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Performance Enhancing Drugs in Sports Fast Facts - CNN
Drug abuse occurs in all sports and at most levels of competition. Athletic life may lead to drug abuse for a number of reasons, including for performance enhancement, to self-treat otherwise untreated mental illness, and to deal with stressors, such as pressure to perform, injuries, physical pain, and retirement from sport. This review examines the history of doping in athletes, the effects of different classes of substances used for doping, side effects of doping, the role of anti-doping organizations, and treatment of affected athletes.
Doping goes back to ancient times, prior to the development of organized sports. Many sports organizations have come to ban the use of performance-enhancing drugs and have very strict consequences for people caught using them.
There is variable evidence for the performance-enhancing effects and side effects of the various substances that are used for doping. Drug abuse in athletes should be addressed with preventive measures, education, motivational interviewing, and, when indicated, pharmacologic interventions. 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.
Substance use rates among different populations of athletes as reported in various recent research studies. Drug abuse in the athlete population may involve doping in an effort to gain a competitive advantage.
Alternatively, 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 careers. Alternatively, substances of abuse may cause mental illness.
We will especially focus on doping in this review, which specifically aims to serve as a single paper that provides a broad overview of the history of doping in athletes, the effects of different classes of drugs used for doping, side effects of doping, the role of anti-doping organizations, and the treatment of affected athletes.
Search terms included the following, individually and in combination: We restricted results to the English language and used no date restrictions. We retrieved all papers discussing drug abuse in athletes. We reviewed the findings of each article, and reviewed the references of each paper for additional papers that had been missed in the initial search and that might include findings relevant to the scope of our review.
Ultimately, 67 manuscripts or chapters were felt relevant and representative for inclusion among those referenced in this paper. 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.
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.
Various plants were used to improve speed and endurance, while others were taken to mask pain, allowing injured athletes to continue competing.
In ancient Greece, for example, identified cheaters were sold into slavery. The modern era of doping dates to the early s, with the illegal drugging of racehorses. Its use in the Olympics was first reported in Up until the s, mixtures of strychnine, heroin, cocaine, and caffeine were not uncommonly used by higher level athletes.
By , use of PEDs in the Tour de France was an accepted practice, and when the race changed to national teams that were to be paid by the organizers, the rule book distributed to riders by the organizer reminded them that drugs were not among items with which they would be provided.
In the s, the Soviet Olympic team began experimenting with testosterone supplementation to increase strength and power. Young female athletes experienced more performance enhancement than did male athletes.
Unfortunately, they also suffered significant and delayed side effects, including reports of early death in three athletes. The specific substances used to illegally enhance performance have continued to evolve. Over the past years, no sport has had more high-profile doping allegations than cycling. 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 European Championships, and 2 years later the IOC implemented their first drug tests at both the Summer and Winter Olympics. This resulted in a marked increase in the number of doping-related disqualifications in the late s, 24 notably in strength-related sports, such as throwing events and weightlifting. While the fight against stimulants and steroids was producing results, 24 the main front in the anti-doping war was rapidly shifting to blood doping.
One of these was erythropoietin. An erythropoietin detection test was first implemented at the Olympic Games. In the s and s, there were suspicions of state-sponsored doping practices in some countries. The former German Democratic Republic substantiated these suspicions. In , police found a large number of prohibited substances, including ampoules of erythropoietin, in a raid during the Tour de France.
As early as , France had been the first country to enact anti-doping legislation. Other countries followed suit, but international cooperation in anti-doping affairs was long restricted to the Council of Europe. In the s, there was a marked increase in cooperation between international sports authorities and various governmental agencies. Before , debate was still taking place in several discrete forums IOC, sports federations, individual governments , resulting in differing definitions, policies, and sanctions.
Athletes who had received doping sanctions were sometimes taking these sanctions, with their lawyers, to civil courts and sometimes were successful in having the sanctions overturned.
The Tour de France scandal highlighted the need for an independent, nonjudicial international agency that would set unified standards for anti-doping work and coordinate the efforts of sports organizations and public authorities. There is a research base demonstrating that many doping agents are in fact performance-enhancing.
However, some substances eg, selective androgen receptor modulators, antiestrogens, and aromatase inhibitors , used in an effort to enhance performance, have little data to back up their effectiveness for such a purpose. Note that the studies cited in this paper are chosen as being historically important or representative of the bulk of the research on the topic, and the broad overview provided in this paper does not aim to cite all evidence on the effects of these substances.
Additionally, research on this topic is limited by the difficulty in performing ethical studies due to the high doses of doping agents used, potential side effects, and lack of information on actual practice. 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.
The latter categories of substances have been used by athletes in an attempt to increase endogenous testosterone in a way that may circumvent the ban enforced on natural or synthetic androgens by WADA. Amounts of testosterone above those normally found in the human body have been shown to increase muscle strength and mass.
For example, a representative randomized, double-blind study involved 43 men being randomized to four different groups: This was a critical study in demonstrating that administration of testosterone increased muscle strength and fat-free mass in all recipients, and even moreso in those who exercised.
That study demonstrated findings similar to the previous one, in showing a dose-dependent increase in leg power and leg press strength, which correlated with serum total testosterone concentrations. Androgen precursors include androstenedione and dehydroepiandrosterone DHEA. We found no evidence that androstenedione increases muscle strength. However, results from placebo-controlled studies of DHEA in males have been mixed.
The males but not females showed increased knee and lumbar back strength during DHEA treatment. 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 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 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.
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. The potential performance benefits of the other ingredients in energy beverages are unclear.
For example, taurine may improve exercise capacity by attenuating exercise-induced DNA damage, but the amounts found in popular beverages are probably far below the amounts needed to be of performance-enhancing benefit.
Of note, the number of athletes, especially at top levels of competition, reported to be using stimulant medications has markedly increased in recent years. In the USA, the National Collegiate Athletic Association acknowledged that the number of student athletes testing positive for stimulant medications has increased three-fold in recent years. Nutritional supplements include vitamins, minerals, herbs, extracts, and metabolites. Studies have shown that many nutritional supplements purchased online and in retail stores are contaminated with banned steroids and stimulants.
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 that may be used in an attempt to enhance performance include alcohol, cannabinoids, narcotics, and nicotine. Alcohol is banned in six sports during competition only. All of these substances may be used by athletes to reduce anxiety, which may be a form of performance enhancement, but we found little research looking at actual performance enhancement from these agents.
Narcotics are used to decrease pain while practicing or playing. Nicotine may enhance weight loss and improve attention. There is debate as to whether beta-2 adrenergic agonists, for example, albuterol, formoterol, and salmeterol, are ergogenic. 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.
Diuretics and other masking agents may be used as doping agents. 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.