muscular man doing a shot in biceps

Drugs in Sports: Statistics, Side Effects, Prevention

Athletics are inherently competitive. If an athlete is not competing with someone else, they are competing with who they were yesterday, striving to do better, to be better. And the pressure to improve is not merely internal; from coaches to parents to fans, it seems that everyone around athletes pushes them to do more and be more.

While they often seem supernatural in their abilities, athletes are human, and humans have their limitations. So how do athletes handle the conflict between pressure to improve and their own limitations?

Current Use of Performance Enhancing Drugs

What athletes use performance enhancing drugs? The practice—often called doping in casual settings and by the media—is used by athletes at all levels and of all ages. In general, performance enhancing drugs are any substances that are banned by the World Anti-Doping Agency, or WADA for short. According to numerous studies, the overall use of WADA banned drugs is around two percent across all athletes over the last year, with certain drugs, such as anabolic steroids, being used in greater numbers. According to the Annals of Applied Sports Science, high-performance sports see the greatest use.

Use of performance enhancing drugs has increased in recent years. However, this is in large part to the availability of more options, many of which feel safer to athletes than traditional drugs. While the idea of injecting steroids may have seemed off-putting to all but the most driven athletes, taking a supplement that can be purchased at any health store seems less risky, or even normal. And doing so is socially acceptable. As a result, up to 12 percent of teens, both athletes and not, are using substances to improve performance and appearance. While women using these substances as well, their use is more prevalent amongst men.

Although medical concern is greatest for teen users, that is generally not where the media focuses. Instead, the media and the public at large are most concerned with doping in major league sports. Both Major League Baseball and the National Football League have seen significant controversy in recent years related to players doping. In fact, the current conversation around the practice can be traced back to the revelation of steroid use in MLB players back in the late 90s to early 2000s. More than 24 MLB suspensions have been related to performance enhancing drugs since 2005; on the NFL side, hundreds of games have been missed due to temporary suspensions related to doping.

Failed doping tests 2003-2015 chart for Olympic and non-olympic sports

Why Do Athletes Turn to Performance Enhancing Drugs?

As with any form of drug use, the exact reasons why an athlete turns to performance enhancing drugs is personal. However, a common factor is—as one would assume—improved performance and physical condition. To better understand the motivation of athletes, let’s look at specific causes in-depth.

  • In the life of every athlete, there is that make-or-break moment—that competition where if they win, it has the potential to alter the course their life takes for the better, and if they lose, they are either looking at an uphill battle or even the end of their career. As a culture, people fixate on these stories, talking about unforgettable Olympic moments and major league games decades after they occurred. For professional, competitive athletes, sports are not about playing the game and having fun; they are about winning. And in many cases, there is little care given to the cost of reaching that goal. Jose Canseco is perhaps one of the most well-known sports figures to be taken down by a doping scandal. Since then, he has been vocal about his use of performance enhancing drugs and their use in sports in general, making him stand out from his fellow scandal-ridden peers. He is quoted as saying: “I truly believe, because I've experimented with it for so many years, that it can make an average athlete a super athlete. It can make a super athlete incredible. Just legendary.” This quote drives at something that is an extension of winning: becoming a sports legend. Successful athletes are not merely winners; they are legends in the public consciousness. They remain relevant long after their careers are over, and even long after they have passed away. So far, the pressures discussed all come from the individual athlete. This does not take into consideration pressure from family, friends, coaches, teammates, fans, schools, governments, and more. Ultimately, the drive to win is strong, and one of the greatest contributing factors in performance enhancing drug use.

  • In the majority of competitive sports, physical form only matters so far as it helps to improve performance. However, there are certain sports where bulking up is key, not because it enhancing their play, but because the appearance of their physical form is central to winning. The most notable sport where this is the case is bodybuilding. The performance enhancing drug most often associated with the world of bodybuilding is anabolic steroids. Approximately 19 percent of bodybuilders acknowledge their use of steroids; studies that do not rely on self-reporting are likely to see results that are much higher. However, there are many other drugs used as an alternative or in addition to these steroids that are known to help users build up significant, defined muscle mass. In some cases, bodybuilders use steroids without realizing they are doing so. This is because many supplements designed for bodybuilders contain steroids that are not noted on their packaging or advertisements. As such, the risk of use within the bodybuilding community is strong.

  • Not every athlete who uses performance enhancing drugs does so because of a powerful drive to win or because the drugs are integral to being competitive in their chosen sport. In fact, for many teens and young adults who use performance enhancing drugs, their motivation is concern for their future. For many student athletes, their only option for getting a college education is to do so on an athletic scholarship. These are tied to their performance, both in order to receive them in the first place and to keep them until they graduate with their degree. And as college tuition continues to rise, these scholarships become vital to even more young people. Unlike in the past, college degrees are no longer seen as optional. 35 percent of jobs require a minimum of a bachelor’s degree, with only 36 percent accepting a high school diploma or less. Of these jobs accepting applicants with lower education levels, the majority do not pay a living wage. As a result, many young athletes feel pushed to use performance enhancing drugs in order to survive in the long term.

athlete holding pills

What Are the Different Types of Performance Enhancing Drugs?

Steroids are easily the most well-known type of performance enhancing drug; however, they are not the only type. In fact, they are not even the most commonly used performance enhancing drug; instead, general supplements are, with creatine leading the pack. The consequences of use—both physically and within the sports world—vary depending on the drug used. Below are some of the most commonly used types of performance enhancing drugs.

Anabolic steroids are synthetic drugs that mimic or enhance the effects of testosterone. They encourage muscle growth. In medical settings, they can be used to treat muscle loss and delay of the onset of puberty.

Stimulants are drugs that act on the central nervous system by speeding up physical process. This can mean increased heart rate and blood flow and elevated body temperature. Athletes abuse both legal, illegal, and prescription stimulants. Some examples include amphetamines, cocaine, and even nicotine.

Human growth hormone naturally occurs within the body. However, synthetic versions have become very popular within the world of sports. When it occurs naturally, it helps teens grow their bones during puberty and strengthen the skeletal structure overall; in medical settings, it can be used to help those who are not producing enough during puberty or who are fighting certain diseases, such as HIV. However, it is used in sports for another reason.

Erythropoietin is a hormone produced by the kidneys in response to not having enough oxygen in the cells of the body. It functions by stimulating the production of red blood cells by the bone marrow. In medical settings, it is used to treat anemia.

This one is a surprising inclusion to many; however, that is because it is used in lesser-followed sports. Beta-blockers reduce the effects of adrenaline and slow heart rate, in turn making the body steadier and increasing focus. In medical settings, they are used to treat heart conditions.

How they enhance performance​Potential side effects
Anabolic SteroidsAnabolic steroids enhance performance by increasing the size of the muscles, and as a result, their strength. As a result of this, overall body fat is reduced as well. Both of these contribute to better physical performance. It has also been noted by the Australian Academy of Science that those taking anabolic steroids tend to recover from injury faster.Anabolic SteroidsHigh blood pressure, poor liver function, and high cholesterol are among the greatest risks.
Other potential side effects include:

Severe acne
Thinning of hair
Fluid retention
Shrinking testicles
Loss of sex drive
Decreased sperm production
Breast development in males
Prostate enlargement
Decreased hormone levels
Sterility and infertility
Menstrual irregularities
Development of facial hair in women
Permanently deepened voice

StimulantsBy giving a jump to the system, stimulants can enhance key aspects of athletic performance. For example, increased blood flow from an increased heart rate can disperse oxygen throughout the body faster, increasing endurance and even healing injuries faster. Sharper focus can increase response time, allowing athletes to better react while competing.StimulantsThe exact side effects of a stimulant will vary depending on which one is being discussed. For example, caffeine is a stimulant—though not one that is banned—and it has relatively minor side effects of increased heart rate, alertness, and sometimes shakiness if too much is consumed. Amphetamines, on the other hand, can permanently damage internal organs and easily lead to drug overdose.
Human Growth Hormone​Human growth hormone drugs enhance performance by increasing the presence of red blood cells, boosting cardiovascular function, and breaking down fat. All of this increases energy in the user by either moving oxygen through the body faster or by consuming fuel at a faster rateHuman Growth Hormone​Human growth hormone drugs enhance performance by increasing the presence of red blood cells, boosting cardiovascular function, and breaking down fat. All of this increases energy in the user by either moving oxygen through the body faster or by consuming fuel at a faster rate.
ErythropoietinThe way erythropoietin drugs assist athletes comes down to the manner in which red blood cells function. Red blood cells are essentially oxygen transportation devices, moving oxygen molecules to the parts of the body where they are needed. When delivered to muscle cells, the muscles operate with greater efficiency. Cyclists, in particular, tend to use this drug.ErythropoietinThe primary risk of using erythropoietin when it is not medically indicated is that having too many red blood cells present can thicken the blood. This can then decrease performance, cause dangerous clotting, and lead to heart attack and stroke. It has been linked to the deaths of numerous athletes.
Beta-blockersIn certain sports, a steady hand and uninterrupted concentration are key to performance. Darts, car racing, archery, shooting, billiards, and golf are all sports where beta blockers can allow athletes to perform better in competition.Beta-blockersBecause they decrease blood flow when used incorrectly, they can leave the extremities without enough blood, causing numbness and lack of function. Beta blockers can also cause impotence, memory issues, and heart failure when taken for unprescribed use.

In addition to these drugs, there are thousands of supplements on the market that can enhance performance. Some of these are banned by professional associations while others are allowed, and others still are being studied.

Usage of performace enhancing drugs by student athletes

The Battle Against Doping in Sports

Ever since doping in sports has been known to exist, there have been efforts made to deter it. However, these efforts did not become mainstream until the last 30 years. During this time, significant measures have been taken to punish the use of performance enhancing drugs, deter athletes from starting them, and improve the methods of testing for them.

  • On August 26th, 1960, doping in sports became an international topic when Knut Jensen died during the Olympic games in Rome. His death was linked to the use of amphetamines.
  • In 1967, after a high-profile Tour de France doping death, the International Olympic Committee established a commission to fight doping in sports.
  • In 1968, the International Olympic Committee began drug testing athletes. This is also the first year an athlete was disqualified for Olympic performance due to doping.
  • On September 27, 1988, Ben Johnson became the first athlete to be stripped of an Olympic medal due to a positive doping test.
  • On October 5, 1990, the United States Congress passed the Anabolic Steroids Control Act.
  • On November 10, 1999, the World Anti-Doping Agency was established.
  • On October 1, 2000, the United States began operating its own anti-doping agency called the US Anti-Doping Agency.
  • In 2004, the World Anti-Doping Agency took over the list of banned substances for the International Olympic Committee.
  • On August 4, 2011, the National Football League became the first US sports agency to make random blood tests mandatory.
  • In August of 2011, the first suspensions of Major League Baseball players for using human growth hormone occurred.
  • On August 23, 2012, Lance Armstrong was stripped of all his Tour de France titles due to doping.
survey on doping in sports

Tests for Performance Enhancing Drugs

The presence of drugs can be tested through urine, blood, saliva, and hair samples. However, blood and urine tests are the most common. The samples can be tested using chromatography, immunologic assay, and mass spectrometry. The exact test used will depend on what types of drugs are being checked for and the policies of the league doing the testing.

For example, anabolic steroids and their byproducts are detected in urine samples examined using a combination of gas chromatography and mass spectrometry; each league determines the allowable testosterone levels, given that it is naturally occurring, and anything above that threshold is deemed to be doping. Human growth hormone is tested for in two steps: a urine test to show current presence and a blood test to prove use of HGH over time.

Can these tests be cheated? Yes, and many athletes have. But the exact methods for cheating them are constantly evolving as the testing process changes. As a result, there is no perfect guide to passing a doping test while still using performance enhancing drugs.

Doping Policies Across Leagues

  • The MLB bans numerous substances from being used by players. Among these substances are drugs of abuse, 71 types of steroids, and 55 types of stimulants. Testing is done at the start of spring training and then randomly throughout the season, except for drugs of abuse; these are only tested for when there is cause to suspect abuse. Urine tests are the most common, though other forms of testing can be used. All players are tested, and penalties include fines and suspensions.

  • The NFL bans anabolic agents, protein and peptide hormones, unrelated anabolic agents, anti-estrogen agents, selective androgen receptor modulators, stimulants, and masking agents that aim to hide the presence of banned drugs. Drug tests are performed randomly, and players will be tested at least once per season, with the maximum times being tested being six in a single season. Both urine and blood tests are used, and those who test positive can be fined and suspended.

  • The NBA has not been rocked by doping scandals in the same way that the MLB and NFL have. However, the association is known for handing out harsh sentences when players are caught doping—suspending them for as many as 50 games. However, the NBA is lighter in its fines and goes easier on certain drugs, such as marijuana, when compared to other professional sports leagues. Amphetamines, stimulants, human growth hormone, and various steroids are all banned. However, their testing policies are not publicly available.

  • The NHL has a policy of conducting two surprise drug tests per player per season; one of these tests must be on the team as a whole. The first positive test results in a 20-game suspension without pay. The second earns a 60-day suspension without pay. The third results in a ban from the league. This means that the NHL has the harshest policy of all the major sports leagues in the United States. The NHL follows the banned substances list curated by the World Anti-Doping Agency and uses both blood and urine tests.

  • The USOC tests athletes for all substances banned by the World Anti-Doping Agency. The committee uses both blood and urine tests, and should a scandal arise, is open to using other testing items, such as hair. The exact frequency of testing varies, as do the penalties. These penalties can include temporary suspensions, the revocation of awards, and permanent bans.

anti-doping rules violations in 2015

Legal Doping

Legal doping refers to the practice of taking drugs that enhance performance for legitimate medical purposes. For example, beta blockers may help someone competing in archery keep their hands steadier, but if they have a heart condition that requires treatment using beta blockers, they may be able to take them and compete legally. However, there is a concern that doctors are prescribing these drugs erroneously, making the claim that the athlete has a condition they do not in order to grant them permission to take performance enhancing drugs without a consequence from their sport’s governing agency. Little focus has been given to this issue, but it is receiving increased attention in recent years.

sports medal and doping pills

Signs Someone Is Using Performance Enhancing Drugs

The signs of performance enhancing drug use depend on the substance being used. In some cases, there are no outward, observable signs. In general, the performance enhancing drugs that have outward symptoms are steroids, human growth hormone, and stimulants.

Signs of Steroid Abuse

  • New or increased acne
  • Overproduction of oil on the scalp and skin
  • Increased muscle mass
  • Puffiness and swelling of the neck
  • Stunted growth in teens
  • Development of breast tissue in males
  • Deepening of the voice in females
  • Excessive body hair in females
  • Difficulty controlling anger
  • Anxiety
  • Depression
  • Increased appetite

Signs of Human Growth Hormone Abuse

  • General swelling
  • Changes in the size of the head, hands, and feet
  • Enlarged facial features, such as the nose or lips
  • General illness due to the questionable quality of illegal growth hormones

Signs of Stimulant Abuse

  • General agitation
  • Anxiety
  • Paranoia
  • Difficulty sleeping
  • Constant movements

Additionally, sudden secrecy, strange habits, and missing money are all signals that someone may have a drug problem, whether it involves performance enhancing drugs or not.

Are Performance Enhancing Drugs Addictive?

The majority of performance enhancing drugs are not considered to be addictive, but those who use them are at a greater risk of developing a substance abuse addiction. The exception to this are stimulants and other drugs of abuse that may be used for their performance enhancing capabilities. These drugs are highly addictive, both psychologically and physiologically.

With that said, a user who wants to stop using performance enhancing drugs may need to taper their dose until they are no longer using rather than quitting all at once. Additionally, there may be a certain mental dependence on the drug, often related to the user’s fear that not taking drugs will result in poor performance and the loss of their dreams and career. As such, users of performance enhancing drugs often need drug rehabilitation care when they are ready to quit using drugs.

How to Prevent the Use of Performance Enhancing Drugs

Current anti-doping measures rely primarily upon the punishment of athletes who use performance enhancing drugs. The effectiveness of this is hotly debated given that many athletes still use these drugs despite the potential consequences. This makes it clear that there is more to be done.

In younger athletes, disapproval from those closest to them helps to deter their use more than any other barrier. A focus on education and helping these athletes see their potential without drugs is vital to keeping them clean. It is also important to establish a moral framework that helps the athlete see that doping isn’t the right choice, even if others are doing it.

Because preventing performance enhancing drug use is so difficult, there is now a movement within athletics to simply allow doping. However, this is problematic in that it does not acknowledge the impact such a decision will have on the health of the athletes who engage in doping. For now, it would seem that the best approach is to discourage use and be there to help those who fall into the trap of using performance enhancing drugs.