The modes of administration of anabolic-androgenic steroid users (AAS): are non-injecting people who use steroids overlooked? / Katinka van de Ven, Renee Zahnow, Jim McVeigh, Adam Winstock

• Drugs: Education, Prevention and Policy 27 (2020) 2 , p 131-135
• DOI:10.1080/09687637.2019.1608910

Abstract

Introduction: There is increasing public health concern about the use of anabolic-androgenic steroids (AAS). Understanding of drug use patterns and practices is important if we are to develop appropriate risk-reduction interventions. Yet, much remains unclear about the modes of administration adopted by AAS users.

Methods: We used data from a sub-sample of participants from the Global Drug Survey 2015; males who reported using injectable or oral AAS in their lifetime (n = 1008).

Results: Amongst our sample, approximately one third (35.62%) reported using only injectable AAS during their lifetime while 35.84% reported using only oral, with less than one third (28.54%) using both.

Conclusion: These findings suggest there may be a sub-population of individuals who only use AAS orally. Needle and syringe programmes (NSPs) are currently the primary point of health service engagement; forming the main healthcare environment for medical and harm reduction advice on steroids. Yet, NSP-based resources are unlikely to reach or be appropriate to those who do not inject AAS. While there is a general need for health services to be more accessible when it comes to AAS use, non-injectors are an overlooked group that require attention.

Dual use of anabolic-androgenic steroids and narcotics in Sweden / Nina Gårevik, Anders Rane

• Drug and Alcohol Dependence 109 (2010) 1-3 (June), p. 144-146
• PMID: 20064696
• DOI: 10.1016/j.drugalcdep.2009.12.024

Abstract

Background: Anabolic-androgenic steroids (AAS) have long been used by body-builders seeking to increase muscle size, strength and beauty. AAS are sometimes used together with narcotic agents and are thought to serve as a gateway to narcotic substance use, but this theory has not yet been substantiated clinically or sociologically.

Methods: Mandatory interviews were carried out with individuals (n=56) suspected of infringement of the narcotic laws in Sweden with confiscated and/or confirmed use of AAS. Data were collected over 12 months.

Results: Seventy-three percent of subjects with confirmed use of AAS were also using narcotic substances. The use of AAS was preceded by the use of narcotic agents in 55% of subjects. Only one-fifth of the subjects in the study had used AAS before using narcotic agents.

Conclusion: Co-use of AAS and narcotics agents is frequent among young people taken into custody for criminal activity and investigated by the police in Sweden. The study does not lend support to the hypothesis that AAS are commonly a gateway drug to narcotic use.

Effects of Pre-, Post- and Intra-Exercise Hyperbaric Oxygen Therapy on Performance and Recovery: A Systematic Review and Meta-Analysis / Xizhang Huang, Ran Wang, Zheng Zhang, Gang Wang, Binghong Gao

• PMID: 34887780
• PMCID: PMC8650584
• DOI: 10.3389/fphys.2021.791872

Abstract

Background: As a World Anti-doping Agency (WADA)-approved treatment, hyperbaric oxygen (HBO2) therapy has been used to improve exercise performance in sports practice.

Objective: We aimed to investigate the effect of pre-, post-, and intra-exercise HBO2 therapy on performance and recovery.

Methods: A literature search was conducted using EMBASE, CENTRAL, PubMed, Web of Science, and SPORTDiscus to obtain literature published until May 2021. A total of 1,712 studies that met the following criteria were identified: (1) enrolled healthy adults who were considered physically active; (2) evaluated HBO2 therapy; (3) included a control group exposed to normobaric normoxic (NN) conditions; (4) involved physical testing (isokinetic or dynamic strength exercise, maximal incremental treadmill/cycle exercise, etc.); and (5) included at least one exercise performance/recovery index as an outcome measure. The Cochrane risk of bias assessment tool was used to evaluate the included studies, and the heterogeneity of therapy effects was assessed using the I2 statistic by Review Manager 5.3.

Results: Ten studies (166 participants) were included in the qualitative analysis, and six studies (69 participants) were included in the quantitative synthesis (meta-analysis). In comparisons between participants who underwent HBO2 therapy and NN conditions, the effects of pre-exercise HBO2 therapy on exercise performance were not statistically significant (P > 0.05), and the effects of post-exercise HBO2 therapy on recovery were not statistically significant either (P > 0.05). Although individual studies showed positive effects of intra-exercise HBO2 therapy on exercise performance, a meta-analysis could not be performed.

Conclusion: Hyperbaric oxygen therapy before or after exercise had no significant effect on performance and recovery. However, hyperbaric oxygen therapy during exercise could improve muscle endurance performance, which needs to be confirmed by further empirical studies. At present, the practical relevance of these findings should be treated with caution.

Cocaine: analysis, pharmacokinetics, and metabolic disposition / P. Jatlow

Copyright © 1988 by The Yale Journal of Biology and Medicine, Inc.

• Yale Journal of Biology and Medicine 61 (1988) 2 (March-April), p. 105-113
• PMID: 3043924
• PMCID: PMC2590277

Abstract

The ability to measure concentrations of cocaine in body fluids can contribute substantially to any investigation of cocaine's pharmacological effects. Design of research which involves the administration of cocaine must take into account current knowledge regarding the drug's pharmacokinetics. Cocaine's very rapid elimination from the body should be considered in attempting to understand patterns of cocaine abuse, and such phenomena as bingeing and acute tolerance. Accurate analysis of cocaine and/or its metabolites is essential to the diagnosis and evaluation of cocaine use whether for medical or forensic purposes. Appropriate selection of methods for analysis of cocaine depends upon the intended purpose of the assay, and correct interpretation of the data obtained upon knowledge of cocaine's kinetics and metabolic disposition.

Benefits and Harms of 'Smart Drugs' (Nootropics) in Healthy Individuals / Fabrizio Schifano, Valeria Catalani, Safia Sharif, Flavia Napoletano, John Martin Corkery, Davide Arillotta, Suzanne Fergus, Alessandro Vento, Amira Guirguis

• Drugs 82 (2022) 6 (2 April), p. 633-647
• PMID: 35366192
• DOI: 10.1007/s40265-022-01701-7

Erratum in:

• Correction to: Benefits and Harms of 'Smart Drugs' (Nootropics) in Healthy Individuals / Fabrizio Schifano, Valeria Catalani, Safia Sharif, Flavia Napoletano, John Martin Corkery, Davide Arillotta, Suzanne Fergus, Alessandro Vento, Amira Guirguis
• Drugs 82 (2022) 7 (May) p. 839
• PMID: 35476318
• DOI: 10.1007/s40265-022-01716-0
• No abstract available.

Abstract

'Smart drugs' (also known as 'nootropics' and 'cognitive enhancers' [CEs]) are being used by healthy subjects (i.e. students and workers) typically to improve memory, attention, learning, executive functions and vigilance, hence the reference to a 'pharmaceutical cognitive doping behaviour'. While the efficacy of known CEs in individuals with memory or learning deficits is well known, their effect on non-impaired brains is still to be fully assessed. This paper aims to provide an overview on the prevalence of use; putative neuroenhancement benefits and possible harms relating to the intake of the most popular CEs (e.g. amphetamine-type stimulants, methylphenidate, donepezil, selegiline, modafinil, piracetam, benzodiazepine inverse agonists, and unifiram analogues) in healthy individuals. CEs are generally perceived by the users as effective, with related enthusiastic anecdotal reports; however, their efficacy in healthy individuals is uncertain and any reported improvement temporary. Conversely, since most CEs are stimulants, the related modulation of central noradrenaline, glutamate, and dopamine levels may lead to cardiovascular, neurological and psychopathological complications. Furthermore, use of CEs can be associated with paradoxical short- and long-term cognitive decline; decreased potential for plastic learning; and addictive behaviour. Finally, the non-medical use of any potent psychotropic raises serious ethical and legal issues, with nootropics having the potential to become a major public health concern. Further studies investigating CE-associated social, psychological, and biological outcomes are urgently needed to allow firm conclusions to be drawn on the appropriateness of CE use in healthy individuals.

CAS 2023/A/9551 Georgi Yomov v. Union Européenne de Football Association (UEFA)

In August 2022 the Union of European Football Associations (UEFA) reported an anti-doping rule violation against the Bulgarian football player Georgi Yomov after his A and B samples tested positive for the prohibited substance Dehydrochlormethyltestosterone (Turinabol).

Consequently the UEFA Appeals Body decided on 10 February 2023 to impose a 4 year period of ineligibility on the Athlete, starting on the date of the provisional suspension, i.e. on 25 August 2022.

Hereafter in April 2023 the Athlete appealed the UEFA Decision with the Court of Arbitration for Sport (CAS). The Athlete requested the Panel to set aside the Appealed Decision and to impose a reduced sanction.

The Athlete accepted the test results and denied the intentional use of the substance. He argued that the positive test was caused by the consumption of a contaminated product.

He testified that he inadvertently had ingested the substance by drinking the leftover of one or more smoothies prepared by his brother whereas unbeknown to him, his brother was taking Turinabol in April 2022. In support of his allegation he produced the witness statements of family, friends and expert witnesses. 

He also relied on the evidence of the person who sold Turinabol to his brother. In addition to the witness evidence, he produced scientific evidence, in particular a polygraph test, a negative hair test for him and a positive nail test for his brother.

UEFA contended that:

• The Athlete failed to establish, on a balance of probability, that the violation was the result of an unintentional and inadvertent ingestion of the substance as a result of his brother’s secret use of Turinabol.
• There are several contradictions in the Athlete's witness statements.
• Experts’ opinions confirmed that the low concentration of Turinabol in his hair test does not enable to exclude a deliberate administration of the substance.
• Low concentrations in his samples might also be expected to be found in a case of intentional use.

The Panel assessed and addressed the evidence and arguments presented by the Parties and determines by majority that:

• It is not possible to draw any material conclusions, one way or another, from the scientific evidence on record.
• The Athlete was unable to establish, on a balance of probabilities, the source of the prohibited substance.
• He has not established that the violation was not intentional.
• The results of the polygraph tests are considered inadmissible or mere statements.

Therefore the Court of Arbitration for Sport decides on 21 September 2023 that:

1.) The appeal filed by Mr Georgi Yomov on 5 April 2023 against the Decision rendered by the UEFA Appeals Body on 10 February 2023 is dismissed.

2.) The Decision rendered by the UEFA Appeals Body on 10 February 2023 in the matter Mr Georgi Yomov v. UEFA is confirmed.

3.) (…).

4.) (…).

5.) All other motions or prayers for relief are dismissed.

CAS 2023/A/9377 Kristian Jensen v. World Rugby

In December 2021 World Rugby reported an anti-doping rule violation against the Australian rugby player Kristian Jensen after his A and B samples tested positive for the prohibited substance LGD-4033 (Ligandrol).

Consequently the World Rugby Judicial Committee decided on 20 December 2022 to impose a 4 year period of ineligibility on the Athlete. The Panel did not accept the Athlete's explanation that contamination had caused the positive test result.

Hereafter in January 2023 the Athlete appealed the Decision with the Court of Arbitration for Sport (CAS). The Athlete requested the Panel to set aside the Appealed Decision and to impose a reduced sanction.

The Athlete accepted the test results and denied the intentional use of the substance. Supported by witness statements and scientific evidence he asserted that there are sufficient grounds for a reduced sanction.

The Athlete explained that a blender which he regularly shared with his housemate at the time was contaminated, because the housemate had admitted using a Selective Androgen Receptor Modulator (SARM) - called RAD-140 - which he believed may have been contaminated with other SARMs such as Ligandrol.

World Rugby contended that the Athlete failed to demonstrate that the violation was not intentional. It rejected his blender contamination theory whereas four other contamination scenarios have not been properly investigated.

The Panel assessed and addressed the evidence and the issues raised by the Parties and determines that: 

• The presence of a prohibited substance has been established in the Athlete's samples.
• He committed an anti-doping rule violation and had accepted the test results.
• The Athlete's scientific evidence failed to establish, on a balance of probabilities, the source of the Ligandrol.
• He did not demonstrate successfully the source of the prohibited substance.
• There are no grounds for a reduced sanction based on no fault or negligence or no significant fault or negligence.
• There are no grounds for a proportional reduced sanction, neither for backdating the commencement of the ineligibility period.

Therefore the Court of Arbitration for Sport decides on 4 December 2022 that:

1) The appeal filed by Mr. Kristian Jensen against the decision rendered by the World Rugby Independent Judicial Committee on 20 December 2022 is dismissed.

2) The decision rendered by the World Rugby Independent Judicial Committee on 20 December 2022 is confirmed.

3) (…).

4) (…).

5) All other motions or prayers for relief are dismissed.

In Mei 2024 the Athletics Integrity Unit (AIU), on behalf of World Athletics, reported an anti-doping rule violation against the Kenyan Athlete Reuben Kiprop Kipyego. The AIU deemed that the Athlete had 3 Whereabouts Failures within a 12 month period:

• a Missed Test and Filing Failure on 8 September 2023;
• a Missed Test and Filing Failure on 5 January 2024; and
• a Filing Failure on 12 March 2024.

After notification a provisional suspension was ordered while the Athlete failed to respond to the communications of the AIU. Because of his failure to respond to the charge within the set deadline the AIU deems that the Athlete has admitted the anti-doping rule violation, waived his right for a hearing and accepted the consequences thereupon.

Therefore the AIU decides on 17 July 2024 to impose a 2 year period of ineligibility on the Athlete, starting on the date of the provisional suspension, i.e. on 27 Mai 2024.

In August 2023 NADO Flanders reported an anti-doping rule violations against the bodybuilder after her sample tested positive for the prohibited substance Hydrochlorothiazide and the presence of Salbutamol.

After notification the Athlete failed to respond, nor attended the hearing of the NADO Flanders Disciplinary Commission. The Commission rendered a decision in absentia of the Athlete.

Because she did not respond in March 2024 within the set deadline, the Disciplinary Commission determines that the Athlete was deemed to have waived her right for a hearing and accepted the consequences.

Therefore the NADO Flanders Disciplinary Commission decides on 28 May 2024 to impose a 2 year period of ineligibility on the Athlete, starting on the date of the provisional suspension, i.e. on 15 August 2023.

Fees and expenses for this Commission shall be borne partially by the Athlete.

In September 2023 United Kingdom Anti-Doping (UKAD) reported an anti-doping rule violation against the Finnish boxer Robert Helenius after his sample tested positive for the prohibited substance Clomifene. Following notification a provisional suspension was ordered and the Athlete filed a statement in his defence.

The Athlete admitted the violation and denied the intentional use of the substance. He assumed that the Clomifene entered his system through the consumption of eggs and chicken meat in his diet.

UKAD accepted that the Athlete's violation was not intentional. However UKAD deemed that he failed to demonstrate with any corroborating evidence that eggs and chicken meat in question were the source of the prohibited substance.

Therefore UKAD decides on 27 June 2024 to impose a 2 year period of ineligibility on the Athlete, starting on the date of the provisional suspension, i.e. on 18 September 2023.