Sports and drugs
Sports âainât never been clean,â says Charles Yesalis, former Pennsylvania State University professor and long-time performance-enhancing drug (PED) researcher.[1]
And by ânever,â Yesalis means never. Research suggests that the first Olympians digested a strange assortment of substances in an effort to improve their strength, overcome fatigue, and enhance their performances. These substances included animal hearts and testicles, dried figs, large amounts of meat, hallucinogenic mushrooms, and potions containing brandy or wine. As journalist Sally Jenkins explains,
The ancient Olympic champions were professionals who competed for huge cash prizes as well as olive wreaths, lived on the public dole and were sometimes recruited by competing cities seeking status. Most forms of what we would call cheating were perfectly acceptable to them, save for game-fixing. There is evidence that they gorged themselves on meat â not a normal dietary staple of the Greeks â and experimented with herbal medications in an effort to enhance their performances. [2]
Athletes of the 19th century continued the experimentation with concoctions supposedly useful as performance enhancers, digesting sugar cubes dipped in ether, brandy laced with cocaine, as well as nitroglycerine and amphetamines. Thus, as Jenkins explains,
the current scourges of steroids and blood boosters are merely a sequential progressionâŠ.The next stepâŠis gene therapy â athletes will be able to inject genes that build muscle. At which point steroids will seem as crude as sugar cubes soaked in ether. [2]
The use of gene-modification technology for non-therapeutic reasons (meaning not to treat an illness but, in the world of sports, to enhance athletic performance) is certainly the ânext big issueâ in discussions of possible cheating in sports, giving rise to the term âgene doping.â This tinkering with an athleteâs genesâin particular, the insertion of new or modified genetic material (transgenes) into an individualâs cells to enhance athletic performance, such as increasing strength, endurance, or oxygen deliveryâis a looming threat and has enormous potential for changing athletic competition. For example, as scientist Fabian Filipp explains, gene-manipulated mice have been renamed
âSchwarzenegger miceâ [after bodybuilder Arnold Schwarzenegger] owing to their enormously increased strength and muscle mass. Genes such as insulin-like growth factor 1 (IGF1) and myostatin, which regulate muscle mass, are obvious targets to increase performance in sporting disciplines in which sheer strength is required. Similarly, genes that stimulate blood production or increase the oxygen-carrying capacity of blood, as well as those that regulate mitochondrial energy production and energy use, are of interest to endurance athletes. And manipulating pain perception by genetically modifying the release of endorphins in athletesâ brains might be the ultimate winning combination.[18]
The World Anti-Doping Agency (WADA), the international agency tasked with enforcing doping rules, anticipated this development as far back as 2003, when it issued a preemptive ban on gene therapy. That ban was extended to all forms of gene editing in 2018. The United States government included a permanent gene-doping ban for athletes in the 2006 reauthorization of the Office of National Drug Control Policy Act. [3] [4] [5]
However, these bans face steep challenges, because gene doping could be difficult to detect. As Sam Moxon of the University of Manchester explains,
current tests are designed to detect foreign substances and chemicals in an athleteâs bloodstream or urine. DNA [found within genes] is far from a foreign substance and is harder to probe for evidence of tampering. For example, unlike classic doping drugs such as steroids, bioengineered substances are chemically identical to the bodyâs natural hormones, making detection difficult at best. Gene editing adds additional layers of concerns. Doping using something like CRISPR [âmolecular scissorsâ that can cut, delete, or replace specific DNA sequences within genes] guarantees that tests will be unable to detect when an athlete has attempted to give themselves a genetic advantage.[3] [4]
Another question is whether âtechno-dopingâ should be allowed. Techno-doping is the use of any specialized equipment or technological augmentation that confers an advantage to the athlete, such as specially designed shoes with added spring technology, hidden tiny bike motors, low drag/buoyancy-enhancing full bodysuits using water-repellent nanotechnology, or limb prostheses that specifically offer an advantage over other athletes in the same competition. Techno-doping can be seen in a positive or negative light: as either balancing the playing field for a disabled athlete or giving an unfair advantage to an athlete. Most famously, when South African Paralympian Oscar Pistorius wore J-shaped âCheetah bladesâ (both of his feet had been amputated due to a congenital disorder) in international competitions and at the 2012 London Games, becoming the first amputee to compete in an Olympic track event, the augmentation ignited fierce debate. Specifically, the carbon-fiber running blades âallowed him to use 25 percent less energy than non-disabled athletes use when running at the same speedâ; they also conferred a disadvantage because of his increased potential for slipping on slick surfaces. [6]
And then thereâs artificial intelligence. With new human-machine interfaces such as smart glasses, the possibilities for boosting competitive advantages through technology are seemingly endless. In football and golf, for example, digital scanners in a playerâs helmet or sunglasses, or even embedded in the playerâs brain, could render the need âto readâ defenses and greens all but obsolete because technology would perform such tasks. True, the athlete would still need to execute the play or shot, but the mental aspect of the sport, so fundamental to the competition, would be dramatically changed by such technological enhancements.[6]
The debates about performance-enhancing drugs and smart technologies also seep into other aspects of fairness in sport and the very question of what counts as âperformance enhancing.â As medicine and technology advance, so, too, will the complexities of these debates over fairness and athletic competition.
Pros and Cons at a Glance
| PROS | CONS |
|---|---|
| Pro 1: PED use is so prevalent that banning it only disadvantages those not doping and hinders the progress of sports. Read More. | Con 1: PEDs and smart technology violate the spirit and integrity of sport. Read More. |
| Pro 2: PEDs help athletes to recover from injuries and to endure the rigors of sports. Read More. | Con 2: Despite any benefit in injury recovery, PEDs are dangerous and can still yield an unfair competitive advantage. Read More. |
| Pro 3: PEDs should be a personal choiceâthey can be safely usedâand are a natural extension of an elite athleteâs innate competitiveness. Read More. | Con 3: Allowing PEDs will increase youth drug use and other unhealthy activities. Read More. |
Pro Arguments
(Go to Con Arguments)Pro 1: PED use is so prevalent that banning it only disadvantages those not doping and hinders the progress of sports.
âBut everyone else is doing itâ might not be an argument a teenager is going to win with a parent, but in the case of professional athletes and PEDs, the argument is one that the sporting world should accept.
As sports editor Matt Glover explains,
Some might argue that performance-enhancing drugs (PEDs) are cheating or unfair. I beg to differ. I believe it would truly even the playing field because some countries (like RussiaâŠ) already are doping, while clean athletes are punished for being clean. There is a prisonersâ dilemma for athletes, with the dominant strategy being to cheat. This penalizes those who have the moral character or fortitude to not cheat, while rewarding others who did cheat.[7]
The solution, Glover asserts,
is not more draconian testing policies, but rather an abolition of these policies and a level playing field where athletes are able to make informed decisions about their bodies. This would ensure all athletes that wanted to use PEDs could, rather than those that can circumvent testing either with new drugs or through sheer luck (as not all athletes are tested).[7]
The âspirit of sportâ evolves in tandem with the evolution of the actual sports and society at large. Torbjörn TĂ€nnsjö, professor of practical philosophy at Stockholm University, notes that paying athletes was once considered highly problematic. Sport evolved to pay athletes for their talents, and it can similarly evolve to allow PEDs because, as TĂ€nnsjö concludes, there is no overriding âmoral virtueâ in âexhibiting natural strength.â [8]
Glorifying ânaturalâ playing in sports only encourages more injuries and, thus, short careers. This hinders the advancement of sport and competition.
Pro 2: PEDs help athletes to recover from injuries and to endure the rigors of sports.
Professional athletes are almost guaranteed to be injured at some point during their career. A 2021 survey (the most recent available) found 62.5 injuries per 100 players in the MLB, NBA, NFL, and NHL from 2007 through 2019. While a similar study of womenâs professional sports injuries was not available, on average, female athletes are prone to even more injuries because of anatomical differences like wider pelvises and weaker knees. [9] [10]
Quite a few drugs, including steroids and growth hormone, that are regularly banned by sports organizations are useful medical treatments, especially for sports injury recovery.
Research is showing that short-term anabolic androgenic steroid use during surgery may help people recover after ACL (the anterior cruciate ligament, which stabilizes the knee) surgery and total joint replacement surgery (in which a human joint is replaced with a prosthesis). The drugs may also âaugment the biological healing environmentâ for muscle injuries, fractures, and rotator cuff repair. In other words, though many PEDs, such as anabolic steroids, have gotten a ârenegadeâ reputation, there are some with useful, âethical clinical applications.â [11] [12]
As Christopher Mendias, a professor at the University of Michigan, explains,
If an [athleteâs] injury is severe enough to sideline a patient for a month or so, thereâs a good chance that there will be long-term consequences of that injury that will extend many years, sometimes decades, into their later life. In patients with ACL tears, for example, even after surgery and rehab, muscles in their injured leg are often around 30 percent weaker than they were before the injury. Over time, this weakness slowly erodes the cartilage in the knee. My lab is currently investigating the possibility that growth hormone â a banned substance by WADA â could help address this weakness in an FDA-approved clinical trial. [13]
Mendias asserts that, unlike the popular news stories of unscrupulous medical drug dealers,
the vast majority of sports medicine clinicians and researchers are interested in finding ways to help restore injured athletes back to their pre-injury levels and not to engage in therapies that give athletes advantages that go above and beyond what they could achieve through approved training techniques and practices. [13]
Adds Bernd Schuster, a former German professional footballer,
If a player can reach his full fitness level two to three weeks faster, then [PED use] makes sense. Itâs not about players being brought up to 120, 150 or even 180 per cent [of their previous capacity and skill level]. Itâs about getting players to their usual level as soon as possible. [14]
Pro 3: PEDs should be a personal choiceâthey can be safely usedâand are a natural extension of an elite athleteâs innate competitiveness.
Professional athletes are adults who deserve bodily autonomy, meaning the right to do with their own bodies as they choose. Banning PEDs, which are otherwise legal drugs, treats adult athletes like children. [15]
âItâs time to head in the opposite direction: legalizing performance enhancing drugs (PEDs)âŠ.If steroid use for professional athletes is permitted, they will be able to legally obtain physical enhancement drugs which have been regulated, and are therefore possibly safe to use,â says columnist Maeve Juday. [16]
âWe do not want an Olympics in which people die before, during, or after competitionâ from taking banned drugs, say professors Julian Savulescu, Bennett Foddy, and M. Clayton. âWhat matters is health and fitness to compete. Rather than testing for drugs, we should focus more on health and fitness to compete.â They continue,
We should permit drugs that are safe and continue to ban and monitor drugs that are unsafe. There is another argument for this policy based on fairness: provided that a drug is safe, it is unfair to the honest athletes that they have to miss out on an advantage that the cheaters enjoy.⊠Far from harming athletes, paradoxically, such a proposal may protect our athletes. There would be more rigorous and regular evaluation of an athleteâs health and fitness to perform. Moreover, the current incentive is to develop undetectable drugs, with little concern for safety. If safe performance enhancement drugs were permitted, there would be greater pressure to develop safe drugs. Drugs would tend to become safer.[17]
Further, the treatment of medical conditions would not be stigmatized and private medical conditions would not have to be divulged publicly because the treatment is a âbannedâ drug. For example, âIf an archer requires ÎČ [beta] blockers to treat heart disease, we should not be concerned that this will give him or her an advantage over other archers. Or if an anaemic cyclist wants to take EPO [erythropoietin], we should be most concerned with the treatment of the anaemia.â Ultimately, taking a health-centered approach, rather than a prohibitive approach to drugs, will safeguard the athletesâand thus the sport. [17]
The same applies to so-called âtechno-doping.â As journalist and bioethicist Alex Pearlman explains,
Supporters of using enhancing technologies in sports counter that people with disabilities already rely on increasingly high-tech assistive devices in everyday life. They point out that enhancements would not worsen an already inherently unjust situation. On the contraryâmore attention to assistive devices might have the fringe benefit of going a long way toward alleviating ableist supremacy and getting more technology to people who need it. [6]
Finally, PEDâs are a natural extension of an athleteâs innate competitiveness. As essayist Sally Jenkins points out,
Our Air Force gives fighter jocks âgo-pillsâ to get them through long missions, but we donât refuse to call them heroes because theyâre on speed. So whatâs this strange amnesia that causes us to seek purity in athletes?⊠The stark truth is that great athletes are fundamentally very different from you and me. They are freaks of nature, with uncanny hand-eye coordination or peripheral vision randomly assigned in the gene pool. They can seem nearly a different species. And they are quite often profoundly cold elitists whose moral code is different from ours, too. To many of them, the performance is all and what they find unnatural is to leave some physical possibility untapped.[2]
Con Arguments
(Go to Pro Arguments)Con 1: PEDs and smart technology violate the spirit and integrity of sport.
As argued by John William Devine, lecturer in sports ethics at Swansea University,
Sports are designed to test a specific cluster of skills and capacities, including physical, psychological, tactical and technical abilities. Performance-enhancing drugs elevate the importance of certain physical attributes, such as strength and stamina. Lifting the ban on drugs would alter the nature of sports by increasing the significance of this sub-set of physical attributes at the expense of other physical attributes, such as coordination and agility, as well as non-physical attributes such as strategic skill, mental resilience, and technical proficiency.[15]
We are sadly âdesigning people for sport. We are treating human beings like pieces of meat. We create them for this activity. If commercialism pushes this so strongly, we lose the core values about celebrating human effort and the joy of the effort and the love of the game,â adds Angela Schneider, professor of kinesiology at Western University. Designer athletes, so to speak, make âsport ⊠a perversion and a circus.â [18]
The World Anti-Doping Agency (WADA) lays out this dynamic:
Anti-doping programs seek to preserve what is intrinsically valuable about sport. This intrinsic value is often referred to as âthe spirit of sport.â It is the essence of Olympism, the pursuit of human excellence through the dedicated perfection of each personâs talents. It is how we play true. The spirit of sport is the celebration of the human spirit, body and mind, and is reflected in values we find in and through sport, including Ethics, fair play and honesty; health; excellence in performance; character and education; fun and joy; teamwork; dedication and commitment; respect for rules and laws; respect for self and other Participants; courage; community and solidarity.[19]
In the 2004 Summer Olympics, Ukraineâs Yuriy Bilonoh earned the gold medal in the shot put. In 2013 that gold medal was awarded to American Adam Nelson âduring a rushed meeting with an IOC official outside Burger King at the Atlanta Airport.â Bilonohâs steroid use had been confirmed via drug tests and, thus, Nelson won the gold medal almost a decade after competing, without the glory or affirmation of the top place on the medal stand and without an estimated $2.5 million in income that would have come had he been awarded gold while actually at the Olympics. [20]
âThe thing that makes sports fantastic is watching competition on a level playing field. Throw PEDs in the mix, and it becomes not about how good you are, but how good your doctor is,â says Nelson. Moreover, Nelson only won the gold medal because Bilonoh was drug tested. Not all athletes in all sports are tested, meaning some who dope keep their ill-gotten awards, throwing into question every win by every athlete who has not been tested. [20]
The rise of smart technology and gene editing has taken these concerns to a new, heightened level. If PEDs mean an athlete is only as good as his or her doctor, âgene dopingâ and âtechno-dopingâ could mean athletes are only as good as the technology at their disposalâinnate skill and training will become increasingly obsolete. From carbon-fiber running blades and gene-manipulation for added strength to water-repellent full-body swimsuits using nanotechnology and AI-powered smart eyewear or digital scanners embedded in the brain, science and technology, if weâre not careful and on guard, could decimate sporting competitions and the conception of fair play.
Con 2: Despite any benefit in injury recovery, PEDs are dangerous and can still yield an unfair competitive advantage.
Even if a PED is originally used for injury or surgery recovery, the drugsâ effects can be addictive and lead to more long-term use and unfair advantage in competition. While PEDs may seem like the quick ticket to athletic glory, they are deadly. They can shorten not only an athleteâs career but their lifespan as well. We only have to look at bodybuilding, a sport that has historically encouraged PED use, for proof of this fact.
Bodybuilders âstack various steroids and other muscle-building drugs, then add in compounds intended to burn fat, blunt appetite or sap water from below the skin,â explain journalists Bonnie Berkowitz and William Neff. âThey might counteract the worst side effects with another arsenal of medications, vitamins and supplements. The result can be outlandish physiques that appear indestructible but are often quite fragile.â These drug combinations essentially send their bodies into survival mode: their bodies believe death is near, and every bodily process slows to try to stay alive. [21]
PED use can result in weak hearts with overly thick walls that cannot pump blood effectively, high cholesterol, blood clots, heart attacks, and strokes, not to mention a complete shutdown of the reproductive system and severe mental alterations, including âroid rage,â mood disorders, depression, psychosis, and suicide, among other disorders. [21]
Former champion bodybuilder and California Governor Arnold Schwarzenegger says bodybuilding is
the most dangerous sport in the world. In MMA fighters, youâve had four guys die in the last ten years. In bodybuilding youâve had 14 guys [die] over the last ten years. So it just shows you how dangerous it is to take some of those medications and things that those guys take. [22]
The sports themselves are brutal enough, as seen in boxing and football and the rise of chronic traumatic encephalopathy (CTE), a degenerative brain disease typically associated with repetitive trauma to the head. CTE can cause headaches, depression, increased irritability, decreased ability to concentrate, loss of short-term memory, and suicidal behavior, leading to headline-making tragedies as well as numerous lawsuits. Why would the sporting world want to compound such serious medical and mental afflictions by now allowing PEDs? [23]
Moreover, as PED use gets more and more âcutting edge,â the dangers rise significantly. Jon Mannah was an Australian National Rugby League player when he died of Hodgkin lymphoma in 2013. The disease was in remission until his teamâs âsports scientistâ began giving him (and other players) peptides, a less-used variety of PED with little to no scientific study behind its use. His cancer returned, and he died at age 23. [24]
Con 3: Allowing PEDs will increase youth drug use and other unhealthy activities.
A review of 52 studies of 187,288 people aged 10â21 years old, as well as an additional 894 adults, found that, on average, kids first use PEDs when they are 14 years old, with some using the drugs as early as nine. [25]
The same study found that kids who use PEDs are more likely to participate in other dangerous behaviors, such as substance abuse (including alcohol, marijuana, and heroin), driving drunk, not wearing a seat belt, riding with a drunk driver, and sexual promiscuity. Whether one bad habit directly fed another is not the pointâall are signs and symptoms of dangerous behavior that should not be condoned or encouraged. [25]
While athletic performance is often a driver for PED use, a correlation between male body image and PED use has also been noted. As Laura Lallenec, physician and medical adviser for the Australian government, explains,
There is increasing concern regarding a rise in body dissatisfaction in young males particularly around masculinity. Individuals develop an unhealthy obsession with muscle growth and definition and are at risk of over-exercising as well as utilising medications including anabolic agents to achieve their goals.[26]
Athletes, like it or not, are role models for children, especially as social media increases access to famous players. Their behavior, good and badâand especially their use of PEDsâcan spur similar actions among their youthful fans. Teddy Bridgewater, self-professed âneighborhood hope dealerâ and a former NFL quarterback, posted about this dynamic on Instagram:
Kids donât be fooled. You can play ball, do the right thing and they still gonna accept you. Look at me, Iâm far from perfect but I chose the ball route but I can still go to the hood and post up and itâs all love. I still keep the same 3 dudes around me. My people accept me for making all the right decisions and not falling victim or being tricked by the false image you see on IG [Instagram] from a lot of ball players. [27]
Sports drug policies
Below, find the drug policies of some major sporting organizations. While most international organizations and leagues follow the World Anti-Doping Agency (WADA) policies, major league American sports each have their own policies.
- WADA covers the Olympics, United States Anti-Doping Agency, International Tennis Federation, USA Cycling, U.S. Armed Forces, and other signatories
- Major League Baseball (MLB)
- Major League Soccer (MLS)
- National Football League (NFL)
- Professional Golfersâ Association Tour (PGA Tour)
Banned performance-enhancing substances and methods
The International Olympic Committee and the U.S. Olympic Committee are among almost 700 sports organizations worldwide as of April 9, 2021, that have adopted the World Anti-Doping Agencyâs (WADA) code banning performance-enhancing substances and methods.
Drugs can be added and removed from this list by WADA annually, and not all of the banned substances are explicitly named. Caroline Hatton, a sports anti-doping science consultant, told ProCon: âA key concept in prohibited lists is that they avoid being finite. Instead of listing all banned drugs one by one, they list entire drug classes and name drugs merely as examples. This is to keep users who took designer drugs from claiming that they didnât break the rules because the drugs they took werenât listed.â
Each sports organization that adopts the code is also responsible for enforcing it through drug testing and noncompliance penalties.
Below are examples of banned substances and methods by category, with information about medical uses, performance effects on athletes, and side effects. Some categories also include common pro and con arguments for banning the substances or doping methods. [28] [29] [30] [31] [32] [33] [34] [35] [36] [37] [38] [39] [40]
For a complete list of banned substances, see the 2021 World Anti-Doping Code International Standard Prohibited List from WADA.
Alcohol
Drinks made from fermented sugars in fruits, berries, grains, and other ingredients.
Medical uses:
- none
Effects on athletes:
- anti-anxiety
- maximize effects of other drugs taken at the same time
- sedative
Side effects:
Examples:
Ethanol: beer, distilled spirits, and wine
Anabolic steroids and agents
Anabolic steroids mimic our bodies natural hormones, specifically male sex hormones, and have legitimate medical uses to treat anemia, asthma, bone pain from osteoporosis, muscle loss, and postmenopausal symptoms, among other ailments. Athletes use the drugs illicitly to achieve endurance increases, fat loss, muscle recovery increases, and muscular size and strength increases. However, the drugs carry serious side effects including but not limited to abnormal menstrual cycles, aggressiveness, brain tissue damage, depression, hypertension, impotence, liver dysfunction, mania, and testicular shrinkage or atrophy.
| Pro | Con |
|---|---|
| Proponents of allowing athletes to use anabolic steroids argue that athletes are going to dope regardless of the rules so steroids should be allowed, that allowing steroids could reinvigorate boring or languishing sports, and that athletes using steroids doesnât lessen, but may increase, the entertainment value. | Opponents of allowing athletes to use anabolic steroids argue that anabolic steroid use is dangerous and can cause serious side effects (including addiction and death), that steroid use is not setting a good example for youth sports, and that sports should encourage clean play for the fairness and spirit of the game. |
Medical uses:
- bone pain from osteoporosis
- gonadal function decrease or absence
- hereditary angiodema
- muscle loss (e.g., burn injury, HIV infection, muscular dystrophy)
- postmenopausal symptoms such as hot flashes and sweating
Effects on athletes:
- endurance increase
- fat loss
- muscle recovery increase
- muscular size and strength increase in combination with exercise
Side effects:
- abnormal menstrual cycles
- acne
- baldness
- brain tissue damage
- breast enlargement
- clitoris enlargement
- dizzy spells
- fever
- hair growth on the face and body
- HIV and other disease contraction due to contaminated needles used for injection of steroid
- masculinization
- muscle strains or ruptures
- myalgia
- periorbital pain
- prostate gland enlargement
- psychiatric dysfunction
- sexual appetite increase
- sperm production reduction
- stunted growth in adolescents
- tearing of tendons
- testicular shrinkage or atrophy
- voice deepening
Examples:
Endogenous anabolic androgenic steroids (AAS): androstenediol, androstenedione, dihydrotestosterone, prasterone, and testosterone
Exogenous anabolic androgenic steroids (AAS): 1-androstendiol, 1-androstendione, bolandiol, bolasterone, boldenone, boldione, calusterone, clostebol, danazol, dehydrochlormethyltestosterone, desoxymethyltestosterone, drostanolone, ethylestrenol, fluoxymesterone, formebolone, furazabol, gestrinone, 4-hydroxytestosterone, mestanolone, mesterolone, metenolone, methandienone, methandriol, methasterone, methyldienolone, methyl-1-testosterone, methylnortestosterone, methyltrienolone, methyltestosterone, mibolerone, nandrolone, 19-norandrostenedione, norboletone, norclostebol, norethandrolone, oxabolone, oxandrolone, oxymesterone, oxymetholone, prostanozol, quinbolone, stanozolol, stenbolone, 1-testosterone, tetrahydrogestrinone, and trenbolone
Other anabolic agents: clenbuterol, selective androgen receptor modulators (SARMs, including ostarine), tibolone, zeranol, and zilpaterol
Beta-2 agonists
Bronchodilators (drugs that widen the bronchial tubes to allow more air to move).
Medical uses:
Effects on athletes:
- aerobic exercise improvement
- fat reduction
- muscle growth
Side effects:
- dizziness
- muscle cramps
- palpitations
- sweating
- tremor, usually of the hands
Examples:
Albuterol, isoetharine, Levalbuterol, metaproterenol, pirbuterol, salmeterol xinafoate, and terbutaline
Beta-blockers
Drugs that reduce excitation of the nervous system.
Medical uses:
Effects on athletes:
- muscle tremor reduction
Side effects:
- blood pressure lowering
- heart rate decrease
- performance capacity decrease in endurance sports
- tiredness
Examples:
Acebutolol, alprenolol, atenolol, betaxolol, bisoprolol, bunolol, carteolol, carvedilol, celiprolol, esmolol, labetalol, levobunolol, metipranolol, metoprolol, nadolol, oxprenolol, pindolol, propranolol, sotalol, and timolol
Cannabinoids (marijuana)
Chemical compounds found in the cannabis plant.
Marijuana is frequently banned by sports organizations, yet the drugâs status as performance enhancing is questioned. Further complicating the issue is that marijuana, as a medical or recreational drug, is legal in most U.S. states. Athletes take the drug illicitly to reduce anxiety, pain, and reliance on opioids. Side effects include appetite increase, balance and coordination impairment, concentration loss, drowsiness, motivation loss, panic attacks, and weight gain. If smoked (rather than consumed via edible), side effects can include bronchitis and cancer of the lung, throat, mouth, and tongue.
| Pro | Con |
|---|---|
| Proponents of allowing athletes to consume marijuana argue that the benefits for athletes are well documented, that the drug is better than opioids, and that the ban is a continuation of an unjust drug war. | Opponents of allowing athletes to consume marijuana argue that all athletes should play drug-free, that marijuana is not legal everywhere, and that its benefits are questionable. |
Medical uses:
Effects on athletes:
- euphoria
- sedation
Side effects:
- addiction and withdrawal
- appetite increase
- balance and coordination impairment
- cancer of the lung, throat, mouth, and tongue
- concentration loss
- drowsiness
- heart rate increase
- dry mouth
- learning ability impairment
- memory impairment
- mood swings
- motivation loss
- motor skill impairment
- paranoid thinking
- reflex loss
- weight gain
Examples:
Diuretics and other masking agents
Drugs that increase the flow of urine or otherwise work to diminish the appearance of drugs in someoneâs body.
Medical uses:
- heart failure from the kidneys
Effects on athletes:
- prevent detection of banned substances
- produce urine excretion to reduce concentration of banned substances
- weight loss
Side effects:
- cramps
- death
- dizziness
- electrolyte imbalance
- muscle cramps
- volume depletion
Examples:
Diuretics: acetazolamide, amiloride, bumetanide, canrenone, chlorthalidone, etacrynic acid, furosemide, indapamide, metolazone, spironolactone, thiazides, and triamterene
Other masking agents: alpha-reductase inhibitors, epitestosterone, plasma expanders, and probenecid
Glucocorticosteroids
Corticosteroids that prevent and reduce inflammation.
Medical uses:
- Crohn disease and other types of inflammatory bowel disease
- eczema and other skin conditions
Effects on athletes:
- anti-inflammatory
Side effects:
- blurred vision
- feeling nervous or restless
- feeling very hungry
- mood swings
- muscle weakness
- stomach irritation
- water retention or swelling
- weight gain
Examples:
Budesonide, cortisone, dexamethasone, prednisone, and triamcinolone
Hormone antagonists and modulators
Drugs that decrease the amount of estrogen in the body or block estrogen receptors.
Medical uses:
Effects on athletes:
- anabolic effects
- strength increase
- reduction of anabolic steroid use side effects (e.g., breast tissue growth)
Side effects:
- abdominal discomfort
- libido reduction
- verbal slurring
Examples:
Aromatase inhibitors: aminoglutethimide, anastrozole, exemestane, formestane, letrozole, and testolactone
Myostatin inhibitors
Other anti-estrogenic substances: clomiphene, cyclofenil, and fulvestrant
Selective estrogen receptor modulators (SERMs): raloxifene, tamoxifen, and toremifene
Hormones and related substances
An organic substance that regulates psychological activities and maintains the bodyâs homeostasis.
Human growth hormone (HGH) is naturally produced by humans to control how the body grows into adulthood. Medical uses for children include growth hormone deficiency, idiopathic short stature, Prader-Willi syndrome, and Turner syndrome. Medical uses for adults include hormone deficiency, radiation therapy, or trauma. Off-label uses on HGH are illegal and can result in felony convictions in the United States, but athletes use the drug illicitly to improve muscle mass and performance. However, side effects of HGH include carpal tunnel syndrome, diabetes, enlarged heart, hypertension, joint pain, and muscle weakness.
| Pro | Con |
|---|---|
| Proponents of allowing athletes to use HGH argue that it can be used safely by athletes to repair injuries and that adult athletes should be able to make their own choices about their bodies. | Opponents of allowing athletes to use HGH argue that any doping is cheating and that doping allows a culture of coercion, bribery, unsafe medical practice, and unsportsmanlike conduct. |
Medical uses:
Effects on athletes:
- anti-inflammatory action aids recovery from injury
- body fat percentage decrease
- growth stimulation
- increases adrenal corticosteroid levels
- masking agent for anabolic steroids
- muscle definition when used in conjunction with other substances
- muscle size and growth when used in conjunction with other substances
- muscle tissue repair
- protein breakdown reduction
- protein synthesis increase
- testicular damage due to anabolic steroid use counteraction
- testosterone and epistestosterone production stimulation
Side effects:
- abnormal body changes
- antibody formation
- brain damage
- brain swelling
- cardiomyopathycoma
- Cruetzfeldt-Jakob disease
- death
- diabetic (hypoglycemic) coma
- drowsiness
- facial nerve paralysis
- forehead and jaw shape change
- gynaecomastia
- hand enlargement
- heart enlargement
- hyperviscosity of the blood
- menstrual irregularities
- psychological effects such as irritability
- shaking
- shortness of breath
- similar effects as anabolic steroids
- softening of connective tissue
- stomach irritation and ulcers
- weakening of an injured area in muscles, bones, tendons or ligaments, osteoporosis, and cataracts
- weakness
Examples:
Erythropoietin (EPO), growth hormone (hGH), insulin-like growth factors (e.g., IGF-1), mechano growth factors (MGFs), gonadotrophins (e.g., LH, hCG), insulins, and corticotrophins (ACTH)
Narcotics
Drugs that produce pain relief, a state of stupor or relief, and addiction.
Medical uses:
Effects on athletes:
- euphoria
- feelings of invincibility
- pain killer
- pain threshold increase
Side effects:
- addiction and withdrawal
- balance and coordination loss
- cardiovascular collapse
- concentration ability decrease
- death
- injury risk
- sleepiness
Examples:
Buprenorphine, dextromoramide, diamorphine (diacetylmorphine/heroin), fentanyl, hydromorphone, methadone, morphine, oxycodone, oxymorphone, pentazocine, and pethidine
Stimulants
Stimulants are drugs that speed up parts of the body and brain, directly affect the central nervous system, and increase heart rate, blood pressure, metabolism, and body temperature. Medical uses include the treatment of allergies, asthma, attention deficit hyperactivity disorder (ADHD), common colds, headaches, and nasal congestion. Athletes use the drugs illicitly to increase alertness, competitiveness, responsiveness, and weight loss. However, side effects of the drugs include addiction, aggression, anxiety, brain hemorrhage, coma, convulsions, dehydration, heart attacks, hypertension, insomnia, stroke, tremors, and even death.
| Pro | Con |
|---|---|
| Proponents of allowing athletes to use stimulants argue that Air Force pilots, long-haul truckers, and others use stimulants without stigma and that their use does not lessen the integrity of the game. | Opponents of allowing athletes to use stimulants argue stimulants are dangerous, can result in death, and do nothing to promote the health of the athlete and that cultural acceptance of stimulant use should change. |
Medical uses:
- allergies
- asthma
- attention deficit hyperactivity disorder (ADHD)
- cold
- headache
- nasal congestion
Effects on athletes:
- alertness
- competitiveness
- responsiveness
- tiredness reduction
- weight loss
Side effects:
- addiction and withdrawal
- alertness
- blood pressure increase
- cardiac arrhythmia
- cerebral hemorrhage
- convulsions
- death
- hand tremors
- heart rate increase
- heat stroke
- inhibited judgment and decision-making
- sweating
- tremor
- weight loss
Examples:
Adrafinil, adrenaline, amfepramone, amiphenazole, amphetamine, amphetaminil, benzphetamine, benzylpiperazine, bromantan, cathine, clobenzorex, cocaine, cropropamide, crotetamide, cyclazodone, dimethylamphetamine, ephedrine, etamivan, etilamphetamine, etilefrine, famprofazone, fenbutrazate, fencamfamin, fencamine, fenetylline, fenfluramine, fenproporex, furfenorex, heptaminol, isometheptene, levmethamfetamine, meclofenoxate, mefenorex, mephentermine, mesocarb, methamphetamine (D-), methylenedioxyamphetamine, methylenedioxymethamphetamine, methylamphetamine, methylephedrine, methylphenidate, modafinil, nikethamide, norfenefrine, norfenfluramine, octopamine, ortetamine, oxilofrine, parahydroxyamphetamine, pemoline, pentetrazol, phendimetrazine, phenmetrazine, phenpromethamine, phentermine, 4-phenylpiracetam (carphedon), prolintane, propylhexedrine, selegiline, sibutramine, strychnine, and tuaminoheptane
Banned methods
Blood doping
Blood doping refers to any method, including using the enhancement drug erythropoietin (EPO), to increase red blood cells. EPO can be used medically to treat anemia, among other applications. Athletes use blood doping illicitly to increase endurance and reduce fatigue. However, blood doping has been found to âthickenâ blood, increasing the chances of blood clots, heart attacks, hypertension, and stroke.
| Pro | Con |
|---|---|
| Proponents of allowing athletes to blood dope argue that blood doping is already so prevalent that banning it now would lessen the sport, that the methods are safe for athletes, and that the same effects can be achieved by working out at high altitudes. | Opponents of allowing athletes to blood dope argue that blood doping is dangerous and can lead to athletesâ deaths, that normalizing blood doping is asking athletes to risk their lives to play a sport, and sport doesnât need more athletes who break the rules. |
Effects on athletes:
- ability to perform better at higher altitudes
- endurance performance improvement
Side effects:
- blood poisoning
- cardiac output decrease
- death
- heart failure
- immune system overload
- infection
- intravascular clotting
- iron overload
- platelet count reduction
- transient fever
Chemical and physical manipulation of samples
Chemical and physical manipulation of S=samples can include catheterization, intravenous infusion, ubstitution and/or alteration of urine, and tampering with samples. Intravenous infusion is prohibited unless there is an acute medical situation (e.g., acute blood loss) for which the use of this method is necessary.
Effects on athletes:
- negative drug tests
Side effects:
- infection
Gene doping
Gene doping is a still-experimental manipulation of cells or genes to improve athletic performance. Gene therapy came about in the 1990s and entered popular culture via âSchwarzenegger mice,â which had been treated for muscle wasting conditions and ended up with twice the normal amount of muscle after gene manipulation. While currently more science fiction than reality, the World Anti-Doping Agency (WADA) has already banned the practice in athletes. The benefits and drawbacks medically are still hypothetical.
| Pro | Con |
|---|---|
| Proponents of allowing athletes to gene dope argue that the enhancements could breathe new life into boring sports, could allow more categories of participation, and could be finely tuned to help athletes with specific issues such as muscle twitches. | Opponents of allowing athletes to gene dope argue that doping is doping and all doping is unfair, and that gene doping is basically science fiction that has numerous and serious ethical concerns, such as parents altering fetuses in vitro to produce super athletes. |
Techno-doping
Techno-doping as a technological augmentation that confers an advantage to the athlete, be it a specially designed shoe, a bike motor, or limb prostheses that specifically offer an advantage over other athletes in the same competition. While the issue currently revolves around athletes who are otherwise impaired (including Oscar Pistorius, who wears âcheetahâ prosthetic legs), future iterations of the debate could involved able-bodied athletes who otherwise augment their bodies and athletes who improve their equipment, such as bicycles.
| Pro | Con |
|---|---|
| Proponents of allowing athletes to techo-dope argue that the advancements could push the sports and athletes in interesting ways and that audiences not only donât oppose new technology but also will be excited to see sports and athletes play a reinvigorated game. | Opponents of allowing athletes to techno-dope argue that doping is doping and all doping is unfair, the advancements disadvantage athletes who refuse to dope, and tech moves sport too far away from the accomplishments of the human body. |