Glucocorticoids are sometimes used by athletes in an attempt to enhance performance because of their anti-inflammatory and analgesic properties.
Athletes may also use phosphodiesterase-5 inhibitors in an attempt to attain increased oxygenation and exercise capacity, since they have vasodilatory effects. Psychiatric medications, including antidepressants, anxiolytics, antipsychotics, and anticonvulsants, are generally not on the WADA banned list. One small study of nine males suggested that bupropion, when used acutely in warm environments, may allow athletes to push themselves to higher body temperature and heart rates without perceiving greater effort.
Gene doping is a concerning potential method of nondrug performance enhancement and is banned by WADA. The potential to directly affect strength and endurance through gene manipulation has been demonstrated in laboratory mice, but no human athletes thus far have been found to be using this method. Additionally, athletes may legally attempt to improve physical performance in a number of nondrug ways. Some studies suggest that a high—low method of sleeping at high altitude followed by training at low altitude is a better training strategy than training or sleeping at either high or low altitudes alone.
Athletes may also make dietary changes to try to increase hemoglobin levels. Unfortunately, given the high doses of these agents used by athletes, it is difficult to confirm such effects.
It would be unethical to give dosages as high as those used by athletes for performance enhancement effects to participants in research studies. Table 2 lists the potential side effects of various forms of doping. Doping in sport. Oxford, UK: Wiley; Drug testing typically occurs only in organized, competitive sports. At the college level, organizations such as the National Collegiate Athletic Association 60 and individual member institutions conduct standard drug testing programs and enforce penalties for positive tests.
Elite athletes competing at international and national levels are subject to standardized anti-doping guidelines under the auspices of WADA and related national organizations. WADA is the international independent agency that publishes the World Anti-Doping Code, which is the document harmonizing anti-doping policies in all sports and all countries.
The Code sets forth specific anti-doping rules and principles that are to be followed by the anti-doping organizations responsible for adopting, implementing, or enforcing anti-doping rules within their authority, including the IOC, International Paralympic Committee, international sport federations for example, the International Cycling Union , major event organizations, and national anti-doping organizations for example, the US Anti-Doping Agency.
WADA revises and publishes its list of banned substances approximately annually. It specifies those banned substances and methods that are prohibited at all times both in-competition and out-of-competition because of their potential to enhance performance in future competitions or their masking potential, and those substances and methods that are prohibited in-competition only.
The list may be expanded by WADA for a particular sport. WADA has also taken the lead in the development of the athlete biological passport concept. The fundamental principle of the athlete biological passport is based on the monitoring of selected parameters over time that indirectly reveal the effect of doping, as opposed to the traditional direct detection of doping by analytical means.
This concept gained momentum as a result of questions raised during the Olympic Winter Games surrounding suspensions of athletes by their federations following health checks that reported high hemoglobin levels.
A positive test result would consist of too dramatic a change from the established individual baseline. This approach is intended to protect athletes from false-positive tests resulting from naturally occurring high levels of endogenous substances, while catching those attempting to cheat by using naturally occurring substances. In the event that an athlete and his or her medical providers feel it necessary, for documented medical reasons, that he or she continue to take a banned substance, WADA may consider granting a therapeutic use exemption, a concept mentioned earlier.
A therapeutic use exemption must be on file before an athlete tests positive for the substance allowed by that therapeutic use exemption. The first level of addressing the problem of drug abuse by athletes is prevention. Didactic education is another method aimed at prevention. Athletes ultimately focus on their performance, and thus may view doping as rational behavior.
For example, in , Bamberger and Yaeger surveyed Olympic athletes. There is little research available to guide counseling and psychiatric approaches to treatment of athletes who abuse drugs. Developing discrepancies between where the athlete wants to go in life after sport and the impact that continued use of the substance might have on those goals.
During this process, the provider helps athletes to clarify conflict among their values, motives, interest, and behaviors. Rolling with resistance. When resistance inevitably occurs, providers should avoid arguing with athletes, as that can exacerbate resistance to change. Encouragement of self-efficacy. Athletes may need to shift their viewpoint from one of being willing to do whatever it takes to win, to acknowledging that they would use PEDs only if ultimately incapable of succeeding without them with the hope that athletes will never get to that point.
If an athlete is physically dependent on a drug, then additional strategies may be needed. These may include pharmacologic interventions such as naltrexone, acamprosate, or disulfiram for alcohol dependence, or buprenorphine for opiate dependence.
Drug abuse in athletes is a significant problem that has many potential underlying causes. The drive to be the best in sport dates to ancient times, as does the use of performance-enhancing substances. With the ever-mounting pressures faced by athletes, it is not surprising that drug abuse by athletes exists across essentially all sports and age groups. If providers become aware of an athlete using PEDs, they should educate the athlete about the potential risks of continued use, regardless of any evidence that suggests this may not be influential for all athletes.
Providers should encourage discontinuation of the abused substance s. There is great variance in drug testing programs in different sports and at different levels of competition. Physicians, trainers, coaches, parents, and others in the athlete entourage need to be well trained in recognizing the signs and symptoms of drug abuse, including changes in physical health and behaviors Table 3. Adapted with permission from Morse ED.
Substance use in athletes. The efficacy of education about PED use as a preventative measure needs further study. Early integration of well designed prevention curricula into sports programs may be beneficial.
Mental health professionals should be included in the network of team doctors and other health care providers readily available to athletes. Psychiatrists are often helpful in developing strong drug prevention policies that emphasize education and treatment and not just sanctions. Screening for and treatment of underlying mental illnesses such as depression that may contribute to self-treatment with drugs by athletes should be increased. The effectiveness of this screening should be studied.
Athletes who are using drugs are often skeptical of the medical field. This may be partly with good reason, as many health care professionals are unfamiliar with the mentality of athletes or common drug abuse patterns in this population.
Accordingly, referral networks or team assistance programs consisting of health care professionals familiar with these issues should be established for athletes and teams. Research should examine differences in treatment approaches that may be needed for athletes who have been using drugs for a shorter versus longer period of time. National Center for Biotechnology Information , U. Journal List Subst Abuse Rehabil v. Subst Abuse Rehabil.
Published online Aug Claudia L Reardon and Shane Creado. Author information Copyright and License information Disclaimer.
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This article has been cited by other articles in PMC. Abstract Drug abuse occurs in all sports and at most levels of competition. Keywords: doping, athletes, steroids, drug abuse, mental illness. Introduction Doping, defined as use of drugs or other substances for performance enhancement, has become an important topic in virtually every sport 1 and has been discovered in athletes of all ages and at every level of competition.
Open in a separate window. History of doping in athletes The belief that doping is only a recent phenomenon that has arisen solely from increasing financial rewards offered to modern day elite athletes is incorrect. Performance-enhancing effects of substances used by athletes There is a research base demonstrating that many doping agents are in fact performance-enhancing. Androgens Androgens include exogenous testosterone, synthetic androgens eg, danazol, nandrolone, stanozolol , androgen precursors eg, androstenedione, dehydroepiandrosterone , selective androgen receptor modulators, and other forms of androgen stimulation.
Stimulants Stimulants include amphetamine, D-methamphetamine, methylphenidate, ephedrine, pseudoephedrine, caffeine, dimethylamylamine, cocaine, fenfluramine, pemoline, selegiline, sibutramine, strychnine, and modafinil.
Nutritional supplements Nutritional supplements include vitamins, minerals, herbs, extracts, and metabolites. The street drugs cocaine and methamphetamine also are stimulants. Although stimulants can boost physical performance and promote aggressiveness on the field, they have side effects that can impair athletic performance, including:. Do performance-enhancing drugs boost performance? Some athletes may appear to achieve physical gains from such drugs, but at what cost? The long-term effects of performance-enhancing drugs haven't been rigorously studied.
And short-term benefits are tempered by many risks. Not to mention that doping is prohibited by most sports organizations. There is a problem with information submitted for this request. Sign up for free, and stay up-to-date on research advancements, health tips and current health topics, like COVID, plus expert advice on managing your health.
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By Mayo Clinic Staff. Thank you for Subscribing Our Housecall e-newsletter will keep you up-to-date on the latest health information. Please try again. Something went wrong on our side, please try again. Show references Madden CC, et al. When used for a legitimate medical reason, for example to treat a heart condition, high blood pressure anxiety, and under the guidance of a trained professional, beta blockers have a good safety record.
When used without a legitimate health reason, side effects can include reduced circulation through the hands and feet, dizziness, fatigue, dry mouth and drowsiness. More serious though rare side-effects can include impotence, asthma attack, memory loss or heart failure. A high-profile case of Beta Blocker use at the elite level was in , when Olympic shooter Kim Jong-su tested positive for Propranolol and was subsequently stripped of his medals.
Diuretics work to promote the production of urine. While putting your hand up for a toilet break may not be deemed professional in modern sport, athletes use diuretics to assist with weight-loss the loss of water through urination leads to an overall loss of body weight. This is particularly useful in sports where weight is critical such as boxing, rowing or horse-racing. The increased urine volume also aids in the dilution of doping agents and their metabolites.
Diuretics have been banned in sport since When used to treat legitimate medical conditions such as heart failure, high blood pressure, kidney and liver problems and glaucoma, and under the supervision of a trained doctor, diuretic use is quite safe.
However, because diuretics promote frequent urination, when used without medical supervision they can lead to dehydration, dizziness, muscle cramps and constipation. Other side effects include tiredness, fever, skin rash and loss of appetite. More serious effect include disruptions to the normal rhythms of the heart, and electrolyte abnormalities, which can affect kidney function. Former Australian cricketer Shane Warne tested positive for a banned diuretic in and subsequently was suspended from all forms of cricket for 12 months, leading to him missing the ICC World Cup.
Previously, diuretics were detected in biological samples through the use of high-performance liquid chromatography HPLC coupled with ultraviolet-diode array detection UV-DAD. However, this method was not deemed rigorous enough in determining the unequivocal identification of banned substances. For this reason, international anti-doping regulations have required the implementation of mass-spectral methodology to test samples.
Setting the benchmarks above which an athlete is deemed to be a drug cheat is a difficult issue for sporting bodies. High levels of hormones do not always indicate cheating, and low levels do not always guarantee innocence. The ABP collates data on the levels of different substances in the body, during and after exercise, and uses this to construct a profile, effectively determining natural levels of various substances in the body for each individual.
From this information, testers can assess if an athlete suddenly has a large jump in certain hormones or proteins in their blood, when compared against their normal levels. This could indicate that doping has occurred. Since ABPs also include a steroidal module, which monitors selected urinary steroid concentrations over time to monitor for potential steroid doping. The advantage of this approach is the biological effects of a performance-enhancing agent are commonly present and detectable for a longer period than the agent itself.
Most athletes dope for short-term gain, but what are the long-term implications of using these drugs? From a health perspective, the verdict is unclear. As listed above, all doping drugs have potential immediate or short-term side-effects and drawbacks, but scientists are still researching the longer-term effects they may have on the body. Some studies have found evidence of early mortality due to cancer or heart attack amongst previous long-term users of PEDs, but these are inconclusive as other factors such as lifestyle, and genetics may also be responsible.
Part of the difficulty is in finding athletes who would agree to participate in such a study. From a performance point of view, scientists from the University of Oslo have released preliminary findings showing that athletes may continue to benefit from having taken banned substances long after the drugs have left their system and their bans have been lifted.
The study , which was undertaken on mice, found that muscles can retain some of the advantages gained through anabolic steroid use for years, possibly even decades after the drugs were taken. Kristian Gunderson, Professor of Physiology at the University of Oslo said 'If you exercise, or take anabolic steroids, you get more nuclei and you get bigger muscles.
If you take away the steroids, you lose the muscle mass, but the nuclei remain inside the muscle fibres. They are like temporarily closed factories, ready to start producing protein again when you start exercising again. If proven, their study would require a complete reworking of the current anti-doping system, including length of bans and ability to return to competition. On 1 January , WADA introduced tougher punishments for doping, including upping the bans from two to four years.
There are also stronger punishments for coaches, trainers and administrators who are found to have helped athletes dope. More than years of sports history tells us that when one method is detected, another rises to take its place. See our infographic on performance drugs. Drugs in sport Expert reviewers. And maybe a few drug cheats? Doping Modern sport is plagued by suspicions that many top athletes resort to drug-taking—doping—to enhance their performance, but this is not a new phenomenon.
Types of performance enhancing drugs Among the most popular PEDs are anabolic steroids, human growth hormone, erythropoietin EPO , beta-blockers, stimulants and diuretics to name just a few. Stimulants Stimulants are drugs that directly affect the central nervous system.
Health risks The risks of using stimulants vary for each drug, but in general are high. Examples of use Jamaican sprinter and track star Asafa Powell was caught using the banned stimulant oxilofrine in Testing The presence of stimulants in the body can be tested by a variety of procedures.
Stimulants, such as ritalin, speed up parts of the brain and body. Anabolic steroids Anabolic steroids are drugs derived from testosterone, a hormone which is produced in the testes of males and, to a much lesser extent, in the ovaries of females. Some of the most common types of anabolic steroids include: stanozolol nandrolone boldenone trenbolone androstenedione tetrahydrogestrinone referred to as THG or The Clear.
Examples of use Androstenedione was used by East German Olympic swimmers and other athletes in the s and s to improve their performances. Health risks Medical experts see significant dangers in the use—and particularly the gross over-use—of anabolic steroids.
Anabolic steroids are derived from testosterone. They have a range of effects, but are most widely known for muscle growth. Image source: Wikimedia Commons.
Human growth hormone Human growth hormone HGH; also called somatotrophin or somatotrophic hormone is a naturally-occurring hormone produced in the human body.
Examples of use English Rugby player Terry Newton was suspended in after testing positive for human growth hormone, while Bulgarian sprinter Inna Eftimova was banned from competition in after a returning a positive HGH test.
Health risks If you believe all the hype—emanating mainly from drug manufacturers—HGH is a wonder drug that will remove wrinkles, reverse the ageing process, restore vitality and improve sleep. But the NFL, like other sports, allows players who have a medical need for the drug to use it without penalty, after they have applied for and been granted a Therapeutic Use Exemption. Such numbers were an eye-opener to Wadler.
The current estimates are that about 5 to 10 percent of kids have it, and about 4 or 5 percent of kids are treated for it.
You start faster, move faster, and it can be habit-forming. Larry Stone: or lstone seattletimes. On Twitter StoneLarry.
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