The International Olympic Committee’s (IOC’s) definition of doping is the following: “Doping is understood as the presence in the human body of substances which are forbidding according to the IOC’s list of forbidden substances. The uses of such substances, the presence of such substances in urine or blood samples, as well as the use of methods to influence the results of urine or blood tests are forbidden.”
Becoming a good or professional athlete or training muscles enough that the body changes its appearance markedly requires hard work and patience. There is a lot of money and prestige to be found in sports. Therefore many people will go to great lengths to win competitions, and some athletes use growth hormones and steroids as a shortcut to the large muscles and athletic feats necessary to win.
The many doping substances are generally harmful to the human body, but the degree of damage that they cause is of course dependent on the amount used, the way they are taken into the body, and the amount of time that they are used. Sensitivity for these substances is, like with other chemical substances, very individual. Some of the more serious side effects can appear years after the use of these substances; for example illnesses such as atherosclerosis, cardiac disease, liver disease, and cancer. In this article the many doping groups, doping methods, and substance groups with limited restrictions are summarised and a list over doping substances from A-Z is outlined.
The five doping groups
Stimulants have a stimulating effect on many of the body’s functions. Substances in this group have different effects which last for varying amounts of time. Many have a stimulating effect on the central nervous system and two of the most common effects are increased blood pressure and pulse.
Others affect fat tissue and cause increased fat metabolism and some dilate the airways. Side effects can include increased blood pressure, heart pounding, sleeplessness, dryness of the mouth, increased sweating, and problems with urination. High doses coupled with physical exertion can cause shock (circulatory collapse), respiratory failure, and death by cardiac arrest. Strong stimulants can affect the central nervous system and there are examples of such substances causing death.
Stimulants include: amphetamine, ephedrine, caffeine, and cocaine. Forbidden substances (IOC) include carphedon, salbutamol, amiphenazol, cocaine, mesocarb, salmeterol, amineptine, ephedrines, pentylentetrazol, selegilin, bambuterol, phencamphamine, pipradol, terbutaline, bromantan, formoterol, reproterol, and other related substances.
Also see the article “Coffee; the good and the bad ”
Narcotics include morphine, and decrease the breathing rate. Morphine’s powerful pain relieving effect is due to its effect on the central nervous system. Large doses can inhibit respiration, which in the worst cases can stop, causing death. Morphine’s effect is primarily pain reducing, but it can cause euphoria and loss of conciseness in higher doses.
The narcotic substances are best known as leisure drugs, but athletes have taken narcotics for their euphoric effects. The risk of abusing these drugs is high because of their strong addictive properties. The prohibited drugs are: morphine, methadone, and diamorphine (heroin).
Anabolic steroids are used for their muscle and tissue building effects. The development of steroids has been underway since the Second World War, and ever since then there has been an increasing use of these substances. They are not only used in elite sports, but also by athletes and competitors in competitions where muscle size and power is important. Users of steroids quickly achieve large muscle size. Steroids are especially used by body builders, as well as in cycle sport, discus and javelin throwing, and in weight lifting.
Anabolic steroids are a chemical imitation of the male sex hormone, testosterone. Steroids work by binding proteins and salt in the body and are used medicinally against bone calcification, chronic kidney disease, illnesses where the blood producing tissue in the bone marrow does not work properly, etc. The muscle building effects of steroids wears off over time, and is in many cases weak and uncertain, even with long term use.
In men, many of the anabolic steroids are converted to female sex hormones. This can cause the development of breasts which, in some cases, must be removed surgically. Other side effects include skin problems, higher pitched voice, hair loss (in men), weight gain, fluid retention, and psychological side effects such as aggression, depression, mood swings, irritation, irritability, violent tendencies, and loss of sleep.
Moreover, blood sugar increases which can lead to diabetes. Overuse can cause defects in the skin and muscles, damage to weight bearing joints, stunted growth (in children), testicular atrophy, lowered or terminated sperm production, prostate growth, increased cholesterol and blood pressure, urinary tract infections, irregular metabolism, reduced kidney function, lever inflammation, worsening of prostate cancer, heart attack, liver cancer, blood clot formation, and suicidal tendencies.
For women side effects also include: deepening of the voice, reduced breast size, enlarged clitoris, increased body hair growth, facial hair, menstruation disturbances, sterility, and breast cancer.
Social addiction often arises in due to peer pressure, but one does not become decidedly physically or mentally addicted to steroids. The increased aggressiveness that the hormones causes many to train longer and harder, leading to overly strained muscles, joints, ligaments, and tendons. Some athletes have felt pressured by their trainers to take such substances in order to increase their chances of winning.
Steroids taken with medications against blood clot formation (blood thinners) increase the effects of these medications and cause an increased risk of bleeding. Steroids are found as tablets, capsules, powders, and ampoules filled with fluid which is injected directly into the muscles (IM). These ampoules are typically taken as a 6-10 week cure, followed by a week (or more) long break. Steroid use is sometimes supplemented by growth hormone in an attempt to reduce some of the side effects.
Names and slang terms for anabolic steroids include: blanks, fake steroids, designer steroids, illegally produced steroids, gunpowder, juice, riods, sauce, etc.
Anabolic steroids have been on the doping list since 1976. If they are detected in urine samples under a drug test, disqualification from sporting competitions follows.
Diuretics increase the kidneys excretion of water and salt. This group of substances includes: butamid, furosemid, thiazides, and pironolactone. In conventional medicine diuretics are used by people who have a tendency of withholding fluid in the body, for example in people with heart or kidney disease.
Because these substances are used to remove water from the body, they are used in sports where fast weight loss can be desirable such as in bodybuilding, boxing, wrestling, and judo. By taking a diuretic a few days before a competition, it is possible to enter a lower weight class and thereby increase the chance or winning. Many bodybuilders use diuretics to reduce the water content in the body in order to make their muscles more defined for competition. Diuretics can also be taken to hide other and more serious doping substances from detection.
The most serious side effect to long term use of these substances is that the body can develop a reduced ability to retain water, which can lead to an increased risk of serious dehydration and subsequent heat stroke under high activity. Almost all diuretics cause the body to loose salt. The body’s natural salt content therefore becomes disturbed, which can cause shaking, cramping, dizziness, and life threatening disturbances of the heart rhythm.
Peptide hormones, related substances, and imitations are hormones which the body produces itself, but which, if supplemented, can be performance enhancing. The intake of large doses can manipulate the hormones’ functions, which normally stimulate and regulate many of the body’s functions. The most well known are: EPO (erythropoietin), insulin, and growth hormone (GH).
EPO (erythropoietin) is produces by the kidneys and is transported via the blood to the bone marrow where it stimulates the production of red, oxygen transporting, blood cells.
Training in elite sports is hard on red blood cells. By taking EPO, the number of red blood cells and their content of haemoglobin, which transports oxygen in the red blood cells, is increased.
The production of EPO is stimulated if the oxygen content in the surrounding air falls. This can be caused by increased altitude. Since 1987 EPO has been used as doping to artificially increase the amount of red blood cells in the body with the premise that, the more red blood cells there are in the blood, the more oxygen the blood can transport to the muscles, and the better performance will be in sports.
Normally the red blood cells of a highly trained athlete will comprise of 38-45% of the blood (this percent is known as the hematocrit). Even on the highest mountain top, this concentration is not normally higher than 47-48%. In demanding athletic efforts, the concentration of red blood cells can reach 50% because of fluid lost as sweat. A stay of at least 4-6 weeks at an altitude of at least 4000m is required to get this concentration over 50%. EPO can give a concentration of as high as 52% after a few days.
Conventionally EPO is used by people with chronic kidney damage which cause anaemia due to a low production of natural EPO.
EPO abuse can cause serious health risks because athletes are unable to control their production of red blood cells exactly. If there are too many red blood cells, the blood becomes too thick, the blood pressure increases dramatically under physical activity, and there is an acute risk of stroke and the formation of blood clots. The long term effects of EPO abuse are as yet unknown, but it has been on the IOC’s doping list since 1989.
A newer drug called Humatropin and otherwise known as artificial haemoglobin has the same effect as EPO without increasing the hematocrit. It is attractive to athletes because it cannot be detected by drug tests.
Insulin is a hormone with is produced in the body by the pancreas. One of insulin’s primary functions is to transport sugar into the cells. The use of insulin causes the muscle cells to increase in size because their uptake of sugar and protein form the blood is increased.
Insulin is hard to administer because the body’s glucose concentration can become too low if glucose is not given at the same time. This is why it is necessary to monitor blood sugar when using insulin. Problems with the blood’s insulin content can cause serious disturbances in the blood sugar balance and can, in the worst case scenario, cause death.
Conventionally, insulin is given to people who have diabetes, because the body’s own production of insulin is lowered or absent, causing sugar to accumulate in the blood while the cells “starve.”
Growth hormone is used in conventional medicine for patients who do not produce enough themselves. Growth hormone (GH) is a peptide hormone produced naturally by the pituitary gland. Growth hormone is especially important for the body’s growth throughout childhood and the teenage years. The concentration of growth hormone varies throughout the day and its production is stimulated by low blood sugar, exercise, and stress.
Growth hormone is used as a doping substance to increase fat metabolism and strengthen the body’s muscles and tendons. The use of the hormone enables harder training and faster restitution after injury. The effect of low doses of growth hormone on healthy adults is believed to be insignificant. Even so, good results have been seen with small, clinically controlled, daily doses of growth hormone in some elderly people.
The acute side effects of growth hormone abuse include massive fluid retention and thereby pressure on nerves in areas of the body where the fluid cannot escape (such as in the wrists). After long periods of abuse, the head, hands, and bones can grow dramatically. The heart and the tongue also grow, and there is a high risk of developing high blood pressure, diabetes, and leukaemia (cancer of the blood).
Doping methods
Blood doping is the introduction of blood or red blood cells into the body. This increased the blood’s content of oxygen carrying red blood cells without the use of medication. It increased oxygen delivery to the muscles and enables them to perform better. The advantage is greatest in endurance sports.
In conventional medicine, blood transfusions are given to people with acute anaemia. EPO treatment, which stimulates the body’s own production of red blood cells, is often used to reduce the number of blood transfusions these people. By giving extra EPO to people with anaemia, a normal blood percent can sometimes be maintained.
Blood doping works by first taking a small amount of ones own blood from the body, after which the plasma is separated form the blood cells, which are subsequently frozen. It remains frozen for a couple of weeks, until the body reproduces the removed blood. After this period, the blood cells are reintroduced into the body. By doing this, the amount of red blood cells in the body is increased. This is also called autologous transfusion.
Alternatively, blood cells can be obtained from a donor with a compatible blood type. This is called homologous transfusion.
Blood doping with donor blood can be easily detected in a doping test. Doping with ones own blood is harder, some say impossible, to detect, unless one is caught in the act.
One side effect to blood doping with ones own blood is that in the few weeks after use one is more tired due to the blood loss until the red blood cells are reproduced. The side effects of blood doping are similar to the side effects of EPO use. With hematocrits over 50%, the blood becomes thicker and more viscous and begins to flow slower to the body’s vital organs. This causes increased blood pressure and increases the risk of blood clots. There is also a high risk of infection and allergic reaction if the blood used comes from another person. Blood doping has been forbidden since 1985.
Artificial oxygen transporters, blood products, and substances which increase plasma volume are substances which, in one way or another, artificially increase the blood’s ability to transport oxygen or disguise such an increase. Examples of such substances are: actovegin, albumin, HES, and bovine haemoglobin (hemopure).
Actovegin contains calf blood extract and is believed to increase the availability of oxygen to the cells as well as increasing blood flow. Research is underway which shows that it might be able to improve the brain’s circulation and aid in wound healing.
Hydroxyethyl starch (HES) and albumin have blood plasma increasing effects and are used for life threatening acute blood loss. HES molecules added to the blood cause water from the tissues to be sucked into the bloodstream by increasing osmotic pressure. This increases the blood volume and leads to thinning of the blood. Blood thinning leads to reduced hematocrit and haemoglobin concentration. Side effects include shivering, nausea, hives, and vomiting.
Pharmacologic, physical, and chemical manipulation are methods which have the purpose of changing the results of the blood and urine tests with are taken to reveal the abuse of illegal substances. Such manipulation includes swapping urine tests with another person, changing your own test, or trying to mask the presence of substances of the doping list (at the bottom of this article).
Masking agents fall under the category of pharmacological manipulation. These methods often have little or no performance enhancing effects, but can be used to cover the use of other illegal substances. The most used are: bromantan, epitestosterone, and probenecid.
Some of these drugs (especially those which are diuretics) are used in conventional medicine along with antibiotics and arthritis medicine. These drugs help to retain medicine in the body and thereby lengthen the working time of the medicine. By doing this, the dosage of the medicine can be reduced, thereby reducing side effects.
The uses of these drugs as doping are many. Some substances retain the prohibited drug in the body until after the drug test. Others function by changing the measured relationships between different substances.
Bromantan is a masking agent which counteracts tiredness (like amphetamine) but is also suspected of being able to mask the presence of anabolic steroids.
Drug tests for testosterone measure (among other things) the relationship between testosterone and its residue, epitestosterone. By adding extra epitestosterone the ratio between these substances is reduced enabling manipulation of the doping test. Epitestosterones side effects are naturally similar to those of testosterone because epitestosterone is taken to mask doping with testosterone.
The diuretic probenecid works both by increasing the urines water content and by keeping prohibited substances in the body. Probenecid’s side effects are stomach and intestinal discomfort and skin reactions.
Gene therapy doping is undertaken by constructing artificial genes with specially selected properties. The genes are put into the athlete’s body to change its functions in the areas where the genes have influence. By doing this the body is manipulated to have the attributes that are desired.
Gene therapy has the declared goal of using artificially produced genes in the treatment of kidney patients, people with diabetes, cancer, and other diseases.
Gene therapy is not fully developed because there is not yet control of the genes’ actions in the body. The side effects of gene therapy and gene doping are incalculable because their actions in the body are not yet well understood.
A manufactured gene is impossible to detect because the body creates genes inside its cells. Gene doping will only be able to control through indirect methods which are not yet fully established. It is expected, and feared, that the development of gene doping in the near future will affect the limits of endurance.
Drug groups with limited restrictions
Alcohol is not regarded as a performance enhancing substance, but in some sports it is not permissible to have over a certain blood alcohol percent. Alcohol increases reaction time and generally reduces coordination.
Alcohol is used medicinally to disinfect wounds and can be found in some types of medicine, such as cough syrup.
Alcohol is used to a lesser or greater degree by some people in the sports world to calm the nerves before a competition. Alcohol abuse can lead to a state of alcohol addiction, which can result in many health problems and side effects.
Side effects include disturbances in the central nervous system (the brain). Alcohol is taken up by the blood and is transported to the rest of the body. In the short term alcohol causes problems with balance, increased reaction time, memory loss, nausea, dizziness, vomiting, and unease.
With long term alcohol abuse long term the damage can become quite serious. Blood sugar problems, impotence, asocial behaviour, weakening of the heart, changes in brain and nerve function, and death can ensue.
Also see "Alcoholism "
Hash, marihuana, or pot is included in the group “groups with limited restrictions” when describing drug abuse. Hash has no improving effect on performance and can reduce the ability to perform for up to a day after use because it is stored in the body’s fat deposits.
Marihuana contains delta-9-tetrahydrocannabinol (THC), which affects the brain, reducing motor function and changing the perception of reality. The drug causes relaxation, an increased appetite, and is pain relieving. The last of these attributes it used medicinally, especially for starving and pained AIDS and cancer patients.
Even though the sale of hash/marihuana is not legal in Denmark, some people are allowed to use hash under the direction of a doctor. In Denmark, there has only been one case of a doctor being allowed to use marihuana in the treatment of pain suffering patients. Marihuana also plays a part in the treatment of pain in AIDS and cancer patients in California, USA and Canada. In Holland, the use and sale of hash falls under a liberal set of laws, and hash is used for pain relief.
The use of hash has side effects such as: memory loss and concentration problems, lowered hand-eye coordination, increased reaction time, and reduced endurance and stamina because of tiredness. With long term use memory and learning ability is reduced and it is normal to experience lowered blood pressure and increased pulse. For some users, long term use of marihuana causes anxiety attacks, paranoia, and apathy.
The IOC regards marihuana use as doping if an athlete has a concentration of over 15 nanograms pr. ml. of the active substance in their urine.
Local anaesthetics do not cause any life threatening side effects and, in regard to sports, the use of local injections is allowed (also in joints). Adrenalin use as a local anaesthetic is both widespread and legal. Local anaesthetic, and legal, substances are: bupivacain, lidocain, and procain; which are also used by dentists and the like to reduce pain.
The use of systematic injections is forbidden or, more accurately, any injections, unless it is medically legitimate. The use of cocaine is likewise prohibited. It is also prohibited to use local anaesthetics systematically after sports injury to be able to engage in sport. Instead, taking a break is recommended to give the body the opportunity to heal itself.
Side effects to bupivacain include headaches, reduced blood pressure, (respiratory muscle paralysis), and in some cases allergic reactions.
Glucocorticosteroids fall under the category “drug groups with limited restrictions.” They are not regarded only as doping substances. These substances have powerful anti-inflammatory and mild pain relieving effects.
They are used in conventional medicine for relieving joint pain, for asthma, and as a local anti-inflammatory. Prolonged or intensive use of glucocorticosteroids increases the risk of osteoporosis and muscle atrophy.
Athletes are allowed to use them in creams, locally working gels, and in inhalation medications. The use of tablets or injections (either in the muscles or directly into the blood) is prohibited.
Without the possession of a doctor’s recommendation or some other form of approval, the use of glucocorticosteroids is regarded as doping by most sporting associations.
Beta blockers fall under the category “drug groups with limited restrictions.” They block special receptors, beta receptors, which are involved in the control of many of the body’s functions, including heart activity. Blocking the beta receptors causes generally lowered activity of tissues where these receptors are present, including muscle tissues and those of the central nervous system.
These substances have, even in small doses, a relaxing effect on the central nervous system and can reduce hand tremors caused by tension or nervousness. Beta blockers include: atenolol, metoprolol, propanolol, and sotalol.
Beta blockers are used by conventional medicine for elevated blood pressure, elevated heart rhythm, and cardiac infarction. The use of beta blockers can be life threatening in people with unstable blood sugar, low blood sugar and poor kidney function because the body’s danger signals become muted by these substances. The use of beta blockers can also dramatically increase breathing difficulty in people who suffer from asthma.
These drugs reduce endurance. Other side effects include depression, diarrhoea, nausea, circulation disturbances, cold hands and feet, nightmares, muscle tiredness, dizziness, sleeping problems, tiredness, breakouts, cardiac insufficiency, acute lung oedema, and impotence. Cessation of beta blocker use can cause withdrawal symptoms including headache, excessive sweating, and chest pain, which is why dosage should be reduced with care.
Beta blockers are often used in sports such as sky diving, shooting, high diving, and other precision sports. The use of beta blockers is not allowed and tests of beta blockers are undertaken in sports such as: biathlon, bobsledding, archery, curling, fencing, gymnastics, luge, modern pentathlon, equestrian sports, sailing, ski jumping, shooting, synchronised swimming, and diving.
IOC’s doping list
The International Olympic Committee’s (IOC’s) doping list comes out yearly. The substances on the doping list are categorized by their group (as described earlier), they way in which they are used, and their degree of restriction. Some substances are included in more than one category because they have more than one effect. The substances listed include, over the counter and prescription medicine as well as some dietary supplements and natural substances. If you take part in athletics which abide by this list and take any of the listed substances, you will have a positive drug test and be excluded from your sport.
IOC prohibited substances: from A-Z
- acetazolamid
- adrenalin
- alfentanil
- almitrin
- amfepramon
- amfetamin
- amilorid + hydrochlorthiazid
- amilorid+furosemid
- anastrozol
- atenolol+chlortalidon
- bambuterol
- bendroflumethiazid
- bumetanid
- buprenorfin
- buprenorphin
- buserelin
- choriongonadotropin alfa
- choriongonatropin
- clomifen
- clopamid
- cocain
- darbepoietin alfa
- dextran
- dipivefrin
- dipivefrinhydrochlorid
- dopamin
- dopexamin
- doxapram
- dutasterid
- efedrin
- ephedrin
- eplerenon
- epoetin alfa
- epoetin beta
- exemestan
- fenoterol
- fentanyl
- finasterid
- finasterid
- fulvestrant
- furosemid
- gonadotropin
- goserelin
- hydrochlorthiazid
- hydrochlorthiazid+metoprolol
- hydrocortison
- hydrocortisonacetat
- hydroklorthiazid
- hydromorphon
- indapamid
- insulin
- isoprenalin
- letrozol
- leuprorelin
- lutropin alfa
- mannitol
- menotropin
- methadon
- methylphenidat
- methylprednisolon
- metoprololsuccinat
- modafinil
- morfin
- morphin
- nafarelin
- noradrenalin
- opium+alkohol
- oxycodon
- pethidin
- prednisolon
- prednisolonphosfat
- prednison
- probenecid
- remifentanil
- selegilin
- sibutramin
- somatropin
- spironolacton
- sufentanil
- sufentanil
- tamoxifen
- terbutalin
- testosteron
- testosteronundecanoat
- tetracosactid
- triamcinolon
- triptorelin
- volumen expanders
Please note
Some of the listed substances are identical but spelled differently.
Some substances, like caffeine have preciously been on the doping list but are no longer prohibited.
More information can be found at World Anti-Doping Agency
