Doping and athletes-Prevention

and counseling

Svein Oseid, M.D. Oslo. Nontg

Doping in sports is an old problem. De~elapmerrt of‘ modern techniques has made doping
control possible for all drugs listed on the International Olwnpic Committee’s list. A .wrwy 1.~
given of the preventive measures (antidoping) that haw been carried out in Norway sinw / 97%.
This comprises re&ar doping control (during cornpetition and at random in the truininp
period) and ertensive injkrmation programs to change attitudes tolcvlrd the use and miwsr 0;
drugs in sports. The basic principles of the antidoping c~ampaiprr iwlude upholding the ethic. , I!
.sports. protection of athletes’ health, and preservation of’ equal c~l71mc~s ,for all. The campaign
IS directed to the athletes, their coaches. and trainers as well as to the tewn ph~sicitrns. the
diflkrent sports federations, and the public. The dec~ision to inten.s$v the random control.~ ji)r
rrnabolic steroids in loaded sports has increased the number of pcwitive rrsu1t.s substantiallv. 7hc
c’oncepts qf’ the antidoping catnpaign are nob\’ wideI! acknon~ledgetl at the national lewl.
Rrc~ommertdatior~s are Ri\,en that the result.5 of the Norwegian antidoping work should hr*
distributed internutionally. (J ALLERGY CLI:V IMMUNOL 73:73S. I%?4 .)

The idolization of winners and the enormoussocial
(and often financial) rewards accordedsuccessfulath-
letes may tempt many to increase their performance
by almost any meansavailable.
Unhealthy national chauvinism together with am-
bition often lies behind these demandsfor increased
performance. Athletes can be forced to push them-
selves further for fame and country than is medically
advisable. To raise the level of achievement, modern
methodsof training have been developed to the max-
imum, not always leading to satisfactory results.
Many athletesfeel that they are neither able nor will-
ing to submit themselves to more training, harder
training, greater sacrifice, or higher stakes.
It is therefore “natural” that other methods of
achieving sporting victories are being considered.The
methods that primarily aim to increase competitive
performanceartificially leadsomeathletesto useprep-
arations broadly classified as drugs. This has created
what is called “the doping problem.” “As for tech-
nology, modem man is a super human. But as for
ethics, there are no more humans.” This quote, in
many ways frightening, could possibly characterize
athletics, unlessthose interests that causeathletes to
aspire to results regardlessof costs can be curtailed.
From the Norwegian College of Physical Education
the Children’s Asthma and Allergy Institute.
University Hospital. Oslo. Norway.
The purpose of the present work is therefore to
further athletic traditions and maintain an ethical at-
titude toward the goals and meansof athletics, which
condemnsthe use of stimulating agents.
UVHAT Is f3a?Pws?
The European Council (1963) defined doping as:
“the administeringor useof substances in any form
alien to the body or of physiolgical substances in
abnormalamountsand with abnormalmethodsby
healthypersonswith the exclusiveaim of attainingan
artificial and Iunfairincreaseof performancein oom-
petition.
Furthermore,variouspsychologicalmethodsto in-
creaseperfomlancein sportmustbe regardedasdop-
ing.”
The latter part of this definition is dSicult to in-
terpret, but it originates from the use of hypnosis in
sports. However, the effects of suchmethodsare high-
ly questionable and their practice is impossible to
monitor, so therefore they will not be consideredfur-
ther in this context.
The Joint Nordic Committee for scientitic athletic
research (Helsinki. 1972) agreed upon another defi-
nition: “Doping comprisesthe administrationof med-
ications-or-the use of other means to artificially in-
and Sport. and
crease an athlete’s competitive performance.” This
Voksentoppen, the definition is somewhat simpler, but it also involves
other meansor methods that may be exrremely dif-
735
736 Oseid
ficult to control, such as blood doping. Because these
definitions and all others put forward to date are lack-
ing, the problem must be examined.
SCOPE OF THE PROBLEM
To improve athletic performance, drugs that stim-
ulate the central nervous system and the heart and/or
working muscles and drugs that stimulate protein syn-
thesis are the most commonly used.
The list of doping classes according to the Inter-
national Olympic Committee (IOC) list includes: (A)
psychomotor stimulant drugs, (B) sympathomimetic
amines, (C) miscellaneous central nervous system
stimulants, (D) narcotic analgesics, and (E) anabolic
steroids.
These groups of doping substances have been well
known for many years, but additional drugs and re-
lated compounds have recently been added. The 1983
addition of caffeine and testosterone to the doping list
complicated testing: The tests required quantitative
analyses while ail other tests to date have been quai-
itative only.
Definition of a positive test for these additional
drugs depends on the following: for caffeine-if the
concentration in urine exceeds 15 pg/ml; for testosl
terone-if the ratio of the total concentration of tes-
tosterone to that of epitestosterone in the urine ex-
ceeds 6.
In Norway we also deal with a group F, which
includes blood doping and drugs not presently in-
cluded on the IOC list, such as B-blockers and drugs
that facilitate the transmission of signals in the syn-
apses. The operational purpose of group F is to state
that the use of these drugs and methods is considered
unethical even if such use is not presently monitored.
However, B-blockers have been listed by the Inter-
national Shooting Federation, and in 1983 the Inter-
national Ski Federation stated that blood doping is
regarded as doping and that an effort must be made
to develop techniques to detect reinfusion of blood to
athletes.
Some international sports federations have devel-
oped their own lists of prohibited drugs, but most
federations have recently agreed fhat the IOC list will
be basic and will be used in any regulation under their
control. Dealing with only one accepted international
list of prohibited drugs also causes less confusion
when athletes and their coaches are informed about
the content of the doping list and also makes it easier
to discuss drugs to be added to the list as well as to
recommend that drugs be deleted from the list.
Today it seems generally accepted that central ner-
vous system stimulants, hormones, and blood doping
represent the most severe problems. Various sympa-
J. ALLERGY CLIN. IMMUNOL.
MAY 1984
thomimetics and miscellaneous central nervous sys-
tem stimulants are being considered for deletion from
the list because they pose no practical danger to health
and do not increase performance: Typical of these
drugs are different antiallergic compounds, cough
mixtures, and nose drops.
Doping substances can also be listed according to
the suitability in relation to the training or the com-
petition: anabolic hormones and neuromuscular stim-
ulation in the training period; blood doping in close
connection with a competition; psychomotor stimulant
drugs, sympathomimetic amines, and miscellaneous
central nervous system stimulants immediately before
or during a competition; and miscellaneous drugs or
methods after competition or between exercise events
to promote restitution.
WHY PROHIBIT DOPING?
Doping is prohibited for the following important
reasons: physical reasons-it is an acute health haz-
ard, and potentially fatal, and there is potential for
chronic disability, possible fatal; ethical reasons-the
use of doping agents is unethical to the concept of
athletics, and use can lead to addiction, which can
result in ethical and social degeneration; legal rea-
sons-it is against the Norwegian Confederation of
Sport’s statutes, and certain doping agents are also
illegal according to the narcotics laws in many coun-
tries, and use therefore may be punishable by law.
Physical side effects have been reported for several
of the drugs on the doping list’. ’ and also by the
athletes themselves.
As early as 197 1 the ethical reasons were thor-
oughly discussed by the General Assembly of the Nor-
wegian Confederation of Sport, and a statement was
issued that condemned the use of “stimulant drugs
and other means to artificially increase performance.”
Many doping agents are distributed by the same
people that distribute other drugs and narcotics to the
young. This creates an additional hazard to health and
social degradation as many of these young athletes
have become drug addicts.
HOW TO PREVENT DOPING?
Preventive measures must be based on the following
two assumptions: acknowledgment that doping exists,
even in our own environment and realization that pre-
vention is better than therapy.
The Norwegian antidoping programs have been
worked out according to these assumptions. Since
1976 our efforts have been concentrated on both dop-
ing control (during competition and at random in the
training period) and an extensive information program
to change attitudes toward the use and misuse of drugs
VOLUME 73 Doping a~:: ar!liete:j 737
NUMRER 5 PART 2

TABLE I. Doping control, Norway 1982 TABLE II. Which sports were controlied?
-_-- _. -._-..--_--
No. of controls: 77 + World ski championships. No. of No.
Nordic events sport controls of tests
Notified controls: I? + World ski championships. Skating .3
Nordic events
Skiing (Nordic and Alpine)
Without prior notice: 65 Power lifting I1
Controls in connection with competition: 48 Judo
Controls during the training period: 21 Weight lifting Ii
7
Controls after summons: 8 Track and field
Bowling
Total no. of tests: 539 Rowing Iii
(including world ski championships, Cycling
Nordic events = 78) Orienteering
No. of dispatches to test laboratory: 9 Wrestling
Water skiing
Swimminganddiving
in sports. These programs have been directed to the Canoeing
athlete, their coaches, and trainers as well as to the Shooting
team physicians, the different sportsfederations, and Boxing
the public. Archery
Tennis
Doping control Motor cycling
Karate
The Norwegian Confederation of Sport, General Basketball
Assembly. decided in 1976to institute regular doping Ice hockey and bandy
control for anabolic steroids, and these controls were Handball
started in 1977 according to the following guidelines: Volleyball
( I) Prior to departure for international championships, Tabletennis
selectedgroupsof Norwegian athleteswill be checked
medically to determine if anabolic steroidshave been
used; (2) randomcontrols may be carried out on Nor- TABLE 13. Top level athletics without doping
wegian representatives in international competitions
Aim: To test top Norwegian athletes regularly for anabolic
and at various times during the year to monitor the
steroids and central nervous system stimulants during the
use of anabolic steroids; (3) each year doping tests preparationperiodfor the SummerandWinter Olympic
will be carried out at selected Norwegian champion- Games
ships; and (4) the Sports Council takes the initiative Results ( 1980 Olympics):
to establishthesecontrols and tests. The arrangements I7 Controls performed during 9 mo: 7 different sports
and procedureswill be carried out in cooperation be- were checked 104individual testswere performed(87
tween the Sports Confederation, the Medical Council. maleathletes--I7 femaleathletesI*
the relevant sportsfederation (through its medicalcon-
*All tests were ne;:ative.
tact board), the medical officer of the meeting, and
the analytic laboratory in question. Checksand doping
tests must at all times be carried out within the es- becausewe tested athletes in almost all sports and
tablished financial framework. All expensesconnect- therefore included athletes who were lesslikely to be
ed with Norwegian control proceduresare covered by drug consumers. It was part of a general preventive
the Sports Confederation budget, with an annual bud- program.
get of 250.000 to 400.000 Norwegian Krugerrands Since 1980 it hasbecomeobvious that somesports
(U.S. $35,000 to $45.000) for doping control. (such as power lifting, weight lifting, and throwing
From 1979 the control measureswere extended to events in track and field) were more loaded with drug
include all athletes regardlessof age, sex, athletic problemsthan other sports-hence the term “loaded
discipline, or individual performing capacity. From sports.”
1980the doping control programshave beenextended Thesefacts were consideredby the Norwegian Con-
to include all drugs and agents adopted by the IOC federation of Sport. which led to another decision
Medical Commission list. From 1977 through 1982 madeby the General Assembly in 1982 to: ( 1) inten-
there were relatively few positive test results,probably sify the random control for both anabolic steroidsand
738 Oseid
central nervous system stimulants; (2) direct the con-
trols more specifically toward sports and individual
exercises that are known to be loaded; (3) increase
the random controls during the training period; (4)
demand that disqualified athletes submit to doping
control regularly during the period of suspension; and
(5) increase the sports confederation’s budget for dop-
ing control.
In 1982 altogether 539 tests were carried out, mostly
in connection with competition but a fair number also
in the training period (Table I). In 1983 this was re-
versed; most of the controls were at random and in
the training period. This resulted in four times as many
positive test results during I yr than in the previous
years together.
Table 11 shows the sports that were controlled and
illustrates the more frequent controls of power lifters
and weight lifters and also athletes in field events.
At the initiative of some of our top athletes (among
them both winners and medalists in Olympic events
and world championships). the project “Top Level
Athletics Without Doping” was launched. These ath-
letes wished to prove that it is possible to reach the
top without using stimulant drugs or hormones. The
results are shown in Table III.
Preventive measures (“antidoping”)
Experience has shown that in addition to regular
random controls, information programs and actions to
influence attitudes are equally important. Such pro-
grams must consider what can be done to limit the
extent of doping in sports. both at the national level
and internationally. The most important tasks are to:
( I) provide information about the dangers of doping
to health; (2) provide information about the limited
value of most doping agents in increasing the perfor-
mance; (3) attempt to produce ethical attitudes toward
the goals and means of sports. directly leading to
condemnation of doping and other artificial means
used to achieve better results; (4) prepare and distrib-
ute exact and detailed lists of different doping agents,
stating both the chemical composition and trade names
of the various drugs in alphabetical order and in ac-
cordance with international resolutions; (5) work to-
ward a stricter control over doctors’ prescriptions of
medications falling under the concept of doping; (6)
demand that more severe action be taken. not only of
athletes but also of coaches and leaders having been
found guilty of introducing doping agents to athletes;
(7) institute and support practical and regular doping
tests also at the national level by putting economic
means at organizers’ disposal: (8) cooperate with the
custom officials to prevent substantial import of drugs:
J. ALLERGY CLIN. IMMUNOL.
MAY 1984
and (9) cooperate with the police authorities to prevent
distribution of narcotic drugs and doping agents.
GUIDELINES FOR THE ATHLETES
Our information programs are primarily directed
toward the athletes. According to the guidelines an
athlete must: know the doping regulations equally as
well as the rules for competition. know the dangers
of doping to health, know the doping classes with
examples of relevant drugs (both the IOC list and the
list of the individual international federation), know
the procedural guidelines for doping control, know
the consequences of refusing doping control and of a
positive test result, know how to obtain a declaration
in case of dependence on regular use of any drug for
medical reasons, realize that import and distribution
of prohibited drugs is strictly forbidden, realize the
responsibility toward other members of the team in
case of doping control, and demand that coaches/lead-
ers procure necessary informational material about
doping.
In case an athlete is dependent on regular use of
any drug(s) for medical reasons he should note the
following recommendations: don’t stop taking the
drug, and contact his physician to obtain information
whether the drug contains any prohibited substances.
The athlete should also consider the following pos-
sibilities: that he can stop taking the drug in connection
with the competition involved, that he temporarily can
use another drug of similar effect that is not prohib-
ited. or that he can change to regular use of another
drug composed of accepted substances.
If the athlete’s physician states that it is not advis-
able or is contraindicated to change to another drug,
he must request a written declaration so stating. This
declaration must include: information about the med-
ical condition or handicap and what kind of drug(s)
the athlete is dependent on (the trade name and chem-
ical composition). This document must be presented
to the physician of the meet or the leader of the doping
commission before the competition. Forms for such
declarations have been worked out and distributed to
team physicians and physicians attached to the dif-
ferent federations. Thus far these declarations are val-
id only at the national level and not internationally.
The main reason for these exceptions is that many
athletes depend on regular use of various antiallergic
drugs that are still banned.
In addition, allergic athletes are informed about
allergen elimination. occasional pharmacoprophylaxis
(premeditation) to prevent exercise-induced asthma.
and continuous pharmacoprophylaxis (medication tak-
en one to four times daily. long term. if required to
VOLUME ;‘3 Doping an;! athletes 739
NUMBER 5. PART 2

preventboth asthmaand allergic rhinitis). Because In informationprogramsit is importantro btzaware

asthma or bronchial obstruction is a multifactorial dis- of all the different problems that may arise. A few of
ease, athletes should also be thoroughly informed them are listed below: (1) Different international fed-
about the different provocative causes and the reasons erations have different lists of doping agents; (2) there
for changes in tolerance thresholds with respect to are different prescription rules and attrtude:, in differ-
exrrcise. ent countries: (3) different sanctions are practiced by
Since outdoor sports are very popular in Scandi- the international federations; (4) the tcsrosteronc:epi-
navia regardless of the weather conditions, asthmatics testosterone ratio indicative of a posttivr: test result is
suffer more on cold and windy days. To overcome still being debated; (5) the question of what is doping
this problem, various face masks to prevent cold, dry and what is therapy; and (6) the long-tertn side effects
air from entering the airways have been tried with of doping agents. particularly hormone\. arc not well
promising results in asthma-disposed athletes. known in contrast to the immediate sidr reactions. We
presume that most of the reactions disappear when
GUIDELINES FOR COACHES/LEADERS drug intake is stopped-but wc do not really- know.
The coach/leader must: know the guidelines for the The future of doping in sports is uncertain. but we
athletes, increase his knowledge about doping to better must strive to obtain mutual international agreement
be able to inform the athletes, suit information to the about the necessity of efficient doping control, not
different groups of athletes (age groups, level of ed- only at international competitions but also randomly
ucation. etc.). plan and arrange teaching sessions at the national level. Our information programs must
about doping, develop a two-way communication sys- bc extensive and realistic. and we must move forward
tem and open support in case of problems, stimulate with ongoing vigilance to protect sport as well as
contact with the athlete’s surroundings (parents, athletes from being degraded. Many questions remain
school. working place, etc.), stimulate contacts with unanswered. But the goal of responsible leadership is
mass media to increase the level of information, show clear: to eradicate abuse and assure thck good health
a positive attitude to and respect for the rules and of our athletes.
ethics of sports, be prepared to deal with the problems
in case of drug misuse, be aware of the dangers and
REFERENCES
temptations involved when an athlete travels abroad.
I. Prokup L: Dnq abuse in intemattonal athlrtt<s XRI J Sports
be prepared to assist in doping control of his own
Med 3:85-7. I975
athletes, and increase his knowledge about training 2. Lamb DR: Allabolic steroids in athletics: NW well do they
principles and new developments to be able to sub- work and hou dangerous are they? MI J Spvn\ Med 17:.71-X.
stitute eventual drug misuse with better training. I983