DRUG ABUSE IN SPORTS - SOME FOOD FOR
THOUGHT
Drugs in sports have a more prominent role than
ever, in this modern day and age with the perception that some
sportsmen and sports-women are now racing against both the clock
and the tester. In short, the Olympic motto of "citius, iltius
et fortius", is driving sports stars to the limits of human
endurance and endeavour by fair means or foul in their attempts
to achieve Olympic medals.
As at now, the drugs prohibited by the
International Olympic Committee (IOC) for international competition
are classified as follows:
A Stimulants
B Narcotics
C Anabolic Agents
D Diuretics
E Masking Agents
F Peptide hormones, mimetics and analogues.
Of the prohibited substances, stimulants are the
most common group of drugs abused in sports. They stimulate the
nervous system and increase cardiovascular activity, reducing
tiredness and muscle fatigue and enhancing aggression, stamina and
competitiveness. Amphetamines are the most potent. They are highly
addictive and adverse affects include anxiety, arrhythmias,
hypertension, strokes and even death. Indeed, abuse of amphetamines
has resulted in a number of sports associated fatalities.
Narcotics do not have a significant performance
enhancing potential and may even impair performance. Nevertheless,
they have been used to reduce pain and enable athletes to
participate in competitions despite injury (e.g.) leg cramps in long
distance events. They are also highly addictive. Morphine, methadone
and pethidine are some of drugs in this category which are in the
banned list.
Anabolic steroids such as testosterone are
responsible for stimulating development of male sexual
characteristics and the build up of muscle tissue. They improve
performance by increasing muscle size and strength and allowing
athletes to train harder and longer and also promote increased
aggression and competitiveness.
Diuretics tend to be used by those competing in
weight classes. (e.g.) weight lifting, boxing, wrestling etc., to
achieve rapid weight loss. They are also used to mask the presence
of prohibited drugs in the urine by producing a significant
dilution. Included among them are drugs such as frusemide,
hydrochlorothiazide etc.
The administration of substances belonging to the
above prohibited classes of pharmacological agents is defined as
"doping"; besides, doping also includes the use of various
prohibited techniques such as the following:
A Blood doping
B Administering artificial
oxygen carriers or plasma expanders.
C Chemical and physical
manipulation
Blood doping means the administration of blood,
red blood cells and / or related blood products to an athlete, which
may be preceded by withdrawal of Mood from the athlete, who
continues to train in such a blood depleted state. The net result is
that when the red blood cell status restores itself in due course,
the athlete will have a very high red-blood cell count, thereby
enhancing his oxygen tarrying ability and his performances.
Regrettably, however, he would run the risk associated with
thickened blood in circulation in his body which could result in
clot formation and perhaps death.
The expression "prohibited techniques" also
includes the use of erythropoietin (EPO) for blood doping, the use
of diuretics which alter the integrity and validity of urine samples
taken for doping control, catheterization, urine substitution, and
tampering with or inhibition of renal excretion, using drugs such as
probenecid, which are known as a "Masking Agents"
Erythropoietin (EPO) stimulates red blood cell
production from the bone marrow, thereby increasing the haemoglobin
levels and hence the packed cell volume (PCV). Improved oxygenation
of blood and hence improved athletic endurance and performance are
the favourable results. However, this also greatly increases the
viscosity of the blood, which can result in poor circulation,
thrombotic lesions and myocardial infarction (heart attack). In
addition to the prohibited classes of drugs mentioned earlier, it
should be noted that there are some other classes of drugs subject
to certain limited restrictions. They are the following:
A Alcohol
B Cannabinoids
C Local Anaesthetics
D Corticosteriods
E Beta-blockers
The restrictions for drugs, such as
Beta-blockers, alcohol, and marijuana, are in respect of certain
sports and the route of administration plays a significant role in
respect of local anaesthetics and corticosteroids. Additionally,
some other substances among the prohibited drugs are determined as
positive in a sample of urine taken for testing, only if their
concentration exceeds a given amount. These are in respect of some
substances either found in normal consumer items or those taken on
medical advice, (e.g.) caffeine found in tea and coffee are
determined as positive for doping, only if found in excess of 12
micrograms per milliliter and ephedrine, methyl ephedrine found in
cough syrups is deemed as positive only if present in concentrations
greater that 10 microgram per milliliter. A few other such
substances also exist which are subject to such restrictions.
In brief, suffice it is to state that no
sportsmen or sportswomen are permitted to use any of the prohibited
drugs classified above under any circumstances, before or during
participation, in international competitions. This is a mandatory
provision applicable to all athletes in respect of all sports which
are included at the Olympics. Additionally, in order to ensure that
all those participating at the Olympics are completely, "drug-free"
at all times prior to and during competition, a provision is also
included in the Olympic statutes for "out-of-competition" testing.
This is, of course, carried out on the advice of the International
Doping Commission by trained International Doping Control Officers.
"Out-of competition" doping control is used as a deterrent
particularly for use of anabolic agents and certain listed hormones,
including the substances involved in the prohibited techniques.
What must be foremost in the minds of all
sportsmen and sportswomen is that doping is strictly forbidden in
international competitions. Doping contravenes the basic ethics of
sport and medical science, and all International Sports
Organizations (Cricket is no exception) are motivated to ensure that
participation in their respective sports is fair. Doping control
seeks to achieve this and, additionally, protect the physical and
mental health of all athletes.
While decidedly stating that participation in
sports by athletes under the influence of performance enhancing
prohibited drugs is unmitigated cheating which should be condemned,
one must also have some consideration for false allegations made for
a variety of reasons, against star international performers whose
innocence has to be proved by them. Two such instances come readily
to mind.
The case of Diane Modahl, a British athlete who
had to face charges of "testosterone abuse" on the basis of a doping
test conducted in Lisbon, Portugal in 1994. Her urine sample taken
for testing revealed a Testosterone (T) to Epitestosterone (E) ratio
of 40 : 1, when the permitted T/E ratio was only 6:1. It required
the services of many medical experts and pathologists to convince
the LAAF Authorities that this high value of the T/E ratio was due
entirely to a poorly stored sample of urine on a hot summer's day in
Lisbon, which had resulted in the generation of testosterone by the
action of bacteria on steroids in the sample. It took Modahl two
years and a considerable amount of stress and trauma, before she was
finally exonerated by the IAAF in 1996.
The second case was that of our own Olympic
bronze medallist Susanthika Jayasinghe who was reported positive for
the presence of metabolites of the banned drug nandrolene in her
sample of urine taken for testing after a gold medal winning
international performance. Here again, it was proved
incontrovertibly that the possibility existed that a permitted drug
taken by her on medical advice called Primolut-N could, through "in
vivo" metabolism result in the formation of the banned substance
nandrolone and hence the presence of its metabolites in her sample
of urine taken for testing. This hypothesis was accepted by the IAAF
and she was duly exonerated, but not before undergoing considerable
pain of mind.
The statistics currently available on the
incidence of positive drug tests for a range of sports on the basis
of a U.K. drug testing programme reveals that sports most commonly
implicated are power lifting, athletics, Association football,
cycling, rugger, boxing, body building, and weight lifting in that
order of frequency. Cricket, swimming, hockey, tennis and golf are
much lower down the list and of not much significance.
The final word, of course is that while the need
exists to safeguard the interests of innocent athletes unfairly
embroiled in doping charges, it must be re-emphasized that doping is
cheating, contrary to the spirit of fair competition and so doping
control in international sport must be enforced.
It is. indeed, a heart-warming thought for all
cricketers, to know that to date, only a few country cricketers with
no worthwhile international backgrounds have been penalized for
doping offences. I am, indeed, hopeful it will remain that way,
cricket still being a "gentleman's" game.
By Dr. A. R. L.Wijesekera
(The writer was the former Government Analyst and
is currently the Consultant attached to the National dangerous Drugs
Control Board.)
