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Performance Enhancing Drugs

The Healthy Competition Foundation is opposed to the use of any prescription drug being used by athletes for reasons and in doses other than the original clinical intent. The Healthy Competition Foundation is also opposed to nutritional supplements being used to increase an athlete's ability to the detriment of his/her health.

The risks associated with using prescription drugs in ways other than the original clinical intent can be high. Each drug is assigned a therapeutic index that measures the dose that is needed to provide a benefit. Amounts given that are less than the therapeutic index level are not as effective; amounts administered above the therapeutic index level could be extremely dangerous. Prescription drugs have a very narrow therapeutic index level because a certain dose is required in order for the drugs to be effective.

A good example of this is chemotherapy. Chemotherapy treatments are designed to bring your body to near death in order to destroy the cancerous cells. If a patient receives too much chemotherapy, it can kill. Too little and the cancer cells live. There is little room for error.

There are three general categories of prescription drugs that may be used as performance-enhancers:

Stimulants (amphetamines) - these drugs can cause the body to run in overdrive. Our bodies are not designed to work that way and could eventually collapse from exhaustion.

Blood Doping - this can be done in one of two ways. First an athlete can give himself his own blood through transfusions. Second he can administer a hormone, like erythropotin (EPO), causing the body to produce an excess amount of blood. In both cases the body has more blood than normal, increasing the number of red blood cells in circulation. This causes the body to carry increased levels of oxygen allowing athletes to run or jump farther and faster without cramps. This can also cause the blood to thicken or result in clots.

Anabolic (steroids) - the body responds to exercise and stress by creating more muscle. Steroids naturally produced in the body are the conduits to muscles being created through activities like running or weight lifting. Steroid doses in excess of what nature intended can cause devastating side effects to the sex hormones, including sterility. Liver damage and liver cancer can also result from high levels of steroid use.

Nutritional supplements can be dangerous for very different reasons than prescription drug misuse - in part because no one knows exactly what many of them can do. Taken in small doses, nutritional supplements may not be harmful, but in high levels they may be extremely dangerous. The full dangers of many of these drugs are not known due to lack of scientific research.

The full extent of the dangers of performance-enhancing drugs is not known. It is extremely important for athletes at all levels to understand the dangers of using drugs for reasons and in doses other than their original intent. In some cases, this type of use has not been tested and can be dangerous or even deadly.

Human Growth Hormone (HGH) is not technically a drug. It is an external source of the natural hormone that promotes growth. The body is exquisitely sensitive to HGH. A tiny increase at puberty accelerates the slow but steady rate of growth begun at birth. All parts of the body respond to this hormone in a precise way. That's why our arms end up being precisely the same length, and our hearts, livers, and lungs are just the right size for the rest of us. Natural production of too much growth hormone (a disease called acromegoly) leads to disfigurement and early death. Tampering with a "master control system" like HGH is potentially dangerous, especially in the young adult years when the body is so sensitive to it.

The Dangers of Performance Enhancing Drugs
Potential Adverse Effects of Androgenic Anabolic Steriods (AAS)
AAS can have adverse effects on virtually every organ of the body, such as:
  • Effects on both sexes: increased body hair, beard growth or heavier beards, baldness, oily skin and acne; levels of good cholesterol fall and levels of cholesterol associated with heart disease rise; blood pressure rises and body retains more fluids
  • Women only: lower voice, clitoral enlargement, breasts shrink, menstrual irregularities and possible cessation of ovulation, increase in facial and body hair
  • Men only: enlargement of prostate gland that results in difficulty urinating and even obstruction of the urethra; development of breast tissue; decline in sperm production that can lead to sterilization, impotence, increase in nipple and breast size (gynecomastia), enlarged prostate
  • Additional effects include urinary and bowel problems such as diarrhea, headaches, aching joints and muscle cramps, nausea and vomiting, sleep problems, increased risk of ligament and tendon injuries, severe acne, especially on face and back, baldness
  • Less well understood effects can include: High blood pressure and heart disease, liver damage and cancers, stroke and blood clots.
  • Several reports of stroke and heart attack have been associated with high doses of AAS.
  • Psychiatric effects may vary from a mild increase in aggressiveness to serious behavioral and psychiatric disorders including aggressive behavior that may result in violence, severe mood swings, hallucinations, paranoia, anxiety, panic attacks and depression.

Potential Adverse Effects of Beta 2 Agonists (clenbuterol and salbutamol} may include:
  • Headaches
  • Anxiety, nervousness and tremors
  • Increased blood pressure
  • Arrhythmia
  • Rarely, sudden unexplained death.

Potential Adverse Effects of Creatine Monohydrate
Creatine Monohydrate is a popular dietary supplement surrounded by controversy. Athletes at all levels of competition and in a broad cross-section of sports are using creatine with little understanding of potential side effects. Increasingly, however, professional sports teams are restricting players' use of this supplement. Used by athletes wishing to enhance their performance, creatine has been linked by anecdotal evidence to a variety of negative effects ranging from cramping to kidney problems.

Many athletes, coaches and trainers believe that creatine supplements are safe to use because creatine is a substance that the body produces naturally. Users assume that creatine use is approved by the government because the supplements are available over-the-counter at health food stores and on the Internet. Unfortunately, as with all substances classified as dietary supplements, this is not the case. Under the Dietary Supplement Health and Education Act of 1994, the Food and Drug Administration (FDA) does not regulate dietary supplements, which include creatine.

The long-term health effects caused by the use of creatine have not been scientifically examined, but a growing number of athletes and doctors have noticed negative health effects. Anecdotal, single-case reports and preliminary evidence suggest that creatine may be linked to cramping, diarrhea, nausea, dizziness, dehydration, incontinence, muscle strain, high blood pressure and abnormal liver and kidney function. There is no conclusive, scientific evidence that creatine use predictably causes any of these problems. Anecdotal evidence suggests that creatine should not be taken immediately prior to exercise and should never be used by children or pregnant or lactating women.

Some athletes have experienced such adverse effects that trainers and coaches of some professional sports teams are discouraging or restricting its use. A recent study conducted by USA Today surveyed 115 professional sports teams and discovered that one in three teams disapprove of creatine's use. Additionally, the University of Tennessee has prohibited the use of creatine after fourteen of its football players experienced cramps during a game.

Experts recommend that athletes interested in using creatine should do so with caution and under medical supervision. Dr. Gary Wadler, Associate Professor of Clinical Medicine at New York University and a widely recognized expert on performance-enhancing drugs, states, "Our concern is that many of the newer substances have not yet been tested for their long-term physiological and potentially adverse effects. As a physician and a father, I would recommend that adults and children consult with their physician before ever taking performance-enhancing supplements."

Dr. Allan Korn, Chief Medical Officer of the Healthy Competition Foundation, reminds us that the term "performance enhancing" may not even apply to creatine. According to Dr. Ronald Terjung of the American College of Sports Medicine, "There is no evidence that creatine supplementation increases aerobic power of muscle."

The long-term effects of creatine use have not been fully examined, and to ignore the potential concerns that surround this supplement could place athletes on the path to serious health problems. Creatine is an unregulated substance that is marketed to and used in large doses by teenagers without proper medical supervision. The Healthy Competition Foundation urges abstinence from creatine use and reminds athletes, parents and coaches that skill, dedication and hard work are the most important qualities of true athletic competition.

Potential Adverse Effects of Diuretics may include:
  • Excessive loss of water and the loss of potassium which accompanies the water loss
  • Excessive weight loss
  • Low blood pressure
  • Low or high blood potassium
  • Disturbances of heart rhythm
  • Decreased muscular work and muscle cramps
  • Increased blood uric acid
  • Low blood sugar
  • Transient deafness
  • Aggravation of diabetes

Potential Adverse Effects of Human Growth Hormone (HGH) may include:
  • Development of a broad range of problems that may eventually result in acromegaly or gigantism (characterized by large hands and feet, a pronounced jaw, separation of the teeth, and enlarged heart, weak muscles and diabetes)
  • Glucose intolerance
  • Fluid accumulation
  • Heart disease
  • Joint and ligament problems
  • High levels of fats
  • Low thyroid activity
  • Disfigurement associated with excessive growth of bones

Potential Adverse Effects Of Erythropoietin (EPO)) May Include:
  • High blood pressure and clogged arteries and veins
  • Dehydration that can thicken the blood and, in combination with EPO, increase the risk of blood clots.
  • Another potential side effect of EPO may be the combination of elevated pressure in the brain, swelling of the brain and seizures (hypertensive encephalopathy) due to poor blood circulation to the brain.
  • Heart palpitations
  • Skin rash
  • A flu-like disease producing aches and pains in the muscles and nausea.

Potential Adverse Effects of Stimulants may include (examples include amphetamines, pseudoephedrine, and ephedrine)
  • Disrupted coordination
  • Aggressive behavior
  • Hallucinations
  • Seizures
  • Hypertension
  • Irregular heart beats


"Steroids: Play Safe, Play Fair", American Academy of Pediatrics Info sheet for Kids and Families--1999 www.aap/org/family/steroids.htm

"Adolescents and Anabolic Steroids: A Subject Review" American Academy of Pediatrics Policy Statement, June 1997

"Doping: an IOC White Paper"

"Quality Control of Dehydroepiandrosterone Dietary Supplement Products" K. Schwartz, MD. Letters JAMA 11/11/98

Banned Substances and Methods

Within the United States, each sport has its own set of rules regarding doping. In addition, governing bodies such as the National Collegiate Athletic Association (NCAA) or the U.S. Olympic Committee impose their own sets of restrictions. Applicable rules can be obtained from the specific sport, league or governing body.

In general, the following are banned:
  • Stimulants (e.g., amphetamines)
  • Narcotics (e.g., painkillers)
  • Anabolic Agents (e.g., steroids)
  • Diuretics (e.g., Lasix)
  • Peptide Hormones and Analogues (e.g., EPO)

In addition, there are banned methods of doping or covering up infractions, including:
  • Blood doping
  • Pharmacological, chemical and physical manipulation of urine

There are also classes of drugs that are often subject to certain restrictions:
  • Beta Blockers
  • Alcohol
  • Local Anesthetics
  • Corticosteroids

Specific Substances Banned

amiphenazole amphetamine bemigride
benzphetamine bromantan chlorphentermine
cocaine cropropamide crothetamide
diethylpropion dimethylamphetamine doxapram
ephedrine ethamivan ethylamphetamine
fencamfamine meclofenoxate methamphetamine
methylphenidate nikethamide pemoline
pentetrazol phendimetrazine phenmetrazine
phentermine picrotoxine pipradol
prolintane strychnine  

Buprenorphine Dextromoramide Diamorphone (heroin)
Methadone Morphine Pentazocine

Anabolic Agents
anabolic steroids androstenediol androstenedione
boldenone clostebol dehydrochlormethyl-
testosterone dehydroepiandrosterone(DHEA) dihydrotestosterone(DHT)
dromostanolone fluoxymesterone mesterolone
methandienone methenolone methyltestosterone
nandrolone norandrostenediol norandrostenedione
norethandrolone oxymesterone oxymetholone
stanozolol testosterone clenbuterol

acetazolamide bendroflumethiazide benzthiazide
bumetanide chlorothiazide chlorthalidone
ethacrynic acid flumethiazide furosemide
hydrochlorothiazide hydroflumethiazide methyclothiazide
metolazone polythiazide quinethazone
spironolactone triamterene trichlormethiazide

Peptide Hormones & Analogues
chorionic gonadotrophin (HCG) (human chorionic gonadotrophin) corticotrophin(ACTH)
growth hormone(HGH) (somatotrophin) erythropoietin (EPO)

Show Your Commitment

Show your commitment to competing fairly by taking the Healthy Competition pledge.

"Healthy Competition" is dedicated to educating parents, teens and coaches about the dangers of performance enhancing drugs.

Go to to make this pledge online.

This is where you can register your commitment to the fight against the use of performance-enhancing drugs at all levels of sport. By submitting the form below, you join thousands of others who have "signed" the Healthy Competition Pledge.

Please read the pledge, fill in all blanks on the form below, and hit "I pledge to compete drug-free". Be sure to request extra paper pledge cards for your friends and teammates. We are not asking for donations, and your information will not be used without your permission.

I support drug-free athletics and believe that athletic goals should be achieved through hard work and dedication. Performance-enhancing drugs can destroy the body and undermine the fairness of competition. I refuse to take performance-enhancing drugs and will discourage others from using them.

Drugs and Drug Policy

Performance Enhancing Drugs
National Steroid Research Center And Other Drugs of Abuse in Sports
1-800-STEROID Fax: 304-797-9748

American Academy of Sports Physicians
17113 Gledhill Street Northridge, CA 91325 818-886-7891

American College of Sports Medicine
P.O. Box 1440 Indianapolis, IN 46206 317-637-9200

American Orthopedic Society for Sports Medicine
2250 E. Devon Avenue Suite 115 Des Plaines, IL 60018 708-803-8700

American Osteopathic Academy of Sports Medicine
7611 Elmwood Avenue Suite 201 Middleton, WI 53562 608-831-4400

Joint Commission on Sports Medicine and Science
Oklahoma State University Student Health Center Stillwater, OK 74078 405-744-7031

National Institute on Drug Abuse
PO Box 30652 Bethesda, MD 20824-0652 1-888-NIH-NIDA

Other Drugs of Abuse
The American Council for Drug Education
164 West 74th Street New York, NY 10023 Phone: 1.800.488.DRUG Fax: 212.595.2553

National Clearinghouse for Alcohol and Drug Information
PO Box 2345 Rockville, MD 20852 Phone:1.800.729.6686 Fax: 301.468.6433

National Council on Alcoholism and Drug Dependence Inc.
12 West 21st St. New York, NY 10010 Phone: 212.206.6770 Fax: 212.645.1690 Hopeline: 1.800.NCA.CALL

National Institute on Drug Abuse Information & Treatment Referral Helpline 1.800.662.HELP

Partnership for a Drug-Free America 405 Lexington Avenue, 16th Floor New York, NY 10174 Phone: 212.922.1560

3610 Decalb Technology Parkway, Suite 105 Atlanta, GA 30340 Phone: 770.458.9900 Fax: 770.458.5030

Youth Power
2000 Franklin Street, Suite 400 Oakland, CA 94612-2908 Phone: 1.800.258.2760 Fax: 510.451.9360

Drug Policy Information
U.S.A. - Office of National Drug Control Policy

U.S.A. - Recommendations of the White House Office of National Drug Control Policy to the International Olympic Committee Concerning Fighting Drug Use in Sports

U.S.A. - Barry R. McCaffrey, Director, Office of National Drug Control Policy

Canada - The Canadian Center for Ethics in Sport

Norway - Information on Norway's doping laws

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