Performance-enhancing drugs

Definition: Substances taken by persons seeking to improve their athletic performance or their physical work capacity

Significance: As the level of athletic competition continues to rise throughout the world, athletes are always looking for ways to get a competitive edge. Superior nutrition and training programs are not enough for some athletes; many choose to use performance-enhancing drugs even though such substances are banned by sports federations and illegal unless prescribed for medical purposes. Law enforcement agencies expend significant resources in efforts to address the illegal sale and use of such drugs.

Athletes’ use of particular substances to improve their physical performance dates back to ancient Greece. Competitors in the ancient Olympics took stimulants such as strychnine and extracts from coca plants, cacti, and fungi to improve their performance. Although the beneficial effects of these substances are questionable, many believe that their widespread use was one of the elements that led to the termination of the Olympic Games and other sporting competitions in about 400 CE.

Competitive sports did not gain great popularity again until the time of the second phase of the Industrial Revolution, around 1850. With competition, the use of performance-enhancing drugs also returned. In particular, competitive swimmers, runners, and cyclists used caffeine, strychnine, codeine, cocaine, heroin, and nitroglycerin to stimulate their bodies to perform. Numerous athletes died from taking these drugs, but their deaths did deter many others from using such drugs. After World War II and throughout the Cold War period, the use of performance-enhancing drugs escalated, particularly the use of anabolic steroids.

Bodybuilding Supplements

The most widely known class of performance-enhancing drugs used since the 1930s is that of anabolic steroids (also known as anabolic-androgenic steroids). These are testosterone-like substances that augment male sex characteristics and the building of muscle. Anabolic steroids were first developed in Nazi Germany, where they were used to increase the aggressiveness of troops in battle.

Many studies have shown that anabolic steroids increase muscle mass and strength, which has made them popular among many different kinds of athletes, from football players to track-and-field athletes who participate in throwing events. Two strategies that athletes use to maximize strength and muscle mass with anabolic steroids are known as stacking and pyramiding. Stacking is the blending of different types of the drug in oral and injectable forms to maximize effect. Pyramiding is the continual increase in dosage over time to maximize benefit. Taking large doses of anabolic steroids comes with many dangerous side effects, however. Because the liver is responsible for breaking down and removing excess chemicals from the body, anabolic steroids can cause severe liver damage. These substances have also been linked to high blood pressure, adult-onset diabetes mellitus, increased blood clotting factors, and decreased high-density lipoproteins (good cholesterol) in the blood, all of which increase the risk of cardiovascular disease.

Another substance that has been reported to increase muscle mass and strength is human growth hormone (HGH). With the advances made in the field of genetic engineering during the 1980s, HGH became increasingly widely available and hit the black market, where athletes could get access to it. Research on the effects of HGH has been very limited, however, and any actual benefits of the substance for athletes have not been identified conclusively. Athletes at the 2012 Summer Olympics were tested for HGH, but because of reliability concerns, the test was taken off the market, rendering the tests invalid.

Two other substances that have been promoted as useful in increasing muscle mass and strength are dehydroepiandrosterone (DHEA) and androstenedione. Both are precursors to testosterone that are converted to testosterone by the body. Research has not found either substance to be effective for the enhancement of athletic abilities, and both decrease the high-density lipoproteins in the blood, which increases the risk of cardiovascular disease.

One supplement that has been shown to be effective in improving performance in high-intensity exercise is creatine. Research indicates that the ingestion of creatine in high doses helps the muscles to work harder and increases the body’s ability to gain muscle and strength. Although creatine is not regulated by the US Food and Drug Administration (FDA), it is banned by most sports federations. The long-term side effects of this substance have not been clearly identified.

Stimulants

The primary stimulant substances used by athletes for much of recent history are amphetamines. Athletes take these drugs to decrease fatigue, increase alertness, and decrease reaction time. Most research has found, however, that these drugs do not improve athletes’ quickness; rather, under influence of the drugs, the athletes only perceive themselves as being quicker. In addition, amphetamines offer only short-term reduction of fatigue; thus in using amphetamines, athletes gain no real performance benefits while exposing themselves to dangerous side effects. Amphetamines are highly addictive, and those who take them experience increased metabolism, loss of appetite, and weight loss.

Athletes also use two stimulants that are not regulated drugs: caffeine and ephedrine. Endurance athletes use caffeine to increase their bodies’ use of fat for energy and to conserve carbohydrates for later stages of their competitive events. Research has found such use to be effective and to have limited side effects, which include increased urine output and blood vessel spasms. The sports federations have not banned caffeine, but most place limits on the amount allowed in a competing athlete’s body. Ephedrine is a naturally occurring stimulant similar to amphetamines. Like amphetamines, it has not been shown to have performance-enhancing benefits, and it has similar side effects. Ephedrine is banned by most sports federations.

Blood Doping

Many athletes in the past have improved their performance through blood doping—that is, by increasing the amount of red blood cells, which carry oxygen, in their blood. This increases the oxygen available to muscles and improves athletic performance in endurance events.

Historically, athletes who practiced blood doping would have several units of their own blood drawn and placed in storage six to eight weeks before competition. Their bodies would produce more red blood cells in the intervening time, and then, prior to the competition, the athletes would re-infuse their stored blood to increase their red blood cells. This process has generally been replaced by the use of the hormone erythropoietin, which causes the body to increase the production of red blood cells. All methods of blood doping are banned by sports federations.

Important Issues

A major concern related to performance-enhancing drugs is the lack of information available about them. New drugs and variations on older drugs are continually being developed, in large part because manufacturers and users are interested in staying ahead of the technology available to test athletes for the use of banned and illegal drugs. When new drugs or new forms of older drugs are developed, several years of research are required to determine if they are effective, what the proper dosages are, and what their side effects are, as well as to develop new tests to detect their use by athletes.

Typically, a new drug formulation is available for more than a year before awareness of it becomes widespread enough that research on the drug is undertaken. After the research begins, more than another year might elapse before scientists are able to determine whether the drug is effective at all, and many years might pass before the negative side effects of the drug can be identified. Developing an effective method of testing for a new drug can also take months or even years. Given this lengthy process, athletes who use performance-enhancing drugs have a wide window of opportunity to cheat using these newly formulated drugs, sometimes called designer drugs. Nonetheless, major professional sports associations have implemented stringent anti-doping policies, and most, including that of Major League Baseball—an organization that has had well-documented problems with its athletes taking performance-enhancing drugs—have been successful in deterring athletes from using illegal substances.

Another serious concern raised by the use of performance-enhancing drugs is the effect of such substances on athletes’ health. Many athletes, whether taking FDA-approved drugs or nontested substances, take very high doses. In fact, many take higher doses than what researchers can ethically test, and thus the true benefits and side effects of these substances are not known. Given that many of the known side effects have negative health implications, athletes who use illegal and banned substances to enhance their performance are not only breaking the rules but also risking serious health problems.

Bibliography

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Bahrke, Michael S., and Charles E. Yesalis, eds. Performance-Enhancing Substances in Sport and Exercise. Champaign: Human Kinetics, 2002. Print.

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