Sports Medicine: Just the Facts

CHAPTER 24 • DRUG TESTING 137

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24 DRUG TESTING

Aaron Rubin, MD, FAAFP, FACSM

INTRODUCTION

• Drug testing of the athlete is an ethical, moral, legal,
  and occasionally medical issue.
  •Team physicians, athletic trainers, team psycholo-
  gists, coaches, administrators, and others dealing with
  the care of the athlete may be asked to become
  involved with drug testing.


• Care should be exercised to keep the punitive aspect
  of drug testing separate from the therapeutic care for
  athlete’s problems.


• Drug testing is performed for many reasons:
  a. To prevent cheating by use of drugs and chemicals
  b. To level the playing field by keeping clean athletes
  from having to compete with anabolic using ath-
  letes
  c. To prevent drug-induced illness and death
  d. To prevent public-relations problems for teams and
  organizations

SCOPE OF PROBLEM

• Olympic drug testing began in the 1964 Tokyo
  Olympics.


• Between the 1968 and 1994 Olympics, over 14,000
  athletes were tested at competition and 56 tested pos-
  itive.

•Various studies suggest that 5–11% of high school

males and 0.5–2.5% of high school females had tried

anabolic steroids.

• This is not merely a problem of athletes: of the high
  school students, 33% using anabolic steroids were not
  athletes.

REGULATING AGENCIES

• United States Anti-doping Agency (USADA)—
  http://www.usantidoping.org:USADA is an independent
  antidoping agency for Olympic sports in the United
  States.


• World Anti-doping Agency (WADA)—www.wada-
  ama.org:The mission of WADA is to promote and
  coordinate at international level the fight against
  doping in sport in all forms.


• National Collegiate Athletic Association (NCAA)—
  www1.ncaa.org/membership/ed_outreach/health-
  safety/drug_testing/index.html: NCAA regulates
  and provides safety guidelines for student athletes
  from member colleges in the United States.

DRUGS, MEDICATIONS, AND

OTHER SUBSTANCES

• There are no inherently good, bad, dangerous, legal,
  or illegal substances.


• In terms of athletic use, it is best to consider allowed
  or not allowedsubstances.


• Illegal substances are determined by rule of law and
  may vary from jurisdiction to jurisdiction. Use of ille-
  gal substance can be punished by criminal law.
  (Marijuana and crack cocaine are illegal substances in
  most jurisdictions in the United States.)


• Components of these substances may be legal.
  (Dronabinol is a derivative of marijuana and legal
  under prescription of a licensed physician. Cocaine is
  a legal medicine for specific indications.)


• Some legal substances can be used illegally.
  (Anabolic steroids are legal substances but can be
  obtained and used illegally.)
  •Over the counter medications are generally legal, but
  may not be allowed for athletic competitions (such as
  high dose caffeine).


• Some substances are legal but not allowed under cer-
  tain circumstance. (Alcohol may not be allowed for
  some events.)


• The ultimate decision regarding allowed or not
  allowed substances falls to the regulating agencies
  responsible for establishing the rules for the various
  sports teams, leagues, and organizations.