🏋🏼Sports Medicine Unit 10 – Pharmacology in sports

What's This Unit About?

• Explores the use and abuse of drugs in sports to enhance athletic performance
• Covers various types of performance-enhancing drugs (PEDs) athletes may use to gain a competitive edge
• Examines how different PEDs work in the body to boost performance
  • Includes stimulants (amphetamines), anabolic steroids, human growth hormone (HGH), erythropoietin (EPO)
• Discusses the short-term and long-term health risks associated with PED use
• Looks at methods used to detect doping in athletes through drug testing
• Explores the ethical dilemmas and legal issues surrounding PED use in sports
• Provides real-world case studies of athletes caught using banned substances

Key Concepts and Terms

• Performance-enhancing drugs (PEDs): substances used by athletes to improve athletic performance beyond natural abilities
• Anabolic steroids: synthetic versions of testosterone that promote muscle growth and strength
  • Examples include nandrolone, stanozolol, oxandrolone
• Stimulants: drugs that increase alertness, attention, energy, heart rate, and blood pressure
  • Includes amphetamines, ephedrine, cocaine
• Blood doping: the practice of boosting red blood cell count to enhance oxygen delivery to muscles
  • Can involve transfusions of additional red blood cells or use of erythropoietin (EPO)
• Human growth hormone (HGH): a peptide hormone that stimulates growth, cell reproduction, and cell regeneration
• Masking agents: drugs used to hide the presence of banned substances in doping tests
• Therapeutic Use Exemptions (TUEs): allows athletes to use a prohibited substance to treat a legitimate medical condition
• World Anti-Doping Agency (WADA): international independent agency that monitors doping in sports

Types of Performance-Enhancing Drugs

• Anabolic steroids: promote muscle growth, strength, and recovery
• Stimulants: increase energy, alertness, reaction time, and endurance
  • Examples: amphetamines, ephedrine, methylphenidate
• Erythropoietin (EPO): hormone that stimulates red blood cell production, increasing oxygen delivery
• Human growth hormone (HGH): builds muscle mass and speeds injury recovery
• Beta-blockers: lower heart rate and reduce tremors, used in precision sports like archery
• Diuretics: promote rapid weight loss and can mask other PEDs in drug tests
  • Often abused by athletes in weight-class sports like wrestling or boxing
• Narcotic analgesics: used for pain relief, can also cause euphoria and reduce fatigue

How Drugs Affect Athletic Performance

• Anabolic steroids increase protein synthesis, leading to increased muscle mass and strength
  • Allow athletes to train harder and recover faster
• Stimulants boost energy levels, increase focus and reaction times
  • Delay onset of fatigue during endurance events
• EPO increases red blood cell production, improving oxygen delivery to muscles
  • Enhances aerobic endurance in sports like cycling and distance running
• HGH promotes muscle growth and speeds recovery from injury
  • Can also have a psychological effect, increasing aggression and competitiveness
• Beta-blockers reduce heart rate and muscle tremors
  • Improves accuracy and precision in target sports like shooting and archery
• Diuretics cause rapid weight loss through fluid loss
  • Helps athletes "make weight" in sports with weight classes
• Narcotic analgesics reduce pain perception and can cause euphoria
  • May allow injured athletes to continue competing

Side Effects and Health Risks

• Anabolic steroids can cause mood swings, aggression, liver damage, and cardiovascular problems
  • In men, may lead to breast development, shrunken testicles, infertility
  • In women, can cause masculinization, menstrual irregularities, deepened voice
• Stimulant abuse can result in anxiety, insomnia, rapid heartbeat, and dehydration
  • High doses may trigger heat stroke or cardiac arrest
• EPO thickens the blood, increasing risk of heart attack, stroke, and pulmonary embolism
• HGH can cause joint pain, muscle weakness, diabetes, and cardiovascular issues
  • Excessive growth of facial features, hands, and feet (acromegaly)
• Diuretic abuse can lead to severe dehydration, kidney damage, and electrolyte imbalances
• Narcotic analgesics are highly addictive and can cause respiratory depression

Doping Detection Methods

• Urine testing: most common method, detects presence of banned substances or their metabolites
  • Some drugs only detectable for a few days after use
• Blood testing: used to detect blood doping, HGH, and some anabolic steroids
  • More expensive and invasive than urine testing
• Athlete Biological Passport (ABP): monitors selected biological variables over time
  • Indirectly reveals effects of doping, rather than detecting substance itself
• Hair testing: can detect drug use over a longer timeframe (months)
  • Not yet widely used or validated for all substances
• Gene doping tests: aim to identify gene therapies that enhance performance
  • An emerging challenge as gene editing techniques advance

Ethical and Legal Issues

• Doping violates the spirit of fair play and creates an uneven playing field
  • Athletes who don't dope may feel pressure to do so to remain competitive
• Long-term health risks of PEDs raise ethical concerns
  • Coaches and sports organizations have a duty of care to protect athlete well-being
• Doping can undermine public trust in the integrity of sports
  • High-profile doping scandals damage the reputation of athletes and their sports
• Anti-doping laws vary by country, making consistent enforcement difficult
  • Some countries have criminalized doping, while others treat it as a civil offense
• Therapeutic Use Exemptions (TUEs) can be exploited as a loophole to use banned substances
  • Strict criteria aim to prevent abuse, but some see TUEs as unfair

Real-World Examples and Case Studies

• Ben Johnson (Canada, sprinting): Stripped of 1988 Olympic gold medal after testing positive for stanozolol
• Lance Armstrong (USA, cycling): Admitted to doping throughout his career, stripped of 7 Tour de France titles
  • Highlights the sophisticated methods used to evade detection, including intimidation of teammates
• Maria Sharapova (Russia, tennis): Tested positive for meldonium in 2016, served a 15-month suspension
  • Raises questions about athlete responsibility to monitor changes in banned substance lists
• Tyson Gay (USA, sprinting): Tested positive for anabolic steroids in 2013, served a one-year ban
  • Cooperated with USADA investigation, had ban reduced for providing substantial assistance
• Russian Olympic doping scandal: Widespread state-sponsored doping program exposed
  • Led to ban of Russian team from 2018 Winter Olympics, with only "clean" athletes allowed to compete as neutrals