Ergogenic Drug Abuse in Sport: Issues & Current Trends

1
Ergogenic Drug Abuse in Sport Issues Current
Trends
Cindy Thomas, MS, ATC, CPCT Director of
Educational Operations
2
Sports Culture Today

• Many 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
3
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
• Todays athletes are utilizing technology,
  nutrition, science are closing the gap on
  physiological limits
• Unfortunately dopers miss the point of athletic
  performance
• They dont understand nor value

4
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
5
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 gt 15
  micrograms/ml.
• S.A. So, how much can I drink before Ill test
  positive?

6
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

7
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

8
Performance-Enhancing Drugs/Substances

• Anabolic Agents
• Stimulants
• Peptide Hormones
• Diuretics (weight loss, dilution of urine)
• Dietary Supplements

9
Anabolic Steroids

• Human-made substances related to testosterone
• Over 100 types of anabolic steroids
• Schedule III Controlled Substances
• Old is New - designer steroids
• Pro-hormones

10
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

11
Who is Using?

• Body Image Disordered
• Eating Disordered Stimulants, Laxatives,
  Diuretics Steroids
• Low Self-Esteem, Depression, Suicide
• Career Professionals
• Models
• Firefighters
• Police Officers
• Military Personnel

12
Body Image Steroid Use

• Body perception issues
• Media promotes idealistic body
• 5-7 of girls have tried steroids to tone bodies
  many have eating disorders

13
Steroids Suicidal Tendencies

• Suicide rates rise in adolescence
• Already at risk 3-11 adolescents
  attempt suicide
• Predisposing factors
• Body image disorders
• Family history
• Low self-esteem
• Risk taker
• Steroid other drug use

Taylor Hooton
Efrain Marrero
Rob Garibaldi
14
When, Why, Access?

• Initial Use of Anabolic Steroids
• 17 initially used in junior high school or
  before
• 39 initially used in high school
• Main Reason for Use
• 51 to Improve athletic performance
• 15.9 to improve appearance
• Sources for obtaining Anabolic Steroids
• 25 from friend or relative
• 22 from Website/mail order
• 17 from coach or trainer
• 15 from teammate or other athlete

2005-06 NCAA Substance Use Abuse Survey
15
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)

• 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 dont believe steroids are risky. (NIDA)
• 2002 Texas AM study indicated 42,000 students
  using anabolic steroids

16
State 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 wont 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

17
State 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)

18
NCAA Drug Test Results
Championship Testing Only
19
NCAA Steroid Results

• 2003-04
• (Most common steroid positives)
• 13 Nandrolones
• 10 Testosterones
• 6 Androstendiones
• 4 Stanozolols
• 2 Boldernones

• 2004-05
• (Most common steroid positives)
• 18 Nandrolones
• 10 Androstendiones
• 8 Testosterones
• 5 Boldernones
• 4 Stanozolols

20
Current 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

21
Current NCAA Initiatives

• Proposed legislation to test for all banned
  substances all the time
• Administrators want marijuana tested for all the
  time
• Currently THC () is a 1-year sanction
• Legislation 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

22
Stimulants

• Increase energy, endurance, reduce mental
  fatigue, increase fat usage
• Amphetamines
• Caffeine
• Synephrine
• Ephedrine
• 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

23
Dietary Supplements

• Muscle builders
• Energy enhancers
• Endurance increasers
• Weight loss
• Weight gain
• Workout recovery
• Pre-workout
• Joint health

Effective? Safe? Pure? Accurate dosing?
24
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

25
Energy 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!

26
Peptide 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

27
Gene 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

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

28
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.'
29
Addressing 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)

• Anti-doping must focus on convincing athletes,
  parents, athletic trainers, coaches,
  administrators of the necessity of a level
  playing field the ideal performance perspective

30
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?