Ergogenic Drug Abuse in Sport: Issues & Current Trends

1. Ergogenic Drug Abuse in Sport: Issues &Current Trends Cindy Thomas, MS, ATC, CPCT Director of Educational Operations

2. Sports Culture Today Many of today’s athletes are choosing to dope, violating their own bodies as well as their principles, values and rules against doping, but WHY? Victor Conte, Director BALCO

3. Why Dope? • To gain an edge on the competition • Because the end justifies the means • Only success and glory really matter • Society rewards for winning; not performing • Today’s athletes are utilizing technology, nutrition, & science & are closing the gap on physiological limits • Unfortunately dopers miss the point of athletic performance They don’t understand nor value…

4. “The most important thing is not to win but to take part, just as the most important thing in life is not the triumph but the struggle. The essential thing is not to have conquered but to have fought well.” Olympic Creed

5. Missing the Boat… A typical conversation with a NCAA student-athlete regarding an inquiry on the REC about an energy drink: S.A.: “If I drink Red Bull will it cause me to test positive?” REC: “Red Bull contains large amounts of caffeine, a banned substance.” S.A.: “Yeah, but will I test positive from drinking just one can?” REC: “The NCAA cutoff for caffeine is > 15 micrograms/ml. S.A.: “So, how much can I drink before I’ll test positive?”

6. What is aPerformance-Enhancing Substance? “...any substance taken in nonpharmacologic doses specifically for the purposes of improving sports performance … by increasing strength, power, speed, or endurance or by altering body weight or body composition.” “Use of Performance-Enhancing Substances” PEDIATRICS 9/9/05

7. What are the categories ofPerformance-Enhancing Substances? • Pharmacologic agents • Agents for weight control • Agents for weight gain • Enhancement of O2 carrying capacity • Any substance used for reasons other than treating documented conditions • Masking agents • Many dietary supplement products

8. Performance-Enhancing Drugs/Substances • Anabolic Agents • Stimulants • Peptide Hormones • Diuretics (weight loss, dilution of urine) • Dietary Supplements

9. Anabolic Steroids • Human-made substances related to testosterone • Over 100 types of anabolic steroids • Schedule III Controlled Substances • Old is New - “designer steroids” • Pro-hormones

10. The Anabolic Steroid Control Act 2004 (effective Jan. 2005) • Specifically lists dozens of precursors as Schedule III substances • Makes it easier for DEA to outlaw similar substances in future • Illegal to possess any of these substances now

11. Who is Using? • Body Image Disordered • Eating Disordered Stimulants, Laxatives, Diuretics & Steroids • Low Self-Esteem, Depression, Suicide Career Professionals • Models • Firefighters • Police Officers • Military Personnel

12. Body Image & Steroid Use • Body perception issues • Media promotes “idealistic” body • 5-7% of girls have tried steroids to tone bodies – many have eating disorders

13. Steroids & Suicidal Tendencies • Suicide rates rise in adolescence • Already at risk: 3-11% adolescents attempt suicide • Predisposing factors • Body image disorders • Family history • Low self-esteem • Risk taker • Steroid & other drug use Taylor Hooton Efrain Marrero Rob Garibaldi

14. When, Why, & Access? • Initial Use of Anabolic Steroids • 17% initially used in junior high school or before • 39% initially used in high school • Main Reason for Use • 51% to Improve athletic performance • 15.9% to improve appearance • Sources for obtaining Anabolic Steroids • 25% from friend or relative • 22% from Website/mail order • 17% from coach or trainer • 15% from teammate or other athlete 2005-06 NCAA Substance Use & Abuse Survey

15. 12% boys & 8% girls use products to improve appearance &/or performance(Pediatrics 2005) 6% of high school athletes have tried steroids within past year (doubled from 1991) (2003 CDC Study) 3.4% high school seniors reported using steroids at least once.(2004 Monitoring the Future) Steroid use down 40 % (lifetime), 37 % (past year), and 21 % (past month) for 8th, 10th, & 12th graders combined. (2006 Monitoring the Future) Over ½ million 8th and 10th grade students use steroids now; increasing number of high school seniors don’t believe steroids are risky. (NIDA) 2002 Texas A&M study indicated 42,000 students using anabolic steroids Other Statistics on Adolescent Steroid Use

16. State High School Initiatives • California • Officials estimate that 20,000 have used PEDs • Requires districts to ban steroids & contract with students & parents • Districts cannot use supplement manufactures as sponsors • Coaches prohibited from promoting supplements • Louisiana, Nevada, & Texas requires signed contract saying they won’t use steroids • Michigan & Florida are participating in Atlas/Athena (Peer Education on Steroids) • Virginiarequires coaches, students, & parents to view the NFHS education video & is participating in the Atlas & Athena programs

17. State H.S. Assoc. Initiatives • New Mexico ran a pilot steroid testing program Spring 2006 & will have mandatory steroid education in every school next year • Illinois bans use & distribution of PEDs, requires steroid education in all secondary schools & is considering a state-wide steroid testing program • New Jersey added random steroid testing at state championships & requires steroid education programs beginning in junior high school • Florida (FHSAA) provides multi-media steroid education opportunities for coaches & athletes • 88% of Americans polled supported testing high school athletes for steroids(The Sacred Heart University Polling Institute May 2006 interviews nationwide)

18. NCAA Drug Test Results *Championship Testing Only

19. 2003-04 (Most common steroid positives) 13 Nandrolones 10 Testosterones 6 Androstendiones 4 Stanozolols 2 Boldernones 2004-05 (Most common steroid positives) 18 Nandrolones 10 Androstendiones 8 Testosterones 5 Boldernones 4 Stanozolols NCAA Steroid Results

20. Current NCAA Initiatives • Division III Pilot Testing begins Fall 2007 • 2 year program • 100 schools will participate • 12-16 athletes per school tested • Testing for all NCAA banned substances • No sanctions for positive tests • Aggregate results reported only • Participating schools will receive grants for education • Anti-estrogens are being added as a Banned Drug Class • e.g., Tamoxifen, a breast cancer drug used to mask steroid use by reducing negative side effects of steroids such as breast enlargement • A medical exception will be provided for legitimate reason

21. Current NCAA Initiatives • Proposed legislation to test for all banned substances all the time • Administrators want marijuana tested for all the time • Currently THC (+) is a 1-year sanction • Legislation seeks to reduce sanction to 50% • To reinstate, school must document treatment, s.a. must be tested by school during sanction time, & need a negative exit test

22. Stimulants • Increase energy, endurance, reduce mental fatigue, increase fat usage • Amphetamines • Caffeine • Synephrine • Ephedrine • Illegal to include in dietary supplement products • Smart Pills “Brain Steroids” • Ritalin [methylphenidate], Provigil [modafinil], Adderall [amphetamine] • High school & college students using to gain an "edge" for academic studies

23. Dietary Supplements • Muscle builders • Energy enhancers • Endurance increasers • Weight loss • Weight gain • Workout recovery • Pre-workout • Joint health Effective? Safe? Pure? Accurate dosing?

24. Caffeine, Ephedrine, Synephrine • Stimulants found in dietary supplements & OTC drugs • All banned in sport • Several NCAA positives • May not be listed ingredient or… • Listed several different ways • Sometimes large quantities

25. Energy Drinks • NOT A SPORTS DRINK • Contains stimulants • Increases HR & BP • Diuretic = Dehydration • Can cause + test • Alcohol further contributes to problems • Considered dietary supplements & contain NCAA banned substances!

26. Peptide Hormones • Human Growth Hormone (hGH) • Real hGH is ineffective in tablet form • Rx = $750/month • Pilot testing with antibody • Insulin-like Growth Hormone (IGF-1) • Increases rate of muscle repair after injury & rate of growth with training • No test yet • Erythropoietin (EPO) • Testing via blood & urine • Hormone lasts only a few days in the bloodstream • If stop taking several days before testing may not be caught • Attempted adulteration in urine by adding pepsin, a chemical found in spot removers –destroyed all EPO including own natural • Circumvent the test by taking very low doses of EPO every day

27. “Non-therapeutic use of cells, genes, genetic elements, or modulation of gene expression, having the capacity to improve athletic performance” (WADA) Repoxygen™ is a type of gene therapy that induces controlled release of (EPO) – may be impossible to detect May see in 2008 Games Current testing method trials include tracking traces left by viruses commonly used in gene doping – detecting in blood, urine & saliva When stimulating growth hormones, also possible that very early cancers, not yet detected, could have their growth dramatically accelerated as well Gene Manipulation

28. Why Not Dope? • Why not risk health? • Why not risk ruin? • Why be concerned with principle of fair play and naturalness of sport? • Why not do what everyone else is doing? ‘It's only cheating if you get caught.'

29. Sport culture has direct effect on athletes’ reasoning or non-reasoning about ethical issues Athletes are very affected by role models around them (e.g., coaches, teammates, athletic trainers) Anti-doping must focus on convincing athletes, parents, athletic trainers, coaches, administrators of the necessity of a level playing field & the ideal performance perspective Addressing Sport Ethics

30. Future? • Scientifically & ethically complex • Future determined more by technology than innate ability • Addressing supplements with industry control, education & testing • Tomorrow? Gene transfer therapy? Stem cell transplants? • Alternative specimens in sports testing?