Faster and stronger: the search for a competitive edge can put lives at risk.
Lance Armstrong, retired American cycling hero and cancer survivor, was stripped of all his titles and banned for life in 2012; he took the fall, but was he just the scapegoat?
In November 2015, Russian athletes were banned from international competition after widespread, state-sponsored doping put sporting integrity and athletes' lives at risk.
Pierre Weiss, former general secretary of the International Association of Athletics Federations (IAAF), commented: "Not only are these athletes cheating their fellow competitors but at these levels are putting their health and even their own lives in very serious danger."
Sports bring people together, but their heady mix of pride, politics and big money can be lethal.
Stimulating substances: as old as sport itself
According to the World Anti-Doping Agency (WADA), the term "doping" probably comes from the Dutch word "dop," an alcoholic beverage made of grape skins that was used by Zulu warriors to make them stronger in battle.
Ancient Greek athletes used special diets and stimulating potions to improve performance, and 19th century endurance athletes indulged in strychnine, caffeine, cocaine and alcohol.
Thomas Hicks took raw egg, injections of strychnine and consumed doses of brandy during the race to help him win the 1904 Olympic marathon.
In the early 20th century, the term doping was introduced to describe illegal drugging of racehorses. In 1928, the IAAF became the first international sports federation to ban it.
Doping tests were introduced for the cycling and football world championships in 1966, and 1968 saw the first Olympic testing. By the 1970s, most international federations had followed suit.
WADA: setting standards in anti-doping
In 1999, WADA were set up to regulate standards in anti-doping, following a major drug scandal at the 1998 Tour de France. It aims to "promote, coordinate and monitor the fight against doping in sport in all its forms."
WADA produce and annually update the official list of banned substances or methods of doping. To be added to the list, an item must meet any two of the following three criteria:
- It enhances or could enhance sporting performance
- It poses or could pose a health risk to the athlete
- It violates the spirit of sports.
The 2016 list is available on the WADA website.
What are the classes of banned drugs?
Six classes of drugs are banned by sports' governing bodies; stimulants, diuretics, anabolic-androgen steroids, beta-2 agonists, narcotic analgesics and hormones and peptides.
Stimulants increase alertness and ability to overcome fatigue by raising heart rate and blood flow. In training, they are used to increase the intensity of a session. They also induce aggression, which may or may not be an advantage during competitions.
Many stimulants, including amphetamines, ephedrines and cocaine, are banned in competition.
Research suggests that deaths have occurred in sports, due to amphetamine misuse.
Stimulants can raise the blood pressure, which, when combined with excessive physical activity and peripheral vasoconstriction, hampers the body's cooling mechanism. Overheating leads to dehydration and reduced blood circulation, potential organ failure, sudden collapse, cardiac or respiratory arrest and death.
Stimulants are also addictive.
Sometimes called anabolic steroids, these help athletes to train harder, increase muscle mass and strength and to recover more quickly.
Risks include kidney damage, increased aggression and disturbing the natural balance of hormones.
Fast facts about anabolic steroids
- 4.9% of US high school boys have tried anabolic steroids at least once
- 2.4% of girls have tried them
- They are often sold by unlicensed vendors.
Testosterone is the main anabolic steroid hormone produced by the body. It has anabolic effects, which promote muscle building, and androgenic effects, which are responsible for male characteristics, such as facial hair and a deeper voice.
Anabolic steroids can lead to baldness and low sperm count in men and increased facial hair and deepened voices for women, as well as other serious health consequences.
Glucocorticoids, such as cortisol, are catabolic steroids, which means they break down muscle mass, in contrast with anabolic steroids, which build it up. These steroid hormones are naturally produced in the adrenal glands, and their effect is anti-inflammatory.
Athletes use them to mask serious injury and to achieve rapid recovery after a hard workout by reducing muscle damage. It allows them to train harder and more frequently.
Working when injured can worsen the injury; glucocorticoids can also affect the metabolism of carbohydrates, fat and proteins, and regulate glycogen and blood pressure levels.
Athletes take a risk by using steroids at much higher doses than would be prescribed for a medical condition. Since these doses could not ethically be administered for research purposes, and also because the drugs are normally used in secret, the effects are not well documented.
Medical News Today previously reported on the use of anabolic steroids among teens who want to "bulk up."
Diuretics increase the rate of urine flow and sodium excretion in order to adjust the volume and composition of body fluids or to eliminate excess fluids from tissues.
Anabolic steroids and diuretics are popular among bodybuilders, but at what cost?
Despite being banned in sports, both in and out of competition, since 1988, athletes have used diuretics for two reasons.
One is to remove water from the body, causing a rapid weight loss that can help meet a weight category - for example, in boxing.
The other reason is to mask other doping agents by reducing their concentration in urine and by altering urinary pH.
Dangers include severe dehydration leading to fluid and electrolyte imbalance, hypotension, circulatory collapse and thromboembolic episodes, cardiac arrhythmias, hypomagnesemia, gout and hyperglycemia.
Diuretics also increase levels of "bad," low-density lipoprotein (LDL) cholesterol and triglycerides and decrease "good," high-density lipoprotein (HDL) cholesterol. Interactions with other drugs can exacerbate the risks.
A number of bodybuilders have succumbed to the dangers of diuretics. Mohamed Benaziza, 33, died in 1992 following severe dehydration and cardiovascular failure. In 1996, Andreas Munzer died of liver and kidney failure after using diuretics.
Narcotic analgesics and cannabinoids
In medical terms, an analgesic narcotic is an opioid - a substance that acts pharmacologically like morphine. They are addictive.
Opioids mask the pain caused by injury or fatigue, enabling athletes to keep working in spite of damage, but training or competing while injured can lead to further damage.
Peptides and hormones
Peptides, hormones and other growth factors used in sports include human growth hormone (hGH), erythropoietin (EPO), insulin, human chorionic gonadotrophin (HCG) and adrenocorticotrophin (ACTH).
EPO increases the number of red blood cells and therefore of oxygen.
Such therapies are used in cancer therapy to help people who were born preterm. EPO, Lance Armstrong's downfall, is used to treat anemia in cases of severe kidney disease.
EPO increases bulk and strength and promotes red blood cells. More red blood cells means more hemoglobin in the blood, higher oxygen levels and greater energy.
EPO was banned by the International Olympic Committee (IOC) in 1990, but the lack of a reliable testing method made it hard to prevent until 2000, when an EPO detection test was approved by WADA. Meanwhile, from 1990-2000, it allegedly contributed to at least 18 deaths.
Gonadotropin, or hGH, is a hormone with an anabolic effect, used to improve muscle mass and performance, although studies have not confirmed any positive effects on strength or endurance.
It builds muscle but causes abnormal growth, heart disease, diabetes, thyroid problems, hypertension, blood cancers and arthritis. Other adverse effects include joint pain, muscle weakness, visual disturbances, enlarged heart and diabetes.
Alcohol, marijuana, local anesthetics and corticosteroids are all banned in competition.
On the next page, we look at some methods of doping and issues surrounding detection.