Professor Christiane Ayotte, Ph.D.
Thirty years ago, the International Olympic Committee created its Medical Commission and started an anti-doping campaign now based upon the principles of protection of the health of the athletes, respect of medical and sport ethics and insurance of a fair chance for every athlete during the competition (IOC, 1995). A list of the prohibited medications and practices was developed and laboratories capable of testing for the presence of these drugs in athlete’s urine samples were formed. The network of IOC accredited laboratories spanned from six in 1984 to twenty-five at the end of this year. Most of the sport organisations now possess regulations for doping controls.
In 1988, when Ben Johnson’s sample was found to contain stanozolol, the sport community was deeply shocked and responded by stronger commitment to eradicate doping opening the way to out-of-competition testing.
The organisation and the regulations of the doping control programmes differ from one country to another, from one federation to the other and for example, the sanctions for a given doping offence may vary from a warning to a four years ban. Furthermore, only a few International Federations have implemented a serious and extensive out-of-competition testing programme.
The list of banned substances and methods is constantly modified to incorporate other classes of drugs following methodological improvements in detection and reports of abuse by athletes (IOC, 1995). In the 60s, strokes and deaths were attributed to the amphetamines and the stimulants and narcotics were the first drugs to be prohibited. Anabolic steroids were added in 1976, blood doping, masking agents, diuretics and b -blockers in 1988, peptide hormones and b 2-agonists as anabolic agents in 1992 (Hemmersbach, 1996).
IOC list of banned substances and methods (1998)
Prohibited classes of substances and some examples
Examples: amineptine, amphetamines, bromantan, caffeine, carphedon, cocaine, ephedrines, mesocarb, methylphenidate, nicetamide, pemoline, phentermine, salbutamol, selegiline, strychnine and others
Examples: heroin, hydrocodone, methadone, morphine, pethidine and others
Examples: androstenedione, boldenone, clenbuterol, dehydrochlormethyltestosterone, dihydroepiandrosterone, fluoxymesterone, methandienone, methenolone, methyltestosterone, nandrolone, oxandrolone, oxymetholone, stanozolol, testosterone and others
Examples: canrenone, furosemide, hydrochlorothiazide, indapamide, triamterene and others
Peptide and glycoprotein hormones and analogues
Examples: human chorionic gonadotrophin (hCG), corticotrophin (ACTH), human growth hormone (hGH), erythropoietin (EPO)
Examples: administration of blood, red blood cells and related blood products
Pharmaceutical, chemical and physical manipulation
Examples: catheterisation, urine substitution – tampering, inhibition of renal excretion. Probenecide, epitestosterone, bromantan, diurectics.
Classes of Drugs Subject to Certain Restrictions:
- Local Anaesthetics
The detection of some drugs such as the anabolic agents represented a real challenge. For many years stanozolol for instance, was reputed to be invisible and indeed sensible detection was not achieved until the end of the 80s. The laboratories ability to detect metabolites traces steadily improved. More sensitive techniques are required for the anabolic agents which were administered during the training periods and stopped prior to the competition testing. The detection periods are extremely variable depending on the steroid metabolism, the pharmaceutical preparation and its mode of administration ranging from one day to several months in the case of the oil – based nandrolone long – chain esters. The International Olympic Committee now requires from the laboratories the implementation of high sensitivity techniques such as those afforded by the high resolution or tandem mass spectrometry.
Now that purely synthetic substances may be detected quite efficiently, some are turning to the natural steroids. Dihydrotestosterone (DHT), testosterone and its precursors, androstenedione, androstenediol and dehydroepiandrosterone (DHEA), banned in sport as anabolic agents, are naturally found in humans of both genders in more or less important amount. Some may be purchased as nutritional supplements in the U.S.A. The administration of these steroids alters the normal urinary steroid profile, the excretion of some metabolites being either suppressed or increased and diagnostic probes can be identified.
There are as yet no methods for the detection of EPO and human growth hormone.
Some Drugs’ Stories
In the meat industry, Clenbuterol and other b 2-agonists may be illegally administered as growth promoters and it was shown in the early 90s, that Clenbuterol was used by athletes during training and competitions (Ayotte, 1992). Zeranol, a non steroidal estrogenic agent and a growth promoter in the veterinary practice was reported once to be present in an athlete’s specimen (Ayotte, 1996).
We owe to Russian scientists the stimulants Mesocarb, Bromantan and Carphedon. Just before the 1996 Olympic Games, through the joined efforts of five IOC accredited laboratories and the International Amateur Athletic Federation, the nature of a new doping agent, Bromantan was discovered (Ayotte, 1998). The metabolite of this unknown substance was found between the end of 1994 through 1996 in the urine samples of many competitors, in the vast majority female athletes from Russia and few from some of the former Eastern block countries. Reportedly a immunomodulating and thermoprotective agent, Bromantan is also considered to be stimulant. A year later, another unknown Russian drug synthesised four years before, Carphedon was added to the list of banned stimulant following its identification in athlete’s urine samples.
During the Asian Games in 1994, Chinese male and female athletes’ urine samples were found to contain a banned anabolic androgenic steroid, dihydrotestosterone reported for the first time. Four years later at the Perth World Swimming Championships, the presence of the diuretic – masking agent triamterene was found in four swimmers’ samples. Adding to the scandal, a female athlete was caught at the Australian customs smuggling vials of human Growth Hormone. Four coaches and two doctors were accused some months ago of causing grievous bodily harm in a spectacular trial revealing how in the former East Germany, female athletes as young as 11 and 13 were forced to take pills and received injections of male hormones (dehydrochlormethyltestosterone, testosterone, mesterolone) referred to as “supporting means” (Franke, 1998). One coach will be fined.
Blood transfusions, Erythropoietine (EPO) and Perfluorocarbons (PFCs) : this is the evolution of endurance.
During the Tour de France 1998, the sport performances were barely noticed : the drug scandal made the front pages. EPO, hGH, corticosteroids, testosterone administered under medical supervision are now known to be the diet of some professional cycling teams.
Other medications are found in urine samples : mixtures of vasodilatators, nootropic agents (brain oxygenators), anti-cancer agents, anti-estrogens, anti- Parkinson drugs. Hormones precursors, testosterone boosters, creatine, tribulus terrestris, Ma Huang, IGF-1, miracle diets, natural supplements must not be forgotten.
The Cat and Mouse Game
Although the East German programme went on for nearly thirty years, very few female athletes were ever caught positive. Scientists developed ways to escape positive testing, designing new undetectable drugs experienced on the young athletes, monitoring the elimination of urinary metabolites and even manipulating the urine samples.
Masking agents effective or not ranging from honey – vinegar, citric acid to diuretics, probenecide, epitestosterone, urine manipulation, substitution, catheterisation may be employed. However, one must recognised that escaping the positive tests do not require all the time sophisticated techniques. The excretion time of doping agents are known, the steroid profiles adjusted to be within the norm. The athletes were able to negotiate drug tests for their participation to events. Litigation of the positive finding is now the norm : each and every step of the testing process are scrutinised and challenged from the sample collection and the sample analysis to the evaluation of the result. An enormous pressure is put on some laboratories involved in endless court cases. The credibility of the testing process is seriously undermined in the media. The litigation of the positive findings jeopardised the financial situation of many sport federations.
The Perception of Elite Sport
Today, the media coverage of the Olympic sports resembles pharmacology lessons. The athletic performances are tainted by rumours of doping cast by observers and competitors. The prevalence of doping in Olympic sports cannot be precisely estimated but its devastating effects are concrete. According to the yearly statistics of the testing activities in IOC accredited laboratories, positive findings are reported in around 1 to 2% of the 50,000 to 60,000 A-samples analysed, not all resulting from doping offences. Including the non Olympic sports for which tests are conducted, the highest number of positive findings is due to the anabolic agents (testosterone, nandrolone, methandienone, stanozolol, clenbuterol) followed by the stimulants (ephedrines, amphetamine, caffeine, cocaine). This low rate of positive results is not perceived as reflecting the actual prevalence of doping in sports but rather the total inefficiency of the doping control programmes.
Cross Road – Diverging Views
Thirty years after the first doping control tests during an Olympic event, some are ready to describe the doping control programmes in Olympic Sports as a total failure and speak publicly for the lift of drugs’ ban in sports. Advocators of the use of performance enhancing substances in elite sports are convinced of a wide-spread phenomenon that nothing can reverse and describe the existing control programmes as motivated by paternalism, as being ineffective, costly, flawed and even endangering the health of the athletes by pushing them to turn to black-market sources, undetectable substances or masking agents. Doping would not mean cheating if the sport authorities had not first made it unethical. They believe that there are no proven serious health problems associated with the use of these substances when administered upon the supervision of a hysician and that as far as competent consenting adults are concerned, doping control programmes conducted by sport authorities constitute an unacceptable paternalistic interference. Since the Tour de France (les événements), we heard experts describing doping as beneficial to the athlete’s health – hormonal re-equilibration – For others, doping should be regarded as a criminal offence.
Doping has no frontiers and it should never be assumed to be restricted to certain countries or sports. Male and females athletes of all origins and sport disciplines and as young as 15 years old, were caught positive. Although in western countries doping is viewed as an individual decision, undoubtedly the pressure on the athlete is nothing else than tremendous (Voy, 1991, Franke, 1998).
While one may consider the wealthy elite athletes to be able to live up to the consequences of doping practices, the pressure for using drugs and medications is not restricted to the elite. Young boys and girls are making use of these substances (CCDS, 1993, Yesalis, 1993, 1997). In last December, a study showed in USA, an increase in the use of anabolic agents amongst young girls that the author attributed in part to their increased opportunity to join athletics! (Yesalis, 1997). A survey made in Montreal showed that 20% of the teenagers participating in specialised school sports programmes were using substances (stimulants) with the intend of increasing their performances.
No doping control programmes exists for many athletes involved in professional sports in North America. Hockey players described how they use cold remedies containing pseudoephedrine before the match – nothing illegal. A baseball player got a home-runs record widely applauded even if it was known that he used androstenedione – nothing illegal. What about the young people? What is the message sent?
The question is simple, do we want our children to be involved in competitive elite sports in 1998?