Ergogenic Drug Use

Jon Fravel, MS, ATC

Recent Cases

• Jessica Hardy- Swimmer1

– US Olympic Trials– July 1 (Negative) Following 100 Breast– July 4 (Positive)– July 6 (Negative)

• Clenbuterol

Clenbuterol

• Bronchodilator/Anabolic Agent– Longlasting– Domestic Rx equine use for airway obstruction– Abroad on humans• Bronchodilation/Asthmatics

– Reasons for abuse• Anabolic effect• Weightloss

– Bodybuilders– Weightloss Supplement of the Stars!

» Lindsay Lohan

Recent Cases

• Đỗ Thị Ngân Thương –Vietnamese Gymnast– Olympic Games– Furosemide• IOC

Furosemide

• Loop Diuretic (Lasix)– Congestive Heart failure– Edema

• WADA Banned Substance– Masking agent

• Reasons for Abuse– Masking agent– Weight loss

Recent Cases

• NFL– Minnesota Vikings/New Orleans Saints– Banned Diuretic• Star Cap

– Bumetanide

Bumetanide (Bumex)

• Loop Diuretic – Heart failure

• Reason for Abuse– Weight loss– Masking agent

History

• Long history of performance-enhancing drugs (PED)– Greek/Ancient Olympics– Roman Gladiators– IOC in the 1960’s– World Anti-Doping Agency (1999)

History of PED’s

• 1. Modern Olympic Games-1970’s– Administration immediately prior/during

competition• Stimulants• Narcotics• Drugs of Abuse

History of PED’s

• 2. Repeated administration over a period of time. – Anabolic Steroids

History of PED’s

• 3. Pharmaceutical development/involvement of protein chemistry, moelcular biology, and genetic engineering.– Peptide Hormones• EPO• Growth Hormone• Gonadotropins

History of PED’s

• 4? Gene doping via gene therapy.

Level The Playing Field

• Republica Socialistă România– Swimming

Clinical Trials

• Phase I Clinical trials – Activity– Dosage range– Side Effects

• Phase II Clinical Trials– Efficacy– Evaluate Safety

• Phase III – Confirm Evidence– Monitor Side Effects

Side Effects

• Off-Label Drugs– Except Designer Steroids

• Overdosing– Acute/Chronic

• Drug/Drug Interaction– Parallel administration for combined therapeutic

schemes

WADA Anti-Doping Code2008 “Prohibited List”

• S1. Anabolic Agents– 1. Anabolic androgenic steroids • a. Exogenous Anabolic androgenic steroids• b. Endogenous anabolic androgenic steroids

– 2. Other anabolic agents• Clenbuterol and selective androgen receptor

modulators)

Substances

• S2. Hormones and related substances– EPO– HGH– Insulin-like growth factors– Gonadotropins– Insulin

Substances

• S3. β2 Agonists– Salbutamol, salmeterol, formoterol, clenbuterol,

etc.

Substances

• S4. Hormone antagonists and modulators – Antiestrogens– Myostatin inhibitors

Substances

• S5. Diuretics and other masking agents – Diuretics– Epitestosterone– Probenecid– α-reductase inhibitors– Plasma expanders

Prohibited Methods

• M1. Enhancement of oxygen transfers– Blood transfusions – Blood derivatives/analogs

Methods

• M2. Chemical and Physical Manipulation– Physical tampering– IV infusions

Methods

• M3. Gene Doping– “Non-therapeutic use of cells, genes, genetic

elements, or modulation of gene expression, having the capacity to improve athletic performance” (WADA)

Substances and Methods Prohibited in Competition

• S6. Stimulants– Amphetamine, cocaine, etc

• S7. Narcotics– Morphine, opioids

• S8. Cannabinoids– Hashish, marijuana

• S9. Gluccocorticosteroids

Substances Prohibited in Particular Sports

• P1. Alcohol• P2. β-Blockers

Olympic Motto

• "Citius, Altius, Fortius”– Faster, Higher, Stronger

• Olympic Creed– "The most important thing in the Olympic Games

is not to win but to take part, just as the most important thing in life is not the triumph but the struggle. The essential thing is not to have conquered but to have fought well."

References• "Press Release - Hardy - August 2008", USADA (2008-08-01). Retrieved on 2 August 2008.• Botre, F. Pavan, A. Enhancement Drugs and the Athlete. Neurol Clin 26 (2008) 149–167• Wagner JC. Enhancement of athletic performance with drugs. An overview. Sports Med• 1991;12:250–65.• Use of Performance-Enhancing Substances Ped 9/9/05• The World Anti-Doping Code. World anti-doping agency. Montreal (Canada). 2007. Available

at: www.wada-ama.org• NCAA Banned-Drug Classes 2007-08. NCAA. Indianapolis, Indiana. 2008. • Spitzer G. Doping with children. In: Peters C, Schulz T, Michna H, editors. Biochemical side

effects of doping. Ko¨ ln (Germany): Sport ch Strauss; 2001. p. 127–39.• Segura J. Sports. In: Karch SB, editor. Drug abuse handbook. Boca Raton (USA): CRC Press;

1998. p. 641–726.