Electroceuticals for Paralympic Athletes: A Fair Play and Classification Concern?

Electroceuticals such as brain computer interfaces and spinal cord stimulation (SCS) represent transformative strategies for neuromodulation. Research has demonstrated that SCS can ameliorate motor and autonomic cardiovascular dysfunctions, particularly in individuals with spinal cord injury (SCI). Notably, SCS has been shown to augment aerobic exercise performance. Owing to the nature of their injury, athletes with SCI are often predisposed to low resting blood pressure and impaired physiological responses to exercise. Therefore, some athletes intentionally induce autonomic dysreflexia ("boosting") to gain a competitive advantage - an act banned by the International Paralympic Committee (IPC). However, the emergence of electroceuticals facilitates an alternative performance enhancement strategy that could be considered unfair without equal access opportunities for all athletes. Currently, the World Anti-Doping Agency and the IPC have not acknowledged the potential impact of electroceuticals in parasport. Herein, we present an argument that the use of SCS meets the criteria for it to be placed on the World Anti-Doping Code Prohibited List (or at the very least be monitored) because collectively: SCS can enhance sport performance, represents a potential health risk to the athlete if misused, and may violate the spirit of sport. Acute and chronic use of SCS may also lead to classification changes, and increased opportunities for athletes to intentionally misrepresent, thereby raising concerns for the IPC. The growing access to electroceuticals (e.g. via clinical trial participation or private healthcare implantation) more than ever increases the likelihood of an athlete using SCS to gain an unfair advantage in parasport.