Drugs in Sport

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Drugs in Sport

A major problem in sport today is the use of performance enhancing drugs as the rewards of competitive sport are so great (financially and prestige), creating a “win at all cost” attitude and its associated pressures. Many athletes believe (either rightly or wrongly) that their competitors are taking drugs. Other pressures come from peers, coaches, media and government authorities (eg the old Eastern bloc countries). Despite widespread programs to eliminate the use of performance enhancing drugs in sport, the use remains widespread. Most drugs for enhancing performance are widely available on the ‘black market’ which can create ethical dilemma for physicians when athletes seek medical advice regarding the use or side effects.

Generally it is considered a certainty that most athletes using performance enhancing drugs will not get caught cheating. The use of banned substances is usually carefully controlled and limited so as they will not be detected by biochemical indicators.

The basic principles of the case against drug use in sport :
i) Drug misuse is unethical because it contradicts basic pharmaco-therapeutic principles. Drugs ought to be used to treat and prevent disease, not to improve performance in the healthy
ii) Drug misuse is immoral because it represents a form of cheating which contravenes the basic principle of competition between athletes on an equal basis
iii) Drug misuse is dangerous because certain drugs have the potential for serious side effects, which may ultimately jeopardise the health of individual athletes.

Classes of drugs are generally banned for two reasons:
1) The class of drugs is considered to be performance enhancing  unfair competitive advantage  unethical
2) The class of drug may cause an unacceptable risk of side effects (unless medically indicated).

Different sporting codes and different countries will have different regulation and testing procedures for the use of banned drugs/substances. All regulations are underpinned by the concept of ‘unfair advantage’. The regulations of the Medical Commission of the International Olympic Committee (IOC) are the most pervasive. The World Anti-Doping Agency (WADA) promotes and co-ordinates the fight against drug use in sport at an international level.

IOC banned substances:
i) Stimulants
ii) Narcotic analgesics
iii) Anabolic agents
iv) Beta blockers
v) Diuretics
vi) Peptide hormones and analogues
Restricted in certain situations:
i) Alcohol
ii) Local anaesthetics
iii) Corticosteroids
Methods banned:
i) Blood doping
ii) Pharmacological and physical manipulation of the urine (ie ‘masking’)

Drug testing in sport is now commonly carried out – both in and out of competition. A strict protocol for testing urine samples has been developed by the IOC medical commission. Laboratories are accredited by the IOC before they can undertake official analyses.

Detection methods for some banned substances are not yet developed (eg human growth hormone) and other detection methods need further development (eg for erythropoietin). It is very possible that detection methods will not be able to keep pace with the development of newer drugs.

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