This study reports in detail on the antidoping program of the Paralympic Movement to improve knowledge and optimize intervention programs, including educational and awareness initiatives. Data retrieved from annual statistics reports and historical records are complemented with personal observations. An overall incidence proportion of <1% of antidoping rule violations in the Paralympic Movement is reported, mainly resulting from urine testing during in-competition periods. This led to a total of 60 antidoping rule violations (of which 37 in the sport of International Paralympic Committee powerlifting) since 2000. A critical analysis of these data allows for an assessment of risk factors by sport. An efficient transfer of knowledge indicates the need to strengthen educational awareness, preferably imbedded in a multidisciplinary approach toward athletes' health. The particular case of autonomic dysreflexia is addressed as a separate theme.