substance use in athletes woodburne o. levy, md developed for the alcohol medical scholars program

Substance Use In AthletesSubstance Use In Athletes

Woodburne O. Levy, MD

Developed for the Alcohol Medical Scholars Program


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INTRODUCTIONINTRODUCTION

Major problems facing sport today – Growing attention– Deaths of elite athletes– Increasing attention of media

Contrary to the ethical principles of athletic competition

Wide spread among athletes


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DRUGS MISUSED BY ATHLETESDRUGS MISUSED BY ATHLETES

• Therapeutic drugs– OTCs, diuretics, opioids, beta-blockers, etc.

Performance enhancing drugs– Amphetamines, ephedrine, caffeine, anabolic

steroids, growth hormone, etc.

Drugs typically misused– Alcohol, nicotine, marihuana, cocaine, etc.


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GOALSGOALS

Historical perspectiveFactors influencing athletes to use drugsTypes of drugs athletes use- consequences

and mythsPreventing and treating drug use in athletes


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Historical perspectiveHistorical perspective

Ancient civilizations– Mushrooms, herbs, liquor

19th Century– Alcohol, caffeine, nitroglycerine, opium,

strychnine, trimethyl

World War II– Amphetamines, testosterone


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Historical perspectiveHistorical perspective

Post war era– Amphetamines continue– Anabolic steroids

Newer agents– Blood doping– Erythropoietin– Growth hormone


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Currently prohibited by IOCCurrently prohibited by IOC

Drugs– Stimulants, opioids, anabolic agents, diuretics,

peptide hormonesMethods

– Blood doping, artificial oxygen administration, plasma expanders, pharmacological, chemical and physical manipulation

In certain circumstances– Alcohol, cannabinoids, local anesthetics,

blockers


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What factors influences athletes?What factors influences athletes?

Belief that competitors take drugsDetermination to do anything to winPressures from coaches, parents, peersCommunity attitudes and expectationsFinancial rewardsMedia influenceBelief of enhanced performance


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THERAPEUTIC DRUGSTHERAPEUTIC DRUGS

OTCs– NSAIDs, laxatives, ephedrine, analgesics,

weight loss meds, corticosteroids, local anesthetics

– Low potential for misuse– Increased risk of further injury, GI bleed,

anemia, eating disorders


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Diuretics– Rapid weight loss– Boxing, wrestling, judo– Excretion or dilution of illegal substances– Overall negative impact on performance– Dehydration, hypotension, muscle cramps,

electrolyte imbalance


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Opioids– Prescription pain killers most common– Allow performance while injured– 75% used after injury only– Increased risk of further injury, dependence,

drowsiness, mental clouding; in high doses: respiratory depression, hypotension


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Beta-Blockers– Anti-tremor, anxiolytic effect– Shooters, ski jumpers, archery– Negative effect on endurance– Depression, bronchospasm, fatigue


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PERFORMANCE ENHANCING DRUGSPERFORMANCE ENHANCING DRUGS

CNS Stimulants– Amphetamines

Delay fatigue, increase alertness, enhance speed, power, endurance, concentration

– Hypertension, angina, vomiting, abdominal pain, cerebral hemorrhage, dependence, death


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CNS Stimulants– Caffeine

Shortened reaction time, improved concentration, diuresis

Glycogen sparing leading to delayed fatigue> 12 ug/mL is a positive urine per IOC

– Dyspepsia, cardiac damage, combination with other stimulants (e.g. ephedrine) may be fatal


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Systemic stimulants– Adrenalin

In local anesthetics

– Ephedrine and pseudoephedrineCold and allergy remedies

– PhenylpropanolamineDiet pills

– Similar effects to the amphetamines in high doses


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Anabolic androgenic steroids– Derivatives of testosterone– First use generally later than other drugs– Drug and method sought for maximum

anabolic and minimum androgenic properties– Sprinting, weight lifting, body building– Acne, abnormal LFTs, feminization,

virilization, premature closure of the epiphysial plates, behavioral changes “roid rage”, CVAs, cardiomyopathy


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Beta 2 agonists– Isoproterenol, epinephrine, norepinephrine– Sympathomimetic amines, anabolic properties– Cardiac arrhythmias in overdose, headaches

Peptide hormones: HCG– Increases testosterone– Maintains testicular volume with anabolic

steroid use– Ovarian cysts


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Pituitary and synthetic gonadotropins– Increases testosterone, anti- estrogenic– Ovarian cysts

Corticotropins– Increase testosterone– Rare and related to excess corticosteroids-

pituitary suppression, immunity, osteoporosis, hyperglycemia


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Growth hormone– Increase muscle mass & decrease fat mass– Gigantism, acromegaly, hypothyroidism,

cardiac disease, myopathies, arthritis, diabetes mellitus, impotence, osteoporosis


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Erythropoietin (EPO)– Stimulates RBC production– Increases oxygen carrying capacity– CVAs

Blood doping– RBC transfusion, artificial oxygen carriers– Increases oxygen carrying capacity– Allergic reactions, sludging of blood


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FOOD SUPPLEMENTSFOOD SUPPLEMENTS

Viewed as legal means of gaining edge76-100% of athletes use vs. 50% general

populationMay or may not contribute to enhanced

performance– Creatine, colostrum, antioxidants, sodium

bicarbonate, vitamins, proteins, amino acids– Adverse effects not investigated


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TYPICAL DRUGS OF MISUSETYPICAL DRUGS OF MISUSE

Most common: marijuana, cocaine, alcohol Generally have negative effect on performance Substance misuse same in college athletes vs. non-

athletes Decrease in use of marijuana, amphetamines and

cocaine, but increase in smokeless tobacco use, 1985-1996

Most drugs first used in junior or senior high school (for recreation not performance)


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Alcohol– Most frequently used– Negative impact on reaction time, hand-eye

coordination, balance, strength– Excessive heat production and dehydration– Cardiovascular and GI complications,

nutritional deficiencies, dependence


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Cocaine– Minimal performance enhancing effect– Heightened arousal and increased alertness

with low doses– Over confidence leading to increased risk of

injury– MI, CVA, seizures, arrhythmias, dependence


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Cannabinoids– Most frequent illegal drug used in the US– Male athletes have higher incidence than

non-athletic peers (opposite for females)– Initial use in high school– Psychomotor impairment, distorted

perception, amotivational syndrome; decreased testosterone with long-term use


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Nicotine– Majority use in form of smokeless tobacco– Males >> females– 52% of baseball players, 26% of varsity football

players used smokeless tobacco (early 1990s California college survey)

– Highest risk for baseball players– Cardiovascular and pulmonary disease, oral

cancers, dependence


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PREVENTION AND TREATMENTPREVENTION AND TREATMENT

Drug testing– Commonplace in amateur and professional

sports– 65% of college athletes agree with testing – 37% agreed that positive should result in

disqualification – 67% of college athletes believe that drug testing

deters drug use


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DRUG PROGRAMSDRUG PROGRAMS

Administered by leagues and associations (NCAA, NFL, NBA)– Responsible for relevant events, fairness,

quality of competition, safety, image of their athletes and events

– Deter use by testing and discipline– Some include evaluation and treatment– Coaches can discourage use


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DRUG PROGRAMSDRUG PROGRAMS

Identify individuals with drug problem to facilitate treatment

Keys to successful drug program:– Inclusion of all involved parties– Reliable and sensitive testing program– Consistent discipline– Evaluation of effectiveness– Confidentiality– Early prevention


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CHALLENGESCHALLENGES

Most drugs not prescribedViewed as essential for successEasy access to drugsPhysician dilemma/role

– Monitoring side effects– Why?, discuss pro/cons, appraisal, explore

optionsNeed for collaboration


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SUMMARYSUMMARY

Substance use in athletes dates to ancient times

Multiple factors why athletes use drugsTypes of drugs used range from therapeutic

and performance enhancing to typical drugs of misuse

Programs are in place to address drug use in athletes

substance use in athletes woodburne o. levy, md developed for the alcohol medical scholars program

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