ANTI-DOPING

Drugs in sport

Steve Bird

Welcome to the murky world of drugs in sport, or to be more encompassing ‘Ergogenic (work enhancing) aids’ in sport. It’s murky because despite the efforts of various authorities it’s complex, with areas of greyness.

AS we’ve seen in recent times, there are issues around whether to discriminate between ‘performance enhancing’ drugs, and the use of ‘recreational’ drugs that may or may not affect performance. There is also an element of greyness in setting the moral boundaries. For example, if we say that drugs or other performance enhancing techniques are banned because they give an unfair advantage, where do we draw the line between: (i) going to altitude to live and train, to enhance oxygen delivery, (ii) sleeping in a hypobaric chamber that simulates being at altitude, (iii) removing some of your own blood, allowing your body the replenish the loss, and then reinfusing the extracted blood to increase oxygen delivery, and (iv) injecting the hormone erythropoietin (EPO) to stimulate your body to produce more red blood cells. Essentially, all of these can have the same effect, yet we have applied a moral stance, in which (iii) and (iv) would be deemed as cheating, whist (i) and (ii) would be permissible. If in the above example we draw the line at blood reinfusion and injecting EPO, on the grounds that they’re not a ‘natural’ effect, why then do we allow other medications to be taken without applying the same criteria, say for example with asthma medication. Since this also enables someone to compete and perform at a level that they may not be able to without the drugs. So in this case we shift the rationale to the difference between ‘illness’ and ‘normal’, but this is a spectrum with no definite line. And to a certain extent, we accept medications because as a society we accept them as part of our daily life, but the way society has shaped us means that taking drugs to enhance performance doesn’t feel right, and so we consider it immoral and cheating. I am, of course, being provocative for the sake of stimulating discussion and I’m not advocating the use of drugs in sport, just highlighting the complexities of the issues which are dictated by our view of society and what it should be. Likewise the argument of giving someone an ‘unfair advantage’ is also ridden with holes, as ‘unfairness’ can have many forms. For example we could extend this to: having the right parents who gave us the best genes for a particular sport; or living in a particular geographic location that has better facilities; or socioeconomic status. Who knows how many potential champion polo players are out there, but never get to ride a horse, let alone afford a stable of polo ponies. So why do we accept some forms of unfairness, but not others. We could say that it’s because taking drugs is bad for your health, but you only need to spend a few hours in the Emergency Department of the local hospital to see that if we applied the criteria of ‘bad for your health/risk of injury’, we would need to ban a whole range of sporting activities outright. And so the philosophical arguments go on, and “being a bear of small brain” (A. A. Milne; Winnie-the-Pooh) I shall leave them to the philosophers, BBQ and Bar Room discussions, whilst I stick to the less subjective aspects of the topic, in outlining some of the basic science. This article will attempt to clarify some of the points involved by reviewing a few of the aspects associated with doping substances and procedures in sport, outlining which drugs are involved and suggesting why those involved in sport may be tempted to use them.

Research evidence for ergogenic benefits

Conclusive research into the ergogenic effects of particular drugs or doping procedures, and the health risks they convey is often difficult due to the nature of the subject. For example, since their use by those involved in sport is, by definition, not permitted, it precludes any sports individuals from taking them as part of any scientific research study on the topic. This means that research findings are sometimes based upon non-sportsmen and women, a consequence of which may be that the results bear little resemblance to the sporting situation and sports performer whose physiological responses may differ quite considerably considering their levels of fitness and training. Additionally in conducting any drug related research there is of course the ethical issue of giving someone a potentially dangerous substance even if they are a volunteer. It’s also a fact that the potential hazards associated with sports related drug abuse often relate to the large doses that are used. When these drugs are used to treat medical conditions they are given in particular dosages under strict medical supervision, with their effects being strictly monitored. Conversely when they are abused by the sports performer, these drugs are often taken in very large dosages which are far in excess of the therapeutic dosage and used without any medical supervision, resulting in a far greater risk of adverse and serious side effects to the user. However despite the difficulties associated with researching into the topic there is a growing body of published scientific evidence which is helping to produce a clearer picture of the situation. These findings are supported by a larger volume of anecdotal evidence, small-scale studies and case reports, all of which contribute to our understanding of the subject.

Medications and doping

The topic of drug abuse is clouded by the fact that many of the banned drugs are medically prescribed to treat particular disorders and some are even present, in small amounts, in common ‘over the counter medicines’. This makes it imperative that anyone involved in sport should be aware of which therapeutic drugs are permitted and which are not. Orienteering Australia has a published anti-doping policy, and the Australian Sports AntiDoping Authority (ASADA) has an Anti-Doping Handbook that can be downloaded from the Web. A key message from this is to contact the relevant team doctor if you are unsure, and for all those competing abroad, do not to buy medicines yourself but go

via your team doctor, who should be familiar with those which are permitted and those which are not. Obviously there are times when people do need specific forms of medication, particularly amongst the older age groups and it should be stressed that the reason for banning a particular drug is not to preclude from the sport those individuals who may be taking it for genuine medical reasons but to prevent its deliberate use as a performance enhancer by otherwise healthy individuals. This is always an issue in Masters age-group competition where the prevalence of certain medications can be quite high.

Doping categories

Due to the vast array of individual substances and methods that could be abused by the sports performer they are grouped into categories and banned by category rather than by individual name. This has been a growing list over the years, which according to the 2007 World Ant-Doping Code now includes:

Prohibited substances

• Agents with anti-oestrogenic activity • Anabolic Agents • Beta-2 agonists • Cannabinoids

• Diuretics and other masking agents • Glucocorticosteroids

• Hormones and related substances

• Narcotics

• Stimulants

Prohibited methods

• Chemical and physical manipulation • Enhancement of oxygen transfer • Gene Doping The benefit and hence potential prevalence of each of these will depend upon the physical and mental demands of the sport, with some being more pertinent to Orienteering than others.

Anabolic Agents

Perhaps the most notorious and widely publicised of these are the Androgenic Anabolic Steroids (AAS). They include the hormone testosterone and related drugs which mimic its activity. Testosterone is the ‘male hormone’ which is produced by the male testes along with other related hormones such as epi-testosterone. The normal actions of these hormones are to promote the male sexual characteristics and promote the growth of body tissues. Hence they are both androgenic and anabolic. Females do produce testosterone but in smaller amounts, with the ovaries and adrenal cortex being the site of its production. The anabolic androgenic steroid drugs that are included in this category attempt to mimic the anabolic (growth promoting) effects of testosterone, whilst minimising their androgenic (masculinising) effects. They do however cause a variety of very serious effects and side-effects upon those who abuse them. Sports performers take these drugs for a number of reasons. They have been used in sports which require large amounts of strength and power where the additional muscle bulk is an advantage. Documented examples of this include the athletic throwing events such as shot putt, weight lifting and American Football where they are incorporated into regimens involving training with heavy weights and high protein diets. They have also been used in other sports such as endurance running for a very different reason. Here their use is not aimed at increasing muscle bulk but their use aids the recovery between hard training sessions. We all know how we feel rather sore, stiff and tired the day after a hard race. We often use the expression ‘I’ve still got yesterday’s session in my legs’. This is because the body needs time to recuperate after very strenuous exercise and must repair any of the damage that has incurred. Steroids can accelerate this process enabling the individual to train harder on a more frequent basis. A number of endurance runners have been caught for steroid abuse. Another effect of steroid abuse is to increase the aggressiveness of the individual and in some cases promote belligerence towards the opposition, a factor for consideration in contact sports. This increased determination to train hard and succeed is put forward by some physiologists as one of the reasons why steroids enhance performance in the way that they do. The risks associated with steroid abuse are quite considerable. Here it is important to emphasise that the medical use of steroid drugs does not necessarily include those being discussed here and when it does, the medical dosages are far smaller than those commonly taken by those seeking to use them as ergogenic aids. Hence the risks being outlined here refer to the mega doses associated with their abuse in the sporting situation. The reported risks include; liver cancers, kidney failure, high blood pressure and an increased risk of coronary heart disease. In juniors their use can stop the long bones from growing and hence will stunt their growth. In males the use of steroids inhibits the normal functioning of the body’s own hormonal systems in such a way as to cause the testes to atrophy and reduce the sperm count very considerably. Furthermore the use of large amounts of anabolic steroids will cause some of them to be converted into estradiol which is a female hormone and cause the subsequent development of breast tissue (gynaecomastia). This is a reason why some users will also take another banned category of substances; the anti-oestrogenic agents. In females the consequences of steroid abuse can extend even further. Here the androgenic properties of the steroids can have a masculinising effect resulting in the growth of facial hair, a permanent deepening of the voice and masculinisation of the genitalia. Other somewhat milder effects include acne in both males and females.

Diuretics

Diuretics are used to reduce the water content of the body by promoting the production of urine. They have been used in some sports for two basic reasons. Firstly to lose weight, usually when attempting to compete in a particular weight category, as in sports such as weight lifting, boxing and judo. Secondly the production of large amounts of urine is used to try and flush other illicit substances, such as other drugs, out of the body as rapidly as possible. In Orienteering they would convey no advantage as their dehydrating effect would adversely affect the functioning of the cardiovascular system, its ability to deliver oxygen around the body and its capacity to cool the body whilst exercising. Furthermore any fluid loss of this sort which is not medically supervised can have serious consequences upon the individual’s health.

Hormones and related substances

This group of substances include a number of natural hormones and their analogues, such as Erythropoetin (EPO), Human chorionic gonadotrophin (hCG), Leutinising hormone (LH), Human Growth Hormone (hGH), and Insulin-like growth factor (IGF-1). Erythropoetin is a naturally occurring hormone which is produced by the kidneys and promotes the production of red blood cells (erythrocytes). Since red blood cells are responsible for the carriage of oxygen around the body, one of the effects of training is to increase their number, thereby enhancing the body’s aerobic capacity. This increase in aerobic fitness enables the individual to sustain a faster running speed. EPO has been used by endurance performers to artificially cause a further increase in

the number of red blood cells in the hope of attaining an even greater improvement in fitness above and beyond that which they have attained from their normal training. However its use has been associated with a number of fatalities, most notably amongst cyclists a number of whom have died of cardiovascular failure. Its use, other than for bona-fide medical purposes, is therefore extremely dangerous. hCG promotes the production of anabolic hormones, such as testosterone, by the body. Its effects are therefore similar to that of Anabolic Steroids and it is taken for similar reasons. It may also be taken to counteract the effects of testicular damage caused by anabolic steroids. Likewise LH may be taken to stimulate the testes to produce testosterone. hGH is produced by the pituitary gland and is another growthpromoting hormone. It influences virtually all the cells of the body but affects the bone, muscle and connective tissues in particular. Due to its growth-promoting effects it has been used by those seeking an increase in musculature. However it also causes a thickening of the bones and this is most noticeable in the face. An excess of hGH can occur naturally in some adults where it causes the acromegaly. Other side-effects of the drug’s abuse include an increased risk of diabetes. IGF-1 has growth-promoting effects, and is the hormone through which hGH works. It has a similar structure to insulin, hence its name, and can produce the same effects, which include the risk of diabetic (hypoglycaemic) coma.

Narcotics

Narcotics are used medically to give pain relief. Chemically they are based upon the opiates and in particular upon Morphine, or its chemical analogues such as Heroin, and can therefore also give a sense of euphoria and invincibility. Codeine is a narcotic, but is permitted (pg 33, Anti-doping handbook, 2007), as are some other pain killers, and to be sure what is permitted it is always best to check with a sports physician. Narcotic drugs affect the central nervous system and inhibit the sensation of pain. They are addictive and have the adverse effect of inhibiting the normal breathing processes as well as causing psychological disturbances. The uses of narcotics in sport are related to their pain-killing properties which can enable participants to continue training and competing despite fairly serious injuries. The problem here is that whereas without the drug the individual would be forced to rest and let the injury heal up before continuing to train, with the drug they don’t feel the pain and are therefore likely to make the injury considerably worse without realising it as they don’t feel the effects of the damage they are doing until the effects of the drug wear off. This can result in permanently disabling injuries and many sporting careers have been prematurely terminated by this ‘compete now - pay later’ attitude.

Stimulants

Stimulants mimic the activity of the sympathetic nervous system and sympathetic hormones such as adrenaline. Participants are not permitted to take them when they are competing, but in terms of some of the medications that contain the stimulants, these may be permitted out of competition. They include the amphetamines and other stimulants. Stimulants increase alertness and reduce the sensation of fatigue. They can also promote hostility and belligerence towards the opposition which is why they are sometimes taken by those involved in contact sports. They can produce side-effects such as elevated blood pressure, headaches, insomnia, irrational behaviour, anxiety, gastrointestinal disorders and irregular heart beats. The fact that they mask the sensation of fatigue makes them particularly hazardous as the sportsperson may push themselves beyond their natural limits. These risks are further increased in hot conditions as they confuse the body’s thermoregulatory system which can result in overheating. These effects have been cited as the cause of a number of drug related fatalities, particularly in competitive cycling, most notably Tommy Simpson in the 1967 Tour de France and Kurt Jensen in the 1960 Olympics. Within this group of drugs it is particularly important to highlight the fact that a number of them may be present in common cold remedies or asthma treatments. For example the stimulants ephedrine and pseudoephedrine; therefore when buying medications, all competitors should check what it contains before they use it. Of course, if you need these medications, you should be asking yourself whether you should be competing at all. Due to its widespread presence in the diet, caffeine was banned above a certain level. Basically this was a level requiring drinking very large amounts of strong coffee just beforehand or taking it in some other form such as tablets. It therefore represented a deliberate attempt by the individual to elevate the amount of caffeine in their body for its use as an ergogenic aid. However there has recently been considerable debate over the practicalities of banning a substance that is so ubiquitous in our diet (as well as being present in the products of so many of the major sponsors of sport!) that according to the ASADA handbook, pg 34, it is no longer prohibited.

Prohibited methods - Blood Doping

Blood doping is a procedure used by some endurance performers. Like the use of EPO its purpose is to increase the number of circulating red blood cells and hence the oxygen-carrying capacity of the blood. The procedure involves removing about two units of blood 4 - 8 weeks before competition. This is then stored for a number of weeks whilst the individual continues to train and will naturally replace the lost blood in their system back up to its normal volume. In some cases the donated blood has been known to have come from relatives of the same blood type rather than the individual themselves. Then a few days or even hours before a competition the stored blood is reinfused back into the individual thereby artificially increasing their blood volume above its normal level. This technique has been used by cyclists, crosscountry skiers and endurance runners. It conveys a number of risks associated with changes in the circulatory system, the risk of infection and the risk of receiving the wrong blood, which could have fatal consequences.

Summary

As indicated in this article the issue of drug abuse in sport is complex. There are many different factors to consider and much debate over the existence of any potential ergogenic effects and the risks involved. However, most authorities would agree that the dangers are real although in the absence of large amounts of documented evidence the exact magnitude of these dangers is unclear. Overall, the sport of Orienteering has a relatively good record as a ‘clean’ sport, with relatively few confirmed cases of doping offences, the majority of which appear to have been inadvertent. The most notable case was that of a Norwegian female relay runner at the World Championships some years ago who tested positive for pseudoephedrine. It was found that she had inadvertently taken it in a medication and was banned for three months. Under today’s rules she would not have been banned.

References: Australian Sports Anti-Doping Authority (ASADA) (2007). Anti-Doping Handbook, Australian Government.