ATHLETIC DRUG TESTING

The use of drugs to enhance performance in sports has certainly occurred since the time of the original Olympic Games. The origin of the word “doping” is attributed to the Dutch word “doop,” which is a viscous opium juice, the drug of choice of the ancient Greeks. The use of stimulants, such as amphetamine, cocaine, strychnine, and ephedrine, in sports was reported in the early 1900s. It is interesting to note that a 1997 survey of student-athletes indicated an increased use of ephedrine. Of the small number of respondents who indicated use of ephedrine, 50% indicated an intent to improve performance. 28 In response to the death of a Danish cyclist at the 1960 Olympics and other evidence of widespread use of potentially life-threatening drugs in sports, the Council of Europe (COE) established the following definition of doping in 1963: The administering or use of substances in any form alien to the body or of physiological substances in abnormal amounts and with abnormal methods by healthy persons with the exclusive aim of attaining an artificial and unfair increase in performance in competition. Furthermore, various psychological measures to increase performance in sports must be regarded as doping. Where treatment with a medicine must be undergone, which as a result of its nature or dosage is capable of raising physiological capability beyond normal level, such treatment must be considered doping and shall rule out eligibility for competition. It should be noted that the most recent known death owing to the use of a drug for performance enhancement was in 1993 when a body builder died of a heart attack caused by diuretic-induced hypokalemia. Having established the basis for doping in athletics, an initial list of banned substances was published by the COE, which included narcotics, amine stimulants, alkaloids, analeptic agents, respiratory tonics, and certain hormones. The International Olympic Committee (IOC) established a Medical Commission in 1967 charged with various responsibilities in the prohibition of doping, including the maintenance of a list of prohibited substances and methods (vide infra). The IOC also adopted a Medical Code “to protect the health of athletes and to ensure respect for the ethical concepts implicit in Fair Play, the Olympic Spirit, and medical practice.” 33 Other national and international sport-governing bodies, especially in Europe, quickly established rules regarding the use of drugs. Interest in doping in North America was stimulated by Congressional hearings in 1973 on the improper use of drugs in sports in the United States and the 1988 Dubin Commission inquiry in Canada. 19 Major athletic organizations in the United States, including the National Collegiate Athletic Association (NCAA), the National Football League (NFL), USA Track and Field (USATF; formerly The Athletics Congress), and the United States Olympic Committee (USOC), implemented comprehensive drug programs during this period. Both educational efforts and testing for prohibited substances are an integral part of all of these programs. In recent years, the line between training for a competitive advantage and the “pharmacologic advantage” explicitly banned in the COE definition of doping has become more difficult to discern. The use of specially researched and prepared diets, including supplements of amino acids, creatine, vitamins, and minerals, to achieve training goals might seem a small step from taking a “natural” supplement that contains ephedrine, strychnine, or androstenedione. Modification of the training environment (e.g., adjusting the oxygen concentration) might seem analogous to administration of recombinant erythropoietin (EPO). Athletes justify bending the rules for a number of reasons. By his or her nature, the elite athlete is driven to succeed. Most athletes surveyed have indicated in an anonymous survey their willingness to take prohibited substances if they could not be caught and would consistently win. 4 Violating the rules and forcing officials to either call the infraction and impose a penalty or accept the illegal behavior can be observed at any level of competition, and in some cases is coached. The second arises from the fact that if the athletes perceive that the competition is winning because of the use of performance-enhancing drugs, they must use them also. A recent NCAA survey indicated that the athletes, at least in this area of competition, believe that the drug control program works in preventing use. This, in turn, means that everyone can compete drug-free. The athlete is also surrounded by individuals committed to their success. As has become clear from the exposition of the German Democratic Republic doping program, 21 at times the athlete needs to be protected from those around them. Although the imposition of testing and strict liability for what is a controversial issue, it is central to controlling drug use. The deterrent effect of testing is an important part of its value. In the end, however, it is the ethics of the athlete and their entourage that determine whether or not to succomb to the lure of drugs.