Drug Use on Mont Blanc: A Study Using Automated Urine Collection

Abstract

Mont Blanc, the summit of Western Europe, is a popular but demanding high-altitude ascent. Drug use is thought to be widespread among climbers attempting this summit, not only to prevent altitude illnesses, but also to boost physical and/or psychological capacities. This practice may be unsafe in this remote alpine environment. However, robust data on medication during the ascent of Mont Blanc are lacking. Individual urine samples from male climbers using urinals in mountain refuges on access routes to Mont Blanc (Goûter and Cosmiques mountain huts) were blindly and anonymously collected using a hidden automatic sampler. Urine samples were screened for a wide range of drugs, including diuretics, glucocorticoids, stimulants, hypnotics and phosphodiesterase 5 (PDE-5) inhibitors. Out of 430 samples analyzed from both huts, 35.8% contained at least one drug. Diuretics (22.7%) and hypnotics (12.9%) were the most frequently detected drugs, while glucocorticoids (3.5%) and stimulants (3.1%) were less commonly detected. None of the samples contained PDE-5 inhibitors. Two substances were predominant: the diuretic acetazolamide (20.6%) and the hypnotic zolpidem (8.4%). Thirty three samples were found positive for at least two substances, the most frequent combination being acetazolamide and a hypnotic (2.1%). Based on a novel sampling technique, we demonstrate that about one third of the urine samples collected from a random sample of male climbers contained one or several drugs, suggesting frequent drug use amongst climbers ascending Mont Blanc. Our data suggest that medication primarily aims at mitigating the symptoms of altitude illnesses, rather than enhancing performance. In this hazardous environment, the relatively high prevalence of hypnotics must be highlighted, since these molecules may alter vigilance.

Going to Altitude with a Preexisting Psychiatric Condition

“…Substance use disorders are very common in the general population with the most common being alcohol, benzodiazepines, and cannabis, and it is known that many mountaineers use legal or illegal substances to enhance their performance (Roggla et al, 1993; Robach et al, 2016). Smoking is more common in individuals with psychiatric disorders (Boksa, 2017), and one study has shown that it might reduce the risk of AMS during acute exposure to an altitude of 3700 m (Song et al, 2014).…”

The effect of zolpidem on cognitive function and postural control at high altitude

“…To improve sleep at high altitude, hypnotics have been recommended [5] and mountaineers use these drugs to enhance sleep quality and recovery. In a recent study from our group investigating drug use at altitude [6], hypnotics were found prevalent (12.9%, including 8.4% of zolpidem) in the urines of mountaineers ascending Mont Blanc (Chamonix, France).…”

“…Mountaineers at high altitude generally wake-up in the middle of the night to climb in the most appropriate conditions (temperature, risks of avalanche, etc). For instance in the mountain huts located on the main climbing routes to the Mont-Blanc [6], waking-up is scheduled at midnight or 01:00 am. Although zolpidem has a short half-life (1.5-2.4 hours) [11], previous results indicate significant residual effects up to 5 hours after drug intake at sea level with alterations in cognitive performances and car driving [12,13].…”

Day of Ascent Dosing of Acetazolamide for Prevention of Acute Mountain Sickness

“…While gradual ascent has proven effective as a preventive strategy (Purkayastha et al, 1995;Beidleman et al, 2009), this is often logistically infeasible in both recreational and tactical situations. The carbonic anhydrase inhibitor acetazolamide is considered the first-line AMS chemoprophylactic (Eigenberger et al, 2014;Robach et al, 2016) and is the only U.S. Food and Drug Administration-approved medication for AMS prevention, with recommendations to administer the day or night before rapid ascent (drugs.com, 2019;Netzer et al, 2013).…”