Performance-enhancing Drugs

The use of performance-enhancing drugs in athletics began to accelerate in the 1960s. Then, athletes from East Germany received drugs as part of a state-sanctioned program designed to ensure Olympic dominance. In 1988, such drug use became infamous when Canadian sprinter Ben Johnson was stripped of his Olympic 100-meter gold medal (and then world record time) following the detection of a metabolic remnant of an anabolic steroid in his urine.

Aside from any moral or ethical considerations of this behavior, the use of performance-enhancing drugs can pose health dangers. Recognizing these dangers, many professional and amateur sporting organizations are increasingly imposing their own standards for performance enhancement and monitoring participants to try to ensure athletic performance is determined by natural talent and training excellence.

In the realm of Olympic sports, the World Anti-Doping Agency, which is headquartered in Montreal, Canada, is responsible for actively discouraging the use of illegal performance-enhancing drugs. A list of prohibited drugs is maintained and updated annually.

Part of the agency's efforts also involves the accreditation of analysis laboratories for the examination of samples. The obtaining and analysis of urine and other samples is essentially a forensic process. The investigators delve back in time to determine what chemical methods might have been used to enhance performance.

Performance-enhancing drugs may exert their effects in different ways. Some, like anabolic steroids, increase the mass and the strength of muscles. Bones can also be strengthened. Other drugs cause more oxygen to be delivered to muscles, which allows the muscles to perform at an intensity that could not otherwise be possible. Still other drugs can blunt pain, stimulate the production of chemicals that spur the body to greater levels of athletic activity, or reduce weight. Some drugs are even taken just to mask the presence of a performance-enhancing drug.

A number of drugs can be used to enhance the amount and strength of muscles. This list includes anabolic steroids, beta-2-agonists, human chorionic gonadotrophin, luteinizing hormone, human growth hormone, insulin-like growth factor, and insulin.

A steroid is derived from cholesterol. Anabolic steroids, which build muscle and bone by stimulating protein production from muscle and bone cells, derive their name from the constructive process of anabolism (the opposite breakdown process is called catabolism).

Anabolic steroids include testosterone, a hormone that predominates in men, and other steroids structurally similar to testosterone. As a result, these steroids, in addition to increasing the intensity and length of athletic training that muscles and bones can tolerate, enhance male reproductive and secondary sexual characteristics including development of testicles, body hair growth, and thickening of the vocal cords (females taking anabolic steroids can thus experience a deepening of their voices).

Besides testosterone, other examples of anabolic steroids include dihydrotestosterone, androstenedione (commonly known as Andro, which reputedly was taken by baseball star Mark McGuire), dehydroepiandrosterone, clostebol, and nandrolone.

The gains in athletic performance bestowed by anabolic steroids come with a price. Mood swings and feelings of depression and aggression (commonly known as "roid rage") can occur, as can liver damage and jaundice. Males can become infertile and experience breast growth, while females can develop facial and body hair and an altered or completely suppressed menstrual cycle.

Beta-2 adrenergic agonists can be life saving to an asthmatic. When inhaled, they mimic the action of epinephrine and norepinephrine, which are secreted by sympathetic nerves, and cause airway muscles to relax, making breathing easier. However, when injected into the bloodstream, the agonists can help build muscle mass and stimulate the utilization of fat. The result is a leaner and stronger athlete, but an athlete who can be prone to nausea, muscle cramps, and even an irregular heartbeat. Examples of beta-2 adrenergic agonists include clenbuterol, tertbutaline, salbutamol, fenoterol, and bambuterol.

Human chorionic gonadotrophin (HCG) is produced naturally by a developing fetus. Indeed, its detection is the basis of home pregnancy tests. HCG functions to stimulate the development of male and female sex steroids. This is exploited as a muscle-boosting performance enhancer in male athletes via the increased production of testosterone.

Luteinizing hormone (LH) is produced by the pituitary gland, which is located at the base of the brain. Normally, the peptide hormone regulates the level of testosterone in males and the ovulation-signaling estrogen in females. In men, excess LH or synthetic forms of LH, such as tamoxifen, boosts levels of testosterone and so produces the increased muscle mass.

Human growth hormone (HGH) is another natural hormone that is produced by the pituitary gland. Normally, the hormone functions to promote growth in childhood and adolescence. But, when exploited as an athletic performance enhancer, the hormone builds muscle, strengthens bone, and stimulates the destruction of fat. Side effects of deliberate misuse include: abnormal enlargement of the hands, feet, and face (acromegaly); enlarged heart, kidneys, tongue, and liver; and heart malfunction.

Both LH and HGH function to promote increased muscle mass. The enhanced athletic performance that can result comes at a potentially lethal price of low blood sugar (hypoglycemia).

Muscles need a supply of oxygen to function. Supplying more oxygen increases the capacity of the muscles to perform. Protein hormones, artificial oxygen carriers, and blood doping (the addition of whole blood into an athlete) are all illicit means of increasing the oxygen content in tissues.

A protein hormone called erythropoietin (EPO) is naturally produced and secreted by the kidneys when oxygen levels are low. The hormone stimulates bone marrow cells to manufacture red blood cells, which function to bind oxygen and ferry the molecule to tissues throughout the body.

By boosting the oxygen levels in the body's tissues, EPO can be a performance enhancer for athletes engaged in sports that require endurance, as opposed to the raw power of an activity like power lifting. Thus, marathon runners, cyclists, and cross-country skiers have all been accused of injecting EPO. Indeed, American cyclist Lance Armstrong, who has won the Tour de France six times in succession through 2004, has long been under a cloud of suspicion regarding EPO use, despite his repeated and vehement denials and lack of evidence of impropriety.

While EPO does boost oxygen levels by up to 10%, the increased number of red blood cells can thicken the blood. The blood, honey-like in consistency, does not flow as well through blood vessels, which causes the heart to work harder. The risk of a stroke or heart attack is increased.

Artificial oxygen carriers are synthetic compounds that mimic the oxygen-binding behavior of hemoglobin (the active component of the oxygen-binding red blood cell). They were initially conceived and made to help assist in conditions of clinical distress, such as breathing difficulties experienced by premature infants or those whose lungs have been damaged. However, the compounds have been exploited in the quest for greater athletic excellence.

The athletic benefits of artificial oxygen carriers are not clear. Moreover, this dubious benefit increases the risk of kidney damage, cardiovascular difficulties, and problems with the immune system.

Blood doping, by transfusing whole blood to an athlete, increases the amount of blood in the body (or more precisely the number of oxygen-binding red blood cells) and the overall oxygen carrying capacity is increased. This process occurs naturally when athletes train at higher altitudes, where the oxygen content in the air is less than at sea-level.

While altitude training is an ethically acceptable training practice, deliberate infusion of blood is not. Furthermore, injection of blood can cause infections and the increased amount of blood can cause similar problems as EPO. As well, if the infused blood is from someone else, there is a risk of acquiring a blood related infection such as acquired immunodeficiency syndrome or hepatitis.

Injury is a natural part of training and competition. A natural part of injury is pain; the signal to cease whatever is causing the damage. Many injuries heal with time and therapy. But, pressure to continue the athletic activity can drive an athlete to dull the pain rather than to stop training.

Narcotics including morphine, methadone, and heroin are effective at masking pain. They are, however, very addictive and can disrupt the mental focus that can be vital to peak athletic performance.

Adrenocorticotrophic hormone (ACTH) is produced by the pituitary gland. Normally, ACTH stimulates the production of other hormones by an organ called the adrenal cortex. The hormones reduce inflammation and so can be used illicitly to ease the trauma of injured muscles. However, immediate side effects include stomach irritation and ulcers. In the longer term, bones and muscles can become weaker.

Stimulants such as caffeine (the wake-up ingredient of coffee), cocaine, and amphetamines increase the beating of the heart, lung activity, and even brain activity. For an athlete, these physiological responses are manifest as increased alertness, decreased fatigue, and promotion of an aggressive, competitive attitude. Side effects include an irregular heartbeat and high blood pressure.

Relaxants such as alcohol and marijuana decrease brain and nervous system activity. They can ease competition jitters. However, impaired focus and coordination can undermine athletic performance.

Beta-blockers are another illicitly used relaxant. They slow down the heartbeat, which can help lessen the movement of the hands and arms that occurs in concert with pumping of blood by the heart. Thus, they can be used by athletes competing in archery or shooting competitions, where steady hands can be a key to the first-place podium.

Paradoxically, athletes may need to take drugs to hide the use of other illicit drugs. One example is epitestosterone. The compound is a natural form of testosterone. Testing for elevated levels of testosterone rely on the comparison of the levels of testosterone and epitestosterone. By artificially increasing the levels of the latter, the presence of increased testosterone can be masked.

The tendency of blood to thicken because of the administration of agent like EPO can be masked by diluting the blood with additional fluid. This process is called plasma expansion.

Organizations such as the World Anti-Doping Agency are actively engaged in testing samples obtained from athletes during training and following competition.

Urine is most often tested. Illicit chemicals can be detected using the technique of gas chromatograph/mass spectrometry, where individual components can be separated from one another based on their different rates of movement through a medium.

Compounds including HCG, LH, and ACTH stimulate the production of antibodies by the body's immune system. These antibodies are used to detect the presence of the compounds in urine samples.

Testing procedures are constantly being refined. Some drugs such as EPO remain difficult to detect. A San Francisco a company called BALCO was exposed in 2004 as the source of a variety of performance-enhancing drugs for athletes, including New York Yankees star Jason Giambi, who has admitted his steroid use. A forensic investigation of BALCO uncovered evidence that existing drugs were being chemically modified to be undetectable.