Drugs and Sport

S Pai, G R McLatchie

Department of Sport Medicine, University Hospital of Hartlepool, UK

Abstract
There has always been the temptation to take prohibited substances in the struggle for an athlete to gain the ‘higher ground’ above the rest of the competitors which allow goals to be attained easier than by the conventional training methods.

The problem of drugs in sport has existed for a long time and is underestimated in its prevalence. This paper deals with the reasons of why athletes take such drugs, which drugs are available and the testing employed to detect their use.

Among the issues discussed will be the future of drugs in sport and what measures can be taken to combat their use.

Key Words: Drugs and sport, performance enhancement, protection and prevention

Introduction
Drugs in sport is a greatly underestimated problem. Its greatest incidence seems to be amongst body builders where the recorded prevalence of steroid use was up to 38.8% in private gymnasia. Even among adolescents in the USA steroid abuse has been estimated at between 3-7.6%.1-5

Although anabolic steroids are the best known drugs of abuse in sport, many others exist and therefore a definition of performance enhancing substances has to be made. The International Olympic Committee (IOC) states that ‘doping consists of the administration of substances belonging to prohibited classes of pharmacological agents or the use of various prohibited methods.’ 6

Drug testing in sport started in the 1960’s when the IOC set up a medical commission in charge of eradicating drug abuse in Olympic sports, the first testing of drug abuse in athletes occurring in the 1968 Mexican Games.

One must ask why do such athletes use prohibited substances? For such a scenario two groups of athletes exist:
Those who deliberately misuse drugs and set out to avoid detection
Those who inadvertently take prescribed medication
For the former group the use of banned substances is the key to success in their professional approach to training and can bring personal rewards ie running faster, jumping further etc. However, the penalties for being caught are grave and can ruin a promising young athlete’s career.

Classes of Prohibited Substances
Stimulants
Narcotics
Anabolic steroids
Diuretics
Stimulants
Stimulants like amphetamines increase aggression and competitiveness and reduce tiredness and fatigue. Originally linked with the sport of cycling, adverse effects have been emphasised and seem to outweigh the benefits by increasing blood pressure and body temperature, reducing arrhythmias, anxiety, aggression and addiction.

Caffeine12 has also been implicated as a substance used by athletes. Its widespread use in the population in beverages has caused problems in classifying it as a banned substance and therefore the threshold of 12 mcg/ml of caffeine in urine has been set.

One group of stimulants on the prohibited list that also causes problems are the sympathomimetic amines, ie ephedrine, pseudoephidrine and phenylpropranolamine, although doubts remain about their ergogenic effects.

Narcotics
These reduce pain and sensitivity and enable the athlete to continue despite injury. However, the adverse effects of, for example, cocaine have been recorded in athletes and permitted IOC analgesics are, for example, codeine, dihydrocodeine and pholcodeine. Dextropropoxyphene is still a banned substance.

Anabolic steroids
Taken by either the oral or injected route, these not only cause an anabolic effect, but also affect mood and aggression enabling the athlete to train harder. There are well documented side effects such as gynaecomastia, hypogonadism, cholestasis, skin disease, hypertension, myocardial infarction and psychological and even psychiatric illnesses.

There are many types of anabolic steroids available. Usually the dose in which these steroids are taken greatly exceed that recommended for therapeutic purposes.

Testing for steroids involves measuring the testosterone-epitestosterone ratio. The use of epitestosterone to correct the ratio is along with the above mentioned, classified as prohibited methods by the IOC. Such classification also includes blood doping or any pharmacological, chemical and physical manipulation of test urine sample.
Beta-2 agonists, for example, eg clenbuterol are banned because of their anabolic effects.

Beta-blockers
These act as antagonists as Beta receptors and hence cause bradycardia and reduce anxiety. A reduction of heart rate is not always advantageous in many sports but their exploitation occurs in those where accuracy and control are important, for instance archery, bowls and even golf. They are also banned from sports such as bobsleigh and the modern pentathlon.

Diuretics
These are used in sports in which weight targets have to be reached quickly. Such sports include horse racing, boxing and weight lifting. They may also be used to increase urine volume and hence dilute the quantity of other drugs in test urine samples.

Peptide hormones
Peptide hormones have anabolic effects which are difficult to detect. Such include corticotrophin and human chorionic gonadotropin both of which increase levels of endogenous steroid production. Recent links have been made between human growth hormone and Creutzfeldt-Jacob disease.

Prohibited Methods
As well as banned substances there are banned procedures, one of which includes blood doping. An increase in oxygen capacity is a big advantage for an endurance athlete. This is not allowed by the IOC and the practice of blood doping is banned but its detection can be very difficult. Blood is taken off, stored and then reinfused at a later date to effectively increase the packed cell volume and hence the oxygen carrying capacity of the blood. Erythropoietin infusion has also been cited as a more convenient method of attaining the same effect and is therefore similarly prohibited.8

Drug Testing
In one survey 10 of senior competitors from 26 winter and summer sports, of 468 respondents 70% believed that testing was a deterrent but a quarter believed that a lack of widespread testing was less of a deterrent for some. However, 34% of respondents expressed dissatisfaction at the range of competitors selected for testing and 41% were dissatisfied with the frequency.

In a similar survey11 of 1015 Italian athletes, over 10% indicated a frequent use of amphetamines. Although the dangers were appreciated by more than 80% of the athletes interviewed, many were willing to risk serious side-effects to win. 66% of the survey population expressed the wish for tighter control in drug abuse.

Legally cases presented in the USA have argued that random blood testing of athletes is a breach of the Fourth Amendment of the United States Constitution which states that ‘citizens must be secure from unreasonable searches and procedures’. Is random drug testing unreasonable if it gives unfair advantage to those taking drugs?

Conclusion
The only way to avoid being tested positive for prohibited substances is not to take them at all. But this problem is not going to end, certainly not while the list of prohibited substances grows and whilst the potential loopholes in testing are further exploited. Possibly the only way to curb the situation is for the laboratories to stay one step ahead of the offending athletes. Rumoured masking techniques and undetectable agents means that as testing techniques advance so too will the means of avoidance. If the penalties for being caught are not sufficient deterrents then widespread testing should be initiated. There should be adequate protection for innocent athletes who inadvertently take prohibited substances.

Drug information leaflets should be available and issued to teams of doctors and physiotherapists who may prescribe such drugs. All of these measures may hopefully encourage the individual that it is only at this level that the change can occur to choose not to take prohibited substances.

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