Drug Use in Sports and Exercise

Abstract

To the Editor: The recent article by Moeller et al1Moeller KE Lee KC Kissack JC Urine drug screening: practical guide for clinicians.Mayo Clinic Proc. 2008; 83: 66-76Abstract Full Text Full Text PDF PubMed Scopus (375) Google Scholar on urine drug screening emphasized drug testing in health care, workplace, and criminal settings. We extend that information to include the problems of drug use (doping) in sports and exercise, highlighted recently by the Mitchell Report on doping in professional baseball.2Mitchell GJ Report to the commissioner of baseball of an independent investigation into the illegal use of steroids and other performance enhancing substances by players in major league baseball. Decmeber 13, 2007.http://i.l.cnn.net/cnn/2007/images/12/13/mitchell.report.pdfGoogle Scholar Doping in sports and exercise could have important implications for the medical practitioner. The World Anti-Doping Agency (WADA) has determined that the presence of a prohibited substance or its metabolites in an athlete's bodily specimen is not the only indication that the athlete or support personnel are violating antidoping rules.3World Anti-Doping Agency http://www.wada-ama.orgGoogle Scholar In addition to positive test results, WADA identifies the following actions as components of doping: (1) using or attempting to use a prohibited substance or method; (2) refusing, or failing without compelling justification, to submit a sample collection after notification, as authorized in applicable antidoping rules or otherwise evading the request for a sample collection; (3) violating requirements regarding athlete availability for out-of-competition testing, including failure to provide information on whereabouts and missed tests; (4) tampering or attempting to tamper with any part of the doping control process; (5) possessing prohibited substances and using prohibited methods; (6) trafficking in any prohibited substance or method; and (7) administering or attempting to administer a prohibited substance or method to any athlete or encouraging, aiding, and abetting any cover-up of other types of complicity involving an antidoping rule violation or attempted violation.3World Anti-Doping Agency http://www.wada-ama.orgGoogle Scholar Simply stated, the use of performance-enhancing drugs in sports and in exercise constitutes “doping.” Doping is cheating, and it undermines the fundamental spirit of sports by eroding its integrity, image, and values.4Anshel MH Russell KG Examining athletes' attitudes toward using anabolic steroids and their knowledge of the possible effects.J Drug Educ. 1997; 27: 121-145Crossref PubMed Scopus (42) Google Scholar, 5Bredemeier BJ Children's moral reasoning and their assertive, aggressive, and submission tendencies in sport and daily life.J Sport Exerc Psychol. 1994; 16: 1-14Google Scholar, 6Ethical Rationale for Promoting Drug-Free Sport. Executive Summary. 1993; Canadian Centre for Ethics in Sport.http://www.cces.ca/pdfs/CCES-RPT-TSWWFinalReport-E.pdfGoogle Scholar Although doping has long plagued elite sports, it has escalated to the point that most authorities think that few levels of sports are immune.7Green GA Doping control for the team physician.Am J Sports Med. 2006 Oct; 34 (Epub 2006 Aug 21.): 1690-1698Crossref PubMed Scopus (14) Google Scholar, 8Green GA Uryasz FD Petr TA Bray CD NCAA study of substance use and abuse habits of college student-athletes.Clin J Sport Med. 2001; 11: 51-56Crossref PubMed Scopus (151) Google Scholar, 9Committee on Sports Medicine and Fitness Adolescents and anabolic steroids: a subject review.Pediatrics. 1997; 99: 904-908Crossref PubMed Scopus (102) Google Scholar, 10Gregory AJM Fitch RW Performance enhancing drugs.Pediatr Clin North Am. 2007; 54: 797-806Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar Many athletes serve as wonderful, clean role models for children and adolescents, but high-profile athletes who cheat encourage the use6Ethical Rationale for Promoting Drug-Free Sport. Executive Summary. 1993; Canadian Centre for Ethics in Sport.http://www.cces.ca/pdfs/CCES-RPT-TSWWFinalReport-E.pdfGoogle Scholar of steroids,9Committee on Sports Medicine and Fitness Adolescents and anabolic steroids: a subject review.Pediatrics. 1997; 99: 904-908Crossref PubMed Scopus (102) Google Scholar supplements,10Gregory AJM Fitch RW Performance enhancing drugs.Pediatr Clin North Am. 2007; 54: 797-806Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar, 11Pipe A Ayotte C Nutritional supplements and doping.Clin J Sport Med. 2002; 12: 245-249Crossref PubMed Scopus (107) Google Scholar, 12Smith J Dahm DL Creatine use among a select population of high school athletes.Mayo Clinic Proc. 2000; 75: 1257-1263Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar stimulants,13Schaefer MP Smith J Dahm DL Sorenson M Ephedra use in a select group of adolescent athletes.J Sports Sci Med. 2006; 5: 407-414Google Scholar and narcotics14US Department of Health and Human Services Substance Abuse and Mental Health Services Administration.http://www.samhsa.gov/newsGoogle Scholar among young athletes. Despite progress in drug testing, challenges remain in addressing this important health and ethical issue.7Green GA Doping control for the team physician.Am J Sports Med. 2006 Oct; 34 (Epub 2006 Aug 21.): 1690-1698Crossref PubMed Scopus (14) Google Scholar Known consequences of doping in sports and exercise depend on the drug and dose and range from addiction and suicide to kidney and liver disease. Nevertheless, our understanding of the consequences of illicit drug-taking behavior is limited. A study by Dr Giselher Spitzer, at Humboldt University in Berlin, Germany, reported (preliminary finding disseminated by his Web site15Spitzer Giselher H “Wunden und verwundungen: dokumentation der doping-schaden bei DDR-sportlern als folge des hochleistungssports der SED-diktatur.http://www.sportphilosophie.de/Wunden_Verwundungen_Pressekonferenz.pdfGoogle Scholar and The Sydney Morning Hearld16Magnay J Children of doping athletes deformed. The Sydney Morning Hearld.http://www.smh.com.au/news/world/children-of-doping-athletes-deformed/2007/10/31/1193618974100.htmlDate: November 1, 2007Google Scholar) that children born to 52 East German athletes who had unknowingly been administered steroids during national training and competition had a higher prevalence of psychiatric disorders, mental retardation, physical abnormalities, asthma, allergies, and cancer than did the general population of children. Miscarriage and still birth rates were 32 times greater among these athletes compared with East German women who were not athletes. The reasons an athlete might choose to dope vary. Many physicians attempt to deter athletes from cheating by educating them about the physical, psychosocial, legal, and ethical consequences of drug use. However, some physicians rationalize that “supervising” doping behavior renders this practice safer, despite no supporting evidence. Physicians who aid and abet doping practices violate the Hippocratic Oath and the policies of most sports and exercise organizations.17United States Anti-Doping Agency Policy 2007 http://www.usantidoping.org/what/management/policies.aspxGoogle Scholar, 18Stoll SK, Beller JM. A proposal for a moral reasoning educational intervention program for Division 1 athletes at the University of Idaho. Unpublished manuscript, University of Idaho, Moscow, IDGoogle Scholar To address the epidemic of doping in sports and exercise, the Association for Applied Sport Psychology, the US Anti-Doping Agency (USADA), the American College of Sports Medicine (ACSM), the National Collegiate Athletic Association, the National Strength and Conditioning Association, and the Taylor Hooton Foundation cohosted a national Anti-Doping Congress in October 2007. Nearly 100 delegates attended the congress, representing the American Orthopaedic Society for Sports Medicine, American Osteopathic Academy of Sports Medicine, American Academy of Pediatrics, National Athletic Trainers Association, National High School Scholastic Federation, and 11 national governing bodies. A DVD recording of the Anti-Doping Congress Proceedings is available at http://www.aaasponline.org. Considerations emerging from the congress that might be helpful for sports medicine and other concerned health care practitioners include the following. 1.Display the ACSM/USADA policy regarding the “Ethical Violation of Aiding and Abetting Athletes to Cheat” in sports medicine centers, physician offices, and patient examining rooms (http://www.usantidoping.org).17United States Anti-Doping Agency Policy 2007 http://www.usantidoping.org/what/management/policies.aspxGoogle Scholar2.Urge your medical organization to take action if physicians and other health care practitioners are overtreating “growth” deficiency or attention deficit hyperactivity disorder or are inappropriately prescribing testosterone and stimulants.3.Play the WADA/AMA (American Medical Association) Level the Playing Field DVD and other educational videos in waiting rooms to promote high ethical standards in sports (http://www.wada-ama.org).4.Adapt the interview form from Pediatric Clinics of North America (Rogers and Hardin, 2007, Performance Enhancing Substances10Gregory AJM Fitch RW Performance enhancing drugs.Pediatr Clin North Am. 2007; 54: 797-806Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar) to use as a guide in medical practice. Educate students, residents, and allied health care professionals about the signs and symptoms and concerning consequences of drug abuse.5.Consider thoughtfully if your medical practice is a source for narcotics and stimulants currently used by adolescents. See Office of National Drug Control Policy at http://www.whitehousedrugpolicy.gov/.6.Promote legislation and policies that pertain to mandatory drug education to deter middle school and high school athletes from using and abusing supplements, steroids, stimulants, etc.7.Ask athletes in your medical practice to commit to seeking your advice on the use of dietary supplements or medication, noting that your advice will be documented in their records.8.Ask coaching and training staff to sign a similar agreement that they will not provide nutritional supplements11Pipe A Ayotte C Nutritional supplements and doping.Clin J Sport Med. 2002; 12: 245-249Crossref PubMed Scopus (107) Google Scholar or vitamin products to athletes or counsel their use without your consent.9.Resist the temptation to prescribe inappropriately in response to pressure from athletes or their representatives.10.Cooperate with local, state, federal, and other authorities if you suspect that certain Web sites, gyms, or medical or antiaging clinics are a source of drugs for your patients.11.Share the Taylor Hooton Foundation Web site with adolescents and parents ([email protected]).12.Review a model based on deterrence theory that has potential to serve as a research framework to guide testing of interventions to help decrease drug use in sports and exercise.19Strelan P Boeckmann RJ A new model for understanding performance-enhancing drug use by elite athletes.J Applied Sport Psych. 2003; 15: 176-183Crossref Scopus (66) Google Scholar By engaging in these activities, physicians will be part of a collaborative effort to promote the opportunity for all children, adolescents, young athletes, and exercisers to participate and compete fairly in clean sports and athletic performance.