs can help remove the stigma by presenting this as standard operating procedure – in order to ensure continued eligibility, all medications should be disclosed upon matriculation into athletics as well as any future new treatments.

 “They should make clear, it’s our standard practice, there’s nothing to be embarrassed about, we hold all of your medical information confidential. And, in cases where a banned substance is being used for supervised medical reasons, we want to make sure you have the appropriate documentation.”

Both current and prospective student-athletes should be advised of the stricter application of the medical-exceptions policy. The stricter policy will apply even to student-athletes who received a medical exception before August 1, 2009, and who may not have provided documentation of a clinical assessment.

“Sports medicine staffs will play a very important role,” Wilfert said. “They’ll be the first line of defense, if you will, by checking with student-athletes during pre-participation exams to ensure they’ve got all the information they will need about any medications – particularly about medications on the NCAA banned substances list. In the latter case, they’ll have the student-athlete gather the documentation from their prescribing physician.”

In situations where the student-athlete has not received a clinical assessment, sports medicine personnel can advise the student-athlete to obtain a referral to a specialist from a personal physician, or refer the student-athlete to local specialists – at a campus counseling and testing program, student support services or a community mental health program -- who are trained to test for and assess ADHD.

“It’s an important role for sports medicine staffs – to make sure they’re telling student-athletes how important it is to inform them you are using these medications, and then making sure to get the right documentation,” Wilfert said.

NCAA student-athletes and athletics staffs can use the Resource Exchange Center (www.drugfreesport.com/rec) to learn whether a medication is banned.