Performance-Enhancing Drugs

History

All types of stimulants, including caffeine, herbs, and hallucinogenic funguses, were used in ancient Greece in hopes of enhancing athletic performance. Although PED use is as old as sport itself, consumption has only been viewed as a medical or social problem for roughly the past century. During the early 20th century, athletes ingested a range of substances including mixtures of alcohol, opium, strychnine, cocaine, and caffeine. Athletes began using cortisone and stimulants (e.g., amphetamines) as they became more available. Fueled in large part by cold war competition, athletes from both superpowers (the United States and the Soviet Union) began injecting muscle-building anabolic steroids derived from the hormone testosterone. As early as the 1960s, endurance athletes experimented with blood manipulation or “blood doping” and, in the 1980s, the use of oxygen-boosting drugs, including erythropoietin, to increase performance and endurance. While erythropoietin, cortisone, human growth hormone, and a range of “designer steroids” are currently some of the most popular PEDs among elite athletes, new substances and methods including so-called gene doping, which holds the potential to modify one's genes, are constantly emerging.

Testing

Antidoping legislation in competitive sports is frequently advocated for reasons of fair play and concern for the health of athletes. The deaths of a few high-profile athletes along with changing conceptions of sport and health precipitated antidoping advocacy following World War II. Early antidoping advocates often employed the rhetoric of “pure” competition and “dirty” cheating to frame PED use as a moral and public health issue. Although some sports began drug testing earlier, the first Olympic testing occurred in Mexico City in 1968. Early testing was often inconsistent, heavy handed, and, in some cases, carried out by police rather than medical professionals. As testing became more rigorous, unannounced and out-of-competition tests were instituted. Early antidoping efforts lacked uniformity as nations and sporting federations often adopted their own banned substance lists, testing protocols, and sanctioning procedures. In 1999, the World Anti-Doping Agency (WADA) was created to harmonize, coordinate, and monitor antidoping efforts for most Olympic sports. Out-of-competition testing for most Olympic sports is conducted by the WADA, [Page 501]while in-competition tests are overseen by various international sports federations. Currently, non-Olympic sports, including American football and baseball, have adopted their own testing and sanctioning procedures, which are generally less severe than WADA's guidelines. The majority of global PED testing is conducted on elite and professional athletes in Olympic sports, but testing also occurs in all major North American National Collegiate Athletic Association and some high school sports.

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