Ergogenic Drug Abuse in Sport: Issues & Current TrendsCindy Thomas, MS, ATC, CPCTDirector of Educational Operations
Sports Culture TodayMany of todays athletes are choosing to dope, violating their own bodies as well as their principles, values and rules against doping, but WHY?Victor Conte,Director BALCO
Why Dope?To gain an edge on the competitionBecause the end justifies the meansOnly success and glory really matterSociety rewards for winning; not performingTodays athletes are utilizing technology, nutrition, & science & are closing the gap on physiological limitsUnfortunately dopers miss the point of athletic performance
They dont understand nor value
The most important thing is not to win but to take part, just as the most important thing in life is not the triumph but the struggle. The essential thing is not to have conquered but to have fought well.Olympic Creed
Missing the BoatA typical conversation with a NCAA student-athlete regarding an inquiry on the REC about an energy drink:
S.A.: If I drink Red Bull will it cause me to test positive?REC: Red Bull contains large amounts of caffeine, a banned substance.S.A.:Yeah, but will I test positive from drinking just one can?REC:The NCAA cutoff for caffeine is > 15 micrograms/ml.S.A.:So, how much can I drink before Ill test positive?
What is aPerformance-Enhancing Substance?...any substance taken in nonpharmacologic doses specifically for the purposes of improving sports performance by increasing strength, power, speed, or endurance or by altering body weight or body composition.
Use of Performance-Enhancing Substances PEDIATRICS 9/9/05
What are the categories ofPerformance-Enhancing Substances?Pharmacologic agents Agents for weight control Agents for weight gainEnhancement of O2 carrying capacity Any substance used for reasons other than treating documented conditionsMasking agentsMany dietary supplement products
Performance-Enhancing Drugs/SubstancesAnabolic AgentsStimulantsPeptide HormonesDiuretics (weight loss, dilution of urine)Dietary Supplements
Anabolic SteroidsHuman-made substances related to testosteroneOver 100 types of anabolic steroidsSchedule III Controlled Substances Old is New - designer steroidsPro-hormones
The Anabolic Steroid Control Act 2004 (effective Jan. 2005)Specifically lists dozens of precursors as Schedule III substancesMakes it easier for DEA to outlaw similar substances in future Illegal to possess any of these substances now
Who is Using?Body Image DisorderedEating Disordered Stimulants, Laxatives, Diuretics & Steroids Low Self-Esteem, Depression, SuicideCareer Professionals ModelsFirefightersPolice OfficersMilitary Personnel
Body Image & Steroid UseBody perception issuesMedia promotes idealistic body5-7% of girls have tried steroids to tone bodies many have eating disorders
Steroids & Suicidal TendenciesSuicide rates rise in adolescenceAlready at risk: 3-11% adolescents attempt suicide Predisposing factorsBody image disordersFamily historyLow self-esteemRisk takerSteroid & other drug useTaylor HootonEfrain MarreroRob Garibaldi
When, Why, & Access?Initial Use of Anabolic Steroids17% initially used in junior high school or before39% initially used in high schoolMain Reason for Use51% to Improve athletic performance15.9% to improve appearanceSources for obtaining Anabolic Steroids25% from friend or relative22% from Website/mail order17% from coach or trainer15% from teammate or other athlete2005-06 NCAA Substance Use & Abuse Survey
Other Statistics on Adolescent Steroid Use12% boys & 8% girls use products to improve appearance &/or performance (Pediatrics 2005) 6% of high school athletes have tried steroids within past year (doubled from 1991) (2003 CDC Study)3.4% high school seniors reported using steroids at least once. (2004 Monitoring the Future)
Steroid use down 40 % (lifetime), 37 % (past year), and 21 % (past month) for 8th, 10th, & 12th graders combined. (2006 Monitoring the Future)Over million 8th and 10th grade students use steroids now; increasing number of high school seniors dont believe steroids are risky. (NIDA)2002 Texas A&M study indicated 42,000 students using anabolic steroids
State High School InitiativesCaliforniaOfficials estimate that 20,000 have used PEDsRequires districts to ban steroids & contract with students & parentsDistricts cannot use supplement manufactures as sponsorsCoaches prohibited from promoting supplementsLouisiana, Nevada, & Texas requires signed contract saying they wont use steroidsMichigan & Florida are participating in Atlas/Athena (Peer Education on Steroids)Virginia requires coaches, students, & parents to view the NFHS education video & is participating in the Atlas & Athena programs
State H.S. Assoc. InitiativesNew Mexico ran a pilot steroid testing program Spring 2006 & will have mandatory steroid education in every school next yearIllinois bans use & distribution of PEDs, requires steroid education in all secondary schools & is considering a state-wide steroid testing programNew Jersey added random steroid testing at state championships & requires steroid education programs beginning in junior high schoolFlorida (FHSAA) provides multi-media steroid education opportunities for coaches & athletes88% of Americans polled supported testing high school athletes for steroids (The Sacred Heart University Polling Institute May 2006 interviews nationwide)
NCAA Drug Test Results*Championship Testing Only
NCAA Steroid Results2003-04 (Most common steroid positives)
13 Nandrolones10 Testosterones6 Androstendiones4 Stanozolols2 Boldernones2004-05 (Most common steroid positives)
18 Nandrolones10 Androstendiones8 Testosterones5 Boldernones4 Stanozolols
Current NCAA InitiativesDivision III Pilot Testing begins Fall 20072 year program100 schools will participate12-16 athletes per school testedTesting for all NCAA banned substancesNo sanctions for positive testsAggregate results reported onlyParticipating schools will receive grants for educationAnti-estrogens are being added as a Banned Drug Classe.g., Tamoxifen, a breast cancer drug used to mask steroid use by reducing negative side effects of steroids such as breast enlargementA medical exception will be provided for legitimate reason
Current NCAA InitiativesProposed legislation to test for all banned substances all the timeAdministrators want marijuana tested for all the timeCurrently THC (+) is a 1-year sanctionLegislation seeks to reduce sanction to 50% To reinstate, school must document treatment, s.a. must be tested by school during sanction time, & need a negative exit test
StimulantsIncrease energy, endurance, reduce mental fatigue, increase fat usageAmphetaminesCaffeineSynephrineEphedrineIllegal to include in dietary supplement productsSmart Pills Brain Steroids Ritalin [methylphenidate], Provigil [modafinil], Adderall [amphetamine]High school & college students using to gain an "edge" for academic studies
Dietary SupplementsMuscle buildersEnergy enhancersEndurance increasersWeight lossWeight gainWorkout recoveryPre-workoutJoint healthEffective?Safe?Pure?Accurate dosing?
Caffeine, Ephedrine, SynephrineStimulants found in dietary supplements & OTC drugsAll banned in sportSeveral NCAA positivesMay not be listed ingredient orListed several different waysSometimes large quantities
Energy DrinksNOT A SPORTS DRINKContains stimulants Increases HR & BPDiuretic = DehydrationCan cause + testAlcohol further contributes to problemsConsidered dietary supplements & contain NCAA banned substances!
Peptide HormonesHuman Growth Hormone (hGH)Real hGH is ineffective in tablet formRx = $750/monthPilot testing with antibodyInsulin-like Growth Hormone (IGF-1)Increases rate of muscle repair after injury & rate of growth with training No test yetErythropoietin (EPO)Testing via blood & urineHormone lasts only a few days in the bloodstreamIf stop taking several days before testing may not be caughtAttempted adulteration in urine by adding pepsin, a chemical found in spot removers destroyed all EPO including own naturalCircumvent the test by taking very low doses of EPO every day
Gene ManipulationNon-therapeutic use of cells, genes, genetic elements, or modulation of gene expression, having the capacity to improve athletic performance (WADA)
Repoxygen is a type of gene therapy that induces controlled release of (EPO) may be impossible to detect
May see in 2008 Games
Current testing method trials include tracking traces left by viruses commonly used in gene doping detecting in blood, urine & salivaWhen stimulating growth hormones, also possible that very early cancers, not yet detected, could have their growth dramatically accelerated as well
Why Not Dope?Why not risk health?Why not risk ruin?Why be concerned with principle of fair play and naturalness of sport?Why not do what everyone else is doing?
It's only cheating if you get caught.'
Addressing Sport EthicsSport culture has direct effect on athletes reasoning or non-reasoning about ethical issuesAthletes are very affected by role models around them (e.g., coaches, teammates, athletic trainers)Anti-doping must focus on convincing athletes, parents, athletic trainers, coaches, administrators of the necessity of a level playing field & the ideal performance perspective
Future?Scientifically & ethically complexFuture determined more by technology than