REVIEWS
Drug Use in Sports: A Veritable Arena for Pharmacists

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ABSTRACT

Objective

To describe opportunities and obligations for pharmacists regarding doping control in sports, and to present information and resources on drugs and dietary supplements that are popular among athletes for performance enhancement.

Data Sources

Sports medicine journals and articles in English obtained from Medline (1966 through June 2003) using the search terms doping in sports, drugs in sports, dietary supplements, sports, amphetamine, stimulants, ephedrine, ephedra, caffeine, anabolic steroids, human growth hormone, erythropoietin, darbepoetin, androstenedione, dehydroepiandrosterone, and creatine. Information was also obtained from sports-governing agencies, such as the National Collegiate Athletic Association and the International Olympic Committee.

Study Selection

Studies and reports that were credible and scientifically sound that evaluated the ergogenic effects of drugs and dietary supplements.

Data Extraction

By the author.

Data Synthesis

Pharmacists can participate in doping control programs in a number of ways. Pharmacists also have an obligation when counseling, advising, and treating athletes to help them avoid banned substances. Athletes use a host of drugs for their performance-enhancing effects, many of which are banned by major sports-governing bodies. Myriad dietary supplements are marketed to athletes, claiming to have ergogenic effects. Some of these popular supplements have proven performance-enhancing effects, while others do not. Adverse effects of these drugs and dietary supplements are discussed.

Conclusion

A variety of drugs and dietary supplements have proven performance-enhancing effects in athletes. However, many of these substances have adverse effects and are banned by various sports-governing organizations. Pharmacists can play a key role in participating in doping control programs, and can prevent athletes from inadvertently consuming a banned substance.

Section snippets

Objectives

This article describes the various opportunities and obligations for pharmacists in counseling, advising, and treating the athlete-patient with regard to doping control. Sports pharmacy is a specialty in pharmacy practice, however, pharmacists may be in a position to provide pharmaceutical care in a variety of settings, and need to consider the special needs of athlete-patients, including doping control issues. Pharmacists can also use their expertise on drugs to participate in education and

Background

The term doping is believed to be a derivative of the Dutch word doop for viscous opium juice, and has evolved to denote the use of performance-enhancing drugs in athletics.14,15 The World Anti-Doping Code, developed by the World Anti-Doping Agency (WADA), defines doping to include one or more of the following: “The presence of a prohibited substance or its metabolites or markers in an athlete's bodily specimen; use or attempted use of a prohibited substance or prohibited method; tampering, or

Patient Counseling

Pharmacists, in a variety of settings including community practice, dispense medications to athletes, and can offer advice on nonprescription products and dietary supplements. Pharmacists should question these patients as to whether they are competitive athletes subject to drug testing by a sports-governing body such as the NCAA, USADA, and professional-sports organizations. If so, pharmacists can help the athlete to avoid banned substances, which are generally considered ergogenic and

Doping Control Programs

Pharmacists are needed to participate in drug testing or doping control programs for the various sports and drug testing organizations (Table 3). Roles for pharmacists in this capacity can include being a resource or a consultant on drugs and other substances regarding whether to prohibit, restrict or permit them. Such categories are based on the potential for unfair or artificial performance-enhancing ergogenic effects, the potential for abuse, safety, efficacy, and therapeutic use of the

Stimulants

The use of stimulants to improve athletic performance is prevalent in both college and Olympic sports, and likely in professional sports as well.14,26–28 In a 2001 study of 21,225 college athletes who responded to a survey, the use of amphetamines and ephedrine was reported to be 3.3% and 3.9%, respectively.26 This is an increase in comparison with similar surveys conducted in prior years. Claims have been made that the majority of Major League Baseball (MLB) players use amphetamines or other

Dietary Supplements Used in Sports

An explosion of dietary supplements has bombarded the American public since the U.S. Congress passed the Dietary Supplement Health and Education Act (DSHEA) in 1994. DSHEA essentially allows substances that are marketed as dietary supplements to be regulated as foods rather than as pharmaceuticals. Dietary supplements under this regulation include vitamins, minerals, herbs and botanicals, amino acids, tissue extracts (e.g., enzymes or tissues from organs or glands), and concentrates,

Other Agents Used in Sports

A multitude of other drugs and supplements have been used by athletes in the hope of obtaining some performance-enhancing benefit. Without a doubt, others will be coming as some athletes will continue to strive for that chemical competitive edge. For example, ribose is a relatively new dietary supplement that is being marketed as an ergogenic aid, supposedly by increasing energy production in a similar fashion as creatine.123,124 Magazines and newspapers are replete with advertisements aimed at

Conclusion

Pharmacists can and should play an important role in doping control, in additional to counseling, advising, and treating athletes. When athletes take drugs for medical conditions, pharmacists can help prevent the inadvertent use of banned substances for those athletes subject to drug testing. Thus, pharmacists need to be familiar with how they can obtain information on banned, restricted, and permitted substances by the various sports-governing organizations. Pharmacists may also be in a

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      Ensuring the safe, effective, and legal use of drugs in sport demands the involvement of healthcare professionals, in particular pharmacists, who have a unique insight into the modes of action, uses, side effects, and legal status of drugs commonly used by athletes. Professional practice areas where pharmacists can provide services related to sports pharmacy include major sporting events, specialized sports medicine hospitals, and community pharmacy settings.8–12 Within these arenas, pharmacists can provide information on prohibited drugs to other healthcare professionals, offer advice on therapeutic use exemptions in sporting events, deliver pharmaceutical services at international games, and serve as doping control officers for anti-doping drug testing authorities.8,9,11–14

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    Continuing education credits: See learning objectives and test questions at the end of this article, which is number 202-000-04-195-H01 in APhA’s educational programs. CEanswer sheets are located inside the back cover of this issue. To take the CE test for this article online, go to www.pharmacist.com/education.cfm, and follow the links to the APhACE center.

    Disclosure: The author declares no conflicts of interest in any product or service mentioned in the article. The author receives compensation from the National Center for Drug Free Sport when conducting drug tests for the National Collegiate Athletic Association.

    Acknowledgment: The author wishes to thank and acknowledge Frank D. Uryasz and Rachel Olander from the National Center for Drug Free Sport for reviewing the manuscript.

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