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. Key Points: Electroceuticals, namely spinal cord stimulation (SCS), have the potential to enhance performance in parasport and influence classification, thereby falling within various International Paralympic Committee (IPC) policies (e.g. The IPC Anti-Doping Code, The Classification Code, The Medical Code, and The Policy on Sport Equipment). Evidence indicates that SCS meets the requirements for the World Anti-Doping Agency (WADA) to consider its place on the Prohibited List, as it meets at least two—and possibly three—of the following criteria: (1) the potential to enhance or enhances sport performance; (2) represents a potential health risk to the athlete if misused, and (3) may violate the spirit of sport. We propose several considerations for the IPC and WADA to get ahead of the impending use of electroceuticals in para-athletes: (1) require athletes to declare whether they have an electroceutical and will use it during competition; (2) develop guidelines for monitoring electroceutical use immediately prior to and during competition; (3) monitor long-term use to assess whether athletes have undergone a period of neuroplasticity whereby improvements in function (i.e. by using SCS to augment training adaptations) may warrant more frequent re-classifications, and (4) start to educate para-athletes and athlete support personnel now so that they are aware of the ethical and practical implications of electroceuticals ahead of future regulation implementation.
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