Understanding the threats that doping poses to the health of athletes

The story so far

The National Anti-Doping Control Laboratory received approval from the World Anti-Doping Agency (WADA) to manage the Athlete Biological Passport (ABP) on December 6, 2024. The ABP is an advanced anti-doping tool that allows for longitudinal monitoring biological markers to detect potential risks. doping practices. ABP regularly collects samples (blood and urine) and monitors and analyzes the athlete’s hematological, endocrine and steroid profiles at specified time intervals. This profiling could serve as corroborative evidence of doping in cases of anti-doping rule violations. ABP does not replace but complements traditional testing by providing indirect evidence of doping and improving detection accuracy. Although doping is generally considered an attack on sportsmanship, it is necessary to understand it from the point of view of the athlete’s health.

What is doping?

Doping, as described by the National Anti-Doping Agency Rules 2021, includes violations such as the use of prohibited substances and the presence of the substance or its metabolites in the body sample, evasion or refusal testing of prohibited substances, failures to locate during testing, possession or trafficking of prohibited substances without proper justification, administration of such substances to others, complicity in violations, association with ineligible persons and acts or retaliation against launchers alert.

Doping is prohibited to preserve the integrity of sport by ensuring fair play and creating a level playing field for athletes. Although these reasons are rooted in ethical concerns, the physical health of the athlete consuming these substances is a direct and often overlooked issue. Performance-enhancing drugs can have several short- and long-term consequences on the health of athletes.

The practice of doping dates back to ancient Greece, when athletes took herbal stimulants to win competitions. In the late 19th century, the development of modern pharmacology led to the introduction of substances such as cocaine and strychnine. The mid-20th century saw the emergence of anabolic steroids, initially developed for medical purposes. The WADA Prohibited List classifies substances into two types: prohibited at any time and prohibited during competition. Substances prohibited at any time are prohibited in and out of competition due to their performance-enhancing or masking effects. Substances prohibited during competitions are only restricted when athletes are actively participating in events.

Doping substances

So what are these substances? First, anabolic agents (e.g. testosterone). These substances mimic the effects of testosterone, enhancing protein synthesis and promoting rapid muscle growth and recovery. They allow athletes to train harder and recover faster, increasing their strength, endurance and muscle mass. The unfair advantage lies in the unnatural enhancement of physical abilities, allowing athletes to outperform competitors who rely solely on training and natural abilities. However, their use carries serious health risks, including cardiovascular diseases such as heart attacks and strokes, liver damage, hormonal imbalances leading to infertility, psychiatric disorders like aggression and depression. and weakened tendons prone to injury.

Peptide hormones (e.g., erythropoietin) are also used. Erythropoietin increases the production of red blood cells, thereby increasing oxygen delivery to muscles and significantly improving endurance in sports like cycling and long-distance running. Growth hormone stimulates tissue repair, muscle growth and fat metabolism, thereby promoting recovery and physical performance. Health risks include thickening of the blood, leading to blood clots, strokes and heart attacks, insulin resistance, acromegaly (abnormal growth of bones and tissues) and increased risk of cancer, particularly colorectal cancer.

Then there are beta-2 agonists, medications that improve breathing efficiency by relaxing airway muscles and improving oxygen delivery during strenuous activities. They may also have mild anabolic effects at higher doses, promoting muscle growth. Health risks include tremors, headaches, palpitations, and potential heart rhythm disturbances with prolonged use. Hormonal and metabolic modulators (eg, tamoxifen). These substances modulate hormonal levels, stimulating testosterone production and promoting muscle growth and recovery. Risks involve blood clots, pulmonary embolism, liver damage and increased risk of endometrial cancer. Diuretics are used to quickly reduce body weight, help athletes in weight category sports and mask the presence of other prohibited substances. This allows athletes to manipulate their weight or evade doping controls. Diuretics cause severe dehydration, electrolyte imbalances, kidney damage, and increased risk of sudden death due to cardiac arrest.

The following substances are prohibited during competitions: Stimulants (e.g. amphetamines) which stimulate the central nervous system by improving alertness, reaction times and energy levels. It helps athletes stay focused and perform longer in intense conditions. The health risks are significant, including addiction, high blood pressure, cardiovascular problems, and serious mental disorders like psychosis. Narcotics (like morphine) reduce the perception of pain, allowing athletes to overcome injuries and physical discomfort. But it leads to respiratory depression, dependence and organ damage, especially with long-term use. Cannabinoids may reduce anxiety and improve concentration, potentially aiding performance in high-stress situations.

Risks include cognitive impairment, breathing problems and a higher risk of addiction. Glucocorticoids – Medications like prednisolone reduce inflammation and pain, allowing athletes to compete despite injuries or overtraining. Health risks include suppressed immune function, osteoporosis, and long-term hormonal imbalances. Beta blockers are prohibited in precision sports because they lower heart rate and reduce anxiety, thereby improving accuracy and stability in sports like shooting and archery. However, they can cause fatigue, dizziness, depression and chronic hypotension.

Exemptions for therapeutic use

Therapeutic Use Exemptions (TUEs) allow athletes to use banned substances for legitimate medical reasons. To qualify, athletes must provide complete medical documentation and demonstrate that the medication is necessary for their health. A panel of experts evaluates these applications, guaranteeing transparency and fairness.

Doping in sport compromises fairness and poses significant health risks to athletes, ranging from dehydration and tremors to long-term consequences such as cardiovascular disease, organ damage and psychological disorders. Doping fuels a global illicit drug trade, as recognized by Interpol, which classifies it as a low-risk, high-profit activity for criminal networks.

(Dr. C. Aravinda is an academic and public health physician. Views expressed are personal. [email protected])