Drugs in Sport

Understand the abuse of drugs in sport (doping).
Gain insights into the social and sporting perspectives of doping.
Appreciate the role of EPO (Erythropoietin) and haematocrit in performance enhancement.
Review a brief history of doping in sports.
Understand the classes of drugs prohibited at all times and those prohibited only in competition according to WADA guidelines.

Profession: Pharmacist
Achievement: Winner of the London Marathon.
Athletic Background: Competed as a long-distance runner and earned a bronze medal in the 1984 Olympics.

Profession: Pharmacologist.
Athletic Background: Competed as a long-distance runner but did not win any Olympic medals.

Doping Examples:
- Historical use of substances such as cocaine, strychnine, and champagne in 1903.
- Modern practices include the use of EPO, which can increase VO2 max by up to 20%, transforming club runners into world-class athletes. Notably, Bjarne Riis used EPO to win the 1996 Tour de France, earning him the nickname "Mr. 60%." Elevated haematocrit levels, exceeding natural amounts (40-50%), are indicative of EPO use.

Historic Incidents:
- Ben Johnson: First athlete to run 100m in under 9.8 seconds (1988) using the anabolic steroid Stanozol.
- Marita Koch: Still holds the record of 47.60 seconds in the 400m from 1985, attributed to the use of anabolic steroids like 4-Chlorodehydromethyltestosterone over several years with significant dosages (530 to 1460 mg/year).

Anabolic Steroids:
- Associated with a variety of side effects including tumors, depression, sexual changes, and cardiovascular problems. A stark example is the reported deaths of 20 Belgian and Dutch cyclists from nocturnal heart attacks between 1987-1990 linked to EPO use.

The East German sports program is infamous for systemic doping practices that heavily emphasized the use of anabolic steroids and performance-enhancing drugs, particularly after its reunification in 1990. The negative long-term impacts on athletes’ health and the sport itself linger to this day.

Key Developments:
- In 1967, the IOC published the first list of banned substances, which has evolved through the years:
  - 1967: Initial five groups of substances.
  - 1976: Introduction of anabolic steroids as prohibited.
  - 1984: Caffeine restrictions introduced alongside testosterone ratio monitoring.
  - 1988: Inclusion of diuretics and blood transfusions on the banned list.

Categories of Banned Substances:
- Prohibited at all times:
  - Non-approved substances (S0), anabolic agents (S1), peptide hormones (S2), beta-2 agonists (S3), etc.
- Prohibited in-competition:
  - Stimulants (S6), narcotics (S7), cannabinoids (S8), glucocorticoids (S9).
- Specific Sports Bans:
  - Beta-blockers (P1).

Characterization and Risk Factors:
- Anabolic steroids are androgens that promote masculine traits and protein synthesis. They are controlled substances with a high incidence of misuse despite legal restrictions.
- They often motivate training due to behavioral changes produced in users, highlighting the insidious nature of their appeal.
Chemical Modifications and Effects:
- Structural changes in anabolic steroids enhance their performance-enhancing properties.

Physical Effects:
- Rise in cardiovascular incidents (thrombosis, strokes), increased LDL, decreased HDL, cardiac damage.
Cognitive and Behavioral Effects:
- Increased libido, aggression, self-harm behaviors, and other psychiatric issues.

Mechanism and Usage:
- EPO stimulates red blood cell formation, crucial for improving oxygen transport and enhancing athletic performance.
- Methods to increase EPO levels historically included altitude training and blood doping.
EPO's detection challenges and its pivotal role in sports like running and cycling.

Use is often anecdotal with little scientific validation for performance enhancement. Challenges in detection pose significant ethical and regulatory questions.

Important for their role in promoting bronchodilation and having anabolic effects, which can be beneficial in avoiding injuries during intense training.

Used to manage heart rate and anxiety in precision sports, however present no advantage in endurance competitions.

Carl Lewis:
- Tested positive for stimulants but claimed it was inadvertent use of a herbal supplement, showcasing the grey areas in doping regulations.

A wide range of stimulants is utilized for enhancing performance; their effects include increased alertness and reduced fatigue.

The theoretical potential of genetic modifications as performance enhancers presents significant ethical and regulatory challenges. Currently, this remains largely speculative.