Woodburne O. Levy, MD
Department of Psychiatry
University of South Florida
A. Drug use is a major problem facing sports today
1. Growing attention (Daryl Strawberry- cocaine and alcohol misuse, MLB; Oksana Baiol- alcohol misuse/DUI; Chris Weber- marijuana misuse, NBA, Alain Baxter (British skier, 2002 Winter Olympics)- amphetamine misuse; Larisa Lazutina (Russian Skier)-darbepoetin misuse
3. Drug misuse in sports has become widely reported by media (1)
1. No improvement of performance offered by most drugs
2. Unfair advantage provided by drugs that do improve performance
3. Bad role models posed by athletes using drugs
C. Drugs to assist performance remain widespread among
athletes despite intense efforts to eliminate the problem (2,3)
D. Drugs misused by athletes can be divided into three
groups:
1. Therapeutic drugs (diuretics, opioids, OTCs, beta-blockers, etc.)
2. Performance enhancing drugs (amphetamines, caffeine, catecholamines, anabolic steroids, growth hormone, etc.)
3. Typical drugs of misuse (alcohol, marijuana, tobacco, cocaine, etc.) (4)
E. Current literature provides only partial picture of
drug misuse in college athletes
1. Research is rare
2. Most data come from national surveys of college athletes in 1985, 1989 and 1996 (5,6,7)
F.
The goal of this lecture
is to review substance misuse among athletes. To accomplish this, the lecture
covers:
1. Historical perspective
2. Factors influencing athletes to use drugs
3. Types of drugs athletes use- consequences and myths
4. Preventing
and treating drug use in athletes
A. Ancient civilizations:
1. The ancient Greeks used mushrooms to enhance performance (possibly containing psychobilins)
2. Roman wrestlers used special mixtures of herbs (composition unknown)
3. Egyptian athletes used the rare hooves of an Abssynian ass ground up boiled in oils and flavored with rose petals and rosehips believed to enhance performance (placebo effect?)
4. Indigenous South African tribes used local liquor called dop¹ as a stimulant (8)
B. 19th century:
1. Alcohol, caffeine, nitroglycerine, opium and strychnine were commonly used
2. The first reported drug-related death occurred in 1896 when an English cyclist died of an overdose of trimethyl¹
C.
World War II:
1. Amphetamines introduced to US troops to help keep them awake at the battlefront
2. Testosterone given to German storm troopers to enhance their aggressiveness
D. Following the war, the use of amphetamines and
anabolic steroids spread among sportspeople:
1. Danish cyclist Kurt Jensen died from a heat-related illness after use of amphetamines at the 1960 Rome Olympics
2. British cyclist Tommy Simpson dies in Tour de France in 1967 due to stimulants
3. Anabolic steroids allegedly used by Soviet athletes in the 1952 Olympics in Helsinki
4. At the 1968 Olympics in Mexico seven athletes, including four medallists, had positive test results to stimulants or narcotics
5. 7 athletes at the 1976 Montreal Olympic Games tested positive for anabolic steroid use
6. At the 1988 Seoul Olympics Ben Johnson, 100 m winner, tested positive for anabolic steroids (focused world attention)
E.
Newer agents (described
in detail later):
1. Blood doping became a focus when used by Finnish distance runners in the 1970s.
2. Erythropoietin has allegedly become widespread among endurance sportspeople.
3. Chinese swimmers at the 1998 World Swimming Championships caught trying to bring human growth hormone through customs into Australia.
F. Over time various substances became prohibited:
1. 1967: IOC Medical Commission formed, prohibited the use of performance-enhancing drugs and commenced drug testing (e.g. stimulants and narcotics)
2. 1975: anabolic steroids were added to the prohibited list
3. 1980s: caffeine and testosterone, beta-blockers, diuretics and glucocorticosteroids, blood doping and growth hormone were added to the prohibited list
4. 1990: erythropoietin was added to the list
G. A summary of currently prohibited methods and substances
by International Olympic Committee
(S 7) (9)
|
Prohibited procedures |
||
|
Stimulants |
Alcohol |
|
|
Narcotics |
Administering artificial oxygen carriers |
Cannabinoids |
|
Anabolic agents Ø
Anabolic androgenic
steroids Ø Beta-2 agonists |
Local anesthetics |
|
|
Diuretics |
Pharmacological, chemical and physical manipulation |
Glucocorticosteroids |
|
Peptide hormones, mimetics and analogs |
|
Beta-blockers |
A. A belief that their competitors are taking drugs
B.
A determination to do
anything possible to win
C.
Pressure from coaches,
parents and peers
D. Community attitudes and expectations of success
E.
Financial rewards
F. Influence from the media in facilitating these expectations and rewards (8)
G. Belief in multiple benefits to be accrued:
A. Therapeutic Drugs (S 9,10,11,12)
1. OTCs (analgesics, laxatives, ephedrine, weight loss medications, NSAIDs, local anesthetics, corticosteroids, decongestants)
a.
Carry extremely low potential for misuse when used for
treatment of appropriate illness
b. Selected subgroups of athletes may misuse certain classes or particular types of substance
i. Gymnasts, ice-skaters diet pills and laxatives (to maintain weight limit)
ii. Runners- caffeine and ephedrine containing products ( endurance/alertness)
iii. Most athletes- will use analgesic and/or corticosteroids following injury
c. 5% of college athletes, mostly females, report appetite suppressants (6)
d. Adverse effects: risk of further injury, gastrointestinal blood loss, anemia, and eating disorders
2. DIURETICS
a. Excretion enhancement to lose weight rapidly prior to competition where weight limits are set (boxing, wrestling, weight- lifting, judo, lightweight rowing)
b. Used in combination with other dehydration techniques such as use of a sauna, exercise in hot conditions and food and water restrictions
c.