DRUG

ABUSE IN
SPORTS
 INTRODUCTION

Doping: Use of performance-enhancing drugs,

particularly those forbidden by
organizations that regulate
competitions.
What is the origin of doping?
Performance enhancement…

1960s Start of extreme abuse of anabolics

DRUGS ABUSE IN SPORTS
end Increase of EPO abuse in endurance
1980s sports (Erythropoietin)
DRUGS ABUSE IN SPORTS

Discovery of designer steroid THG

2003
(Tetrahydrogestrinone)

2007
Various doping cases at the Tour de
France
What are the time markers of anti-doping
activities?
1968
First doping controls at the Olympics

1988 First out-of-competition testing in Germany

1999 World Anti-Doping Agency (WADA)

World Anti-Doping Code and International

2004
Standards

2007 International Convention against Doping in

Sport
 Performance Enhancers:
Substances that are banned
S1. ANABOLIC AGENTS:
• Anabolic Androgenic Steroids
• Other Anabolic Agents

S2. HORMONES AND RELATED SUBSTANCES

• Erythropoietin (EPO)
• Growth Hormone (hGH), Insulin-like Growth Factors (e.g. IGF-1)
• Gonadotrophins (e.g. LH, hCG), prohibited in males only;
• Corticotrophins

S3. BETA-2 AGONISTS

• Exempted if taken by inhalation
 Performance Enhancers:
Substances that are banned

• S4. HORMONE ANTAGONISTS AND MODULATORS

Aromatase inhibitors
Selective estrogen receptor modulators
Other anti-estrogenic substances

• S5. DIURETICS AND OTHER MASKING AGENTS

Furosemide
Hydrochlorothiazide
Spironolactone
 Performance Enhancers:
Substances that are banned

• S6. STIMULANTS
Amphetamine, methylphenidate, caffeine, cocaine etc

• S7. NARCOTICS
Morphine, pethidine etc

• S8. CANNABINOIDS
Hashish, marijuana etc

• S9. GLUCOCORTICOSTEROIDS
Prednisolone, betamethasone, dexamethasone etc
 Performance Enhancers:
Prohibited Methods

• M1. ENHANCEMENT OF O2 TRANSFER

Blood doping
Artificially enhancing uptake/transport/delivery of O2

• M2. CHEMICAL / PHYSICAL MANIPULATION

Tampering / attempting to tamper, of Samples
Intravenous infusion

• M3. GENE DOPING

Use of cells, genes, genetic elements, or of the modulation of
gene expression
 WHAT ARE ANDROGENIC ANABOLIC STEROIDS
(AAS) ?

• Synthetic derivative of testosterone

• Responsible for androgenic (masculinizing)

and anabolic (tissue building) effects.
 USERS OF AAS
• Body builders
• Weight lifters
• Field athletes
• Swimmers
• Runners
• Football players
 MECHANISM OF ACTION

• AAS are hormones

• AAS enhance the protein metabolism
• Anabolic means “to build-up” muscle
proteins
• They may have severe health side effects like
masculinise (women) or feminise (men)
 SIDE-EFFECTS OF AAS
• Cardiovascular Problems
• Baldness
• Increased aggressiveness
• Kidney and liver dysfunction
• Gynaecomastia
• Virilization
 DRUGS ABUSEAGENTS
LIST OF ANABOLIC IN SPORTS
BANNED BY
WADA

1. Exogenous AAS 2. Endogenous AAS

Bolasterone Androstenedion
Boldenone Androstendiol
Dihydrotestosterone
DRUGS ABUSE IN SPORTS
Boldione
Testosterone
Calusterone
Clostebol 3. Other Anabolic agents
Damazol Clenbuteron
Testosterone Zeranol
4-hydroxytestosterone Zioaterol
HORMONES AND RELATED SUBSTANCE
ERYTHROPOIETIN (EPO)

• Erythropoietin is a hormone

• Increases the synthesis of erythrocytes

• Oxygen is needed to secure endurance performance

• Legal alternative in high altitude training

USES IN SPORTS (EPO)
Long-distance runners
Cross-country skiers
Tri-athletes
Bi-athletes
Cyclists
Side effects
• Kidney/Liver failure
• Increased risk of HIV and Hepatitis through
the use of needles and transfusion
• Increases blood viscosity
• Increases risk of high blood pressure (arterial
hypertension)
• Increases risk of blood clots
2. HUMAN GROWTH HORMONES
• Polypeptide(anterior pituitary)
• Regulates growth and development

USE IN SPORTS
• Increase muscle mass and strength
• Increase lean body mass
• Improve muscular appearance and height
• Decrease body fat
• Increase training motivation
Side effects
Acute Chronic
• Fatigue Acromegaly
• Joint and muscle pain Diabetes mellitus
• Water retention Arrhythmia
Tumors
INSULIN LIKE GROWTH FACTOR
• Polypeptide
• Mediator of all biological action
• Plays important role in growth and development
• Anabolic effect

Effects on performance
• To increase muscle mass
• Increase in total protein synthesis
Side effects:
• Hypoglycemia
• Acromegaly
• Headache and joint pain
• Enlargement of jaw
• Enlargement of internal organs
GONADOTROPIN
• Glycoprotein(anterior pituitary)
• Maintains synthesis and secretion of
hormones(progesterone and epitestosterone)

Abuse in sports:
• When injected hCG in males stimulates
leydigs cell of testis to secrete testosterone
• Mimics natural stimulation of testicular
hormones by LH
 CORTICOTROPIN
• Pituitary hormones
• Increase endogenous corticosteroid
• To reduce lethargy
• Produce positive effect on mood during
training and competition
 β2 Agonist
• Increase the skeletal muscle mass
• Lipolysis
• Increased lean body mass
• Increased non shivering thermogenesis via β
receptor in brown adipose tissue
Uses in sports
Sync. Swimming
Gymnastics
Bobsleigh
Archery
Curling
DRUGS ABUSEtoINperformance
Enhancements SPORTS
• Lowers heart rate in stressful sporting situations

• Lowers breathing rate preventing big movements in a

stationary position

Side effects DRUGS ABUSE IN SPORTS

• Dizziness
• Fainting
• Lowering heart rate
• Tremor, anxiety, palpitation
• Interfere with sleep
• Nausea and vomiting
List of β2 agonist banned by WADA

Bitolterol
Orcitprenaline
Reproterol
Rimiterol
Salbutamol
Salmeterol
Terbutaline
 HORMONE ANTAGONIST
• Aromatase inhibitor
• Block the action of aromatase enzymes
• More androgen available in the body
• Arimedex ,femara and aromasim commonly
use
 DIURETICS
• Change body’s normal electrolyte balance
• Helps in lighter weight class sports
• Masking use of other doping substances
Uses in sports
• For acute reduction in weight
• To overcome fluid retention
• To modified the excretion of urine and to
alter urinary concentration of the prohibited
drugs
(E.g. epitestosterone , probenecid)
Side effects

Dehydration Electrolyte imbalance

Weakness Muscle cramp
Drowsiness Cardiac arrhythmia
Fatigue
Increased risk of thrombosis
LIST OF DIURETICS BANNED BY WADA

Benzthiazide
Diclofenamide
Spironolactone
Acetazolomide
Furosemide
Amiloride
Hydrochlorothiazide
 STIMULANTS

• Increases alertness, competitiveness and

aggression
• Reduces tiredness and less sensitivity to pain
• Suppression of
Anxiety
Panic
Appetite
• E.g. , Amphetamine, Cocain
AMPHETAMINE OR COCAINE ABUSE
ACUTE SIDE EFFECTS

MORE FREQUENTLY RARELY

Perspiration or Chill
Acceleration of heart beats Pupillary dilatation
Cardiac disorders
High blood pressure

CHRONIC SIDE EFFECTS

Appetite depression
Central nervous reaction
 NARCOTIC
• Derivative of opium
• Powerful analgesic drugs
• Reduction of pain
• Euphoria
• Sedative
LIST OF NARCOTIC ANALGESIC
BANNED BY WADA
Alphaprodine
Anileridine
Buprenorphin
Dextromoramide
Diamorphin
Dipipanone
Ethoheptazine Fentanyl
Hydrocodone
DRUGS ABUSE IN SPORTS
CANNABINIOD
• Psychoactive chemical
• Tetrahydrocannabinol (THC )most active
• Marijuana and Hashish derived from
DRUGS ABUSE IN SPORTS
cannabis plant
• Effect depend on strength and potency of
THC
• Euphoria followed by relaxation
Side Effects:
• Impaired memory
• Loss of coordination
• Insomnia
• Increases appetite
• Hyperactivity

Withdrawal symptom
• Decreases appetite

• Insomnia ,hyperactivity
 PROHIBITED METHOD
Blood doping
• Administration of red blood or related blood product
• Increases the total aerobic power (increases
transport of oxygen)
• Increases endurance-performance
• Comparable effects to erythropoietin but with an
immediate effect
Side effect
• Increased blood pressure

• Increased risk of thrombosis

• Risk of a transfusion accident by allergies or

incompatibilities

• Risk of severe infections like hepatitis or HIV

ARTIFICIAL OXYGEN CARRIER(AOC)
• Increases the ability to carry extra oxygen in the
blood
• Uses when human blood are not available
• Risk of infection is high
Side effects
Transient fever
Reduction in platelet count
Potential overloading of phagocyte cells
Hypertension
 PLASMA EXPANDERS
• Increases the volume of plasma in the blood
• Replace fluid incase of severe shock, fluid loss in
surgery
 Dextran:
Control haematological parameters & masking of an EPO
misuse
 Mannitol:
Impair the excretion of prohibited substances
Side effect
• Allergic reaction
• Anaphylactic shock
 PHARMACOLOGICAL,CHEMICAL AND
PHYSICAL MANIPULATION

• Catheterization
• Urine substitution or swapping
• Tampering with and inhibition of renal
excretion
 GENE DOPING
Non-therapeutic use of genes
• Genetic element
• Cells that have the capacity to enhance
athletic performance
 CONCLUSION
• It is unlikely that athletes will stop using drugs or
doping methods to try and gain a competitive edge.

• Gene therapy is potential future doping which if

becomes possible, will be challenge even for detection.

• Clinicians who treat athletes should be familiar with

the commonly abused substances and doping methods
& research should be made towards detection of all
potential doping agents.
DRUGS ABUSE
References:
IN SPORTS
• Dr. Alka Beotra, Dope Control Centre; Sports Authority of India. DRUG
ABUSE IN SPORTS Fifth Edition 2005.
• Dr. Alka Beotra & S D seth, DRUGS OF ABUSE IN SPORTS in Textbook of
Pharmacology by S D seth & Vimal seth, 3rd edition.
• Chalrles P. O’brien, DRUG ADDICTION & DRUG ABUSE in Goodman and
DRUGSBasis
Gilman’s The Pharmacological ABUSEofINTherapeutics,
SPORTS 11th Ed., 2006.
• Thomas R. Kosten, DRUGS OF ABUSE in Katzung Basic and Clinical
Pharmacology, 10th Ed.,2007.
• HL sharma & KK sharma, DRUG DEPENDENCE AND DRUG ABUSE in
Principles of Pharmacology, 1st edition 2007.
• Dr. H.J. Haisma,P. Sollie ,J. Vorstenbosch & O. de Hon GENE DOPING
Netherlands Centre for Doping Affairs,2004.
• www. wada-ama.org
Steroids can not replace any
training session!