Chapter 17: Pharmacology, Drugs and Sports

• Pharmacology is the branch of science that deals with the action of drugs on the biological systems

• Specifically those that are used in medicine for diagnostic and therapeutic purposes

• Used to achieve definite outcomes that improve quality of life

• Various drugs and other substances are being used widely for performance enhancement or mood alteration

What is a drug?

• Chemical agent used in prevention, treatment, & diagnosis of disease

• Ancient practice dating back to the Egyptians

• Many are derived from natural sources

• Drugs which have, in the past, come from nature are now produced synthetically

Pharmacokinetics

• Method by which drugs are absorbed, distributed, metabolized and eliminated from the body

• Pharmacodynamics is the actions or effects of drugs on the body

Administration of Drugs• Must first enter the system and reach receptor tissue to be

effective

• Drug vehicles– Therapeutically inactive substance used to transport drug (solid or

liquid)

• Internal administration– Inhalation (medication through respiratory tract)– Intradermal (into the skin)– Intramuscular (medication directly into muscle)– Intranasal – Intraspinal (medication injected into the spine)

– Intravenous (into a vein)– Oral (most common form)– Rectal (limited due to dosage regulation)– Sublingual/buccal (dissolvable agents placed under tongue

• External Administration– Inunctions (oil based medication rubbed into skin)– Ointments (long lasting topical medication)– Pastes (ointments with nonfat base)– Plasters (thick ointment, counterirritant for pain & inflammation relief,

increasing circulation) – Transdermal patches (adhesive bandage with slow

release medication)– Solutions (administered externally- antiseptics, disinfectants)

Absorption of Drugs• Drug must dissolve before absorption

• Rate and extent determined by chemical characteristics of drug, dosage, and gastric emptying

• Bioavailability– How completely a drug is absorbed by the system– Dependent on characteristics not dosage– (Absorption rate dependent on dosage form)

• Distribution– Once absorbed, drug is transported through blood to target tissue– Volume of distribution: volume of fluid through which drug would have

to be distributed to reach therapeutic level of concentration– Efficacy: capability of producing therapeutic effect– Potency: dose of the drug required to produce a desired therapeutic effect

• Metabolism– Biotransformation of drug to water soluble compounds that can be

excreted– Most takes place in liver, rest in blood and kidneys– Liver detoxifies active agents– Metabolites may be toxic

• Excretion– Excretion of drug or its metabolites is

controlled by kidneys– Filtered through kidneys and usually excreted

in the urine (some is reabsorbed)– May also be excreted in saliva, sweat and feces

Drug Half-Life

• The amount of time required for the plasma drug level to be reduced by one half

• It is either measured in minutes, hours, or days depending on the drug

• Critical information in determining how much of what drug to utilize

• Drug steady state– The amount taken is equal to the amount excreted– Drugs with long half-lives may take days or weeks to

reach steady state

Effects of Physical Activity on Pharmokinetics

• Exercise decreases the absorption after oral administration

• Exercise increase absorption after intramuscular or subcutaneous administration due to the increased rate of blood flow

• Exercise has an influence on the amount of a drug that reaches the receptor site

Legal Concerns in Administering Versus Dispensing Drugs

• Defined as a single dose of medication to be used by a patient

• Dispensing constitutes providing a sufficient quantity to be used for multiple doses– By law, only licensed persons may prescribe or

dispense prescription drugs for an athlete

– ATC’s are not allowed to dispense medication unless allowed by state licensure

• Administering Over the Counter Drugs– ATC may be allowed to administer a single dose of

nonprescription medication– Rules relative to secondary schools

• Oral medications and wound medication

– College and professional athletes• Most are of legal age and are allowed to used whatever

nonprescription drugs they choose• ATC must still use reasonable care and be prudent about types of

medication provided• In all cases, actions should be performed under the supervision of a

physician

• Record Keeping– Must maintain accurate and up to date medical

records– Should include the following in log

• quantity of medication given

• method of administration

•Record Keeping

-Must maintain accurate and up to date medical records

• Name

• Complaint

• Current medications

• Any known drug allergies

• Name of medication

• Lot number

• Expiration Date

• Quantity of medication given

• Method of administration

• Date and time of administration

- Should be aware of state regulations relative to ordering, prescribing, distributing, storing and dispensing of the medications

-Obtaining legal counsel, working w/ state boards of pharmacy, student health clinic, physicians and establishing policies to minimize violating state laws

•Labeling Requirements (federally mandated)

• Name of product• Name and address of

manufacturer, packer or distributor

• Net contents of package• Name of active

ingredients and quantity of certain other ingredients

• Name of any habit forming drug contained

• Cautions and warnings to protect consumer

• Adequate directions for safe, effective use

• Expiration date and lot number

– Nonprescription drugs should not be repackaged w/out meeting labeling criteria

– All drugs dispensed from the athletic training room must be properly labeled

– Legal liability if drugs removed from original packaging and dispensed

• Unable to review contents, dosage, directions and precautions (information needed for safe use)

• Same liability associated with providing prescription medication

• Safety in Use of Pharmaceuticals– No drug is completely safe and harmless– Any drug under the correct conditions can be potent and

dangerous, w/ every individual reacting differently– Athlete must be instructed on specifics of medications (when to,

how to and w/ what medication should be taken with)– Drug Responses

• Individuals react differently to the same medications, w/ different conditions causing altered effects of drugs

• Drugs can change with aging and relative to how they are administered• Alcohol ingestion w/ medications should be avoided

• Alcohol is a depressant and can increase or decrease effects of other drugs• Also used in many liquid preparations• Medication can potentially effect certain physiologic functions related to

dehydration (sweating, urination, and the ability to control and regulate body temperature)

• Can cause fluid depletion, further complicating illness, or make individuals sensitive to sunlight increasing risk of sunburn and allergic reactions

• Different diets may impact absorption rate• Consumption of acidic foods such as fruit, carbonated drinks and

vegetable juice may cause adverse reactions• ATC must know their athlete’s w/ whom they work to avoid potential

adverse reactions

• Buying Medication– Pharmacist is a vital resource, assisting in selection and

purchase of nonprescription drugs, suggesting less expensive generic drugs, and acting as a general advisor

– Properly storing medication is critical• Keep in locked cabinet

• Maintain original container

• Store away from direct light, heat, damp places and extreme cold

• Traveling with Medications– When traveling with a team or individually the athlete should

be advised to do the following relative to medications• Medication should not be stored in a bag/luggage but carried by the

athlete taking it

• Sufficient supply should be packaged in case of emergency

• Make sure there is a source of medication while traveling

• Take copies of written prescriptions

• Keep medication in original container

• If traveling internationally, understand restrictions of individual boundaries

Selected Therapeutic Drugs to Treat the Athlete

• Widespread use in athletics and general society• Pharmaceutical labs develop compounds in vitro

and then test, retest, and refine drugs in vivo before submitting it to the Food and Drug Administration (FDA)

• Number of texts and databases are available for reference to determine appropriateness and effectiveness of medications for different conditions

Drugs to Combat Infection

• Local Antiseptics and Disinfectants– Antiseptics are substances that can be placed on

living tissue for killing bacteria or inhibiting growth

– Disinfectants are used to combat microorganisms but should be applied to non-living objects

– Germicides (generic name) designed to destroy bacteria, fungicides, sporicides and sanitizers

– Alcohol• Most widely used skin disinfectant• Ethyl alcohol (70% by weight) and isopropyl alcohol (70% by weight) are equally

effective• Inexpensive and nonirritating, kill bacteria immediately with the exception of

spores• No long lasting germicidal action, can be used as an antiseptic or astringent• 70% solution can be used disinfect instruments• Also can be utilized as mild anesthetic and topical skin dressing when combined

with 20% benzoin

– Phenol• Early antiseptic and disinfectant in medical profession• Control disease organisms• Found in various concentrations and emollients• Derivatives include, resorcinol, thymol, and common house cleaner Lysol

– Halogens• Chlorine, bromine, fluoride (used for antiseptic effect)• Iodophor or halogenated compounds create a much less irritating solution

than tincture of iodine• Betadine solution- excellent germicide, very effective for skin lesions,

abrasions and lacerations

– Oxidizing agent• Hydrogen peroxide is commonly used in the athletic training room• Readily decomposes in presence of organic substances and has little use as an

antiseptic• Cleanses infected cutaneous and mucous membranes• Dilute solution can be used to treat inflammatory mouth and throat conditions

• Antifungal Agents– Medicine used to treat fungi (epidermophyton, trichophyton,

and candida albicans)– Numerous antifungal agents – Some can be used against deep seated fungal infections– Others are administered orally

• Must be carefully monitored by physician

• Antibiotics– Chemical agents that are produced by microorganisms – Interfere w/ necessary metabolic processes of pathogenic

microorganisms

– Used topically or as systemic medication– Indiscriminate use can produce hypersensitivity and prevent

development of natural immunity or resistance to subsequent infections– Must be carefully controlled by physician– A number of antibiotics are available– Penicillin

• Most important antibiotic• Useful in skin and systemic infections• Interferes w/ metabolism of bacteria

– Bacitracin• Antibacterial agent

– Tetracycline• Wide group of antibiotics that have broad antibacterial spectrum• Usually oral, modifies infection rather than eradicating it completely

– Erythromycin• Used for streptococcal infection and mycoplasma pneumoniae• Same general spectrum as penicillin but can be used with

individuals allergic to penicillin

– Sulfonamides• Group of synthetic antibiotics• Make pathogens vulnerable to phagocytes and certain enzymatic

actions

– Quinolones• New group of antibiotics with broad spectrum of activity• Must be carefully monitored for adverse effects

Drugs for Asthma• Used to treat chronic inflammatory lung disorder• National Asthma Education and Prevention Program has established

guidelines for diagnosis and treatment• Goals of asthma therapy are to prevent chronic and troublesome

symptoms, maintain normal lung function, prevent exacerbation and provide adequate pharmacotherapy with minimal adverse effects

• Portable hand-held inhalers are available– Meter dosed inhalers (pressurized canister)– Dry powder inhalers– Nebulizer

• Often individuals become dependent on inhalers• Treatment should not just be drug based

Drugs that Inhibit Pain and Inflammation

• Pain Relievers– Numerous drugs and procedures can be used– Reasons for effectiveness

• Excitatory effect on an individual impulse is depressed

• Individual impulse is inhibited

• Perceived impulse is decreased

• Anxiety created by pain or impending pain is decreased

• Counterirritants and Local Anesthetics– Analgesics give relief by causing systemic and topical analgesia– Application causes local increases in circulation, redness, rise in skin

temperature,– Mild pain can often be reduced w/ counterirritants– Examples include

• Liniments• Analgesic balms• Spray coolants• Alcohol• Menthol• Cold• Local anesthetics (injected by physician)

• Narcotic Analgesics– Most derived from opium or are synthetic opiates (morphine and

codeine)– Depress pain impulse and respiratory center– Examples include

• Codeine (morphine like action, found in cough suppressants)• Morphine (dangerous due to respiratory effects, habit forming qualities)• Propoxyphene hydrochloride (slightly stronger than aspirin and can be fatal

if mixed with sedatives or depressants)• Meperidine (Demerol - substitute for morphine, effective when given

intravenously or intramuscularly)

• Non-narcotic Analgesics and Antipyretics– Designed to suppress all but most serious pain

w/out losing consciousness– Acetaminophen

• Tylenol - effective analgesic and antipyretic but has no anti-inflammatory activity

• Does not irritate GI system and is often replacement for aspirin in non-inflammatory conditions

• Over-ingestion can lead to liver damage

Drugs to Reduce Inflammation• Acetylsalicylic Acid (Aspirin)

– Widely used analgesic, anti-inflammatory, antipyretic and abused drug

– Helps reduce pain, fever and inflammation– Adverse reactions generally GI related– Over-ingestion can lead to ear ringing and dizziness, Reye’s

syndrome (adolescents)– Allergic reactions result in anaphylaxis -- asthmatics may be

at risk for reactions– Should be avoided w/ contact sports as it prolongs clotting

time

• Nonsteroidal Anti-inflammatory Drugs (NSAID’s)– Anti-inflammatory, antipyretic and analgesic properties– Inhibit prostaglandin synthesis and effective for osteo- and rheumatoid arthritis– Used primarily to reduce pain, stiffness, swelling, redness, fever associated w/

localized inflammation– Fewer side effects and longer duration than aspirin– Should not be used in place of acetaminophen or aspirin for headaches or

increased temperature– Individuals w/ nasal polyps, associated bronchospasm or history of anaphylaxis

should not receive NSAID’s– Can cause GI reactions, headache, dizziness, depression, tinnitus,– Taken in conjunction w/ heavy alcohol use can produce stomach bleeding

• Corticosteroids– Used primarily for chronic inflammation of musculoskeletal and joint

problems– Prolonged use can create complications

• Fluid and electrolyte disturbances• Musculoskeletal and joint impairment• Dermatological problems• Neurological impairment• Endocrine dysfunction• Ophthalmic conditions• Metabolic impairment

– Cortisone is primarily injected• Can have negative effect on ligaments and tendons

– Also administered through iontophoresis and phonophoresis

Drugs that Produce Skeletal Muscle Relaxation

• Include methocarbamol (Robaxin) and carisoprodol (Soma)

• Due to overall relaxation effect, physicians believe these are less specific to muscle relaxation than once believed (also cause drowsiness)

• Used to eliminate muscle guarding and spasm• Do not appear to be superior analgesics or

sedatives in either acute or chronic conditions

Drugs Used to Treat Gastrointestinal Disorders

• Includes stomach upset, gas formation due to food incompatibilities, acute or chronic hyperacidity

• Poor eating habits may lead to digestive dysfunction such as diarrhea or constipation

• Antacids– Neutralize acidity in upper GI, reducing pepsin

activity (particularly on mucosal nerve endings– Relief of acid indigestion, heart burn, peptic ulcers

– Sodium bicarbonate or baking soda are popular– Antacids w/ magnesium tend to have laxative effect– Those w/ aluminum and calcium cause constipation– Overuse can cause electrolyte imbalance

• Antiemetics– Used to treat nausea and vomiting– Working Locally

• Work on mucosal lining of stomach (may be more placebo)

– Working Centrally• Affect brain, making it less sensitive to nerve impulses from inner ear and stomach

– Variety of meds available, but may cause drowsiness

• Carminatives– Provide relief from flatulence (gas)– Inhibit gas formation and aid in expulsion

• Cathartics (laxatives)– Must be under direct supervision of physician

• Constipation may be symptomatic of serious disease

– Indiscriminate use may render athlete unable to have normal bowel movements

– May cause electrolyte imbalance

• Antidiarrheals– Diarrhea tends to be a symptom, not a disease– Result of emotional stress, allergies, adverse drug reactions, or different

intestinal problems

• Antidiarrheal (continued)– Acute diarrhea

• Accompanied by chills, vomiting, intense abdominal cramps/pain• Will typically run course and stop when irritating agent removed from

system– Chronic diarrhea

• May lasts for days or weeks and may be the result of more serious disease states

– Treat with Kaolin (absorb chemicals and pectin), substances that add bulk to stool

– Systemic agents (except Imodium AD) are prescription drugs• Most are opiate derivatives and will cause drowsiness, dry mouth, and

constipation• Do not treat antibiotic induced diarrhea as it may be protective symptom in

antibiotic induced psuedomembranous colitis

• Histamine-2 Blockers– Reduce stomach acid output by blocking

histamine on certain stomach cells– Used to treat peptic and gastric ulcers and GI

hypersecretory conditions– Drug examples include Cimetidine (Tagamet)

and ranitidine (Zantac)

Drugs Used to Treat Colds and Allergies

• Nasal Decongestants– Number of topical nasal decongestants available– Prolonged use may cause rebound congestion and

dependency• Antihistamines

– Often added to decongestants– Opposes histamine actions, but have little effects on

the common cold– Beneficial in allergies– Impair body’s ability to dissipate heat

• Cough Medications– Suppress cough (antitussives) or produce fluid in respiratory

system (expectorant)– Few side effects from nonnarcotic antitussives and are not addictive– Little evidence that expectorants are any more effective on reducing

cough than simply drinking water

• Sympathomimetics– May cause heat related problems– Epinephrine (Epipen)

• ATC’s can receive instruction on use

• Used to treat anaphylaxis resulting from food or insect bites

Drugs to Control Bleeding• Vasoconstrictors

– Most often administered externally at sites of profuse bleeding

– Epinephrine or adrenaline commonly used

– Acts immediately, constricting vessels --very valuable in instances of epistaxis (nosebleed)

• Hemostatic Agents– Drugs that immediately inhibit bleeding (under

investigation)

– Thrombin

• Anticoagulants– Heparin

• Prolongs clotting time but will not dissolve clot once formed

• Controls extension of a thrombus already present

– Coumarin derivatives• Acts by suppressing formation of prothrombin in the liver

– Given orally, they can be used to slow clotting time in certain vascular disorders

Substance Abuse Among Athletes

• Drug use and performance enhancing agents in athletics

• Substance abuse has no place in athletics

• Use and abuse of substances can have a profound effect on performance

• Athletic trainer must be knowledgeable about substance abuse in athletic population and should be able to recognize signs that athlete may be engaged in substance abuse

Performance Enhancing Substances (Ergogenic Aids)

• Stimulants– Used to increase alertness, reduce fatigue, increase

competitiveness and hostility– Psychomotor stimulant drugs

• Amphetamines and non-amphetamines• Produces rapid turnover of catecholamines, which have strong effect on

nervous and cardiovascular systems, metabolic rates, temperature and smooth muscle

– Sympathomimetic drugs• Work on adrenergic receptors (those that release catecholamines) • Cause mental stimulation and increased blood flow but can cause

elevated blood pressure, headache, increased and irregular heart beat, anxiety and tremors

– Amphetamines and cocaine are the two psychomotor drugs most commonly seen in athletics

– Sympathomimetic drugs are a difficult problem for the USOC as they are often found in cold remedies

– Some products have been approved for asthmatics (B2 agonists)

– Before engaging in competition a team physician must notify the USOC Medical Subcommission in writing about athlete’s use

• Amphetamines– Synthetic alkaloids (potent and dangerous)– Injected, inhaled, taken as tablets– Most widely used for performance enhancement– Can produce euphoria w/ heightened mental status until fatigue

sets in, accompanied by nervousness, insomnia, and anorexia– In high doses, will reduce mental activity and decrease

performance– Athlete may become irrational

• chronic use causing individual to become “hung up” in state of repetitious behavioral sequences

– Can lead to amphetamine psychosis, manifesting in auditory and visual hallucinations and delusions

– Physiologically, high doses can cause mydriasis (abnormal pupil dilation), increased blood pressure, hyperreflexia and hyperthermia

– Believed to improve performance - promote quickness and endurance, delay fatigue, increase confidence causing increased aggressiveness

– Studies indicate the opposite --create increased risk for injury, exhaustion and circulatory collapse

• Caffeine– Found in coffee, tea, cocoa and cola– CNS stimulant, diuretic and stimulates gastric secretion– In moderation it will cause cerebral cortex and medular

centers stimulation, causing wakefulness and mental alertness

– Large amounts will cause elevated blood pressure, changes in heart rate, increased plasma levels of epinephrine, norepinephrine and renin --impacting coordination, sleep, mood, behavior and thinking processes

– Adverse effects include, tremors, nervousness, headaches, diuresis, arrhythmia, restlessness, hyperactivity, irritability, dry mouth, tinnitus, ocular dyskinesia, scotomata, insomnia and depression

– Habitual user that ceases use may go through withdrawal -- sufferer headache, drowsiness, lethargy, rhinorrhea, irritability, nervousness, depression and lost interest in work

– Believed to act as ergogenic aid during prolonged activity– Banned by USOC as stimulant in high doses (12

micrograms/milliliter)

• Narcotic Analgesic Drugs– Derived from opium or synthetic opiates– Morphine and codeine are made from alkaloid of opium– Used for management of moderate/severe pain– Risk physical and psychological dependency

• Beta Blockers– Block of sympathetic nerve ending receptor– Primarily used for hypertension and heart disease.– Used for sports requiring steadiness– Adrenergic agent that inhibits catecholamines– Relax blood vessels, slows heart rate and decreases cardiac output

and heart contractility

• Diuretics– Increase kidney excretion by decreasing kidney

resorption of sodium– Excretion of potassium and bicarbonate may also

occur– Used for variety of cardiovascular and

respiratory conditions– In sports, misused for weight loss and decreasing

concentration in urine

• Anabolic Steroids– Synthetic chemical (structure resembles sex hormone, testosterone)– Androgenic effects

• Growth, development and maintenance of reproductive tissues, masculinization

– Anabolic effects• Promote nitrogen retention leading to protein synthesis - causing increased

muscle mass and weight, general growth and bone maturation• Goal is to maximize this effect

– Can have deleterious and irreversible effects causing major threats to health

– Use most commonly seen in sports that involve strength and power

• Androstenedione– Weak androgen produced primarily in testes and in lesser

amounts by adrenal cortex and ovaries– Increases testosterone in men and particularly women– Effects last a few hours– No scientific evidence to support or rebuke efficacy or safety of

using this ergogenic aid

• Human Growth Hormone (HGH)– Produced in somatotrophic cells of anterior pituitary and

released into circulatory system– Amount released varies with age

– Can be produced synthetically– Results in increases muscle mass, skin thickness, connective tissue

in muscle, organ weight– Can produce lax muscles and ligaments during periods of growth– Increases body length, weight and decreases body fat %– Difficult to detect so use is on the rise– Little current information on the effects of HGH– No proof that increased HGH and weight training contributes to

strength and muscle hypertrophy– Can cause premature closing of growth plates, acromegaly which

may also result in diabetes mellitus, cardiovascular disease, goiter, menstrual disorders, decreased sexual desire and impotence

• Blood Reinjection (Blood Doping, Packing or Boosting)– Endurance, acclimatization and altitude make increased metabolic

demands for the body, requiring increased blood volume and RBC’s

– Can replicate physiological responses by removing 900 ml of blood and reinfusing is after 6 weeks (allows time to replenish supply)

– Can significantly improve performance– While unethical, it can also prove to be dangerous– Risks involve allergic reactions, kidney damage, fever, jaundice,

infectious disease, blood overload (circulatory or metabolic shock)

Recreational Substance Abuse Among Athletes

• It occurs among athletes

• Desire to experiment, temporarily escape, be part of the group

• Can be abused and habit forming

• Drug used for non-medical reasons with the intent of getting high, or altering mood or behavior

• Psychological vs. Physical Dependence– Psychological dependence is the drive to repeat the

ingestion to produce pleasure or avoid discomfort– Physical dependence is the state of drug adaptation that

manifests self in form of tolerance • When cease consumption abruptly unpleasant withdrawal

occurs

– Tobacco Use• Cigarettes, cigars & pipes are increasingly rare in athletics

• Smokeless tobacco and passive exposure to others continues to be an ongoing problem

– Smoking• Seriously impact performance for those that are highly sensitive

• Associated with 4,700 different chemicals

• 10 inhalations can cause average maximum decrease in airway conductance of 50% (secondhand also)

• Reduces oxygen carrying capacity of blood

• Aggravates and accelerates heart muscle cell stimulation through over-stimulation of sympathetic nervous system

• Decreases lung capacity and maximum breathing capacity, also decreases pulmonary diffusion

• Accelerates thrombolic tendency

• Carcinogenic factor in lung cancer and contributes to heart disease

– Nicotine is the addictive chemical in tobacco- one of the most toxic drugs

• Causes elevated blood pressure, increased bowel activity, and antidiuretic action– Smokeless Tobacco

• Loose leaf, moist, dry powder, and compressed• Posses serious health risk

– Bad breath– Stained teeth– Tooth sensitivity to heat and cold– Cavities and gum recession– Tooth bone loss– Leukoplakia– Oral and throat cancer

• Major substance ingested is nitrosonornicotine– Absorbed through mucous membranes

• More addictive habit w/out exposure to tar and carbon monoxide• Will increase heart rate

• Alcohol Use– Most widely used and abused substance with athletes– Depresses CNS– Absorbed from digestive tract into bloodstream– Absorption affected by drinks consumed, rate of

consumption, concentration and amount of food in stomach– Can be oxidized by liver at 2/3 of an ounce per hour– If excess is in blood stream

• .1% - lose motor function• .2%-.5% symptoms become more profound and life threatening

– Metabolism can not be accelerated– Athlete abusing alcohol may exhibit the following

• Mood and attitude changes

• Missed practices

• Isolation

• Fighting or inappropriate outburst of violence

• Changes in appearance

• Hostility

• Complaints from family

• Changes in peer group

• Drug Use– Cocaine

• CNS stimulant w/ short duration effects (intense)• Produces immediate feeling of euphoria, excitement, decreased fatigue

and heightened sexual drive• Long term use results in psychological tolerance and dependence• Long term effects include

– Nasal congestion, damage to cartilage and mucous membranes of nose, bronchitis, loss of appetite, convulsions, impotence, cocaine psychosis w/ paranoia, depression, hallucinations, and disorganized mental function

• Overdose can lead to – Tachycardia, hypertension, extra heartbeats, coronary vasoconstriction, strokes,

pulmonary edema, aortic rupture and sudden death

• Can be taken in many forms including snorted, intravenously, or smoked (freebased)

• In form of crack - very short term rush, followed by depression

• Sudden stimulation w/ crack can cause cardiac or respiratory failure

– Marijuana (carcinogenic drug)• Formerly most abused drug in Western society

• Similar components and cellular changes as tobacco

• Can lead to respiratory disease,asthma, bronchitis, lowered sperm count and testosterone levels, limited immune functioning and cell metabolism

• Causes increased pulse rate and can cause decrease in strength

• Psychologically causes diminution of self-awareness and judgement, slower thinking and short attention span

• Has also been found to alter the anatomical structures suggesting irreversible brain damage

• Contains cannabinoids (can store like fat cells) • May remain in the body and brain for weeks and months

resulting in cumulative deleterious effects

• Managing a Drug Overdose– In the event of an overdose, EMS should be contacted as

well as the poison control center immediately

– Athletic trainer should be certain that the correct steps have been taken either by phone or going to deal with the athlete in person

Drug Testing in Athletics

• Purpose is to identify individuals who have problems with drug abuse

• Controversial topic• NCAA and USOC routinely test

– Began at the Olympics in 1968 and has since expanded nationally (USOC and NCAA) and internationally

– Institution of testing and education

– Performed to ensure health of athletes and fair practices

– Mandatory and random testing occurs at both levels

• The Drug Test– Slight differences between NCAA and USOC, mostly

in area of selection• NCAA requires all athletes to sign consent form agreeing to

participate in testing throughout the year

• USOC tests randomly throughout the year and before USOC sanctioned events

• During the test, athlete provides identification, and 2 samples under direct supervision

– One for testing and confirmation, second for reconfirmation

• If positive, athlete is subject to sanctions

• Sanctions for Positive Tests– NCAA

• First time positive in NCAA results in minimum one year suspension; will undergo random testing throughout the year

• Must test negative prior to reinstatement• However, additional positives can result in lifetime

disqualification from NCAA

– USOC• Sanctions range from 3months-24 months depending on the

drug for a first time offense• Lifetime ban for subsequent positive tests

• Banned Substances– Both NCAA and USOC have a banned substance list for athletes

– Includes performance enhancing drugs and street or recreational drugs, as well as OTC medications

– Includes 4,600 different medications

– USOC is more extensive than NCAA because it is also subject to IOC rules

– Athletic trainer working w/ athletes who may be tested for drugs by NCAA or world-class or Olympic athletes governed by USOC should be familiar w/ the lists of banned drugs and substances