Ergogenic Drug Abuse in Sport: Issues & Current Trends

Ergogenic Drug Abuse in Sport: Issues & Current Trends

Cindy Thomas, MS, ATC, CPCTDirector of Educational Operations

Cindy Thomas, MS, ATC, CPCTDirector of Educational Operations

Sports Culture TodaySports Culture Today

Many of today’s athletes are choosing to dope, violating their own bodies as well as their principles, values and rules against doping, but WHY?

Many of today’s athletes are choosing to dope, violating their own bodies as well as their principles, values and rules against doping, but WHY?

Victor Conte,Victor Conte,Director BALCODirector BALCO

Why Dope?Why Dope? To gain an edge on the competition Because the end justifies the means Only success and glory really matter Society rewards for winning; not performing Today’s athletes are utilizing technology,

nutrition, & science & are closing the gap on physiological limits

Unfortunately dopers miss the point of athletic performance

They don’t understand nor value…

To gain an edge on the competition Because the end justifies the means Only success and glory really matter Society rewards for winning; not performing Today’s athletes are utilizing technology,

nutrition, & science & are closing the gap on physiological limits

Unfortunately dopers miss the point of athletic performance

They don’t 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 Boat…Missing the Boat…

A 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 I’ll test

positive?”

A 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 I’ll test

positive?”

What is aPerformance-Enhancing Substance?

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

“...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?

What are the categories ofPerformance-Enhancing Substances?

Pharmacologic agents Agents for weight control Agents for weight gain Enhancement of O2 carrying capacity Any substance used for reasons other than

treating documented conditions Masking agents Many dietary supplement products

Pharmacologic agents Agents for weight control Agents for weight gain Enhancement of O2 carrying capacity Any substance used for reasons other than

treating documented conditions Masking agents Many dietary supplement products

Performance-Enhancing Drugs/Substances

Performance-Enhancing Drugs/Substances

Anabolic AgentsStimulantsPeptide HormonesDiuretics (weight loss,

dilution of urine)

Dietary Supplements

Anabolic AgentsStimulantsPeptide HormonesDiuretics (weight loss,

dilution of urine)

Dietary Supplements

Anabolic SteroidsAnabolic Steroids

Human-made substances related to testosterone

Over 100 types of anabolic steroids

Schedule III Controlled Substances

Old is New - “designer steroids”

Pro-hormones

Human-made substances related to testosterone

Over 100 types of anabolic steroids

Schedule III Controlled Substances

Old is New - “designer steroids”

Pro-hormones

The Anabolic Steroid Control Act 2004 (effective Jan. 2005)

The Anabolic Steroid Control Act 2004 (effective Jan. 2005)

Specifically lists dozens of precursors as Schedule III substances

Makes it easier for DEA to outlaw similar substances in future

Illegal to possess any of these substances now

Specifically lists dozens of precursors as Schedule III substances

Makes it easier for DEA to outlaw similar substances in future

Illegal to possess any of these substances now

Who is Using?Who is Using?

Body Image Disordered Eating Disordered

Stimulants, Laxatives, Diuretics & Steroids

Low Self-Esteem, Depression, SuicideCareer Professionals Models Firefighters Police Officers Military Personnel

Body Image Disordered Eating Disordered

Stimulants, Laxatives, Diuretics & Steroids

Low Self-Esteem, Depression, SuicideCareer Professionals Models Firefighters Police Officers Military Personnel

Body Image & Steroid UseBody Image & Steroid Use

Body perception issues

Media promotes “idealistic” body

5-7% of girls have tried steroids to tone bodies – many have eating disorders

Body perception issues

Media promotes “idealistic” body

5-7% of girls have tried steroids to tone bodies – many have eating disorders

Steroids & Suicidal TendenciesSteroids & Suicidal Tendencies

Suicide rates rise in adolescence

Already at risk: 3-11% adolescents attempt suicide

Predisposing factorsBody image disordersFamily historyLow self-esteemRisk takerSteroid & other drug use

Suicide rates rise in adolescence

Already at risk: 3-11% adolescents attempt suicide

Predisposing factorsBody image disordersFamily historyLow self-esteemRisk takerSteroid & other drug use

Taylor Hooton

Efrain Marrero

Rob GaribaldiRob Garibaldi

When, Why, & Access?When, Why, & Access?

Initial Use of Anabolic Steroids17% initially used in junior high school or before39% initially used in high school

Main Reason for Use51% to Improve athletic performance15.9% to improve appearance

Sources for obtaining Anabolic Steroids25% from friend or relative22% from Website/mail order17% from coach or trainer15% from teammate or other athlete

Initial Use of Anabolic Steroids17% initially used in junior high school or before39% initially used in high school

Main Reason for Use51% to Improve athletic performance15.9% to improve appearance

Sources for obtaining Anabolic Steroids25% from friend or relative22% from Website/mail order17% from coach or trainer15% from teammate or other athlete

2005-06 NCAA Substance Use & Abuse Survey

Other Statistics on Adolescent Steroid Use

Other Statistics on Adolescent Steroid Use

12% 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)

12% 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 ½ million 8th and 10th grade students use steroids now; increasing number of high school seniors don’t believe steroids are risky. (NIDA)

2002 Texas A&M study indicated 42,000 students using anabolic steroids

Steroid use down 40 % (lifetime), 37 % (past year), and 21 % (past month) for 8th, 10th, & 12th graders combined. (2006 Monitoring the Future)

Over ½ million 8th and 10th grade students use steroids now; increasing number of high school seniors don’t believe steroids are risky. (NIDA)

2002 Texas A&M study indicated 42,000 students using anabolic steroids

State High School InitiativesState High School Initiatives California

Officials estimate that 20,000 have used PEDs Requires districts to ban steroids & contract with students &

parents Districts cannot use supplement manufactures as sponsors Coaches prohibited from promoting supplements

Louisiana, Nevada, & Texas requires signed contract saying they won’t use steroids

Michigan & 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

California Officials estimate that 20,000 have used PEDs Requires districts to ban steroids & contract with students &

parents Districts cannot use supplement manufactures as sponsors Coaches prohibited from promoting supplements

Louisiana, Nevada, & Texas requires signed contract saying they won’t use steroids

Michigan & 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. InitiativesState H.S. Assoc. Initiatives

New Mexico ran a pilot steroid testing program Spring 2006 & will have mandatory steroid education in every school next year

Illinois bans use & distribution of PEDs, requires steroid education in all secondary schools & is considering a state-wide steroid testing program

New Jersey added random steroid testing at state championships & requires steroid education programs beginning in junior high school

Florida (FHSAA) provides multi-media steroid education opportunities for coaches & athletes

88% of Americans polled supported testing high school athletes for steroids (The Sacred Heart University Polling Institute May 2006 interviews nationwide)

New Mexico ran a pilot steroid testing program Spring 2006 & will have mandatory steroid education in every school next year

Illinois bans use & distribution of PEDs, requires steroid education in all secondary schools & is considering a state-wide steroid testing program

New Jersey added random steroid testing at state championships & requires steroid education programs beginning in junior high school

Florida (FHSAA) provides multi-media steroid education opportunities for coaches & athletes

88% of Americans polled supported testing high school athletes for steroids (The Sacred Heart University Polling Institute May 2006 interviews nationwide)

NCAA Drug Test ResultsNCAA Drug Test Results

*Championship Testing Only

2003-042003-04 2004-052004-05

Total # Tests:Total # Tests: 10, 54110, 541 11,61011,610

Stimulants*Stimulants* 1313 1414

EphedrineEphedrine 22 11

SteroidsSteroids 4646 5151

Beta blockers*Beta blockers* 00 00

Diuretics or Diuretics or ManipulatorsManipulators

33 33

Street Drugs*Street Drugs* 1010 1717

Protocol Protocol issuesissues

00 2020

TOTAL +:TOTAL +: 74 (< 1%)74 (< 1%) 106 (< 1%)106 (< 1%)

NCAA Steroid ResultsNCAA Steroid Results

2003-04 (Most common steroid positives)

13 Nandrolones10 Testosterones6 Androstendiones4 Stanozolols2 Boldernones

2003-04 (Most common steroid positives)

13 Nandrolones10 Testosterones6 Androstendiones4 Stanozolols2 Boldernones

2004-05 (Most common steroid positives)

18 Nandrolones10 Androstendiones8 Testosterones5 Boldernones4 Stanozolols

2004-05 (Most common steroid positives)

18 Nandrolones10 Androstendiones8 Testosterones5 Boldernones4 Stanozolols

Current NCAA InitiativesCurrent NCAA Initiatives

Division III Pilot Testing begins Fall 2007 2 year program 100 schools will participate 12-16 athletes per school tested Testing for all NCAA banned substances No sanctions for positive tests Aggregate results reported only Participating schools will receive grants for education

Anti-estrogens are being added as a Banned Drug Class e.g., Tamoxifen, a breast cancer drug used to mask steroid use

by reducing negative side effects of steroids such as breast enlargement

A medical exception will be provided for legitimate reason

Division III Pilot Testing begins Fall 2007 2 year program 100 schools will participate 12-16 athletes per school tested Testing for all NCAA banned substances No sanctions for positive tests Aggregate results reported only Participating schools will receive grants for education

Anti-estrogens are being added as a Banned Drug Class e.g., Tamoxifen, a breast cancer drug used to mask steroid use

by reducing negative side effects of steroids such as breast enlargement

A medical exception will be provided for legitimate reason

Current NCAA InitiativesCurrent NCAA Initiatives

Proposed 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

Proposed 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

StimulantsStimulants Increase energy,

endurance, reduce mental fatigue, increase fat usage

AmphetaminesCaffeineSynephrineEphedrine

Illegal to include in dietary supplement products

Smart Pills “Brain Steroids”

Ritalin [methylphenidate], Provigil [modafinil], Adderall [amphetamine]

High school & college students using to gain an "edge" for academic studies

Increase energy, endurance, reduce mental fatigue, increase fat usage

AmphetaminesCaffeineSynephrineEphedrine

Illegal to include in dietary supplement products

Smart Pills “Brain Steroids”

Ritalin [methylphenidate], Provigil [modafinil], Adderall [amphetamine]

High school & college students using to gain an "edge" for academic studies

Dietary SupplementsDietary Supplements

Muscle builders Energy enhancers Endurance

increasers Weight loss Weight gain Workout recovery Pre-workout Joint health

Muscle builders Energy enhancers Endurance

increasers Weight loss Weight gain Workout recovery Pre-workout Joint health

Effective?

Safe?

Pure?

Accurate dosing?

Caffeine, Ephedrine, Synephrine

Caffeine, Ephedrine, Synephrine

• Stimulants found in dietary supplements & OTC drugs

• All banned in sport• Several NCAA positives• May not be listed

ingredient or…• Listed several different

ways• Sometimes large

quantities

• Stimulants found in dietary supplements & OTC drugs

• All banned in sport• Several NCAA positives• May not be listed

ingredient or…• Listed several different

ways• Sometimes large

quantities

Energy DrinksEnergy Drinks

NOT A SPORTS DRINK Contains stimulants Increases HR & BP Diuretic = Dehydration Can cause + test Alcohol further contributes

to problems Considered dietary

supplements & contain NCAA banned substances!

NOT A SPORTS DRINK Contains stimulants Increases HR & BP Diuretic = Dehydration Can cause + test Alcohol further contributes

to problems Considered dietary

supplements & contain NCAA banned substances!

Peptide HormonesPeptide Hormones Human Growth Hormone

(hGH) Real hGH is ineffective in tablet form Rx = $750/month Pilot testing with antibody

Insulin-like Growth Hormone (IGF-1) Increases rate of muscle repair after injury

& rate of growth with training No test yet

Erythropoietin (EPO) Testing via blood & urine Hormone lasts only a few days in the

bloodstream If stop taking several days before testing

may not be caught Attempted adulteration in urine by adding

pepsin, a chemical found in spot removers –destroyed all EPO including own natural

Circumvent the test by taking very low doses of EPO every day

Human Growth Hormone (hGH) Real hGH is ineffective in tablet form Rx = $750/month Pilot testing with antibody

Insulin-like Growth Hormone (IGF-1) Increases rate of muscle repair after injury

& rate of growth with training No test yet

Erythropoietin (EPO) Testing via blood & urine Hormone lasts only a few days in the

bloodstream If stop taking several days before testing

may not be caught Attempted adulteration in urine by adding

pepsin, a chemical found in spot removers –destroyed all EPO including own natural

Circumvent the test by taking very low doses of EPO every day

Gene ManipulationGene Manipulation “Non-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 & saliva

“Non-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 & saliva

When stimulating growth hormones, also possible that very early cancers, not yet detected, could have their growth dramatically accelerated as well

When 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 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?

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 It's only only cheaticheating if ng if you you get get caughtcaught.'.'

Addressing Sport EthicsAddressing Sport Ethics

Sport culture has direct effect on athletes’ reasoning or non-reasoning about ethical issues

Athletes are very affected by role models around them (e.g., coaches, teammates, athletic trainers)

Sport culture has direct effect on athletes’ reasoning or non-reasoning about ethical issues

Athletes 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

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?Future?

Scientifically & ethically complex

Future determined more by technology than innate ability

Addressing supplements with industry control, education & testing

Tomorrow? Gene transfer therapy? Stem cell transplants?

Alternative specimens in sports testing?

Scientifically & ethically complex

Future determined more by technology than innate ability

Addressing supplements with industry control, education & testing

Tomorrow? Gene transfer therapy? Stem cell transplants?

Alternative specimens in sports testing?