CHAPTER 9
PERFORMANCE-ENHANCING DRUGS

The spirit of sport is the celebration of the human spirit, the body and the mind. Doping is contrary to the spirit of sport, erodes public confidence and jeopardises the health and well-being of athletes.
—World Anti-Doping Agency

The word doping is often used to refer to any practice involving prohibited substances or other methods to give an athlete an unfair advantage over other competitors. The article "Doping in Sports: Steroids and Supplements" (World Almanac and Book of Facts, 2007) notes that the word dope probably comes from the Dutch word dop, an alcoholic beverage made from grape skins that traditional Zulu warriors believed enhanced their fighting ability.

A BRIEF HISTORY OF DOPING

For as long as people have been engaging in athletic competition, they have been seeking ways to gain an edge on their opponents. There is evidence that doping took place in the ancient Olympics, which lasted from 776 BC until AD 393. For example, Will Carroll notes in The Juice: The Real Story of Baseball's Drug Problems (2005) that Spartan coaches fed their athletes special herb and mushroom concoctions—during a period in which they were supposed to be consuming nothing but cheese and water—believed to render them oblivious to pain.

The first known case of an athlete dying as a result of doping occurred in 1886, when the Welsh cyclist Andrew Linton died during a race from Paris to Bordeaux. The substance he ingested was thought to be trimethyl, an alcohol-based product used by distance racers to ease pain and increase stamina.

According to Carroll, the modern era of doping began with the development of injectable testosterone in 1935. Testosterone is a male hormone produced naturally by the body. Injecting additional testosterone into the system increases muscle mass and strength. Originally introduced by Nazi doctors to make soldiers more aggressive, it did not take long for laboratory-produced testosterone to make its way from the battlefield to the athletic field. German athletes dominated the medals in the 1936 Olympics, probably with the assistance of these newly developed synthetic drugs.

The father of anabolic steroids—chemical variants of testosterone—in the United States was John Ziegler (1917–2000), a physician for the U.S. weightlifting team in the mid-twentieth century. Ziegler learned from his Russian counterparts that the Soviet weightlifting team's success was in part attributable to their use of performance-enhancing drugs, the formulas for which had been brought east by German scientists defecting to the Soviet Union after World War II (1939–1945). Deciding that U.S. athletes needed chemical assistance to remain competitive, Ziegler worked with the CIBA Pharmaceutical Company to develop an oral anabolic steroid. These efforts resulted in the creation of methandrostenolone, which appeared on the market in 1960. During the Olympics that year, the Danish cyclist Knut Jensen collapsed and died while competing in the 100-kilometer (62-mile) race. An autopsy revealed the presence of amphetamines and a drug called nicotinyl tartrade in his system.

Drug testing was introduced at the Olympics in 1968. By this time the International Olympic Committee (IOC) had developed a list of officially banned substances; however, because no test had yet been invented that could distinguish between anabolic steroids and naturally occurring testosterone in the body, the testing was largely ineffective. Only one athlete was found to be in violation of the new drug policy in 1968: the Swedish pentathlete Hans-Gunnar Liljenwall, who was found to have too much alcohol in his blood after drinking a few beers before the shooting portion of his event.

Steroids found their way into professional football in the late 1960s, as teams began hiring strength and conditioning coaches, who were charged with the task of growing a new breed of bigger, bulkier players. Taking their cue from the weightlifting world, these coaches turned to steroids as the fastest way of accomplishing this goal. During the 1970s performance-enhancing supplements were still way ahead of the dope detectors in the scientific arena. The East Germans showed up at the 1976 Olympics in Montreal with a team of women swimmers sporting man-sized muscles and deep voices. They won most of the medals. However, even though there was much talk about the likelihood that they were using banned substances, not a single one of these athletes tested positive. It later became clear that the athletes themselves were the victims of a mandatory doping program overseen by East German Olympic officials, who injected the swimmers with steroids without their informed consent. Several East German swimmers of that era have reported that they began receiving steroid injections at age thirteen and have suffered serious long-term health consequences—ranging from liver damage to infertility—as a result of doping (January 19, 2003, http://www.cbc.ca/sports/indepth/drugs/stories/top10.html#1).

Doping in sports has increased dramatically since then. As the practice has grown, so have the methods for detecting it and for keeping it from being detected. By the 1970s the use of performance-enhancing drugs had reached epidemic proportions among elite athletes. It was widely known that there were whole national sports programs whose success was based largely on sophisticated doping techniques, but scientists lacked the tools to prove what was going on. A breakthrough took place in 1983, when newly developed technology for analyzing blood for the presence of banned substances was deployed at the Pan Am Games in Caracas, Venezuela. The Associated Press reports in "Inquiry Set on Pan Am" (New York Times, September 14, 1983) that sixteen athletes from several countries were caught with performance-enhancing drugs in their system. Many other athletes, including twelve members of the U.S. track and field squad, withdrew from the event rather than risk the embarrassment of being caught cheating.

The first big-time Olympic disqualification due to steroids occurred in 1988, when the Canadian sprinter Ben Johnson (1961–) was stripped of both his gold medal and his world record in the 100-meter (109-yard) dash after testing positive for the banned steroid stanozolol. Years later, it was revealed that a number of U.S. track competitors had tested positive for illicit drugs before the 1988 Olympics in Seoul, South Korea.

THE BALCO SCANDAL

The cat-and-mouse game of doping and detection methods went on for more than two decades. A major turning point came in June 2003, when the track and field coach Trevor Graham turned over to authorities a syringe containing what turned out to be tetrahydrogestrinone (THG), a previously unknown anabolic steroid. THG was considered a designer steroid, in that it was manufactured to be undetectable by the existing methods. Lab testing methods were quickly adjusted to detect THG. U.S. government investigators soon turned their attention to the Bay Area Laboratory Co-Operative (BALCO), the California-based distributor of the drug.

On September 3, 2003, agents of the Internal Revenue Service, the U.S. Food and Drug Administration (FDA), the San Mateo County Narcotics Task Force, and the U.S. Anti-Doping Agency raided BALCO facilities and seized containers of steroids, human growth hormone, and testosterone. Two days later officials searched the home of Greg Anderson (1964–), the personal weight trainer of the baseball star Barry Bonds (1964–), and seized more steroids, as well as documents thought to implicate a number of high-profile athletes. Over the next few months urine samples from the U.S. Track and Field Championships were retested for THG, and several came up positive. One of those athletes was Kelli White (1977–), who had won both the 100- and 200-meter (109- and 218-yard) world championships in 2003. White was stripped of her titles and banned from competition for two years. Evidence was collected from computers and documents connecting a number of other athletes to BALCO.

Victor Conte Jr., the BALCO founder and owner; James Valente, a BALCO executive; Anderson; and the track coach RemiKorchemnywereindictedinFebruary2004fordistributing steroids. Later that year, Conte described on the December 3, 2004, broadcast of American Broadcasting Company's 20/20 how he provided performance-enhancing drugs to many elite athletes, including the sprinters Tim Montgomery (1975–) and Marion Jones (1975–). Dick Patrick, in "Doping Test Criticized, Defended after Jones Cleared" (USA Today, September 8, 2006), reports that Jones proclaimed her innocence throughout the scandal and sued Conte for defamation of character. She settled the suit out of court in 2006, and later that year she was cleared after her alternate blood sample tested negative for banned substances. However, the cost of defending herself was steep; according to the article "Marion Jones Running Out of Money" (Boston Globe, June 25, 2007), the affair cost Jones hundreds of thousands of dollars in endorsements and appearance fees, which coupled with legal fees brought her to the brink of financial ruin. In October 2007 Jones admitted to having used illegal performance-enhancing drugs during the period surrounding the 2000 Olympics in Sydney, Australia, in which she won three gold medals and two bronze. Under pressure from the U.S. Olympic Committee she surrendered her Olympic medals, and was retroactively disqualified from all events datingbacktoSeptember1,2000. Several other high-profile track and field athletes received bans in the wake of the BALCO scandal, including the sprinters White, Montgomery, and Chrystie Gaines.

The BALCO scandal also brought fines and suspensions for a handful of professional football players: Chris Cooper (1977–), Barrett Robbins (1973–), and Dana Stubblefield (1970–). Elliot Almond and Peter Carey note in "Bonds, Marion Jones Alleged to Have Received Steroids" (Knight-Ridder/Tribune News Service, April 25, 2004) that Bill Romanowski (1966–) was reported by the San Jose Mercury News to have been implicated by Conte, but Romanowski retired before the National Football League (NFL) could take any formal action against him. Romanowski later admitted to having used steroids during his playing career.

In March 2005 a congressional committee held hearings on the issue of steroids in baseball. A number of legislators mocked Major League officials for the sport's weak policy and feeble efforts to deal with the problem. Many of those who testified came out looking bad, including the former home run champion Mark McGwire (1963–), who was evasive when asked whether his power-hitting abilities were chemically aided. Other current and former baseball players who testified included Jose Canseco (1964–), Curt Schilling (1966–), Sammy Sosa (1968–), Rafael Palmeiro (1964–), and Frank Thomas (1968–).

In October 2005 Conte was sentenced to four months in prison and another four months of house arrest. Anderson received three months each of prison time and home confinement. Valente and Korchemny were given probation, Valente for three years, and Korchemny one year.

WHAT ARE PERFORMANCE-
ENHANCING DRUGS?

Anabolic Steroids

When people speak of performance-enhancing drugs, more often than not they are referring to anabolic steroids. In Steroid Abuse in Today's Society (March 2004, http://www.deadiversion.usdoj.gov/pubs/brochures/steroids/professionals/), the U.S. Drug Enforcement Administration (DEA) defines anabolic steroids as "synthetically produced variants of the naturally occurring male hormone testosterone." The full name of this class of drugs is androgenic anabolic steroids. The term androgenic means that the drugs promote masculine physical characteristics, and anabolic means tissue building. According to the DEA, the list of commonly abused steroids commercially available in the United States includes:

• Fluxoymesterone
• Methyltestosterone
• Nandrolone
• Oxandrolone
• Oxymetholone
• Stanozolol
• Boldenone

Others that are not approved for use in the United States include ethylestrenol, methandriol, methenolone, and methandrostenolone.

The main users of anabolic steroids are athletes seeking to add bulk and strength to their bodies. Besides building lean body mass, another way steroids are purported to help athletes get stronger is by reducing the amount of recovery time needed between workouts, allowing them to train harder. Anabolic steroids are currently banned by most sports organizations, including the IOC, the NFL, the National Basketball Association (NBA), the National Collegiate Athletic Association (NCAA), the National Hockey League (NHL), and Major League Baseball (MLB).

The only way to get steroids legally is through a doctor's prescription, and there are many legitimate medical uses for which a doctor might recommend them, including growth deficiencies, muscle-wasting diseases, loss of testicular function, breast cancer, low red blood cell count, or debilitated states resulting from surgery or illness. Steroids are also widely used in veterinary medicine to promote weight gain, to treat anemia, or to counteract tissue breakdown from illness or trauma. Most illicit steroids come from one of two sources. Some are diverted from the legitimate market, often through stolen or fraudulent prescriptions. The largest share, however, is smuggled into the United States from Mexico or from European countries where a prescription is not required to obtain steroids. Michael Ormsbee and Matt Vukovich report in "Performance-Enhancing Drugs: Who's Taking Them, and What Are the Benefits and Risks?" (IDEA Fitness Journal, May 1, 2005) that the black market sales of steroids exceed $100 million per year.

Steroids are available in several different forms, including tablets, liquids, gels, and creams. Typically, users ingest the drugs orally, inject them into muscle, or rub them on their skin. The doses taken by people who abuse steroids can be ten to one hundred times stronger than those recommended for medical conditions. Many steroid abusers engage in what is called stacking, which means mixing oral steroids with injectable ones, often taking multiple forms of the drug. Another common practice among steroid abusers is pyramiding, which means administering doses in cycles of six to twelve weeks where the dose is slowly increased to a peak midway through the cycle, then tapered back down toward the end. There is a widespread belief among steroid users that stacking and pyramiding maximize the benefits of the drugs while reducing their harmful effects, though there is no scientific evidence to support these contentions.

Other Substances and Supplements

There are a number of performance-enhancing substances besides anabolic steroids, some of which have until recently escaped the scrutiny of those in the business of regulating sports. As a result, these substances, often billed as dietary supplements, have been readily available, usually as nearby as the nutrition and vitamin store in a local mall.

ERYTHROPOIETIN.

Erythropoietin (EPO) is a hormone produced naturally by the kidneys. It plays a role in regulating the number of red blood cells in the blood stream. A synthetic version of EPO was developed in the 1980s, and it quickly became popular as a performance-enhancing drug, particularly among athletes involved in endurance sports such as cycling. When used excessively, EPO can increase the number of red blood cells to such a degree that the blood becomes too thick to flow properly, potentially leading to heart attacks and strokes. According to the 2007 World Almanac and Book of Facts, in the late 1980s, shortly after the appearance of synthetic EPO, thirty top endurance athletes, mainly cyclists, in Belgium, the Netherlands, Denmark, and Sweden died; the likely cause of their deaths was EPO.

CREATINE.

One of the most popular supplements used by athletes at all levels is creatine. Creatine is available over the counter (without a prescription) and is reputed to help improve performance in sports that involve short bursts of power, such as weightlifting, wrestling, and sprinting. Even though reliable research has not yet established a connection between creatine and serious health problems, there is some evidence that heavy use may cause kidney, liver, and heart problems. Known side effects of creatine include muscle cramps and digestive problems such as stomach pain, diarrhea, and nausea. In "Taking Performance-Enhancing Drugs: Are You Risking Your Health?" (December 26, 2006, http://www.mayoclinic.com/health/performance-enhancing-drugs/HQ01105), the Mayo Clinic explains that what actually happens when people take creatine is that their muscles draw water away from the rest of the body, creating the illusion of added muscle mass. The increased bulk is really just extra water stored in the muscles.

ANDROSTENEDIONE.

Androstenedione (or andro) enjoyed a huge burst of popularity in the late 1990s, as McGwire chased, and eventually shattered, the old record for number of home runs in a single season. McGwire admittedly used andro, which was perfectly legal and within the rules of MLB at the time. Countless young aspiring power hitters followed his lead. Whether andro really helped McGwire hit seventy home runs in 1998 is not known.

Andro is a direct precursor to testosterone—meaning it turns into testosterone in the body—and is found naturally in humans. It is also found naturally in Scotch pine trees, which is why manufacturers were allowed to sell it as a dietary supplement. Andro was discovered in the 1930s, but it was not until the 1950s that scientists became aware that it turned into testosterone in the body. Andro is widely believed to boost testosterone production, which in turn increases muscle mass, energy, and strength. The Mayo Clinic disputes these claims, though proponents of andro—including companies that make money selling it—cite research supporting andro's effectiveness as a performance enhancer. Andro is now classified as a controlled substance. The Anabolic Steroid Control Act of 2004 essentially reclassified andro as an anabolic steroid, making it illegal for use as a performance enhancer.

Heavy use of andro can produce side effects similar to those associated with other anabolic steroids. Andro can actually decrease testosterone production in men and increase production of the female hormone estrogen. It can also cause acne, shrinking of the testicles, and reduced sperm count. In women side effects of andro can include acne as well as the onset of masculine characteristics such as deepening of the voice and male-pattern baldness.

EPHEDRA.

Ephedra is an herb that has been used in Chinese medicine—where it is known as ma huang —for thousands of years. An American version widely used by early settlers in the Southwest was called Mormon or Squaw tea. The main chemical constituent in ephedra is ephedrine, which is a powerful stimulant, similar to amphetamines. It also contains another chemical called pseudoephedrine, which has long been used as a nasal decongestant but has recently come under tighter regulation because of its role in manufacturing illegal methamphetamine. Besides its use by athletes as an energy booster, ephedra has been used as an ingredient in popular over-the-counter weight loss pills. It has also been used by people seeking to stay alert for late-night studying or socializing activities; until recently, it was an ingredient in many popular energy drinks.

Ephedra has been linked to serious side effects, such as strokes, seizures, and heart attacks, and many people have died as a direct result of its use. Ephedra can also cause elevated blood sugar levels and irregular heartbeats. It may be addictive when used over time. In February 2003 the Baltimore Orioles pitcher Steve Bechler (1979–2003) died of heatstroke after a spring training workout. Ephedra toxicity was identified as a contributing factor in his death. Bechler's death sparked renewed efforts by the FDA to take action on ephedra. In December 2003 the FDA banned ephedra from being sold over the counter as a dietary supplement. However, in April 2005 a federal judge overturned the FDA's ban on procedural grounds. The Combat Methamphetamine Epidemic Act of 2005, signed into law in March 2006, placed strict regulations on the sale of ephedrine-containing products, including record-keeping, sale from locked cabinets behind the counter, and positive identification for purchasers.

HEALTH RISKS OF STEROID USE

Steroid abuse has been linked with a wide range of health hazards, both physical and mental. Among the

physical problems are liver and kidney tumors, high blood pressure, elevated cholesterol levels, fluid retention, and severe acne. Ormsbee and Vukovich note that some studies associate steroid use with serious cardiovascular problems, including cardiomyopathies (inflammation of the heart muscle), irregular heart rhythm, development of embolisms (blockage of an artery by a clot or particle carried in the bloodstream), and heart failure. Men sometimes experience symptoms such as shrunken testicles, reduced sperm count, baldness, breast development, and increased risk of prostate cancer. Among women, growth of facial hair, male-pattern baldness, menstrual cycle disruptions, and deepening of the voice have all been reported. Adolescents who use steroids run the risk of halting their growth prematurely, as their bones fuse ahead of schedule. Another problem for teenagers is that steroids cause muscles to grow but do not strengthen the tendons that connect these muscles to bones. This can increase the risk of injury.

Emotional/psychological problems stemming from abuse of steroids include extreme mood swings, depression, paranoid jealousy, irritability, delusions, and impaired judgment. Sometimes these steroid-induced mood swings lead to violent behavior, a condition popularly referred to as "'roid rage."

STEROID USE AND YOUTH

Data from Lloyd D. Johnston et al.'s Monitoring the Future, National Results on Adolescent Drug Use: Overview of Key Findings, 2006 (May 2007, http://www.monitoringthefuture.org/pubs/monographs/overview2006.pdf), an ongoing study of behavior among secondary school students, college students, and young adults, suggest that steroid use among young people peaked in the early part of the twenty-first century and has been tapering off since then. (See Figure 1.1 in Chapter 1.) According to Johnston and his colleagues, 2.7% of twelfth graders in 2006 had used steroids at some time, whereas 1.8% of tenth graders and 1.6% of eighth graders had done so. Among twelfth graders, 1.8% reported having used steroids in the past year. Less than 1% of eighth graders had done so.

PERFORMANCE-ENHANCING DRUGS
IN COLLEGE SPORTS

The NCAA Committee on Competitive Safeguards and Medical Aspects of Sports regularly compiles the results of the association's drug-testing program. The most recent available data was published in NCAA Drug-Testing Results 2004–05 (July 6, 2006, http://www1.ncaa.org/membership/ed_outreach/health-safety/NCAA_DT_0405report.pdf). According to the NCAA, positive steroid tests among intercollegiate athletes have declined steeply in recent years. Forty-nine student-athletes tested positive for steroids in year-round testing in 2004–05, compared with ninety-three positive tests in 2000–01. Table 9.1 shows drug testing results by division since 1993. This table shows that even though steroid use has declined dramatically, dropping by nearly half in Divisions I and III and nearly three-quarters in Division II, amphetamine use has increased just as sharply, more than doubling in Division III and nearly doubling in Divisions I and II. Table 9.2 indicates that the decrease in steroid use has been most evident among white athletes, dropping from 2.6% to 1% between 1993 and 2005 among that group. Table 9.3 and Table 9.4 break the results down by gender and sport. Table 9.3 shows that the pattern of increased amphetamine use held across each of the sports listed (with baseball, football, and tennis the highest at 3.9% in 2005), whereas steroid use declined among male basketball, football, tennis, and track and field participants. As shown in Table 9.4, the pattern of increasing amphetamine use and decreasing steroid use among female college athletes held across all sports listed, with 2005 amphetamine use highest among softball players at 5.2%.

STEROIDS IN PROFESSIONAL SPORTS

Every sport has its own way of testing for performance-enhancing drugs and its own policy for dealing with

players who use them. The NFL requires its players to take year-round drug tests. The penalty for those caught using banned substances for the first time is a suspension that lasts four games, which amounts to a quarter of a season. The second offense results in a year-long suspension. MLB, which has the most widely publicized steroid problem among the major sports, implemented a new, much harsher drug policy in 2006. Under the new policy, a player's first positive test results in a fifty-game suspension without pay. A second failed test brings a one-hundred-game suspension. A player who tests positive three times is banned for life. In the NBA first-time offenders are suspended for five games. The NHL implemented random drug testing at the beginning of the 2005–06 season.

Football

About seven players per year fail the NFL steroid test, but there is reason to believe that many more steroid users are getting away with it. In 2005 Onterrio Smith (1980–) of the Minnesota Vikings was suspended for a year after being caught with a device called a Whizzinator, which is designed to undermine the accuracy of a urine test. In "Steroids Prescribed to NFL Players" (March 30, 2005, http://www.cbsnews.com/stories/2005/03/29/60II/main683747.shtml), 60 Minutes Wednesday reveals that three players on the Carolina Panthers had filled prescriptions for steroids before the 2004 Super Bowl. None of these players failed a drug test, but the league has indicated that they will be monitored closely.

Baseball

For the last several years, MLB has suffered from a serious steroid-induced public relations problem. Baseball had no official steroid policy before 2002. That year, as part of the collective bargaining agreement between players and owners, a plan was put in place to hold survey testing in 2003; if more than 5% of players came up positive in anonymous tests, a formal testing policy, with accompanying penalties, would be implemented the following year. When the results of the survey showed a positive rate of between 5% and 7%, the policy development process was triggered. Beginning in 2004 every player was to be tested once per year during the season. The first time a player tested positive, he was to be placed in treatment; a second positive test would result in a fifteen-day suspension. A fifth positive test could result in a suspension lasting up to a year.

Under the policy, not a single player was suspended. However, it was clear that performance-enhancing drugs were still being used on a large scale, and pressure mounted to toughen the policy. The 2005 season brought a new policy in which steroids, steroid precursors (such as andro), designer steroids, masking agents, and diuretics were all banned. All players would be subject to unannounced mandatory testing during the season. In addition, there would be testing of randomly selected players, with no maximum number, and random testing during the off-season. The penalties for a positive result were a ten-day suspension for the first offense, thirty days for a second, sixty days for the third, and one year for the fourth. All these suspensions were without pay. The following season, the penalties were stiffened to those noted earlier.

The question of steroid use in baseball began to arise more frequently as long-standing home run records began to topple in quick succession. In 1998 McGwire and Sosa both passed the single-season home run record of sixty-one set by Roger Maris (1934–1985) in 1961, hitting seventy and sixty-six, respectively. Both players were dogged by rumors that they were assisted by performance-enhancing drugs. In 2001 Bonds extended the record to seventy-three. In 2005 Canseco published Juiced: Wild Times, Rampant 'Roids, Smash Hits, and How Baseball Got Big. In it, Canseco paints a lurid picture of rampant steroid use throughout the sport and names a number of players as steroid users.

Amid the furor created by Canseco's book, Congress convened in March 2005 a series of hearings on steroid use in baseball. Several prominent players were called to testify, including Canseco, McGwire, Palmeiro, Sosa, and

Schilling. Canseco reiterated his claims before the congressional panel. McGwire was elusive, saying, "I'm not here to talk about the past," whereas Palmeiro denied all wrongdoing. Palmeiro, after testifying under oath that he had "never used steroids," tested positive for the drug in July 2005. Bob Hohler notes in "Palmeiro Remains on Sideline" (Boston Globe, August 12, 2005) that Palmeiro was suspended for ten games and fined $164,000.

Palmeiro was not the first high-profile baseball player to get caught using steroids. As the BALCO scandal continued to unfold, Bonds admitted during grand jury testimony in 2004 to having used steroids, though he claimed that he had done so unknowingly via an arthritis cream he thought was steroid-free. Even though baseball players test positive regularly—Palmeiro was the seventh to do so in 2005—most of them are lesser known, and their stories do not make the headlines. The only prominent baseball player to publicly admit to intentionally using steroids is Jason Giambi (1971–), who confessed that he had used performance-enhancing drugs during his stellar 2003 season, in which he hit forty-one home runs. Table 9.5 contains a list of MLB players who have been suspended for using performance-enhancing drugs as of July 2007.

Another book sparked a further investigation in 2006. In Game of Shadows: Barry Bonds, BALCO, and the Steroids Scandal That Rocked Professional Sports (2006), Mark Fainaru-Wada and Lance Williams outline a series of damaging accusations associated with the BALCO affair. Fainaru-Wada and Williams focus most of their attention on Bonds, but they also implicate several other athletes, including Jones and Montgomery. Shortly after the book came out, it was announced that Allan H. Selig (1934–), the baseball commissioner, had engaged the former U.S. senator George Mitchell (1933–) to head an independent investigation into steroid use in baseball, in an effort to stave off further intervention by Congress. As Bonds was surpassing Hank Aaron's (1934–) all-time home run record in the summer of 2007, a feat he accomplished on August 7, Mitchell announced that his investigation was in its final phase and that a report would be released in the coming months.

Steroid use in baseball appears to be particularly widespread among players from Latin American countries. Joseph Contreras, in "Too Intense?" (Newsweek, May 27, 2006), notes that a majority of players who tested positive during MLB's first year of mandatory testing were from Latin America. Contreras quotes some insiders as pointing to the increased pressure on young players from poor countries to do well, as baseball presents one of the few potential paths out of poverty for these individuals. In "Caught Looking" (ESPN Magazine, May 28, 2007), Ian Gordon points to a language barrier as part of the problem, suggesting that some Spanish-speaking players may not be getting the message about banned substances in spite of the league's best outreach efforts.

Basketball

Rookie NBA players are tested up to four times per season, and veterans are subject to one random test during training camp. Prohibited substances include amphetamines, cocaine, opiates, marijuana, and steroids. Penalties range from suspensions for a number of games to a lifetime ban. As of 2007, basketball had largely avoided the kind of scandals involving performance-enhancing drugs that plagued the baseball world.

Hockey

Until 2005 the NHL had no formal antidoping policy. However, in the wake of scandals that dogged other major sports in recent years, the league unveiled its first such policy in September 2005 at a congressional hearing on drug use in professional sports. Under the new policy, NHL players are subject to a maximum of two random tests with no advance notice during the NHL season for the performance-enhancing drugs designated on the World Anti-Doping Agency's (WADA) "Prohibited List" (2007, http://www.wada-ama.org/en/prohibitedlist.ch2). A first-time positive test will result in a twenty-game suspension. The suspension increases to sixty games for a second offense, and a third positive test can result in permanent suspension from the league.

Cycling

Perhaps no other sport has been tainted by doping scandals more than professional bicycle racing, particularly the sport's most illustrious event: the Tour de France. During the 1967 Tour, the British cyclist Tom Simpson (1937–1967) died on one of the climbs in the race after using large amounts of amphetamines. The first major drug scandal in cycling took place in 1998, when the Festina cycling team was thrown out of the competition after the team masseur Willy Voet (1945–) was caught in possession of various narcotics and other banned substances, including EPO, growth hormones, testosterone, and amphetamines. In 2004 David Millar (1977–), a time-trial world champion, was banned from the tour following the discovery of banned drugs at the offices of his cycling team, Cofidis. Doping allegations have plagued the career of the American cyclist Lance Armstrong (1972–), who won his seventh consecutive Tour de France in 2005 before announcing his retirement. In 2002 Armstrong was linked to the sports physician Michele Ferrari (1953–), who was reputed to have developed a system for taking EPO without detection. In 2005 EPO was found in Armstrong's old laboratory samples from the 1999 Tour de France. Armstrong vehemently denied ever using banned drugs and questioned the validity of such old samples that had passed through so many hands over the years. In 2006 investigators cleared Armstrong of the charges and criticized antidoping authorities for mishandling evidence and making irresponsible accusations.

Armstrong's exoneration notwithstanding, the situation only became worse for the Tour de France. On the eve of the 2006 race, several top riders, including the contenders Jan Ullrich (1973–) and Ivan Basso (1977–), were banned from competing as a result of accusations made by Spanish police after a long investigation called Operacion Puerto. The2006TourwaswonbytheAmericancyclistFloyd Landis (1975–). However, shortly after the conclusion of the race, it was revealed that Landis had failed a drug test at the seventeenth stage of the race, with tests showing an abnormally high level of testosterone in his blood. Landis maintained his innocence, but he was nevertheless stripped of his title and fired from his racing team.

The doping situation at the tour continued its downward spiral in 2007. Several prominent riders either tested positive for banned substances before or during the race, or were punished for avoiding testing. They included the German cyclist Patrik Sinkewitz (1980–), who tested positive at a pre-tour training camp; Alexander Vinokourov (1973–) of Russia, who was pulled after the fifteenth stage for receiving an illicit blood transfusion; and the Danish racer Michael Rasmussen (1974–), who was withdrawn from the tour for intentionally avoiding a required blood test.

STEROIDS AND THE LAW

Anabolic steroids are Schedule III–controlled substances in the United States. In October 2004 the federal Anabolic Steroids Act was signed into law. The act updated the Anabolic Steroid Control Act of 1990 in a number of ways. It amended the definition of anabolic steroids, adding THG, androstenedione, and certain related chemicals to the list of substances the law covered. The act also directed the U.S. Sentencing Commission to review federal sentencing guidelines for offenses related to steroids and provided for increased penalties for committing these offenses. It authorized the U.S. attorney general to exempt from regulation steroid-containing drugs that do not pose a drug abuse threat. Finally, the law directed the U.S. secretary of health and human services to provide grants for the development of science-based educational programs for elementary and secondary schools on the hazards of anabolic steroid use. A number of states have passed their own laws targeted specifically at curbing steroid use among youths.

Antidoping Agencies

By the end of the twentieth century the global sports community recognized that it would take a coordinated international effort to bring the problem of performance-enhancing drugs under control. WADA was created in 1999 as a collaborative initiative between sports agencies and governments across the globe. WADA's role is to lead international efforts against doping in sports through public education, advocacy, research, and drug testing and to provide leadership for the efforts of agencies working against doping in individual countries. Table 9.6 shows a list of organizations that have signed on to the WADA code. The U.S. Anti-Doping Agency (USADA), an independent nonprofit organization, was launched in October 2000 to lead this work at the national level. The USADA oversees testing, education, research, and adjudication on drug issues for U.S. athletes competing in the Olympic, Pan Am, and Paralympic games.

Performance-enhancing Drugs

The use of performance-enhancing drugs in athletics began to accelerate in the 1960s. Then, athletes from East Germany received drugs as part of a state-sanctioned program designed to ensure Olympic dominance. In 1988, such drug use became infamous when Canadian sprinter Ben Johnson was stripped of his Olympic 100-meter gold medal (and then world record time) following the detection of a metabolic remnant of an anabolic steroid in his urine.

Aside from any moral or ethical considerations of this behavior, the use of performance-enhancing drugs can pose health dangers. Recognizing these dangers, many professional and amateur sporting organizations are increasingly imposing their own standards for performance enhancement and monitoring participants to try to ensure athletic performance is determined by natural talent and training excellence.

In the realm of Olympic sports, the World Anti-Doping Agency, which is headquartered in Montreal, Canada, is responsible for actively discouraging the use of illegal performance-enhancing drugs. A list of prohibited drugs is maintained and updated annually.

Part of the agency's efforts also involves the accreditation of analysis laboratories for the examination of samples. The obtaining and analysis of urine and other samples is essentially a forensic process. The investigators delve back in time to determine what chemical methods might have been used to enhance performance.

Performance-enhancing drugs may exert their effects in different ways. Some, like anabolic steroids, increase the mass and the strength of muscles. Bones can also be strengthened. Other drugs cause more oxygen to be delivered to muscles, which allows the muscles to perform at an intensity that could not otherwise be possible. Still other drugs can blunt pain, stimulate the production of chemicals that spur the body to greater levels of athletic activity, or reduce weight. Some drugs are even taken just to mask the presence of a performance-enhancing drug.

A number of drugs can be used to enhance the amount and strength of muscles. This list includes anabolic steroids, beta-2-agonists, human chorionic gonadotrophin, luteinizing hormone, human growth hormone, insulin-like growth factor, and insulin.

A steroid is derived from cholesterol. Anabolic steroids, which build muscle and bone by stimulating protein production from muscle and bone cells, derive their name from the constructive process of anabolism (the opposite breakdown process is called catabolism).

Anabolic steroids include testosterone, a hormone that predominates in men, and other steroids structurally similar to testosterone. As a result, these steroids, in addition to increasing the intensity and length of athletic training that muscles and bones can tolerate, enhance male reproductive and secondary sexual characteristics including development of testicles, body hair growth, and thickening of the vocal cords (females taking anabolic steroids can thus experience a deepening of their voices).

Besides testosterone, other examples of anabolic steroids include dihydrotestosterone, androstenedione (commonly known as Andro, which reputedly was taken by baseball star Mark McGuire), dehydroepiandrosterone, clostebol, and nandrolone.

The gains in athletic performance bestowed by anabolic steroids come with a price. Mood swings and feelings of depression and aggression (commonly known as "roid rage") can occur, as can liver damage and jaundice. Males can become infertile and experience breast growth, while females can develop facial and body hair and an altered or completely suppressed menstrual cycle.

Beta-2 adrenergic agonists can be life saving to an asthmatic. When inhaled, they mimic the action of epinephrine and norepinephrine, which are secreted by sympathetic nerves, and cause airway muscles to relax, making breathing easier. However, when injected into the bloodstream, the agonists can help build muscle mass and stimulate the utilization of fat. The result is a leaner and stronger athlete, but an athlete who can be prone to nausea, muscle cramps, and even an irregular heartbeat. Examples of beta-2 adrenergic agonists include clenbuterol, tertbutaline, salbutamol, fenoterol, and bambuterol.

Human chorionic gonadotrophin (HCG) is produced naturally by a developing fetus. Indeed, its detection is the basis of home pregnancy tests. HCG functions to stimulate the development of male and female sex steroids. This is exploited as a muscle-boosting performance enhancer in male athletes via the increased production of testosterone.

Luteinizing hormone (LH) is produced by the pituitary gland, which is located at the base of the brain. Normally, the peptide hormone regulates the level of testosterone in males and the ovulation-signaling estrogen in females. In men, excess LH or synthetic forms of LH, such as tamoxifen, boosts levels of testosterone and so produces the increased muscle mass.

Human growth hormone (HGH) is another natural hormone that is produced by the pituitary gland. Normally, the hormone functions to promote growth in childhood and adolescence. But, when exploited as an athletic performance enhancer, the hormone builds muscle, strengthens bone, and stimulates the destruction of fat. Side effects of deliberate misuse include: abnormal enlargement of the hands, feet, and face (acromegaly); enlarged heart, kidneys, tongue, and liver; and heart malfunction.

Both LH and HGH function to promote increased muscle mass. The enhanced athletic performance that can result comes at a potentially lethal price of low blood sugar (hypoglycemia).

Muscles need a supply of oxygen to function. Supplying more oxygen increases the capacity of the muscles to perform. Protein hormones, artificial oxygen carriers, and blood doping (the addition of whole blood into an athlete) are all illicit means of increasing the oxygen content in tissues.

A protein hormone called erythropoietin (EPO) is naturally produced and secreted by the kidneys when oxygen levels are low. The hormone stimulates bone marrow cells to manufacture red blood cells, which function to bind oxygen and ferry the molecule to tissues throughout the body.

By boosting the oxygen levels in the body's tissues, EPO can be a performance enhancer for athletes engaged in sports that require endurance, as opposed to the raw power of an activity like power lifting. Thus, marathon runners, cyclists, and cross-country skiers have all been accused of injecting EPO. Indeed, American cyclist Lance Armstrong, who has won the Tour de France six times in succession through 2004, has long been under a cloud of suspicion regarding EPO use, despite his repeated and vehement denials and lack of evidence of impropriety.

While EPO does boost oxygen levels by up to 10%, the increased number of red blood cells can thicken the blood. The blood, honey-like in consistency, does not flow as well through blood vessels, which causes the heart to work harder. The risk of a stroke or heart attack is increased.

Artificial oxygen carriers are synthetic compounds that mimic the oxygen-binding behavior of hemoglobin (the active component of the oxygen-binding red blood cell). They were initially conceived and made to help assist in conditions of clinical distress, such as breathing difficulties experienced by premature infants or those whose lungs have been damaged. However, the compounds have been exploited in the quest for greater athletic excellence.

The athletic benefits of artificial oxygen carriers are not clear. Moreover, this dubious benefit increases the risk of kidney damage, cardiovascular difficulties, and problems with the immune system .

Blood doping, by transfusing whole blood to an athlete, increases the amount of blood in the body (or more precisely the number of oxygen-binding red blood cells) and the overall oxygen carrying capacity is increased. This process occurs naturally when athletes train at higher altitudes, where the oxygen content in the air is less than at sea-level.

While altitude training is an ethically acceptable training practice, deliberate infusion of blood is not. Furthermore, injection of blood can cause infections and the increased amount of blood can cause similar problems as EPO. As well, if the infused blood is from someone else, there is a risk of acquiring a blood related infection such as acquired immunodeficiency syndrome or hepatitis.

Injury is a natural part of training and competition. A natural part of injury is pain; the signal to cease whatever is causing the damage. Many injuries heal with time and therapy. But, pressure to continue the athletic activity can drive an athlete to dull the pain rather than to stop training.

Narcotics including morphine, methadone, and heroin are effective at masking pain. They are, however, very addictive and can disrupt the mental focus that can be vital to peak athletic performance.

Adrenocorticotrophic hormone (ACTH) is produced by the pituitary gland. Normally, ACTH stimulates the production of other hormones by an organ called the adrenal cortex. The hormones reduce inflammation and so can be used illicitly to ease the trauma of injured muscles. However, immediate side effects include stomach irritation and ulcers. In the longer term, bones and muscles can become weaker.

Stimulants such as caffeine (the wake-up ingredient of coffee), cocaine, and amphetamines increase the beating of the heart, lung activity, and even brain activity. For an athlete, these physiological responses are manifest as increased alertness, decreased fatigue, and promotion of an aggressive, competitive attitude. Side effects include an irregular heartbeat and high blood pressure.

Relaxants such as alcohol and marijuana decrease brain and nervous system activity. They can ease competition jitters. However, impaired focus and coordination can undermine athletic performance.

Beta-blockers are another illicitly used relaxant. They slow down the heartbeat, which can help lessen the movement of the hands and arms that occurs in concert with pumping of blood by the heart. Thus, they can be used by athletes competing in archery or shooting competitions, where steady hands can be a key to the first-place podium.

Paradoxically, athletes may need to take drugs to hide the use of other illicit drugs . One example is epitestosterone. The compound is a natural form of testosterone. Testing for elevated levels of testosterone rely on the comparison of the levels of testosterone and epitestosterone. By artificially increasing the levels of the latter, the presence of increased testosterone can be masked.

The tendency of blood to thicken because of the administration of agent like EPO can be masked by diluting the blood with additional fluid. This process is called plasma expansion.

Organizations such as the World Anti-Doping Agency are actively engaged in testing samples obtained from athletes during training and following competition.

Urine is most often tested. Illicit chemicals can be detected using the technique of gas chromatograph/mass spectrometry, where individual components can be separated from one another based on their different rates of movement through a medium.

Compounds including HCG, LH, and ACTH stimulate the production of antibodies by the body's immune system. These antibodies are used to detect the presence of the compounds in urine samples.

Testing procedures are constantly being refined. Some drugs such as EPO remain difficult to detect. A San Francisco a company called BALCO was exposed in 2004 as the source of a variety of performance-enhancing drugs for athletes, including New York Yankees star Jason Giambi, who has admitted his steroid use. A forensic investigation of BALCO uncovered evidence that existing drugs were being chemically modified to be undetectable.

see also Illicit drugs; Saliva; Souvenirs from athletic events; Sports testing.