THE DRUG PROBLEM IN SPORTS
Dr. Larry Weisenthal, Personal communication, (1999).
Forty one amateur body builders in a West of Scotland gymnasium were questioned about body building drug usage during the period January 1984 to January 1985. Eight out of 41 (19.5%) had used drugs to enhance their physique and performance. Anabolic and androgenic agents were mainly used but diuretics, thyroxine and human chorionic gonadotrophin were also used. Those who took drugs, in all cases, took combinations of drugs. Drug dosage was generally much in excess of that normally recommended, though there were no serious side effects at the time of the study. If this experience was typical nationwide it would represent a significant number of body builders abusing drugs. In no case was there any medical supervision.
Why would any athlete expose himself to these pharmacologic agents? The most obvious answer is to improve performance. Since athletic performance is composed of so many variables, for example, attitude, diligence in training, strength, agility, and the competitive spirit, it is difficult to ascribe improvement in performance to any particular agent. It may be due to the placebo effect or to better or more efficient training, to say nothing about the effects of the normal maturational process. Certainly the peer pressure of others using these agents weighs heavily upon the adolescent's mind. Might peers have a competitive advantage? All of these points would be moot if it were not for the ready availability of many of these compounds. All are within reach of the athlete with a little knowledge of this subculture, and all are relatively inexpensive (with the exception of GH). They can be as tempting to adolescents as are brightly colored packages of household cleaners, vitamins, or flavored children's aspirin tablets to toddlers. Continuing with this analogy, one notes that most of the time children easily recover from accidental ingestions, but these instances, just as with drugs of adolescent and adult abuse, can be deadly.
This article provides the practicing physician with an account of the commonly used ergogenic substances. Specific agents discussed include the following: stimulants, narcotic analgesics, anabolic-androgenic steroids, beta-blockers, diuretics, growth hormone, other peptide hormones, blood doping, and erythropoietin.
In the context of sport, an ergogenic aid can be broadly defined as a technique or substance used for the purpose of enhancing performance. Ergogenic aids have been classified as nutritional, pharmacologic, physiologic, or psychologic and range from use of accepted techniques such as carbohydrate loading to illegal and unsafe approaches such as anabolic-androgenic steroid use. The efficacy of many of these techniques is controversial, whereas the deleterious side effects are clear. The purpose of this article is to review the epidemiology, administration, efficacy, pharmacology, and side effects of commonly used ergogenic aids. Physical therapists should be able to recognize the signs of ergogenic aid abuse in individuals under their care, and they should be aware of the side effects of these aids. Moreover, the physical therapist can serve as a resource for those individuals seeking information on the risks and benefits of ergogenic aids.
Anabolics (anabolic steroids and, in recent years, recombinant human growth hormone) are used to enhance athletic performance. Although there is no definite proof of a performance enhancing effect of anabolic steroids (ethical difficulties and blinding problems with high dose steroid treatment), evidence suggests that steroids may increase muscular strength in some subgroups of athletes. Unfortunately, numerous side effects and (in some cases at any rate) permanent damage may occur as a consequence of abuse of anabolics. This is chiefly the case in adolescents and women. As long as athletes and their trainers believe in the efficacy of anabolics, and no mandatory testing in the training periods is imposed, the abuse of anabolics by athletes will distort fair competition in sport.
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