Substance Use In Athletes

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Substance Use In Athletes

• Woodburne O. Levy, MD
• Developed for the Alcohol Medical Scholars
  Program
  

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INTRODUCTION

• 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 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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GOALS

• Historical perspective
• Factors influencing athletes to use drugs
• Types of drugs athletes use- consequences and
  myths
  
• Preventing and treating drug use in athletes

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Historical perspective

• Ancient civilizations
• Mushrooms, herbs, liquor
• 19th Century
• Alcohol, caffeine, nitroglycerine, opium,
  strychnine, trimethyl
  
• World War II
• Amphetamines, testosterone

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Historical perspective

• Post war era
• Amphetamines continue
• Anabolic steroids
• Newer agents
• Blood doping
• Erythropoietin
• Growth hormone

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Currently prohibited by IOC

• Drugs
• Stimulants, opioids, anabolic agents, diuretics,
  peptide hormones
  
• Methods
• 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?

• Belief that competitors take drugs
• Determination to do anything to win
• Pressures from coaches, parents, peers
• Community attitudes and expectations
• Financial rewards
• Media influence
• Belief of enhanced performance

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THERAPEUTIC 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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THERAPEUTIC DRUGS

• 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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THERAPEUTIC DRUGS

• 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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THERAPEUTIC DRUGS

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

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PERFORMANCE 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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PERFORMANCE ENHANCING DRUGS

• 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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PERFORMANCE ENHANCING DRUGS

• Systemic stimulants
• Adrenalin
• In local anesthetics
• Ephedrine and pseudoephedrine
• Cold and allergy remedies
• Phenylpropanolamine
• Diet pills
• Similar effects to the amphetamines in high doses
  
  

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PERFORMANCE ENHANCING DRUGS

• 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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PERFORMANCE ENHANCING DRUGS

• 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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PERFORMANCE ENHANCING DRUGS

• 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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PERFORMANCE ENHANCING DRUGS

• Growth hormone
• Increase muscle mass decrease fat mass
• Gigantism, acromegaly, hypothyroidism, cardiac
  disease, myopathies, arthritis, diabetes
  mellitus, impotence, osteoporosis

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PERFORMANCE ENHANCING DRUGS

• 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 SUPPLEMENTS

• Viewed as legal means of gaining edge
• 76-100 of athletes use vs. 50 general
  population
  
• May 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 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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TYPICAL DRUGS OF MISUSE

• 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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TYPICAL DRUGS OF MISUSE

• 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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TYPICAL DRUGS OF MISUSE

• 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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TYPICAL DRUGS OF MISUSE

• 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 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 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 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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CHALLENGES

• Most drugs not prescribed
• Viewed as essential for success
• Easy access to drugs
• Physician dilemma/role
• Monitoring side effects
• Why?, discuss pro/cons, appraisal, explore
  options
  
• Need for collaboration

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SUMMARY

• Substance use in athletes dates to ancient times
• Multiple factors why athletes use drugs
• Types of drugs used range from therapeutic and
  performance enhancing to typical drugs of misuse
  
• Programs are in place to address drug use in
  athletes