Introduction

1. Introduction A seven year old boy dreams of one day becoming the greatest baseball player the world has ever seen. He practices and works on his physical strength every day, but he knows it won’t be enough to beat the best of the best. The long hours of practice are not as long as they could be if he had a little extra help. Does he let the dream die, or does he pursue his lifelong dream with the assistance of performance enhancing drugs? Is it right to punish him if he continues striving toward his goal? Performance enhancing drugs should not be prohibited in professional sports. Performance enhancing drugs should be allowed in sports because permitting the use of performance enhancing drugs would reduce the black market monopoly of steroids, which in turn would reduce the risk of improper dosage and make steroids safer; it would create an equal opportunity for athletes; there are no proven long term health effects; using steroids does not lead to an addiction; and there would be no need to test for drugs, which would save a lot of money.    

2. Athletes Already Use Other Means to Enhance • Dieticians • Coaching • Legal Drugs • Special Training • Special Equipment • "There is no coherent argument to support the view that enhancing performance is unfair; if it were, we would ban coaching and training. Competition can be unfair if there is unequal access to particular enhancements, but equal access can be achieved more predictably by deregulation than by prohibition.“ Norman Fost, MD, MPH Professor and Director of the Medical Ethics Program at the University of Wisconsin

3. Athletes Already Use Other Means to Enhance • Dieticians • Coaching • Legal Drugs • Special Training • Special Equipment • "There is no coherent argument to support the view that enhancing performance is unfair; if it were, we would ban coaching and training. Competition can be unfair if there is unequal access to particular enhancements, but equal access can be achieved more predictably by deregulation than by prohibition.“ Norman Fost, MD, MPH Professor and Director of the Medical Ethics Program at the University of Wisconsin

4. Athletes Already Use PED’s • Ritalin • Adderall • Beta Blockers • Inhalers • "Sport is for enjoyment and competition, and usually aims to improve; but what is the difference between increasing skill and performance by training, and taking drugs? If it is the use of personal effort rather than outside help, then what of ropes, crampons and oxygen for climbing? What of advanced training by teams of sports physiologists who wire athletes to equipment monitoring heart, muscle, brain and nerves to optimise activity; or teams of sports psychologists improving your responses and neutralising those observed in competitors? What of dieticians tampering with foods and additives - drugs by any other name - to improve performance? What is more 'fair' - the use of a team of sports specialists or a simple pill? What is the difference between training at altitude and taking erythropoietin to achieve a similar effect? Sam Shuster, PhD Emeritus Professor of Dermatology at Newcastle University

5. Ingenuity, innovation, and knowledge about what makes us faster and stronger (and avoiding what might do more harm than good) has always been a part of the game.

6. Effects on the Black Market • What the Black Market Provide? • Access to illegal substances including steroids. • Black market steroids come from 3 sources. • Steroids manufactured legally and illegally in other countries and smuggled into the U.S. • Steroids manufactured in this country by licensed pharmaceutical companies and diverted to the black market by the producer, distributor, pharmacist, veterinarian, or physician. • Steroids produced by clandestine laboratories. • i.e. counterfeit products sold as steroids but containing no active anabolic agent or; • Counterfeit preparations containing an anabolic steroid, but of a different type or dose than is indicated on the package (Burge). • International smuggling is the main supply of illicit anabolic steroids in the US, followed by illegally diverting and clandestinely manufactured steroids. • Where/how are steroids obtained? • Most illicit anabolic steroids are sold at gyms, competitions, and through mail-order operations (via the internet). • What is the prevalence? • estimated that there were more than 1 million people in the United States spending $100 million a year, according to Federal law-enforcement officials (Alfano and Janofsky). • Why a black market? • The Anabolic Steroids Control Act labeled a dozen forms of the drug as Controlled Substances, meaning that the production and distribution of them would be strictly monitored by the feds. • Made it a felony to possess or distribute AAS for nonmedical purposes. • The House Report (108-461) stated that the purpose of the Act is "to prevent the abuse of steroids by professional athletes (Group).

7. Risks Associated with Steroids Obtained through the Black Market • Reduced the likelihood that the average steroid user will seek or be able to obtain medical supervision. • Athletes are injecting powerful drugs about which medical experts no very little about. • Often take in doses as much as 10 times amount used for legitimist medical purposes. • Combination of different steroids. Manny also mix in additional medications including: legal over the counter medications, prescription drugs, and/or illegal recreation drugs. The combinations and effects of mixing different types of medications without consulting a medical profession is inherently risky. Drug interactions pose serious health risks (Burge). • Factors have limited the trust and credibility that many steroid users place in health professionals • Compounding this lack of trust is the demonization of steroids and users by the media and wider society, as well as the fact that government policy has been directed predominately by anti-doping efforts within elite sport. • This has left the majority of steroid users marginalized limited opportunities have been developed for this population to engage with health professionals to reduce harm and promote health. Ultimately, as a result, users have had to rely on ‘locker-room anecdotes’ both within gyms, and, increasingly, through the internet.

8. Ex. DEA’s “Raw Deal” In 2007, the DEA’s “Raw Deal” enforcement action revealed a vast network of national and international suppliers producing all types of steroids, using the internet and U.S. mail system to consummate sales of, in many cases, impure injectable steroids. In sum, continued steroids enforcement currently costs the U.S. over $7 billion annually and has inadvertently fueled a large market of more dangerous drugs that are readily available to users. Federal agents report that many of the underground steroid labs seized in are extremely unsanitary, further illustrating the danger in buying these products illegally (DEA).

9. Black Market Activity Ex: alcohol prohibition Ex. Alcohol Prohibition Alcohol prohibition did not deter people from buying illegal alcohol In fact statistics of alcohol consumption/distribution increased. Illicit production and distribution continued to expand throughout Prohibition despite the ever-increasing resources devoted to enforcement. That pattern of consumption is to be expected after an entire industry is banned as new entrepreneurs in the underground economy improve techniques and expand output, while consumers begin to realize the folly of the ban. The average age of people dying from alcoholism fell by six months between 1916 and 1923, a period of otherwise general improvement in the health of young people (Thornton).. Resulted in black market , the consumption of unregulated alcohol rose. By amending the Prohibition law, decreased the need for a black market, and alcohol is now one of the most regulated substances in the US. • Assuming enforcement is necessary, any time one imposes an enforcement regime, black-market activity will arise, presenting many problems in the steroid context. • High prices from black market suppliers increase profits and attract criminals into the black-market. • Policy has actually created greater access to more dangerous forms of steroids through the supplement industry’s uncontrolled production of new, undetectable and untested laboratory steroid products. Sales of these black-market steroids have exploded in recent years, using the web as a vehicle to locate both national and international sources.

10. Rebuttal argument: That the black market will create an excessive consumption of steroids • This would actually allow for the recommendation of safe level dosing in conjunction to warnings against excess use or abuse. • Public would have the ability to make safe informed decision, obtain reliable medical drugs, consultations, follow–up, screening, and care. • Save the lives of athletes and reduce risks to others. • Note: Legalization of steroids in sports would never eliminate all risk. However, it would give athletes the ability to make informed decisions regarding their health and steroid use, receiving medical treatment, consultations, thereby reducing the danger of self-administrating, improper dosages, and the use of altered steroids in the market.

11. Reduction for the need of Black Market Steroids • By legalizing steroids in sports we should see: • A decline in the need for regulatory agencies’ scientists having to design tests in time to proactively catch these new and existing drugs, which is exacerbated by the black market which produces or uses a new untested or unknown substance. • Effective short and longitude studies in order to maximize the benefit to risk ratio. • The role of a doctor is to preserve their patients best interests with respect to present and future health. A sports doctor has to fulfill this role while maintaining the athletes performance at as high of level as possible(Kayser, Maucon and Andy). • Should the ban on drugs in sports be removed , pharmaceutical companies would have huge incentives to establish safe dose for steroids and other drugs (Black).

12. Testing Problems • Tests can only screen for known Performance enhancers. • Designer Steroids. • Performance enhancers are not universally illegal. • Test results are not binomials.

13. Equal Opportunity/ Cheating Athletes with genetics potential are dealt an “unfair” advantage at birth • African Americans genetics • Gold Medalist, Eero Maentyranta. • 40–50% more red blood cells

14. Equal Opportunity/ Cheating Spirit of Sport • Character and Education • Fun and Joy • Teamwork • Excellence in Performance If steroids are made legal and all bans are lifted in professional sports, than is the spirit of sport, defined by The World Anti-Doping Agency Code, being violated?

15. Equal Opportunity/ Cheating Cheating? • Adderall/ Ritalin being used by students • Beta blockers being used by musicians and actors

16. Can abusing steroids lead to addiction? Abusing steroids cannot lead to addiction. The evidence that abusing steroids creates dependence is inconclusive. ADDICTION: “Addiction is a biological and psychological condition that compels a person to satisfy their need for a particular stimulus and to keep satisfying it, no matter what.” DEPENDENCE: “Dependence is a physical state that occurs when the lack of a drug causes the body to have a reaction. Physical dependence is solely a physical state indicating that the body has grown so adapted to having the drug present that sudden removal of it will lead to negative consequences such as a withdrawal reaction. This can occur with almost any kind of drug. *Source (http://health.discovery.com/centers/pain/medicine/med_addict.html)

17. Can abusing steroids lead to addiction? Recent Studies show mixed data on Steroid dependence among abusers*: *Published in Addiction Review, July 2009. *Authors include Gen Kanayama1, Kirk J. Brower2, Ruth I. Wood3, James I. Hudson1 & Harrison G. Pope Jr1 Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts, and Department of Psychiatry, Harvard Medical School, Boston, MA, USA,1 University of Michigan Addiction Research Center, Ann Arbor, MI, USA2 and Department of Cell and Neurobiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA3

18. Can abusing steroids lead to addiction? • Study concludes that among abusers, only approx 30% develop dependence • Admits possible selection bias • Suggests reasons for possible dependence, including: • Possible Body Dimorphic disorder • More biologically vulnerable to effects of withdrawal • Overlap of dependence with other forms of substance dependence/conduct disorder

19. Can abusing steroids lead to addiction? Dependent AAS users also reported a much more frequent history of conduct disorder than non-dependent AAS users and a much higher life-time prevalence of non-alcohol substance dependence than either comparison group…" New study indicates: Specifically, dependent AAS users were: • Significantly older and more muscular • More likely to have had a single parent by age 13 • More likely to report a first-degree relative with a substance use disorder • Less educated

20. Rebuttal: Long Term Health Effects? “There has been no credible study for the long-term health effects of anabolic steroid use, not abuse… any evidence of long-term damage is purely anecdotal right now.” -Charles E. Yesalis Health & Human Development Penn State University • National Institute of Health (A part of the US Dept. of Health and Human Services)

21. Rebuttal: Health Effects to Steroids The 15 leading causes of death in 2006 were: Diseases of heart (heart disease) Malignant neoplasms (cancer) Cerebrovascular diseases (stroke) Chronic lower respiratory diseases Accidents (unintentional injuries) Diabetes mellitus (diabetes) Alzheimer’s disease Influenza and pneumonia Nephritis, nephrotic syndrome and nephrosis (kidney disease) Septicemia Intentional self-harm (suicide) Chronic liver disease and cirrhosis Essential hypertension and hypertensive renal disease Parkinson’s disease Assault (homicide) Drug & Alcohol Review, Nov2008, Vol. 27 Issue 6, p679-686, 8p, 3 charts, 1 diagramChart; found on p68 by Melonie Heron, Ph.D.; Donna L. Hoyert, Ph.D.; Sherry L. Murphy, B.S.; JiaquanXu, M.D.; Kenneth D. Kochanek, M.A.; and BetzaidaTejada-Vera, B.S.; Division of Vital Statistics. National Vital Stastics Report, Apr2009, Vol. 57 Issue 14. Steroids have not been proven to have devastating long term side effects

22. Rebuttal: Health Effects of Steroids • Needle Sharing is More Dangerous than actual Steroids Injecting risk Behaviour % Ever Engaging % engaging in In Risk Practice risk practice over last month of use Re-using injecting equipment 4.2 2.1 Use of injecting equipment after someone else 0.0 0.0 Use of injecting equipment before someone else 2.1 0.0 Dividing AAS doses using syringes 17.0 17.0 Using a multi-dose vial 61.7 21.3 Sharing a multi-dose vial 23.4 19.1 Observing others sharing injecting equipment 4.8 0.0 Midgley, S. J., et al. "Risk behaviours for HIV and hepatitis infection among anabolic-androgenic steroid users." AIDS Care 12.2 (2000): 163-170. Academic Search Premier. EBSCO. Web. 28 Apr. 2010.

23. Rebuttal: Health Effects of Steroids Joyce, B. Matthew, Paul E. A. Glaser, and Greg A. Gerhardt. "Adderall^® produces increased striatal dopamine release and a prolonged time course compared to amphetamine isomers." Psychopharmacology 191.3 (2007): 669-677. Academic Search Premier. EBSCO. Web. 28 Apr. 2010. Athletes are more likely to be harmed from use of Adderal and Ritalin Leads to vomiting, increased blood pressure, paranoia, hypertension, and irregular heart beat. Alcohol Use in Sports

24. Rebuttal: Tradition of Sports Fost,Norman. “What should professional sports organizations do about players who use steroids?” Washington Post TIMES SUNDAY READ; Pg. 11 October 18, 2009 Sunday Search for the Competitive Edge: A History of Dietary Fads and Supplements1 Elizabeth A. Applegate and Louis E. Grivetti2 Department of Nutrition, University of California, Davis, CA 95616 • Performance Enhancing Drugs can be traced as far back as 500 BC • Warriors used deer liver and lion hearts • Celtics drank wine with flavored borage • Babylonians and Romans used herbs before battle

25. Rebuttal: Tradition of Sports • Athletes have used performance-enhancing drugs and devices since the beginning of recorded history • Greeks put on shoes to run faster. • Runners carbo-load to improve their endurance • Taking caffeine pills before working out • Kenyan runners training at higher elevation • Lasik surgery: Mark McGwire, Tiger Woods

26. Rebuttal: Athletes are Role Models Role Models: model of a specific “role” “Athletes display the athletic virtues: diligence, perseverance, the value of training, fair play and sportsmanship, grace under pressure, the pursuit of excellence.” –Jeffrey Standen, Sports Law Professor “My one son loves watching Pujols and he swings exactly like him. He likes to play the game like he does, but that's where it stops. He might want to shoot the ball like Kobe, or tackle like a line-backer, or run like Walter, or pass like Vick, But I never hear them say....I want to be just like Vick....or I want my life to be just like Walter.” -

27. Rebuttal: Athletes are Role Models “Athletes are models for their roles, and like any role model they can succeed or fail at that role. But it is on that singular and limited dimension, as an example or model of the specific role of the athlete, that we should judge our professional athletes, and no more.”-Jeffrey Standen, Sports Law Professor

28. Actresses, actors, musicians encourage drugs/drinking through their music, movies, and lifestyles. Why are athletes held to a different standard?

29. References Akunyili, Dora Nkem and Ijeoma P.C. Nnani. "Risk of medicines: Counterfeit drugs." The International Journal of Risk and Safety in Medicine 16.3 (2004): 181-190. Alfano, Peter and Michael Janofsky. "Drugs That May Build Bulk Pull Weight on Black Market." The New York Times (1988). Black, Terry. "Repeal the Ban on Drugs in Sport for Fairer Contests and Reduced Health Risks." A Journal of Policy Analysis and Reform (1996): 101-106. Burge, John. "Legalize and Regulate: A Prescription for Reforming Anabolic Steroid legislation." Loy. L.A. Ent. L.J. 15.33 (1994-1995): 33-62. DEA, U.S. DEA Announces Largest Steroid Enforcement Action in U.S. History. 24 September 2007. 23 April 2010 <http://www.justice.gov/dea/pubs/pressrel/pr092407.html>. Evans-Brown, Michael, Andreas Kimergårdb and Jim McVeighc. "Elephant in the room? The methodological implications for public health research of performance-enhancing drugs derivedfrom the illicit market." Wiley Interscience (2009). Group, Steroids Working. "The United States Sentencing Commission." 2006. 2006 Steroids Report. 2010 25 2010 <http://www.ussc.gov/USSCsteroidsreport-0306.pdf>. Kayser, Bengt, AlexandreMaucon and Mtah Andy. "Viewpoint Legalisation of performance-enhancing drugs." Lancet (2005): 21. Thornton, Mark. "Prohibition's Failure: Lessons for Today." USA Today 1 March 1992.

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