Doping in sports and its spread to at-risk populations : an international review / David A. Baron, David M. Martin, Samir Abol Magd. – (World psychiatry 6 (2007) 2 (June); p. 54-59)

• PMCID: PMC2219897

Doping is now a global problem that follows international sporting events worldwide. International sports federations, led by the International Olympic Committee, have for the past half century attempted to stop the spread of this problem, with little effect. It was expected that, with educational programs, testing, and supportive medical treatment, this substance-abusing behavior would decrease. Unfortunately, this has not been the case. In fact, new, more powerful and undetectable doping techniques and substances are now abused by professional athletes, while sophisticated networks of distribution have developed. Professional athletes are often the role models of adolescent and young adult populations, who often mimic their behaviors, including the abuse of drugs. This review of doping within international sports is to inform the international psychiatric community and addiction treatment professionals of the historical basis of doping in sport and its spread to vulnerable athletic and non-athletic populations.

Human enhancement drugs and the pursuit of perfection /
J. McVeigh, M. Evans-Brown, M.A. Bellis. – (Adicciones 24 (2012) 3 : p. 185-190)

• PMID: 22868973

The emerging threat to public health posed by the use of human enhancement drugs has remained largely unrecognised. In attempts to become stronger, happier or smarter, or to look thinner, younger or more beautiful, people are turning to a diverse range of pharmaceuticals. The widespread availability of drugs with the potential to improve human attributes, appearance and abilities has generated a new and growing audience of users. Unlike users of drugs such as heroin, cocaine etc, users of human enhancement drugs do not necessarily perceive themselves as 'drug users'. Those attracted to these drugs may have little or no knowledge or understanding of the physical or psychological harm associated with these substances or their potential for addiction. In addition to the potent effects of many human enhancement drugs, there are considerable risks associated to the clandestine nature of the market. The growing number of untested, banned or adulterated drugs and the lack of safeguards and quality assurance in the illicit manufacturing process has resulted in serious harms and fatalities. The ease with which pharmaceuticals can be manufactured and distributed, combined with the significant profits that can be made from the illicit market, has resulted in a growing challenge for policy makers and health systems in many countries. This editorial aims to raise awareness of this emerging drugs situation and provide a brief overview of some of the drugs and their associated risks.

Sudden or Unnatural Deaths Involving Anabolic-androgenic Steroids / Shane Darke, Michelle Torok, Johan Duflou. – (Journal of Forensic Sciences (2014) : p. 1-4)

• doi: 10.1111/1556-4029.12424

Anabolic-androgenic steroids (AASs) are frequently misused. To determine causes of death, characteristics, toxicology, and pathology of AAS positive cases, all cases (n = 24) presenting to the New South Wales Department of Forensic Medicine (1995–2012) were retrieved. All were male, and the mean age was 31.7 years. Deaths were mainly due to accidental drug toxicity (62.5%), then suicide (16.7%) and homicide (12.5%). Abnormal testosterone/epitestosterone ratios were reported in 62.5%, followed by metabolites of nandrolone (58.3%), stanozolol (33.3%), and methandienone (20.8%). In 23 of 24 cases, substances other than steroids were detected, most commonly psychostimulants (66.7%). In nearly half, testicular atrophy was noted, as was testicular fibrosis and arrested spermatogenesis. Left ventricular hypertrophy was noted in 30.4%, and moderate to severe narrowing of the coronary arteries in 26.1%. To summarize, the typical case was a male polydrug user aged in their thirties, with death due to drug toxicity. Extensive cardiovascular disease was particularly notable.

A methamphetamine analog (N,α-diethyl-phenylethylamine) identified in a mainstream dietary supplement / Cohen, P. A., Travis, J. C. and Venhuis, B. J.. - (Drug Test Analysis (2013 ; 14 October)

• doi: 10.1002/dta.1578)

Pharmaceuticals and banned substances have been detected in hundreds of purportedly natural supplements. Recently, several athletes have been disqualified from competition after testing positive for the methamphetamine analog N,α-diethyl-phenylethylamine (N,α-DEPEA). Athletes have claimed they unknowingly consumed the banned stimulant in workout supplements. Three samples from different lot numbers of Craze, a workout supplement, were analyzed to detect the presence and concentration of N,α-DEPEA. Two labs independently identified N,α-DEPEA in the supplement using ultra high performance liquid chromatography (UHPLC) coupled to an LTQ Orbitrap XL mass spectrometer and UHPLC-quadruple-time-of-flight mass (Q-TOF) spectrometer, respectively. The identity of N,α-DEPEA was confirmed using nuclear magnetic resonance and reference standards. Manufacturer recommended servings were estimated to provide 21 to 35 mg of N,α-DEPEA. N,α-DEPEA has never been studied in humans. N,α-DEPEA is a methamphetamine analog; however, its stimulant, addictive and other adverse effects in humans are entirely unknown. Regulatory agencies should act expeditiously to warn consumers and remove N,α-DEPEA from all dietary supplements.

Copyright © 2013 John Wiley & Sons, Ltd.

Fitness Supplements as a Gateway Substance for Anabolic-Androgenic Steroid Use / Tom Hildebrandt, Seth Harty, James W. Langenbucher. – (Psychology of addictive behaviors 26 (2012) 4 (December); 955-962)

• doi: 10.1037/a0027877. Epub 2012 Apr 9

Approximately 3.0% of young Americans have used anabolic-androgenic steroids (AAS). A traditional model of adolescent substance use, the gateway hypothesis, suggests that drug use follows a chronological, causal sequence, whereby initial use of a specific drug leads to an increased likelihood of future drug use. Therefore, the use of illicit appearance and performance enhancing drugs (APED), such as AASs, also follows an analogous progression, whereby legal APEDs, (e.g., nutritional supplements) precedes illicit APED use. We examined the relationship between nutritional supplement use, beliefs about APEDs, and APED use in 201 male (n = 100) and female (n = 101) undergraduates. Participants completed measures of muscle dysmorphia (MDDI), body checking (BCQ, MBCQ), eating disorder symptoms (EDE-Q), perfectionism (FMPS), positive beliefs about the efficacy-safety of AAS use and APED use patterns. A series of covariance structure models (CSM) showed body image disturbance, compulsive exercise, illicit drug use, and perfectionism, independent of gender, were significant predictors of positive beliefs about AAS. Those who used both fat burning and muscle building supplements reported the strongest beliefs in AAS efficacy-safety, which was associated with higher likelihood of current illicit APED use. There was evidence of significant indirect relationships between supplement use and illicit APED use through contact with other AAS users and beliefs about AAS. The potential role for nutritional supplement use in the initiation of illegal APED use is discussed. Future prevention efforts may benefit from targeting legal APED users in youth.

Enquête onder topsporters over doping, dopingcontroles en medicijngebruik in de sport : evaluatie van de kennis en houding van topsporters over doping, dopingcontroles en medicijngebruik in de sport, alsmede hun oordeel over het voorlichtingsprogramma hieromtrent / S. de Groot, F. Hartgens, M.F. Zweers. – Rotterdam : Nederlands Centrum voor Dopingvraagstukken (NeCeDo), 1999. – 40 p. : fig.. – (NeCeDo praktijkpublikaties). – Uitg. in samenw. met Nationaal Olympisch Comité*Nationale Sport Federatie (NOC*NSF)
Met lit. opg. – Met samenvatting in het Engels
ISSN 1383-6730 ; 2

Het doel van deze enquete was voor het Nederlands Centrum voor Dopingvraagstukken (NeCeDo) tweeledig. Ten eerste was de enquete bedoeld om inzicht te krijgen in de huidige kennis en houding van topsporters over doping, dopingcontroles en medicijngebruik in de'sport. Ten tweede wilde het NeCeDo evalueren welke mening de topsporters over het voorlichtingsprogramma omtrent doping hebben, hoe de naamsbekendheid van het NeCeDo is en hoe de topsporters de dopingwaaier beoordelen.

Inhoud:
1. Samenvatting
2. Summary
3. Inleiding
4. Methoden
5. Resultaten
6. Discussie
7. Conclusie
8. Aanbevelingen

Summary:

Aim of the study:
For this study two main goals were set. Firstly, the study was performed to determine the knowledge and attitude of elite athletes about doping, doping tests and drug use. In the second place this investigation was pointed towards the opinion of the elite athletes regarding the education program of doping. Therefore, the following questions were formulated: a) How do elite athletes evaluate the doping education program? b) Are the elite athletes familiar with the Netherlands Centre for Doping Affairs (NeCeDo) and the doping guide and how do they assess this guide? c) Which groups (e.g. age, level of sport) need extra education concerning doping?

Methods:
The study was performed by means of a questionnaire. A total number of 1332 elite athletes, registered in the files of the Dutch Olympic Committee (NOC*NSF), received a questionnaire.

Results:
Subjects: A response rate of 44.7% was obtained. Most of the subjects were aged between 18 and 25 years (56.8%). The cooperating elite athletes performed their sport mainly at the A- (40.2%) or B2- level (44.8%). The majority of the respondents was supported by a national coach (59.8%), the individual/club trainer (55.5%), the individual/club coach (54.6%), the parents (44.5%) and a physical therapist (44.0%). A great part of the respondents (53.2%) had never experienced a doping test.
Knowledge: 69.7% of the respondents did not know that, even if the athlete doesn't agree with the doping test, he or she always has to sign the doping test form. 21.2% of the athletes were not aware that a refusal of a doping test may lead to a ban of the athlete. A majority did not know that dietary supplements (37.5%), cough mixture (19.2%), natural food products (41.4%) and drugs on doctors prescription (27.9%)
may contain substances of doping.
Attitude: Sixteen subjects (2.7%) admitted to have used a doping substance in the past. Nineteen respondents (3.2%) admitted to consider the use of performance enhancing drugs. One third of the respondents did not examine their own drugs with respect to doping regulations. A vast majority of the respondents (87.2%) indicated that there were no pressures present to use performance-enhancing drugs. In addition, a large majority (72.4%) indicated that there was no pressure concerning not using doping in the Netherlands. Most elite athletes advocated an increase in the number of doping tests (54.5%), of out-of-competition doping tests (46.2%) and of doping tests during important competitions (68.3%). To the opinion of, most respondents (67,9%) the punishments after a positive test result had to be more severe.
Education: Most elite athletes had received information of doping, doping tests and drug use from the NOC*NSF (51.3%), the national sport association (36.6%) and the NeCeDo (33.8%). The respondents were not well informed about the doping rules in the sport (52.1%), the procedure of doping tests (49.7%), use of drugs (64.2%) and about dietary supplements (74.2%). The youngest athletes (younger than 18 years) admitted to feel informed badly. For information about doping related subjects, the majority consulted to the doctor of their national team (44.2%). Older athletes (31 years and older) consulted their general practitioner about doping more frequently. The elite athletes appreciated to receive more information about doping regularly.
NeCeDo/Doping guide: Half of the respondents had never heard of the NeCeDo before they received the questionnaire. Those who knew the NeCeDo before, were made familiar by the NOC*NSF (75.1%). A majority of the athletes (53.4%) did not know how to contact the NeCeDo. Almost 55% of the respondents were familiar with the NeCeDo doping guide in a fan-shaped formation. 84% of them had received this doping guide, mainly via the NOC*NSF. Three quarter of the cooperating athletes was satisfied with the quality of the doping guide. Again the youngest athletes were less familiar with the NeCeDo and the doping guide.

Conclusions:
Overall, it can be concluded that the general knowledge of elite athletes concerning doping is not optimal and needs to be improved. Most of the athletes supported the idea of a more severe doping policy regarding the number of doping tests and penalties. Not all the respondents felt well informed about doping. Certain items, like dietary supplements and the use of drugs, need more attention. The NeCeDo was not very well known in the group of athletes. Not everybody knew how to contact the NeCeDo. The doping guide was evaluated rather well although several topics should be added or extended. Especially, the youngest group of elite athletes (below 18 years) requires more education.

Recommendations:
To increase the response rate of the survey it will be better to send the questionnaire to the elite athletes in the months November/December. Those months are quieter concerning competition or tournaments.
A great part of the athletes supported a more severe doping policy. The NOC*NSF and Dutch government have started a more sever doping policy. The youngest athletes (younger than 18) and the athletes of the lowest sport category are not well informed. Those groups need more information about doping. This might be realized by informing these groups about doping as soon as they receive their official B/C license of the NOC*NSF. An important way to inform the athletes seems to be via the sports associations (e.g. the associations magazine), at training hours and tournaments. Up to date information can be provided by a newsletter for the athletes supported by the NOC*NSF. The education program has to be objective and practical. The NeCeDo doping guide in a fan-shaped form provides a lot of information. According to the respondents the guide has to contain up to date information. This may be realized by releasing a new edition every year or by releasing some pages with the latest developments, which can be added to the doping guide. The terminology should be simple and unequivocal. Because the athletes would like to receive a lot of information about doping and the fan-shaped doping guide should stay handy-sized, it might be an interesting idea to release a more detailed book besides the doping guide. Furthermore, a number of athletes indicated interest in improving their knowledge about doping by means of a symposium or course. The education program should also be directed towards coaches, doctors et cetera.
Most of the athletes will first contact these persons with questions about doping. The NeCeDo is not very well known by the athletes. Therefore, the name and address of the NeCeDo should be written more prominent on the distributed information.

Striking down the “Osaka Rule” – An unnecessary departure / Jan F. Orth. – (International Sports Law Journal (2012) 3-4 : p. 28-34)

Content:
1.) Introduction
1.1.) The sport politics background
1.2.) Factual background of the case
2.) The decision of the Court of Arbitration for Sport
3.) Critical Review
4.) Conclusion

The reasoning of the CAS in its decision CAS 2011/O/2422, which strikes down the “Osaka Rule”, consists of 23 single-spaced pages and seems therefore to be well substantiated.
However, a critical review of the reasoning reveals remarkable shortcomings in the argumentation scheme of the competent CAS panel. The author reaches the result that the invalidation of this important anti-doping provision was not compelling at all.

Proportionality and the application of the World Anti-Doping Code / Herman Ram. – (International Sports Law Journal (2012) 3-4 : p. 8-11)

Content:
1.) Introduction
2.) The Athlete’s Position
2.1.) Legal Counsel
2.2.) Confidents and Activists
2.3.) Disciplinary Panels
3.) The NADO’s Position
3.1.) The Position of NADO’s in the Code
3.2.) The Position of the Dutch NADO
4.) The Approach of the Dutch Doping Authority
4.1.) Pre-Hearing Information
4.2.) Legal Opinions
4.3.) Right to Appeal
4.4.) Impartial Advice
5.) Conclusions and Discussion

the present World Anti-Doping Code (the Code) offers relevant possibilities for individual assessment of doping cases. This is not always recognized by the general public and, more importantly, it is not always understood by legal counsel, which acts on behalf of the athlete in doping cases. In other words, there is limited but relevant room for flexibility and proportionality proportionality within the Code, but this room is not always used as it could and should be.

In this article, the Author will try to shed some light on the positions of athletes (paragraph 2) and Anti-Doping Organizations (paragraph 3), in relation to the proportionality issue introduced above. In the fourth paragraph, he will describe the approach of the Dutch Doping Authority, and the fifth and last paragraph provides some conclusions and input for further discussion.

A Critical Analysis of Article 4.3 of the World Anti Doping Code / Steve Cornelius. – (International Sports Law Journal (2012) 3-4 : p. 3-7)

Content:
1.) Introduction
2.) Prohibited List
3.) Can the Prohibited List be Challenged?
4.) The Way Forward
5.) Conclusion: Proposed Amendments

This article provides a critical analysis of article 4.3 of the Code and questions whether the Prohibited List can be challenged on the grounds that one or more of the substances or methods have been inappropriately classified in terms of article 4.3 and should therefore not be included on the Prohibited List. This article does not address issues relating to the prudence or desirability to include or not to include any particular substance or method on the Prohibited List. It merely highlights flaws in the drafting of article 4.3, warns of a potential basis on which WADA and the Prohibited List can be challenged and proposes ways to deal with this risk.

The Battle over the Osaka Ruling / Daniel Gandert. – (International Sports Law Journal (2012) 1-2 : p. 111-122)

Content:
1.) Introduction
2.) Background Relating to the Osaka Rule
3.) The Need for Strict, Uniform Anti-Doping Rules
4.) The Prescribed Penalties for Doping Under the World Anti-Doping Code
5.) CAS and the Principle of Proportionality
5.1.) The History of Proportionality
5.2.) The Legal Requirement for Proportionality
6.) Cases under the Osaka Rule
6.1.) Jessica Hardy’s Case
6.2.) LaShawn Merritt’s Case
6.3.) CAS Reaches Decision Regarding the Osaka Rule
6.4.) The Effect of the CAS Decision on the Osaka Rule
7.) Conclusion

The IOC’s Osaka Rule prohibited any athlete with a doping suspension of greater than six months from competing in the next Olympic Games, even for cases where the athlete’s suspension has already been completed. In October of 2011, the Court of Arbitration for Sport (CAS) invalidated the Osaka Rule which prevented athletes who committed a doping offence inadvertently from receiving disproportionately harsh consequences relative to their violation.
The first part of this article will describe the background relating to the Osaka Rule. The second part article will describe the system in place to prevent doping. The third part will discuss the principle of proportionality.
First, the history of the principle in CAS jurisprudence will be discussed through a description of important cases. Second, the importance of proportionality will be explained. The fourth part will
describe the three cases dealing with the Osaka rule as well as the impact of these cases on the Olympic World.