The implications of methylphenidate use by healthy medical students and doctors in South Africa / Chad Beyer, Ciara Staunton, Keymanthri Moodley. - (BMC Medical Ethics 15 (2014) 20 (4 March); p. 1-8)

• PMID: 24592964
• PMCID: PMC3974029
• DOI: 10.1186/1472-6939-15-20

Abstract

Background: The use of medical stimulants to sustain attention, augment memory and enhance intellectual capacity is increasing in society. The use of Methylphenidate for cognitive enhancement is a subject that has received much attention in the literature and academic circles in recent times globally. Medical doctors and medical students appear to be equally involved in the off-label use of Methylphenidate. This presents a potential harm to society and the individual as the long-term side effect profile of this medication is unknown.

Discussion: The implication of the use of Methylphenidate by medical students and doctors has not been fully explored. This article considers the impact of this use on the traditional role of medicine, society, the patient and suggests a way forward. We discuss the salient philosophy surrounding the use of cognitive enhancement. We query whether there are cognitive benefits to the use of Methylphenidate in healthy students and doctors and whether these benefits would outweigh the risks in taking the medication. Could these benefits lead to tangible outcomes for society and could the off label-use of Methylphenidate potentially undermine the medical profession and the treatment of patients? If cognitive benefits are proven then doctors may be coerced explicitly or implicitly to use the drug which may undermine their autonomy. The increased appeal of cognitive enhancement challenges the traditional role of medicine in society, and calls into question the role of a virtuous life as a contributing factor for achievement. In countries with vast economic disparity such as South Africa an enhancement of personal utility that can be bought may lead to greater inequities.

Summary: Under the status quo the distribution of methylphenidate is unjust. Regulatory governmental policy must seek to remedy this while minimising the potential for competitive advantage for the enhanced. Public debate on the use of cognitive enhancement is long overdue and must be stimulated. The use of Methylphenidate for cognitive enhancement is philosophically defendable if long-term research can prove that the risks are negligible and the outcomes tangible.

The influence of age of onset and acute anabolic steroid exposure on cognitive performance, impulsivity, and aggression in men / Tom Hildebrandt, James W. Langenbucher, Adrianne Flores, Seth Harty, Heather A. Berlin. - (Psychology of Addictive Behaviors 28 (2014) 4 (December); 1096-1104)

• PMID: 24841181
• PMCID: PMC4237679
• DOI: 10.1037/a0036482

Erratum included:

• Psychol Addict Behav. 2014 Dec;28(4):1104. Berlin, Heather [corrected to Berlin, Heather A]

Abstract

A growing translational literature suggests that adolescent exposure to anabolic-androgenic steroids (AASs) leads to increased aggression and impulsivity. However, little is known about the cognitive effects of AASs among AAS users or the differences between adolescent- and adult-onset users. This study provides a test of the effects of acute naturalistic AAS use and age of onset (adolescent vs. adult) on measures of inhibitory control, planning and attention, and decision making. Seventy-one active adult male AAS users completed self-report measures of impulsivity and aggression, and a subsample (11 adolescent onset vs. 11 adult onset) matched on current age were administered 4 computerized tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) (Cambridge Cognition, 2002) and the Iowa Gambling Task (Stanton, Liening, & Schultheiss, 2011). Multiple regression analyses and a series of 2 (adolescent vs. adult) × 2 (on-cycle vs. off-cycle) analyses of variance (ANOVAs) were used to examine the differential effects of age of onset and acute drug use on cognition and behavior. Regression analyses revealed larger on-cycle effects for adolescent users than adult users. Subsample analyses indicated that on-cycle users performed less well on cognitive measures of inhibitory control and attention, but not on tests of planning or decision making. Adolescent onset was associated with greater impulsivity and more acute sensitivity to AAS effects on attention. These preliminary findings suggest the possibility that acute AAS use is associated with some differences in inhibitory control and impulsivity and to a lesser degree, aggression. These effects may be more potent for those initiating AAS use in adolescence.

The Influence of Concomitant Use of Alcohol, Tobacco, Cocaine and Anabolic Steroids on Lipid Profiles of Brazilian Recreational Bodybuilders / Paulo Adriano Schwingel, Cláudio Cesar Zoppi, Helma Pinchemel Cotrim. - (Substance Use & Misues 49 (2014) 9 (July); p. 1115-1125)

• PMID: 24766402
• DOI: 10.3109/10826084.2014.903753

Abstract

Anabolic-androgenic steroids (AAS) are used to enhance physical performance and/or appearance. The aim of this study was to evaluate the influence of the concomitant use of alcohol, tobacco, cocaine, and AAS on blood lipid profiles of 145 asymptomatic male bodybuilders from the Northeast region of Brazil. Interviews, clinical exams, and serological evaluations were performed on all participants between 2007 and 2009. All subjects' self-reported use of testosterone or its derivatives, 118 individuals reported alcohol intake, 27-reported cigarette smoking, and 33 confirmed cocaine use. Four subjects were users of all drugs at the same time. Higher levels of total cholesterol and LDL-cholesterol were observed among concomitant users of alcohol, tobacco, cocaine, and AAS.

The Influence of Training Load on Hematological Athlete Biological Passport Variables in Elite Cyclists / Tiffany Astolfi, Fabienne Crettaz von Roten, Bengt Kayser, Martial Saugy, Raphael Faiss. - Frontiers in Sports and Active Living (2021) 18 March)

• PMID: 33817634
• PMCID: PMC8012815
• DOI: 10.3389/fspor.2021.618285

Abstract

The hematological module of the Athlete Biological Passport (ABP) is used in elite sport for antidoping purposes. Its aim is to better target athletes for testing and to indirectly detect blood doping. The ABP allows to monitor hematological variations in athletes using selected primary blood biomarkers [hemoglobin concentration (Hb) and reticulocyte percentage (Ret%)] with an adaptive Bayesian model to set individual upper and lower limits. If values fall outside the individual limits, an athlete may be further targeted and ultimately sanctioned. Since (Hb) varies with plasma volume (PV) fluctuations, possibly caused by training load changes, we investigated the putative influence of acute and chronic training load changes on the ABP variables. Monthly blood samples were collected over one year in 10 male elite cyclists (25.6 ± 3.4 years, 181 ± 4 cm, 71.3 ± 4.9 kg, 6.7 ± 0.8 W.kg-1 5-min maximal power output) to calculate individual ABP profiles and monitor hematological variables. Total hemoglobin mass (Hbmass) and PV were additionally measured by carbon monoxide rebreathing. Acute and chronic training loads-respectively 5 and 42 days before sampling-were calculated considering duration and intensity (training stress score, TSSTM). (Hb) averaged 14.2 ± 0.0 (mean ± SD) g.dL-1 (range: 13.3-15.5 g·dl-1) over the study with significant changes over time (P = 0.004). Hbmass was 1030 ± 87 g (range: 842-1116 g) with no significant variations over time (P = 0.118), whereas PV was 4309 ± 350 mL (range: 3,688-4,751 mL) with a time-effect observed over the study time (P = 0.014). Higher acute-but not chronic-training loads were associated with significantly decreased (Hb) (P <0.001). Although individual hematological variations were observed, all ABP variables remained within the individually calculated limits. Our results support that acute training load variations significantly affect (Hb), likely due to short-term PV fluctuations, underlining the importance of considering training load when interpreting individual ABP variations for anti-doping purposes.

The International Antidoping System and Why It Works / Larry D. Bowers. – (Clinical Chemistry 55 (2009) 8 (August) : p. 1456-1461)

Purpose of this article is to provide an overview of how the current antidoping rules came into effect, to review some of the science underlying the antidoping rules, and to discuss a few of the cases decided by the Court of Arbitration in Sport (CAS).

The Internet and drug markets / Jane Mounteney, Alessandra Bo, Alberto Oteo. - Lisbon : European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 2016

• ISBN: 978-92-9168-841-8
• DOI: 10.2810/324608

Abstract:

The last decade has seen the emergence of new internet technologies that have acted as important facilitators of online drug markets. The internet now hosts a range of virtual marketplaces (both on the surface and deep web) for selling and buying illicit substances, as well as representing a new arena for health and law enforcement interventions. This first EMCDDA investigation into the world of online drug markets brings together state-of-the-art input from over 20 experts - from academia, journalism and frontline practice - and contributes to the knowledge base on this part of the supply chain.

Content:

• CHAPTER 1: The internet and drug markets: shining a light on these complex and dynamic systems
  * Jane Mounteney, Alberto Oteo and Paul Griffiths
  • SECTION I: Dark net cryptomarkets
• CHAPTER 2: Cryptomarkets and the future of illicit drug markets
  * Judith Aldridge and David Décary-Hétu
• CHAPTER 3: Tor and links with cryptomarkets
  * Andrew Lewman
• CHAPTER 4: Staying in the shadows: the use of bitcoin and encryption in cryptomarkets
  * Joseph Cox
• CHAPTER 5: Reputation is everything: the role of ratings, feedback and reviews in cryptomarkets
  * Joseph Cox
  • SECTION II: Dark net markets — key actor perspectives
• CHAPTER 6: Silk Road: insights from interviews with users and vendors
  * Eileen Ormsby
• CHAPTER 7: The emergence of deep web marketplaces: a health perspective
  * Fernando Caudevilla
• CHAPTER 8: The drug trade on the deep web: a law enforcement perspective
  * Joost van Slobbe
• CHAPTER 9: How the use of the internet is affecting drug trafficking practices
  * Anita Lavorgna
  • SECTION III: Surface web markets and social media
• CHAPTER 10: A method for exploring the number of online shops selling new psychoactive substances: initial I-TREND project results
  * Magali Martinez, Daniela Kmetonyová and Vendula Běláčková
• CHAPTER 11: Online supply of medicines to illicit drug markets: situation and responses
  * Lynda Scammell and Alessandra Bo
• CHAPTER 12: Social media and drug markets
  * Danica Thanki and Brian Frederick
  • SECTION IV: Insights and implications
• CHAPTER 13: What is the future for internet drug markets?
  * Jane Mounteney, Paul Griffiths and Liesbeth Vandam

The Legal Nature of Doping Law / Janwillem Soek. – (International Sports Law Journal (2002) 2 : p. 2-7)

Content:
- Doping as a social phenomenon
- The legal instruments
- Conclusion

In the disciplinary law concerning doping, use has to be made of the principles and doctrines which have reached maturity in the sanctioning systems of the states, i.e. criminal law, and which are universally recognized, in order to attain a just and fair balance between the interests of the prosecuting sport organization and the prosecuted athlete who is suspected of having used doping.

The List of Prohibited Substances and Methods in Sport: Structure and Review Process by the World Anti-Doping Agency / Irene Mazzoni, Osquel Barroso, Olivier Rabin. – (Journal of Analytical Toxicology 35 (2011) 9 (November/December) : p. 608-612) PMID: 22080899
Content:
- Historical Background
- The Prohibited List Under WADA
• Periodic update of the list
• Criteria to include substances or methods in the List
• Categories and subcategories under the List
• Monitoring Program
- Conclusions

The List of Prohibited Substances and Methods (the List) is the International Standard that determines what is prohibited in sport in- and out-of-competition. The official text of the List is produced by the World Anti-Doping Agency (WADA), the international independent organization responsible for promoting, coordinating and monitoring the fight against doping in sport. The drafting of the annual List is a highly interactive and consultative process involving scientific and medical experts in anti-doping, sport federations and governments. In this article, the elements that compose the List as well as the process behind its annual revision and update are presented.

Bain J.
Clin Interv Aging. 2007;2(4):567-76.

Testosterone is more than a "male sex hormone". It is an important contributor to the robust metabolic functioning of multiple bodily systems. The abuse of anabolic steroids by athletes over the years has been one of the major detractors from the investigation and treatment of clinical states that could be caused by or related to male hypogonadism. The unwarranted fear that testosterone therapy would induce prostate cancer has also deterred physicians form pursuing more aggressively the possibility of hypogonadism in symptomatic male patients. In addition to these two mythologies, many physicians believe that testosterone is bad for the male heart. The classical anabolic agents, 17-alkylated steroids, are, indeed, potentially harmful to the liver, to insulin action to lipid metabolism. These substances, however, are not testosterone, which has none of these adverse effects. The current evidence, in fact, strongly suggests that testosterone may be cardioprotective. There is virtually no evidence to implicate testosterone as a cause of prostate cancer. It may exacerbate an existing prostate cancer, although the evidence is flimsy, but it does not likely cause the cancer in the first place. Testosterone has stimulatory effects on bones, muscles, erythropoietin, libido, mood and cognition centres in the brain, penile erection. It is reduced in metabolic syndrome and diabetes and therapy with testosterone in these conditions may provide amelioration by lowering LDL cholesterol, blood sugar, glycated hemoglobin and insulin resistance. The best measure is bio-available testosterone which is the fraction of testosterone not bound to sex hormone binding globulin. Several forms of testosterone administration are available making compliance much less of an issue with testosterone replacement therapy.

The market of sport supplement in the digital era: A netnographic analysis of perceived risks, side-effects and other safety issues / Valeria Catalani, Attilio Negri, Honor Townshend, Pierluigi Simonato, Mariya Prilutskaya, Anna Tippett, Ornella Corazza. - (Emerging Trends in Drugs, Addictions, and Health 1 (2021) 100014 (13 June))

• DOI: 10.1016/j.etdah.2021.100014

Abstract

Background

The market of sport supplements is expanding worldwide. Such phenomenon is often supported by captivating marketing strategies and social media advertising providing unscientifically founded claims, thus raising safety concerns. The aim of our study is to provide a comprehensive analysis of the online market, patterns of use, perceived risks and other safety issues on supplement use as reported in online fitness communities.

Methods

A mixed method approach was employed. An automatized web-based monitoring tool (Brand24®) was used to track the most popular supplements and related discussions according to the number of interactions between users and shares; the number and category of websites; the social media reach; and the most popular hashtags. Results were assessed through a netnographic qualitative analysis of online fitness fora, to identify motivations of intake, self-reported side effects andthe overall safety perception reliability of supplements information online.

Results

A social media reach of over four million individuals, inclusive of 18595 posts, emerged from our search. The most cited supplements were “Whey Protein”, “Branched Chain Amino-Acid”, “Creatine”, “Multivitamin supplements” and “Nitric Oxide boosters”. Supplements were mainly taken for muscle gain (23%), increase energy (17%), and weight loss (8%). Although the web narrative on supplementation was overall positive, a wide range of side effects were reported by 19% of fitness fora users. These included acne (9%), water retention (9%), stomach pain (9%), rashes (7%), erectile dysfunctions (7%) and weight gain (5%). Concerns about contamination (47%), counterfeit content (17%) and the presence of hidden ingredients (11%) were also recorded.

Conclusions

In a poorly regulated context, where unsolicited social media posts have replaced the typical advice provided by professionals, efforts should be made to ensure the reliability of the provided information to avoid the insurgence of unwanted adverse effects and safeguard public health.