You are on page 1of 21

Principal doping substances and their side effects

A compilation prepared for the International Cycling Union

Laurent RIVIER, Ph.D., chemist and toxicologist, Scientific Director of the Swiss
Institute of Doping Analysis, Martial SAUGY, Ph.D., biochimiste, Technical Director
of the Swiss Institute of Doping Analysis, and Professor Patrice MANGIN Md Ph.D.,
forensic scientist, Director of the Swiss University Institute of Forensic Medicine,
Lausanne, Switzerland.

Introduction
Any sport may be defined as a game of intelligence and a challenge of ideas combined with
the expression of perfection of the human body and its movement. There are no sports which
involve a course on pharmacology. Unfortunately, the misuse and abuse of
pharmacologically active substances have become so widespread in present day sports that
the safety, the health and the longevity of far too many athletes are now compromised. In a
sense, the initial pursuit of the sporting activity has been perverted.

Even the youngest athletes, both professionals and amateurs, have not been spared. Their
trainers, physicians and other assistants have already given them countless pills, tablets,
ointments, injections, vitamins and other potions. The goals are numerous: to stimulate, to
calm, to numb the pain caused by a wound, to enhance performance, to reduce
inflammation, sometimes to suppress anxiety. As a result, many athletes have come to
believe that successful development in the world of sports is impossible without
pharmacologically active substances. There are not many drugs that such athletes wouldn't
take in order to improve performance, to feel calm or to feel better. Some people say that is
simply impossible to resist…

It is thus essential that all athletes, beginners and professionals alike, fully understand that
the use of a forbidden substance may have severe consequences. Indeed, athletes often
have no knowledge about the immediate and delayed toxic effects of many medical drugs.
On the one hand, it has become very easy to obtain both approved substances and illicit
drugs. On the other hand, the seemingly medical information that is available is often of
pseudo-scientific nature. As a result, it has become difficult to differentiate acceptable
practices from hazardous techniques. In writing this document, our wish was to provide the
reader with simple and straightforward information, based on our current objective
understanding of the relationship between the principal doping substances and the
occasionally toxic side effects commonly observed in cases of abuse and utilization outside
the commonly accepted medical context.

According to G.-I. Wadler et B. Hainline (authors of L’athlète et le dopage, drogues et


médicaments (The Athlete and Doping, Drugs and Medication), Collection Sport et
enseignement, Editions Vigot, Paris, 1993), athlete doping and drug addiction have their
roots in pharmacological research aimed at improving athletic performance with ergogens.
Conversely, doping testing in athletes is an attempt to prevent any artificial ergogen
advantage conferred by an illicit drug, as well as the associated immediate or delayed impact
on the athlete’s health.

An athlete consumes ergogens to gain an advantage in the face of physical and emotional
challenges in a sports competition. However, as seen in the table below, the advantages
2

conferred by a particular substance must be seriously evaluated in terms of the performance-


health damage ratio.

Because of practical, legal and ethical considerations, it is difficult to evaluate the effects that
a substance may have on an athlete’s performance. Indeed, one cannot carry out
pharmacological experiments on healthy individuals without a therapeutic justification.
Moreover, volunteers cannot be subjected to the same conditions experienced by athletes
engaged in doping. This limitation is explained by the fact that the levels of drugs that are
used in doping are 10-, 50- and sometimes even 100-fold higher than the accepted
therapeutic values. The cheaters do not seek the therapeutic activity of a substance but
secondary effects that appear only at levels that are never reached during normal treatment.
Finally, it is usually difficult to extrapolate the standard pharmacological parameters because
of many variables, such as the degree of purity of the drug, mode of intake, the dose-
response effect and the relation between time of intake and time of effort.

There are three main categories of drugs that are used by athletes today :

1. Ergogen substances or techniques that are aimed at improving performance. Typical


examples include testosterone, anabolic steroids, stimulants such as amphetamines, and
peptide hormones such as growth hormone and erythropoietin.
2. Medical drugs. This category includes substances prescribed for treating specific medical
conditions and that are used in manners that are contrary to conventional clinical
practice.
3. Uncontrolled substances sold on the open market for recreational purposes or pleasure.
This category includes illegal drugs or drugs that are taken at very high doses relative to
standard prescription levels. The result is a modification in the mood and in the
perception of the athlete.

List of substances and associated side effects:

The list presented below includes the main substances or classes of substances that cause
well documented side effects on the human organism. The knowledge about certain PFCs is
still very fragmentary and we have omitted them form our compilation. Moreover, besides the
substances listed here, there are many other pharmacologically active compounds or
medical drugs that also have sepcific side effects (see J.-P. de Mondenard : Dictionnaire des
substances et procédés dopants en pratique sportive (Dictionary of doping substances and
behaviors) ; Editions Masson, Paris, 1990). It is important to realize that the substances
presented here are normally used to treat specific diseases or serious health conditions:
they have strong biological activity and are not to be consumed without forethought as if they
were some nutritional supplement, such as vitamins or amino acid concentrates. As a rule,
any plan to use a pharmacologically active substance must always be validated by a
physician, who in turn must confirm the rightfulness of the approach, regardless of dosage
and the health condition of the athlete.

ACTH or Corticotrophin

ACTH is used in an attempt to increase the corticosteroid levels in the blood, and to produce
the associated euphoric effects on the organism. The use of these products may cause an
allergic reaction, in particular in individuals that have a predisposition towards asthma,
urticaria, eczema, etc. Drug injections can cause severe reactions, such as anaphylactic
shock. Undesirable side effect of ACTH include many different reactions such as:
3

Water retention, edema


Hyperglycemia
Blood hypertension
Modification in the psyche
Osteoporosis
Decrease in resistance to infections

Amphetamines

Amphetamines were first synthesized in 1887. In addition to their principal effects,


amphetamines have different activities on different levels, mediated by more or less specific
receptors in the organism. The desired effects include a sense of well-being, a decrease in
the perception of fatigue, an increase in self-confidence, in motor function and a decrease in
appetite.

In contrast to anabolic drugs which are used during the athlete's training, amphetamines are
usually consumed just prior to competition. Indeed, there are no positive long term effects. In
fact, most of the main pharmacological effects of amphetamines resemble those of cocaine.
One athlete may want to increase his concentration and awareness, another one will
consume massive doses to become more aggressive and develop endurance, and a runner,
for instance, may feel ready to deploy more instant energy and speed.

An individual may be inclined to increase the doses of amphetamines to obtain the same
stimulating effects experienced in the very beginning. This results in rapid addiction. The
initial use, the extended use and high-dosage use of amphetamines may all provoke severe
side effects, as shown in the table below:

Acute or early onset side effects Chronic use side effects


Average Severe

Impatience Confusion Addiction


Vertigo Fights Weight loss
Tremors Delirium Psychosis
Irritability Paranoia Paranoid delirium
Insomnia Hallucinations Dyskinesia
Euphoria Convulsions Behavioral disorders :
compulsive / stereotypical /
repetitive
Uncontrolled movements Cerebral hemorrhage Vascularity
Cephalgia Angina pectoris / infarction of Neuropathies
the myocardium
Palpitations Blood hypertension
Anorexia Circulatory collapse
Nausea
Vomiting

A brutal withdrawal after repeated use of amphetamines may result in chronic fatigue,
lethargy, somnolence and depression.

An amphetamine user may display the following external signs:


4

Changes in one's judgement capacity


Repeated occurrence of wounds
Increase in recuperation time
Side effects that penalize a sports activity (see above)
Repeated variations in the mood (stimulation of anxiety)
The face of amphetamine: external signs of the amphetamine user
- Facial expression of anxiety
- Pinched nose
- Dilated pupils
- Teeth grinding (bruxism)
- Dry mouth
- A nauseous state
- Paleness of mucous membranes and on the finger tips (nails)
- Cold extremities
- Goose bumps
- Sudation
- Palpitations
- Accelerated or lowered heartbeat
- Hyper or hypotension
- Erection
- Loss of vision in the absence of visible eye alterations (amaurosis)
- Nervousness
- Tics: frequent touching of one's face
- Disorientation relative to people and places
- Mistrust of one's entourage and the impression of being constantly watched
- Incoherent speech
- Violent acts
- Psychosis (severe personality problem which alters the perception and understanding of
reality)
Addiction
The habit is essentially psychological
There is a tendency to use dangerous associations of medical drugs

Anabolic substances (steroids)

This class of doping substances includes all steroids that possess anabolic properties,
meaning that they cause an extensive increase in the muscular mass. This effect is never
isolated: a more or less pronounces androgen activity is also present. This chapter also
deals with testosterone.

These ergogen substances are generally used without interruption and during several weeks
preceeding a competition. The preferred method is "piling up" oral ingestion and injections.
The amount of the substances used exceeds dramatically the standard doses recommended
in a therapeutic procedure.

There has been a report of an athlete diagnosed with AIDS and whose sole risk factor was
sharing needles to inject anabolic steroids. It is not uncommon to discover that anabolic
steroids bought on the black market have not been adequately sterilized and are deliberately
mislabeled. The possible complications arising from the use of such unknown and impure
preparations are unimaginable.
5

The side effects associated with the use of anabolic steroids have been scientifically
observed and documented:

Anomalies in the function of the liver


Benign and malignant liver tumors (liver cancer)
Hypercholesterolemia (excessive blood cholesterol levels)
Prostate Adenocarcinoma (prostate cancer)
Hypertension spells
Infarction of the myocardium
Diabetes
Sleep apnoea syndrome
Hypogonadotropic hypogonadism and testicular atrophy (decrease in the size of testicles)
Azoospermia (disappearance of sperm in the semen), reversible sterility
Feminization : gynecomastia (breast development in men) and high-pitched, castrato-like
voice
Behavioral modifications (aggressiveness, groundless violence) – psychiatric troubles
(addiction to anabolic products)
Humoral immunity problems
Acne
Muscular rupture
Hair loss
Premature suture of the epithelial cartilage in the prepubescent child which results in an
arrest of growth in the young athletes.
Irreversible virilization or masculinization in women
- Husky voice (which can also become screeching)
- Hirsutism : appearance of body hair in regions that are normally hairless (face, regions
between and around nipples, back, shoulders, the back of thighs, infra-umbilical and
intergluteal regions): the average life span of body hair is two years and excessive body
hair may sometimes appear as late as one year after the end of hormone absorption
- development of male pattern baldness
Virilization of the female fetus

In addition to the above-mentioned symptoms, there are subjective reactions to the intake of
anabolic substances:

Modifications in sex drive (increases and decreases)


Fainting and vertigo
Headaches
Lethargy or excessive aggressiveness
Psychiatric effects: steroid-induced rage or spells of extreme violence
Tics
Dependence

Non steroid anti-inflammatory drugs (NSAIDs)

Severe undesirable side effects of NSAID drugs are rare. The common side effects include
irritations and bleeding of the gastric mucous membranes.

The other undesirable effects are :

Skin eruptions
Ear ringing
6

Edemas
Bronchial spasms
Sever diarrhea is a classic side effect of mefenamic acid (Ponstan).

Asthma and sports, see Ephedrine, beta-2 stimulants and corticosteroids

Barbiturates et Benzodiazepines

Barbiturates such as benzodiazepines and alcohol are usually not considered as ergogen
drugs.
However, there is scientific evidence that barbiturates and benzodiazepines may have
beneficial effects in some specific situations. Indeed, both substances are effective in
reducing tremors, which is important in some easily identified sports activities. This soothing
action has been extensively studied in cases of epileptic spells.

The side effects of theses substances are significant:

Sedation
Reduced acuteness of vision
Lowered vigilance (very important when driving a motorized vehicle)
Problems with walking and keeping balance
Decrease in memorization capacity
Euphoria
Withdrawal insomnia
Dependence
Tolerance
Clinical withdrawal syndrome
Respiratory distress
Coma

Beta-blockers

The undesirable effects of beta-blockers stem from their inhibitory properties. Asthma
sufferers in particular should avoid products belonging to this category since they can cause
bronchial spasms. Certain beta-blockers, such as propranolol, may cause insomnia,
nightmares and even a depression syndrome.

Some male users also experience sexual difficulties, such as impotence and weakened
erection.

The use of beta-blockers should be strictly prohibited in case of asthma, cardiac


insufficiency, digestive tract hemorrhages, occult bleeding, significant bradycardia (above 50
heartbeats per minute) and insulin-dependent diabetes.
The following undesirable effects are observed when these drugs are used :

Hypoglycemia
Troubles with digestion
7

Asthenia
Cramps
Cephalgia, vertigo, diplopia
Raynaud’s disease : circulation problems in the extremities upon exposure to cold ; the
fingers turn pale
Insomnia, nightmares
Mood alterations (depressive tendencies) and changes in the libido
Hypothernia
Cardiac insufficiency
Cardiac rhythm problems
Anaphylactic shock after a hymenoptera sting (bee, wasp, etc.)
Numerous drug interactions

Caffeine

Caffeine resembles cocaine and amphetamines in that it essentially stimulates the central
nervous system in a dose-dependent fashion. Caffeine is known to have many deleterious
effects on the health consulting the table below, one should distinguish the chronic effects of
caffeine from acute effects following absorption of this stimulant (which may constitute
doping behavior).

Acute intoxication, severe Acute intoxication, less Chronic intoxication


severe

Peptic ulcer Nervousness, excitation Increase in cholesterolemia


Delirium Irritability Increased risk of ischemic
cardiopathy
Convulsions Insomnia Teratogenic activity
Coma Tachycardia Carcinogenic activity
Arrhythmia Blood hypertension Risk of breast fibrocystic
lesions
Palpitations Problems with digestion , in
particular when coffee is
mixed with milk
Death (the lethal dose is Headaches
approximately 6 liters
depending on the brewing
strength of coffee or caffeine
content of the liquid)
Tremors
Exaggerated fear or anxiety
Increased levels of
cholesterol and higher risk of
heart attack

Cannabis (Marijuana, Hashish, Kif, …)


8

Cannabis has been cultivated for centuries but cannabis-derived products have been
available world-wide only starting second world war. The interest in this plant stems from its
psychotropic properties. Most countries consider cannabis as an illegal drug. Over the recent
past, the quality of the drug has improved dramatically : the levels of active substances in
plants bred nowadays are 10- to 30-fold higher than 15 years ago. Hence, it is difficult to still
consider cannabis as a harmless product. Indeed, certain preparations found on the present
day market are extremely potent. Consequently, there is a corresponding increase in the
principal undesirable side effects which are listed below :

Psychiatric effects Cardiovascular effects

Panic attacks Tachycardia


Delirium Orthostatic hypotension
Psychosis Increase in carboxyhemoglobin
Loss of motivation syndrome
Broncho-pulmonary effects
Immunological effects
Rhinitis
Decrease in cellular immunity Pharyngitis
Decrease in monocyte maturity Bronchitis
Bronchial spasms
Endocrinological effects Squamous bronchial metaplasia
Pulmonary fibrosis
Decrease in sperm production Pneumomediastinum
Inhibition of ovulation in women
Gynecomastia in men

Negative effects affecting performance

Increase in recuperation time after exercise Bloodshot and light-sensitive eyes


and in the duration of muscle aches .
A faster onset of fatigue during exercise Mood hyper-instability: rapid switch from
euphoria to depression
Acceleration of cardiac rhythm Hallucinations
Enhanced feeling of thirst Deterioration in vigilance and coordination :
dangerous when driving a vehicle !
Loss of motivation

Cocaine

Cocaine abuse in the adult represents a significant risk. Competition merely increases the
cardiovascular side effects through cardiac hyper-stimulation accompanied by arrhythmia
and heart attacks.

The principal side effects caused by cocaine are listed in the table below :

Cardiovascular Cerebrovascular Neuropsychiatric


complications complications complications

Ventricular arrhythmia Cerebral infarction Convulsions


Sudden death Brain Hemorrhage Exacerbation of the Gilles de
la Tourette syndrome
9

Angina pectoris Meningeal hemorrhage Cephalgia


Infarction of the myocardium Transitory cerebral ischemia Visual scotoma
Aortic dissection Blindness
Myocarditis Optical neuritis
Tachycardia gyneco-obstetrical
complications
Habit formation
Premature detachment of Insomnia
placenta
Ear-Nose-Throat Spontaneous abortion Mental confusion
complications
Congenital malformations Aggressiveness
Osteolytic sinusitis Transplacental or milk- Paranoid delirium
mediated Mother-infant
transfer and secondary
withdrawal syndrome
Necrosis et perforation of the Visual and tactile
nose septum hallucinations
Loss of sense of smell Repetitive behaviors
Miscellaneous Stereotyped movements of
complications the mouth and tongue

Complications related to Liver toxicity Anorexia


drug addiction
Gastrointestinal ischemia Specific delirium
HIV infection Pneumomediastinum Thymic troubles linked to
hallucinogens
Bacterial infections Hyperthermia Sex problems
Viral hepatitis

Codeine, opiates and other morphine derivatives

The use of pain killers is frequent in sports, especially among athletes engaged in violent
activities (such as boxing for instance). Often, the fear of losing a place or not fulfilling a
contractual obligation leads to an obsession to keep the fight in spite of any type of wound or
handicap. The most common effect of this class of substances is sedation, providing habitual
doses are used. One must be aware of physical and psychological addiction induced by
many opiates which are justly classified as narcotics:

Nausea
Vomiting
Vertigo
Memory loss
Mood problems
Pruritus
Constipation
Delirium
Convulsion crises
Addiction
Withdrawal syndrome
10

Corticosteroids

As seen in the table, the undesirables side effects associated with these substances are so
severe that they should never be administered in the absence of a medical imperative:

Hydro-electrolytic imbalance leading to edemas and increase in body weight


Increase in glycemia (blood sugar levels) and appearance of glycosuria (presence of glucose
in the urine)
Increase in blood pressure
Decrease in antibodies and natural defense mechanisms leading to higher susceptibility
towards infections
Gastric pyrosis (heartburn and regurgitation) and gastrointestinal ulceration
Diffuse osteoporosis with an increased risk of fractures and delayed bone repair
Alterations in the walls of blood vessels with possible formation of blood clots leading to
embolism
Decrease in muscle nutrition, risk of severer muscular atrophy
Eye disorders : keratitis, glaucoma, cataract
Dangerous effects on the fetus
Disorders of the nervous system: convulsions, muscular cramps
Psychiatric disorders: mood alterations, insomnia, sometimes even genuine maniac-
depressive psychoses
Decrease or even arrest in the growth in young athletes

Diuretics

All diuretics have the same side effects: dehydration, hypovolemia, muscular cramps, and
orthostatic hypotension. Biochemical shifts in potassium levels (kaliemia) may be life
threatening if strong modification are induced by diuretics.

Ephedrine (and phenylpropanolamines)

They are present in many innocuous pharmaceutical preparations used to treat benign
conditions such as a cold. One must be very cautious in examining this class of substances
since there are over 50 derivatives which have similar effects. The table shows the acute
side effects caused by ephedrine analogs (effects are ordered by severity)

Moderate effects Severe effects

Nervousness Agitation
Irritability Confusion
Insomnia Paranoia
Anorexia Mania
Vertigo Hallucinations
Cephalgia Ictus / Transitory ischemic attack
Tachycardia Cerebral vascularisation
Palpitations Cerebral hemorrhage
Slight increase in blood tension Severe hypertension
Myocardial ischemia
Intolerance reactions Ventricular arrhythmia
Rhabdomyolysis
Should never be combined with an anti- May cause convulsive crises in epileptics
11

depressant

Erythropoietin

This peptide hormone is used in medical practice in cases of severe anemia and during
treatment of chronic renal insufficiency, such as in dialysis patients. In each case, there is a
specific evaluation of the benefits vs. the dangers of this type of treatment. The first clinical
trials involving erythropoietin started in 1985 and it is hence premature to draw a clear picture
of the side effects. Nevertheless a few undesirable consequences have already been
identified:

Hypertension thrusts when the substance is introduced too rapidly


Vascular thrombosis
Convulsions
Influenza-like symptoms, bone aches et shivering following the injection
Skin reactions, Allergy-like edema at the site of injection
Polyglobulism

Chorionic gonadotropin (hCG)

This natural product is classified as a stimulant because it causes an increase in the


production of endogenous testosterone. The associated dangers depend on dosage and
vary according to sex:

In women In men

Salt retention Allergic manifestations


Ovarian hyperstimulation and risk of multiple Nausea, vomiting
pregnancies
Ovarian cysts Novel distribution of fat throughout the body
Gynecomastia and possible secretion of milk
Hypercoagulability See also the chapter on anabolic drugs

Pregnancy

In terms of doping, the desired effect is the increase in cardiac capacity during the first
months of pregnancy. Later there is an increase in blood volume, in the number of red blood
cells and in hemoglobin. Apparently the resulting enhancement in oxygen delivery to the
muscles translates into a 10% increase in the deployment of effort.

The risks stem from the vulnerability of the fetus starting with the third month of pregnancy.
A abortion planned after the key competition represents a significant danger for the woman if
it is carried out in a non-medical environment by unexperienced hands. There may also be a
great psychological impact.

Growth hormone (somatotropic hormone or somatotropin)

Uncertainties remain about the safety of exogenous hGH as a therapeutic treatment. We still
do not know what influence it may have on normal individuals, even though there is a good
12

deal of information about side effects of endogenous hGH hypersecretion in acromegaly.


This condition has an associated 50% mortality at age 50 and 89% mortality at age 60.

The table below summarizes the side effects linked to the presence of high hGH levels in the
adult (the same side effects are noticed in children; in addition, there is an occurrence of
gigantism due to the increase in the linear growth of bone tissue).

Tumefaction of soft tissue (may be irreversible)


Hypertrophy and bone protuberance (may be irreversible), arthritis, induced acromegaly
Thickening of the skin
Hirsutism (hair growth over the entire body)
Hypersecretion of sebaceous glands
Increase in perspiration
Peripheral neuropathies
Myopathies
Hypertrophy of the viscera : spleen, salivary glands, liver, kidneys, heart
Colon polyps
Cardiovascular diseases such as coronary disease, cardiomyopathy and blood hypertension
Glucose intolerance / diabetes mellitus

There have also been reports of the development of anti-growth hormone anti-bodies after
administration of exogenous growth hormone. This causes an interference with endogenous
hormone activity and necessitates an immunological surveillance. In order to avoid
hyperglycemia, it is also necessary to monitor blood glucose levels. An injection of this
hormone affects very fundamental processes of regulation. It may upset the balance of
thyroid and corticotropic hormones, which will have a major impact on the individual's health.

One should point out that a bovine growth hormone may be found on the market and that a
horse growth hormone may soon become available as well. These substances have no
activity on the human organism but they may cause an irreversible sensitization which can
lead to severe consequences (anaphylactic shock) if the exposure is repeated. Yet another
type of hormone may be found on the black market: the extractive growth hormone. It is
actually extracted from the pituitary gland of corpses. In this particular scenario, the industrial
method used to purify the hormone does not guarantee the removal of other biological
molecules such as prions. Based on the well-known scenario of contamination that led to the
mad cow disease, which is transmitted by a prion, one cannot exclude a similar
contamination by a prion present in an extractive hGH preparation from an individual that
died from the Creutzfeldt-Jakob's disease. This type of encephalitis, believed to be caused
by an infectious agent resembling a slow virus, has an incubation period in humans that is
close to 15 years !

Insulin (and diabetes)

Insulin causes hypoglycemia. If the organism does not produce insulin in sufficient amounts,
as is the case in certain types of diabetes, additional insulin is injected to reach normal
physiological balance. In this scenario, physical sports activities are entirely acceptable.
Unfortunately, this state of balance is so difficult to maintain that many physicians
recommend that diabetics abstain from any serious physical activity, especially sports that
demand a high energy input. The international sports regulating bodies prohibit the non-
therapeutic use of insulin for one main reason: insulin induces growth hormone release. In
itself, insulin causes a number of side effects some of which are listed below:

Tremors, sweat, anxiety, agitation


13

Asthenia, hypothermia, cravings


Cardiovascular problems, infarction of the myocardium
Anaphylactic shock, insulin allergy
Numerous drug interactions (it is absolutely necessary to consult a physician because there
are many dangerous associations)
Alcohol consumption should be restrained, since it enhances hypoglycemia and may lead to
a hypoglycemic coma
Overdose: hypoglycemia may result from poorly estimated insulin dosage, a mistake in
feeding or a unforeseen physical effort that is not compensated. The symptoms of
hypoglycemia include hunger, sweat, asthenia, tremors, confusion, problems with vision,
headaches, etc). Unless treated promptly, hypoglycemia may result in a coma.

Nicotine

In the present context, we will only deal with the toxic effects of passive smoking. Indeed,
athletes do not consume tobacco in large amounts (passive smoking, in a closed space
shared with smokers, is a marginal toxicological occurrence in terms of doping behavior). On
the other hand, chewing tobacco or snuff are popular practices in certain countries which
often cause serious diseases.

Periodontal decay
Teeth abrasion
Hyperkeratosis of the mouth mucous membranes
Gingivitis
Leukoplasia
Anomalies of the sense of taste : dysgeusia
Problems with olfaction : dysosmia
Spinocellular epithelioma of the oral cavity
Dependence and withdrawal syndrome
Halitosis: bad breath

PFCs (Perfluorocarbons)

These substances are all composed of fluorine, carbon and hydrogen atoms, but have
important structural differences. Unlike erythropoietin, all PFCs are synthetic and hence
never occurr naturally in the organism. Although they are in principle inert molecules, PFCs
can dissolve large quantities of gas, including oxygen. Various PFC preparations (emulsions
containing egg yolk lecithin or phospholipid) are currently undergoing clinical tests. The goal
is to provide temporary oxygen supply to the brain and other tissues in patients that have lost
important amounts of blood and whose vital functions are in danger. Little is known about the
long-term effects of these substances on the human organism. The toxicity of repeated
treatment is also unclear in situations other than extensively invasive surgical operations. In
terms of tolerance by the organism, the physical and chemical state of the preparation is as
important as its biological purity. Indeed, intra-venous injection is the only means to make
PFCs participate in gas exchange. The clinical preparations currently tested have been found
to have the following side effects:

Increase in body temperature above 40°C, fever et cold


Diarrhea
Kidney, liver and lung toxicity; the lesions are probably irreversible in most cases
14

Blood infections if the preparations are bacteriologically impure


Embolism and thromboses (thrombocytopenia)
Risk of Aids virus transmission if needles are shared

Because of the lack of published scientific evidence, it is a completely unconscious act to


attempt to use PCFs outside of the specific clinical context described above. this is true even
if the patient is closely and continuously monitored. Unfortunately, the world of sports is also
inhabited by unscrupulous hotheads who do not worry about the aftereffects of their
"experiments" on the "human guinea pigs". A hospital context is quite different from a sports
context. One can imagine for instance that PCFs, which already very volatile at ambient
temperatures, may form gas bubbles once injected into the blood vessels. Indeed, an
increase in body temperature is inevitable during intense physical exercise, the warm season
or upon long exposure to the sun. Given the current state of knowledge, one must absolutely
refrain from using these products in the absence of close and extensive medical surveillance.

Probenecid

This substance is used to mask the use of doping substances, anabolic drugs in particular,
by delaying their elimination. The medical application of Probenecid is to treat gout
rheumatism. It may cause the following undesirable effects:

Cephalgia
Anorexia
Nausea
Stomach aches
Vertigo
Frequent micturition
Anemia
Possible anaphylactic-like reactions with fever
Dermatitis and other skin irritations

Blood procedures (see also Erythropoietin)

Because of possible HIV infection, blood transfusions performed outside a hospital context
are simply too dangerous to be even considered as an option. This is common knowledge. It
is important to emphasize the risk of a shock if the donor and the recipient are incompatible.
While homologous transfusions are safer, they also represent a significant hazard. Only
medical surroundings can ensure the absolutely sterile conditions required by transfusion.

Testosterone : see Anabolic drugs

Vitamins

An excessive uptake of vitamin leads to well known side effects which vary with each
vitamin. The following effects are worth mentioning:

Diarrhea
Nausea
15

Urticaria
Muscular weakness
Fatigue
Cephalgia
Anorexia
Blood hypertension
Cardiac Arrhythmia
Cirrhosis
Teratogen activity

Conclusions

The conclusion is clear: one should never use medication or pharmacologically active
substances without appropriate advice from a physician. If the medical drugs available today
are very potent and effective in treating disease, they also strongly affect healthy individuals
which may be tempted to use them, even though there is absolutely no therapeutic need.
One must never forget that the side effects of a drug are always present but that the
beneficial effects are felt only in case of a disease that has to be treated. The magnitude of
the side effects is of course dependent on the amount of the drug that is consumed.
Unfortunately, this amount is often excessive. The athlete that relies on doping is under
pressure to obtain quick results. Naturally, there is a strong temptation to increase the doses
to really push one's luck. We wish to emphasize yet another point: it is necessary to check
the purity of all substances of uncertain origin. Some products on the black market are
grossly mislabeled and preparations for injection are often contaminated with bacteria or
even viruses. In such cases, there is a significant risk to develop a serious condition and put
a definitive end to one's athletic career. Clearly, the game of doping is not worth playing.

Glossary of principal medical terms:

(The majority of the definitions below are taken from the Dictionnaire français de Médecine et
de Biologie en 4 volumes (French Dictionary of Medicine and Biology in 4 Volumes) A.
Manuila, L. Manuila, M, Nicole et H. Lambert. Paris : Masson, 1971)

Anaphylactic shock The combination of acute morbid manifestations


resulting from the reintroduction of a particular
substance into an already sensitive organism.
This shock may be an extremely dramatic event
leading to imminent death, or to a giant urticaria
with congested respiratory mucous membranes
(asthma). Anaphylactic shock often occurs in
sensitive individuals following injections of
therapeutic sera, allergens, peptide hormones,
or penicillin, etc. or after insect bites.

Anemia Individual or combined decrease below normal


levels in the number of red blood cells per cubic
milliliter of blood, in the hematocrit or in
hemoglobin. Anemia may show various general
symptoms: paleness of skin and of mucous
membranes, nervous disorders (fainting, vertigo,
etc), dyspnea, tachycardia, digestion problems.
16

It may be caused by a hemorrhage, hemolysis


(extensive destruction of red blood cells), a
deficiency (in protein, vitamin B12, etc.), a
disorder interfering with red blood cell
development (infectious diseases, effects of
toxic substances, etc.), or a congenital illness.

Angina pectoris A painful constructive syndrome, which


develops as a crisis during a specific effort or a
walk. It is localized in the retrosternal region and
may irradiate into the shoulders, arms, and jaws.
It causes severe distress and an interruption of
effort. Coronary arteriosclerosis is the most
common etiology. The pain is caused by the
reduction of blood flow to the heart. Possible
outcome includes chronic angina pectoris,
sudden death, heart attack, and progressive
cardiac insufficiency.

Anorexia A partial or complete loss of appetite.

Aortic dissection Formation of a pocket within the wall of an artery


caused by the splitting of the internal membrane
of the vessel and subsequent intra-pericardial
hemorrhage (synonym: dissecting aneurysm of
the aorta). The associated pain is intense and
violent. Survival is rare.

Arrhythmia Irregularities in a rhythm. By extension, an


anomaly in the heart rhythm resulting in irregular
heart beats.

Arthritis Inflammation of a joint. May be acute or chronic.

Asthenia Weakening of the general state of health, of the


functions of an organ or a system. Decrease in
the vitality of an organism.

Carboxyhemoglobin The form of hemoglobin which fixes carbon


dioxide thus allowing the transport of this gas
from various tissues to the lungs.

Cecity Blindness.

Cephalgia Diffuse or widespread pain located in the cranial


region, and exacerbated by external factors
(light, noise, jolts), internal factors (emotions,
intellectual effort) or movement and physical
effort.

Cholesterolemia Concentration in cholesterol of the circulating


blood, usually measured in grams per liter of
serum. Normal values oscillate around 2.5
grams per liter of serum. Pathological values
may point to various metabolic disorders and
17

liver diseases.

Circulatory collapse Side effect linked to a collapse in blood pressure


and a significant slow-down in blood circulation.
Also called cardio-circulatory collapse. The
symptoms are prostration, loss of
consciousness, cold sweat, rapid, weak and
occasionally indiscernible pulse. Could lead to
death if it isn’t treated.

Cirrhosis Term invented by Laennec to describe the


disease which causes reddish granulation in the
liver. This liver sclerosis may have many
different origins (alcohol intoxication,
malnutrition, viral hepatitis, etc.). It results in
liver insufficiency.

Dependence A state resulting from periodic and repeated


absorption of a psychotropic substance (such as
narcotics, anabolic and related substances).
The subject feels the need to continue drug
intake and to increase dosage to reach the
same or more pronounced effects. An
interruption in consumption leads to a
withdrawal syndrome which is more or less
severe, depending on the substance.

Dermatitis Skin inflammation. More generally, a skin


disorder which may not be inflammatory in
nature.

Drug interactions Influence of two or more medicinal substances


on the biochemical phenomenon at the basis of
their mode of action. Drug interactions can be
beneficial, additive, multiplicative or detrimental.

Dyskinesia Any disruption of movement: absence of


coordination, spasms, tremors, etc.
Epithelioma Malignant cancerous tumour formed by the
epithelium (one of the skin tissues).

Ergogen Which lies at the basis of and improves the


efficiency of muscular work.

Gynecomastia In men, hypertrophy of mammary glands


(breasts).

Hemorrhage A more or less important discharge of blood


from a blood vessel.

Hypercoagulability Increase in the normal ability to coagulate of a


biological fluid, mainly blood.

Hyperglycemia Increase in the amount of glucose in blood.


Depending on the measurement method used,
18

the increase is considered significant above 7.8


mmol/L. With the exception of transient
hyperglycemia caused by food ingestion, cold,
emotions and altitude, most occurrences are
pathologic and involve the pancreas (diabetes
mellitus), the hypophysis (acromegaly) or the
adrenal gland (tumours).

Hypoglycemia Decrease in the amount of sugar in blood ,


below the threshold of 2.8 mmol/L. A medicinal
cause for hypoglycemia usually involves
excessive insulin absorption.

Hypovolemia Decrease in the volume of circulating blood.

Ictus In neuropathology, a sudden morbid


occurrence.

Ischemia Decrease in blood flow to a particular part of the


organism. It can be caused by a
vasoconstriction, an obstruction or arterial
compression.

Ischemic cardiopathy A disease caused by a low blood flow to the


heart.

Keratosis More or less pronounced thickening of skin


epidermis.

Lethargy Pathological state of prolonged and deep sleep,


which can be avoided by the affected individual
only partially and during brief periods of time. An
apparent state of death, but without loss of vital
functions, which may last a few hours or several
years.

Micturition Urination.

Motor function The sum of activities carried out by the organism


necessary for motion

Myocardial infarction Necrosis of the cardiac muscle, caused by an


acute coronary thrombosis, and involving one or
several limited, isolated foci. The overall clinical
picture is more or less dramatic, with a
prominent characteristic pain and a drop in
tension. The affected person is at all times
exposed to lethal complications.

Myocarditis Acute or chronic inflammation of the heart


muscle (myocardium). It may be caused by an
infection (bacteria, viruses, parasites, fungi),
chemical or medicinal agents, or other factors.
The symptoms are variable. Frequent
manifestation include tachycardia, palpitations,
19

signs of cardiac insufficiency, and muffled


heartbeat sounds during auscultation, including
gallop rhythm.

Neuropathy A disorder affecting the central or peripheral


nervous system. Usually degenerative.

Optical neuritis An inflammatory disorder of the optical nerve.

Orthostatic hypotension A drop in blood tension measuring 2 cm of


mercury or more, which takes place during the
transition from decubitus (horizontal, resting
position) to a standing, vertical position.

Osteolytic sinusitis Inflammation of the mucous membranes of the


facial sinuses. This type of sinusitis may be
frontal, maxillary or sphenoidal. There are acute,
chronic, purulent or non-purulent forms.
Osteolytic sinusitis has a destructive action on
the proximal bones.

Osteoporosis A bone lesion characterized by the thinning and


rarefaction of bone traveculae which is
visualized as a decrease in the radiological
opacity of the skeleton. Localized or diffuse
osteoporosis implies the weakening of bones.

Ovarian cyst A benign tumor of the ovaries of variable size


and of many types.

Paranoia (paranoid delirium) From the times of Hippocrates and through the
Middle Ages, paranoia was a synonym of mental
disease. Until the 1920's and under the
influence of the German school, paranoia
referred to mental disorders affecting the
intelligence, as opposed to emotions. Today, it
designates a hallucinatory or interpretative
systematic delirium.

Pharyngitis Inflammation of the pharynx (schematically, the


pharynx corresponds to the respiratory tract
between the mouth and the lungs on the one
hand, and the tract between the mouth and the
stomach, on the other hand). Pharyngitis may
have many causes (influenza, common cold,
other viral diseases, intoxication, etc.). The
clinical manifestations involve signs of local
irritation (feelings of dryness, burns, irritations,
etc.).

Pneumomediastinum A rare condition caused by physical efforts of


different nature and first described by Laennec
in 1837. It corresponds to the presence of air in
the mediastinum (a region located in the median
part of the rib cage, between the two lungs).
20

Polyglobulism Increase in the number of circulating red blood


cells resulting in a higher corpuscular volume,
higher levels of hemoglobin and increased blood
viscosity.

Pruritus An itchy skin feeling caused by a skin disease, a


general disorder or an allergic reaction to a
foreign substance.

Pulmonary fibrosis Pathological formation of fibrous tissue in the


lungs. The clinical signs include irritated cough,
halting respiration and cyanosis. The outcome is
invariably fatal.

Respiratory distress A decrease in the extent of respiration that can


lead to death.

Rhabdomyolysis Muscle breakdown caused by an exceptionally


intense physical effort or intoxication. It results
in abnormal levels of myoglobin in the urine
(synonym: paroxystic myoglobinuria).

Rhinitis Catarrhal inflammation of the nasal mucous


membrane, sometimes a synonym of a cold.

Side effects The effect of a medical drug which is not related


to its primary activity or therapeutic effects. By
extension, all undesirable and often toxic effects
of medication.

Squamous bronchial metaplasia Transformation of the alveolar lung tissue. It is


often linked to an inflammatory process and
implies a pre-cancerous state.

Tachycardia Acceleration of the heart rate above 100 beats


per minute.

Teratogen Which causes deformities.

Thrombosis Formation of a firm or gelatinous mass inside a


blood vessel or a heart cavity , which causes
complete or partial obstruction.

Tolerance The capacity of the organism to tolerate physical


or chemical aggressions, without apparent
damage. Tolerance may be acquired after
repeated exposure to a particular medicine.

Tumefaction Any increase in the size of a cell, a tissue, an


organ or an organism. Usually pathological.

Urticaria Skin condition characterized by the eruption of


pinkish or whitish papules, accompanied by a
21

burning sensation. The cause is often an


allergy (sensitization of the organism to medical
drugs, parasites, physical agents, etc.).

Vasculitis Inflammation of blood vessels.

Visual scotoma Blind spots in the field of view which correpond


to insensitive regions of the retina. The usual
cause is a lesion of the opitcal nerve.