Drugs and the athlete
Doping, defined as use of drugs or other substances for performance enhancement, has become an important topic in virtually every sport1 and has been discovered in athletes of all ages and at every level of competition. performance-enhancing drugs (PEDs) are not restricted to illegal drugs or prescription medications, such as anabolic steroids.11 They include dietary supplements and a variety of compounds that are available at grocery and health food stores and online. Drug abuse in the athlete population may involve doping in an effort to gain a competitive advantage. it may involve use of substances such as alcohol or marijuana without the intent of performance enhancement, since athletes may develop substance use disorders just as any nonathlete may. Athletes may turn to substances to cope with numerous stressors, including pressure to perform, injuries, physical pain, and retirement from a life of sport (which happens much earlier than retirement from most other careersathletes may be significantly less likely to receive treatment for underlying mental illnesses such as depression.14
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. in fact, doping is older than organized sports. Ancient Greek Olympic athletes dating back to the third century BC used various brandy and wine concoctions and ate hallucinogenic mushrooms and sesame seeds to enhance performance. The modern era of doping dates to the early 1900s, with the illegal drugging of racehorses. Its use in the Olympics was first reported in 1904. Up until the 1920s, mixtures of strychnine, heroin, cocaine, and caffeine were not uncommonly used by higher level athletes. By 1930, use of PEDs in the Tour de France was an accepted practice. n the 1950s, the Soviet Olympic team began experimenting with testosterone supplementation to increase strength and power. the East German government’s program of giving PEDs to young elite athletes was made public. The “advances” in doping strategies have been driven, in part, by improved drug testing detection methods. Many sports organizations have come to ban the use of PEDs and have very strict rules and consequences for people who are caught using them. The International Association of Athletics Federations was the first international governing body of sport to take the situation seriously.
The first actual drug testing of athletes occurred at the 1966 European Championships, and 2 years later the IOC implemented their first drug tests at both the Summer and Winter Olympics.
This removal and subsequent reinfusion of an athlete’s blood in order to increase the level of oxygen-carrying hemoglobin has been practiced since the 1970s. The IOC banned blood doping in 1986. Erythropoietin was included in the IOC’s list of prohibited substances in 1990. An erythropoietin detection test was first implemented at the 2000 Olympic Games. The most prominent doping case of the 1980s concerned Ben Johnson, the 100 meter dash champion who tested positive for the anabolic steroid stanozolol at the 1988 Olympic Games in Seoul.
The IOC took the initiative and convened the First World Conference on Doping in Sport in Lausanne in February 1999. Following the proposal of the Conference, the World Anti-Doping Agency (WADA) was established later in 1999.
Performance-enhancing effects of substances used by athletes
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.
dose-dependent increase in leg power and leg press strength, which correlated with serum total testosterone concentrations.
DHEA is available as a nutritional supplement that is widely advertised in body building magazines as a substance that will improve strength.
Selective androgen receptor modulators are not approved for use in humans in any country, but athletes are able to obtain these substances on the Internet.
Other forms of androgen stimulation include exogenous human chorionic gonadotropin, antiestrogens such as tamoxifen, clomiphene, and raloxifene, and aromatase inhibitors such as testolactone, letrozole, and anastrozole. These substances may result in increased serum testosterone.
Growth hormone and growth factors
Growth hormone and growth factors are also banned by WADA. Research shows recombinant human growth hormone to increase muscle mass and decrease adipose tissue.
In both males and females, growth hormone was associated with significantly decreased fat mass, increased lean body mass, and improved sprint capacity (although with no change in strength, power, or endurance). Sprint capacity improvement was even greater when growth hormone and testosterone were coadministered to males.
Growth factors include insulin-like growth factor and insulin. They are presumed to have similar effects to growth hormone, but have not been studied in athletes.
Stimulants
stimulants include amphetamine, D-methamphetamine, methylphenidate, ephedrine, pseudoephedrine, caffeine, dimethylamylamine, cocaine, fenfluramine, pemoline, selegiline, sibutramine, strychnine, and modafinil. Research has shown stimulants to improve endurance, increase anaerobic performance, decrease feelings of fatigue, improve reaction time, increase alertness, and cause weight loss.
while WADA bans stimulants as a class, it does allow use of caffeine. Energy beverages now often include a variety of stimulants and other additives including not only caffeine, but also the amino acids taurine and L-carnitine, glucuronolactone, ginkgo biloba, ginseng, and others.
Nutritional supplements
Nutritional supplements include vitamins, minerals, herbs, extracts, and metabolites.39 Importantly, the purity of these substances cannot be guaranteed, such that they may contain banned substances without the athlete or manufacturer being aware.
Methods to increase oxygen transport
Substances athletes use to increase oxygen transport include blood transfusions, erythropoiesis-stimulating agents such as recombinant human erythropoietin and darbepoetin alfa, hypoxia mimetics that stimulate endogenous erythropoietin production such as desferrioxamine and cobalt, and artificial oxygen carriers.
Transfusions and erythropoiesis-stimulating agents have been shown to increase aerobic power and physical exercise tolerance.
Other recreational drugs
Other recreational drugs that may be used in an attempt to enhance performance include alcohol, cannabinoids, narcotics, and nicotine.
Beta agonists
There is debate as to whether beta-2 adrenergic agonists, for example, albuterol, formoterol, and salmeterol, are ergogenic. oral beta agonists may increase skeletal muscle, inhibit breakdown of protein, and decrease body fat.
Beta blockers
Beta blockers such as propranolol result in a decreased heart rate, reduction in hand tremor, and anxiolysis. These effects may be performance-enhancing in sports in which it is beneficial to have increased steadiness, such as archery, shooting, and billiards.
Other prescription drugs
Diuretics and other masking agents may be used as doping agents. Diuretics can result in rapid weight loss such that they may be used for a performance advantage in sports with weight classes, such as wrestling and boxing. Diuretics may also be used to hasten urinary excretion of other PEDs, thereby decreasing the chances that athletes will test positive for other banned substances that they may be using.
Masking agents in general conceal prohibited substances in urine or other body samples, and include diuretics, epitestosterone (to normalize urine testosterone to epitestosterone ratios), probenecid, 5-alpha reductase inhibitors, and plasma expanders (eg, glycerol, intravenous administration of albumin, dextra, and mannitol).
Glucocorticoids are sometimes used by athletes in an attempt to enhance performance because of their anti-inflammatory and analgesic properties.
Nondrug performance-enhancing measures
Gene doping is a concerning potential method of nondrug performance enhancement and is banned by WADA. These have varying degrees of research into their effectiveness and safety, and include hypoxia induction techniques.
Side effects of substances used by athletes
It is presumed that most if not all doping agents have potential short-term and/or long-term side effects. It would be unethical to give dosages as high as those used by athletes for performance enhancement effects to participants in research studies.
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 was first adopted in 2003 and became effective in 2004. 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.
WADA revises and publishes its list of banned substances approximately annually. It specifies those banned substances and methods that are prohibited at all times .
WADA has also taken the lead in the development of the athlete biological passport concept.
biological passport is based on the monitoring of selected parameters over time that indirectly reveal the effect of doping.
An athlete’s passport purports to establish individual baseline hormone/blood levels, which are moA positive test result would consist of too dramatic a change from the established individual baseline.nitored over time for significant changes.
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.
Treatment of affected athletes, including counseling and psychiatric support
The first level of addressing the problem of drug abuse by athletes is prevention.
Drug screening is used in higher-level athletics both to deter athletes from using drugs and to punish and offer opportunities for rehabilitation to those who are found to have done so.
Didactic education is another method aimed at prevention.
frequent, accurate, very closely observed, truly random urine drug testing.
Leave a Reply