Transcript Substance Abuse In Athletes

Substance Use In Athletes
Woodburne O. Levy, MD
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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.
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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
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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
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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?
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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
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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
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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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THERAPEUTIC DRUGS
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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 DRUGS
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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
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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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PERFORMANCE ENHANCING DRUGS
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Systemic stimulants
– Adrenalin
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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
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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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PERFORMANCE ENHANCING DRUGS

Beta 2 agonists
– Isoproterenol, epinephrine, norepinephrine
– Sympathomimetic amines, anabolic properties
– Cardiac arrhythmias in overdose, headaches
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Peptide hormones: HCG
– Increases testosterone
– Maintains testicular volume with anabolic
steroid use
– Ovarian cysts
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PERFORMANCE ENHANCING DRUGS
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Pituitary and synthetic gonadotropins
– Increases testosterone, anti- estrogenic
– Ovarian cysts
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Corticotropins
– Increase testosterone
– Rare and related to excess corticosteroids-
pituitary suppression,  immunity,
osteoporosis, hyperglycemia
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PERFORMANCE ENHANCING DRUGS
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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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PERFORMANCE ENHANCING DRUGS
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Erythropoietin (EPO)
– Stimulates RBC production
– Increases oxygen carrying capacity
– CVAs
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Blood doping
– RBC transfusion, artificial oxygen carriers
– Increases oxygen carrying capacity
– Allergic reactions, sludging of blood
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FOOD SUPPLEMENTS
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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
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Most common: marijuana, cocaine, alcohol
Generally have negative effect on performance
Substance misuse same in college athletes vs. nonathletes
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
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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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TYPICAL DRUGS OF MISUSE
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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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TYPICAL DRUGS OF MISUSE
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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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TYPICAL DRUGS OF MISUSE
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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 TREATMENT
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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
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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
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Identify individuals with drug problem to
facilitate treatment
 Keys to successful drug program:
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Inclusion of all involved parties
Reliable and sensitive testing program
Consistent discipline
Evaluation of effectiveness
Confidentiality
Early prevention
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CHALLENGES
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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
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Need for collaboration
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SUMMARY
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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
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