Drug Abuse by Athletes

Making headlines, Maria Sharapova, a Russian-born professional tennis player currently ranked number-seven in the world by the Women’s Tennis Association, announced on March 7 that she had fail a drug test during the 2016 Australian Open. At her press conference, the athlete explained that her failure came as a result of taking meldonium, a clinically used anti-ischemic drug.

Although the tennis superstar claimed to have been legally taking the drug for a decade to combat a variety of illnesses, the World Anti-Doping Agency (WADA) publicly issued a ban on meldonium effective Jan. 1, 2016. According to the Partnership for Clean Competition, an organization tasked with evaluating global athlete usage of meldonium, after an analysis of 8,300 random, anonymous urine samples collected at doping control sessions it was revealed that 182 (2.2%) contained the apparent energy-shifting drug.

“Mildronate has never been available in the United States other than by direct overseas purchase,” explained Richard Wright, MD, cardiologist and chairman of the Pacific Heart Institute at Providence Saint John’s Health Center in Santa Monica, Calif. “Athletes, mostly in Russia and other areas of the former Soviet Union, have used mildronate in the vain hope that it will improve muscle function and blood flow. At doses used, the drug is likely to be safe but unlikely to be effective.”

In a statement released by the WADA following Sharapova’s press conference, the organization confirmed that the drug was added to the list of prohibited substances due to evidence of its use by athletes with the intention of enhancing performance.

“One of the biggest challenges we face is keeping track of the ever-growing number of new substances that athletes abuse. Through our science capacity, and our List Committee, we have a thorough consultative process that every year examines what should and should not be added to the list of banned substances and methods,” explained Ben Nichols, WADA’s senior media relations and communications manager. “They analyze submissions by our stakeholders in sport and government, and decide whether there is sufficiently solid evidence to make changes to the list. By the end of September, WADA publishes the next year’s list so that sports and anti-doping organizations – we have approximately 670 signatories worldwide – can advise athletes under their jurisdiction of what the changes are.”

sports rehab drug abuse athletes

Doping Prevalence

Sharapova’s failure to comply with WADA standards is far from the first time a sports star has been involved in a doping scandal. The reliance of athletes on substances to enhance their performance has been an ongoing trend for centuries. Whether their goal is to build muscle, perform better, decrease physical pain or to deter early retirement, there is no denying their attempts to cheat the system.

“We fight challenges on a number of different fronts. Lack of regulation of substances worldwide; sheer scale of availability of dangerous, prohibited substances via the internet; the criminal underworld involved in sport and looking to help athletes cheat so that they can get a slice of the profits available from an athlete’s success – these are all concerns,” further explained Nichols. “WADA also works closely with pharmaceutical companies with the aim of sharing information and awareness of substances that might be at risk of abuse. Oppositely, if we’re aware that a substance is being abused, we alert the pharmaceutical companies. Such anti-doping/pharmaceutical partnerships have been a step forward for anti-doping.”

This extreme availability of performance-enhancing substances has led to multiple instances of people suffering serious side effects from products bought online, with many containing counterfeit, illegal or unapproved substances.1 Another problem with vast availability is that, as more athletes find ways to engage in the use of performance-enhancing substances, their teammates and competitors begin to feel the pressure to gain a similar competitive advantage to remain up to par.

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Commonly Misused Substances

One of the most frequently abused categories of substances by athletes is androgens. These include exogenous testosterone, synthetic androgens (e.g., danazol, nandrolone, stanozolol), androgen precursors (e.g., androstenedione, dehydroepiandrosterone), selective androgen receptor modulators, and other forms of androgen stimulation. Their usage by athletes typically occurs in an attempt to increase endogenous testosterone, thereby increasing muscle strength and mass.2

Also banned by WADA, growth hormone and growth factors likewise assist athletes by increasing muscle mass and decreasing adipose tissue. Although not banned, the compound formed in protein metabolism and present in much living tissue, creatine is currently the most popular nutritional supplement for performance-enhancement among athletes. Studies have demonstrated that this substance is capable of increasing maximum power output and lean body mass when consumed.

Stimulants, including amphetamine, D-methamphetamine, methylphenidate, ephedrine, pseudoephedrine, caffeine, dimethylamylamine, cocaine, fenfluramine, pemoline, selegiline, sibutramine, strychnine and modafinil, also top the list of most frequently used performance-enhancing drugs. They are known to improve endurance, increase anaerobic performance, decrease feelings of fatigue, improve reaction time, increase alertness and cause weight loss.2

To increase oxygen transport, athletes have additionally relied on blood transfusions and the erythropoiesis-stimulating agents, recombinant human erythropoietin and darbepoetin alfa. Hypoxia mimetics that stimulate endogenous erythropoietin production, including desferrioxamine and cobalt, are also used alongside artificial oxygen carriers for increased aerobic power and physical exercise tolerance.

Despite consuming these substances in the hopes of achieving better performance, athletes run the risk of encountering numerous negative side effects and ultimately having their careers ended if their methodologies are exposed. This begs the question, is doping really worth the risk?

“I don’t want to end my career this way,” Sharapova commented at her press conference. “I really hope I will be given another chance to play this game.”


1. NPS Medicinewise. Beware performance enhancing drugs. http://sport.gameday.com.au/index.php?id=718&tx_ttnews%5Btt_news%5D=947&cHash=811cf22644

2. National Center for Biotechnology Information, U.S. National Library of Medicine. Drug abuse in athletes. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4140700/

Lindsey Nolen is a staff writer at ADVANCE. Contact: lnolen@advanceweb.com.

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