SOC 204 Goldberg Ch 14 OTC + steroids
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SOC 204 Goldberg Ch 14 OTC + steroids
- 1. Goldberg Chapter 14 Over-the-Counter Drugs Chapter 3 Performance- Enhancing Drugs
- 3. A. Sure, vitamins B. Herbal supplements C. Amino acids to bulk up D. No way! Sure, vitamins Herbal supplements Amino acids to bulk up No way! 57% 0% 30% 13%
- 4. Food, Drug & Cosmetic Act Food = safe, pure, NOT required to show they are effective or have benefit Drug = intended for use in diagnosis, cure, mitigation, treatment or prevention of disease
- 5. Dietary Supplement Health and Education Act 1994 Defined supplements and set regulation for safety and labeling Same as food labeling ▪ Includes: vitamins, minerals, herbs (and concentrates), amino acids
- 6. Category I: generally recognized as safe (GRAS) generally recognized as effective (GRAE) generally recognized as honestly labeled (GRAHL) Category II: Not generally recognized as safe or effective or is improperly labeled Category III: Cannot be sold
- 7. A. My mom. B. Advertisements. C. Friends. D. Used it in the past. E. Nothing. My mom. Advertisements. Friends. Used it in the past. Nothing. 42% 15% 12% 12% 18%
- 8. 1962 Kefauver-Harris amendment required all drugs be evaluated for safety and efficacy
- 9. FDA can only declare a product adulterated if it presents a significant or unreasonable risk of illness or injury Health claims Structure/function claims Carries disclaimer
- 11. What are the pros and cons of current supplement regulations? What are some supplements you’ve heard of? FILM http://digital.films.com/Portal ViewVideo.aspx?xtid=32926#
- 12. Definitely hazardous Aristolochic acid Ephedra Very likely hazardous Comfrey Androstenedione Chaparral Germander Kava Cesium Colloidial Siver Graviola Likely hazardous Bitter orange Organ/glandular extracts Lobelia Pennyroyal oil Scullcap Yohimbe Commonly used St. John’s Wort Gingko Biloba Echinacea Goldenseal Aloe Vera Flax Seed Oil Green Tea Primrose Ginseng Saw Palmetto
- 13. A. 2 B. 4 C. 10 0% 0% 0% 2 4 10 Response
- 14. A. It doesn’t; they are the same. B. OTC drugs are safer than prescription drugs. C. Supplements are safer than prescription drugs. 0% 0% 0% OTC drugs are safer than... It doesn’t; they are the ... Supplements are safer t... Response
- 15. A. Yes, thoroughly B. Well, I skim it C. Nope, never looked 0% 0% 0% Yes, thoroughly Well, I skim it Nope, never looked
- 17. A. 1 in 20 B. 1 in 50 C. 1 in 100 0% 0% 0% 1 in 20 1 in 50 1 in 100
- 18. A. True B. False 0% 0% True False
- 19. 1938 Food, Drug & Cosmetic Act established class of prescription drugs DIFFERENCES: Dosage Active ingredient FDA reviews products, may switch to OTC
- 20. Stimulants Only caffeine Weight-control products Only Orlistat/Alli Sedatives/sleep aids No approved sedatives, sleep aids contain antihistamine
- 21. Analgesics Acetylsalicylic Acid, Acetaminophen, Ibuprofen (NSAIDs) Cold/Allergy remedies Antihistamines Nasal decongestants Analgesic-antipyretics
- 22. A. True B. False 0% 0% True False
- 23. A. True B. False 0% 0% True False
- 24. A. Seizures B. Cancer C. Infections D. Mental illnesses 0% 0% 0% 0% Seizures Cancer Infections Mental illnesses Response
- 27. A. Mood stabilizer B. Testosterone C. Enzyme D. Protein 0% 0% 0% 0% Mood stabilizer Testosterone Enzyme Protein Response
- 28. A. Deepening voice B. Growth of facial and chest hair C. Decrease depression D. Increase muscle mass 0% 0% 0% 0% Decrease depression Deepening voice Growth of facial and ches... Increase muscle mass Response
- 29. A. Changing metabolism B. Increasing protein synthesis C. Affecting neurotransmitters D. Increasing growth hormone 0% 0% 0% 0% Changing metabolism Increasing protein synthesis Increasing growth hormone Affecting neurotransmitters Response
- 30. A. Depression B. Growth deficiencies C. AIDS D. Cancer 0% 0% 0% 0% Depression Growth deficiencies AIDS Cancer Response
- 31. A. Using steroids to get bigger and stronger B. Using steroids to ward off depression C. Using steroids to improve looks D. Using steroids to combat side effects from chemotherapy 0% 0% 0% 0% Using steroids to ward of... Using steroids to get bigg.. Using steroids to improve... Using steroids to combat ... Response
- 32. A. Respiratory distress B. High blood pressure C. High cholesterol D. Liver damage 0% 0% 0% 0% Respiratory distress High cholesterol High blood pressure Liver damage Response
- 33. A. Abnormal growth of muscles B. Having an unrealistic perception of your body C. A symptom of eating disorders D. Caused by a hormone imbalance Abnormal growth of mus... 0% 0% 0% 0% A symptom of eating dis... Caused by a hormone im... Having an unrealistic per... Response
- 34. Stimulants Steroids Human growth hormone Creatine
- 35. A. Yes B. No C. Depends 0% 0% 0% Response Yes No Depends
- 36. A. Yes B. No 0% 0% Yes No Response
- 37. In your group, talk about use of performance-enhancing drugs: 1. Under what circumstances is it acceptable? Why? 2. Under what circumstances is it unacceptable? Why? 3. When should testing for PEDs be implemented? Under what situations or conditions? Why? For what groups? High school, college, professional athletes? Cheerleading? Academic competitors?
Editor's Notes
- Drugs and food share certain characteristics They contain chemicals that interact with the body’s physiology Drugs and food are not regulated in the same ways Supplements may be thought of as drugs by consumers but are legally classified as food products Pills, capsules, liquids, and powders classified as dietary supplements may be thought of as drugs by consumers BUT They are legally classified as food products They are treated very differently by the Food and Drug Administration (FDA) Example of Saint John’s wort Many people take it for its suggested ability to improve mood, reduce anxiety, and induce sleep Classified as a dietary supplement, it is regulated more like a food than a drug A drug is a product intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease Before marketing, drugs must be shown to be Safe when used as directed Effective for their intended use Food products and ingredients must be Safe Pure (unadulterated) They are not required to show that they are effective or provide any benefit Dietary Supplement Health and Education Act (DSHEA) of 1994 Passed in part due to pressure on Congress from the supplement industry in response to indications that the FDA was planning to expand regulation of dietary supplements Defined supplements and set regulations for safety and labeling Billions of dollars are spent each year on OTC drugs In the US, four out of five adults take medicine or supplements on a weekly basis The perception that nonprescription drugs (OTCs) are completely safe can have grave consequences For many years, people could get OTC drugs (patent medicines) from traveling shows or from a local pharmacist or physician The contents of these drugs were not regulated The Pure Food and Drug Act (1906) stipulated that ingredients had to be listed on labels
- The Food, Drug, and Cosmetic Act (1938) required that prescription drugs be proved safe and effective before being marketed The Kefauver-Harris Amendment (1962) required that nonprescription (OTC) drugs be proved safe and effective The FDA evaluated ingredients in OTC drugs rather than examining each product In 2007, the FDA proposed a category for “behind-the-counter” (BTC) drugs which consumers would have to ask for after consultation with their pharmacist The Combat Methamphetamine Epidemic Act (2005) banned OTC cold medicines containing pseudoephedrine, an ingredient used to make methamphetamine
- A drug is a product intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease Before marketing, drugs must be shown to be Safe when used as directed Effective for their intended use A drug is a product intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease Usage by Americans Americans self-treat four times as many health problems as doctors treat, often with OTC drugs Americans spend over $18 billion per year on OTC drugs 1962 Kefauver-Harris amendment required that all drugs be evaluated for safety and efficacy Active ingredients reviewed individually; three standards considered: GRAS (generally recognized as safe) means that, given currently available information, the ingredient is considered safe Nothing is entirely safe Safe = a “low incidence of adverse reactions or significant side effects under adequate directions for use and warnings against unsafe use as well as low potential for harm which may result from abuse” GRAE (generally recognized as effective) = a reasonable expectation that the pharmacological effect of the drug will provide clinically significant relief of the type claimed in a significant proportion of the target population 3. GRAHL (generally recognized as honestly labeled) More than 300,000 OTC products on the market contain fewer than 1,000 total active ingredients now reviewed in over 80 therapeutic classes. Those that the FDA has classified as safe and effective Uniform labeling standards were adopted in 1997 to reduce consumer confusion Layout, headings, and topics are consistent, and language has been made clearer and more concise, with less medical terminology Consistent labels make it easier for consumers to compare products Food products and ingredients must be Safe Pure (unadulterated) They are not required to show that they are effective or provide any benefit
- FDA can declare a product to be adulterated (unsafe) only if it presents a significant or unreasonable risk of illness or injury Ingredients already on the market at the time of the Act: Considered safe enough to be sold unless the FDA can demonstrate a risk New ingredients: Need some evidence that they would not present a significant or unreasonable risk BUT much less evidence is required than for drugs FDA authorizes a small number of health claims that food and supplement manufacturers can use if their products meet certain requirements Based on available scientific research Examples: Adequate calcium intake and reduced risk of osteoporosis Soluble fiber intake and reduced risk of heart disease Unapproved health claims are not allowed, BUT Supplement labels can make so-called structure/function claims Relate to the structure or functioning of the body or to overall well-being Examples: Maintains cell integrity Supports the immune system Not a claim to prevent or treat a disease Not reviewed by the FDA Must carry a disclaimer: This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Same label format as those for packaged foods Not as accurate or precise as drug labels Testing has found that potency varies from bottle to bottle and even capsule to capsule Amounts listed on label are for a plant substance and not the presumed active ingredient Ingredients listed on the label may not be the actual active ingredients in a plant or herb Dosage guidelines are not well-established for many supplements There is no requirement for proof of effectiveness Generic drugs are copies of brand name drugs and have the same dosage, safety, strength, and quality One advantage of generic drugs is that they cost less Trademark laws in the United States require that generic drugs not look exactly like brand name drugs
- Same label format as those for packaged foods Not as accurate or precise as drug labels Testing has found that potency varies from bottle to bottle and even capsule to capsule Amounts listed on label are for a plant substance and not the presumed active ingredient Ingredients listed on the label may not be the actual active ingredients in a plant or herb Dosage guidelines are not well-established for many supplements There is no requirement for proof of effectiveness DSHEA expanded the definition of supplements to include a variety of substances: Vitamins and minerals Herbs and concentrates and extracts of herbs Amino acids Many forms: Tablets Capsules Liquids Powders FDA can declare a product to be adulterated (unsafe) only if it presents a significant or unreasonable risk of illness or injury Ingredients already on the market at the time of the Act: Considered safe enough to be sold unless the FDA can demonstrate a risk New ingredients: Need some evidence that they would not present a significant or unreasonable risk BUT much less evidence is required than for drugs FDA authorizes a small number of health claims that food and supplement manufacturers can use if their products meet certain requirements Based on available scientific research Examples: Adequate calcium intake and reduced risk of osteoporosis Soluble fiber intake and reduced risk of heart disease Unapproved health claims are not allowed, BUT Supplement labels can make so-called structure/function claims Relate to the structure or functioning of the body or to overall well-being Examples: Maintains cell integrity Supports the immune system Not a claim to prevent or treat a disease Not reviewed by the FDA Must carry a disclaimer: This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
- Pro: Many more supplements on the market Consumers have more options Con: Much less research available about safety and effectiveness of supplements Con: Supplements remain on the market unless or until the FDA presents clear evidence of risk Example: Ephedra, a stimulant taken by people wanting to lose weight First evidence of safety concerns published by the FDA in 1994 With the burden of proof now with the FDA, it took 10 additional years for the FDA to compile evidence to get ephedra off the market Definitely hazardous Aristolochic acid Very likely hazardous Comfrey Androstenedione Chaparral Germander Kava Cesium Colloidial Siver Graviola Likely hazardous Bitter orange Organ/glandular extracts Lobelia Pennyroyal oil Scullcap Yohimbe DIETARY SUPPLEMENT ACT Introduced by Senator John McCain in February 2010. Would have required all manufacturers to register with the FDA and provide a complete list of ingredients. The FDA could also recall any ingredient they found to be unsafe. The dietary supplement industry mounted a campaign against the regulation and McCain withdrew the bill PSYCHOACTIVE SUPPLEMENTS Saint John’s wort (Hypericum perforatum) Was originally thought to prevent possession by demons Currently used as a potential treatment for both anxiety and depression Research results have been mixed, but there is some evidence supporting its use for depression It may interact with prescription drugs, so users should notify their physicians S-adenosyl-L-methionine (SAMe) A naturally occurring substance, the active form of amino acid methionine Researched as a possible antidepressant Not yet any solid evidence it is more effective than placebo Ginkgo biloba Long history of medical use in China Active ingredients and mechanisms of action haven’t yet been identified Reduces blood clotting; thins blood to improve circulation PotentiallyResearch suggests a slight ability to improve memory risky if used with aspirin or other drugs that reduce clotting Supplements: no requirement for proof of effectiveness Disclaimer for any structure/function claim: “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”
- Herbal drugs are largely unregulated It is unclear whether they should be classified as drugs, foods, or herbs Manufacturers of herbal drugs cannot make claims regarding their benefits without proof Some herbal remedies can interfere with the effectiveness of conventional drugs
- Consumers must look at advertisements for OTC drugs carefully because they may give inaccurate impressions Always read the information on labels of OTC medicines Relieving the symptoms of an illness is not the same as curing the illness Some OTC drugs (stimulants, nasal sprays, sedatives, eye drops, cough syrups, and laxatives) can result in dependency
- Consumers must look at advertisements for OTC drugs carefully because they may give inaccurate impressions Always read the information on labels of OTC medicines Relieving the symptoms of an illness is not the same as curing the illness Some OTC drugs (stimulants, nasal sprays, sedatives, eye drops, cough syrups, and laxatives) can result in dependency
- 1938 Food, Drug, and Cosmetic Act established a classification of drugs that can be sold only by prescription Possible differences between OTC and prescription drugs Dosage: An OTC version of a drug may come in smaller doses Chemicals: A prescription drug may contain a chemical not allowed for OTC sale due to potential toxicity FDA panels review products and may switch drugs to OTC status Examples of drugs switched to OTC status include ibuprofen (analgesic), orlistat (weight-loss), and cetirizine (antihistamine) Should there be a class of drugs between OTC and prescription? Pharmacist recommended?
- Stimulants FDA allows stimulants to be sold to “help restore mental alertness or wakefulness when experiencing fatigue or drowsiness” Only ingredient allowed by FDA in OTC stimulants is caffeine Combinations of caffeine and other stimulants (e.g., ephedrine) are not allowed The primary ingredient in OTC stimulants is caffeine Does not reverse alcohol intoxication Examples include Vivarin, No Doz, and “energy drinks” and inhalable forms of caffeine Excessive caffeine consumption (caffeinism) results in nervousness, anxiety, tachycardia, sweating, and panic Weight-control products Phenylpropanolamine (PPA) was sold over the counter by the late 1970s Combinations of PPA and caffeine sold for a brief period before being banned in 1983 Concerns over effectiveness of PPA and the safety of recommended dosage due to its effects on blood pressure 2000: FDA requested all companies to stop marketing products containing PPA Weight-control products Additional products banned due to lack of safety or effectiveness Ephedrine Benzocaine-containing candies and gums Starch blockers Cholecystokinin (CCK) Currently, one FDA-approved weight-control OTC drug: Orlistat (alli) Ephedrine (ephedra) can be fatal when combined with other stimulants such as caffeine Orlistat (alli) works by blocking the absorption of about 25% of the fat in the foods that people consume Phenylpropanolamine (PPA) is an appetite suppressant, structurally similar to amphetamines Benzocaine is a topical anesthetic that numbs the tongue and palate Sedatives and sleep aids Early OTC sedatives and sleep aids acetylcholine receptor blocker scopolamine + antihistamine methapyrilene FDA review panel eventually rejected scopolamine but accepted methapyrilene Later methapyrilene was found to cause cancer in rats, so it was no longer classified as GRAS Different antihistamines were then marketed, and brands changed active ingredients frequently Currently, there are no approved OTC sedatives; OTC sleep aids contain antihistamines Anesthetics (“without sensibility”) reduce all types of sensation or block consciousness completely Analgesics (“without pain”) reduce pain selectively without causing a loss of other sensations Types of pain, based on place of origin Visceral pain from nonskeletal portions of the body Relieved by opioids Somatic pain from muscle or bone Relieved by aspirin and related products About 35 percent of patients obtain pain relief from a placebo Development Long historical use of teas and extracts of willow and poplar bark for pain relief Active ingredient—salicylic acid—was identified, synthesized, and mass-produced in the nineteenth century Related compound—acetylsalicylic acid—was synthesized in 1898 by a Bayer Laboratories’ chemist; had fewer side effects 1899: Patented and released for prescription sale in the form of a white powder 1915: Sold over the counter in tablet form The primary ingredient in many OTC sedatives and sleep aids is some type of antihistamine A person should not drive an automobile, drink alcohol, or engage in potentially hazardous activities while taking antihistamines Examples include Nytol, Sominex, and Seep-Eze ASPIRIN Therapeutic use Analgesic—effectively blocks mild-to-moderate somatic pain Maximum pain relief occurs in about one hour; effect lasts for up to four hours Especially effective for headache and musculoskeletal pain Antipyretic—reduces fever Does not lower body temperature in someone with normal body temperature Causes vasodilation of peripheral blood vessels and increased perspiration Therapeutic use Anti-inflammatory—reduces swelling, inflammation and soreness Relatively low toxicity Absorbed from the stomach and intestines Effects/Risks Increases bleeding time by inhibiting blood platelet aggregation Can cause bleeding problems for surgical patients May prevent heart attacks and strokes by preventing clots in high-risk patients Induces gastrointestinal bleeding Reye’s syndrome—rare but serious disease Effects can include disorientation, personality changes, lethargy, coma, and death CDC recommends that aspirin should not be given to anyone under age 20 who has a suspected viral illness such as cold, influenza, or chicken pox Accidental poisonings and suicide attempts Mechanism of action Prostaglandins are local-acting hormones Released when cell membranes are injured Mediate pain in injured areas by sensitizing neurons to stimulation Aspirin inhibits two forms of the cyclooxygenase (COX) enzyme Blocks the synthesis of pain-causing prostaglandins Aspirin also acts on prostaglandins involved in heat regulation ACETOMINAPHEN Acetaminophen is closely related to phenacetin, a now banned pain reliever Compared to aspirin: As effective in analgesic and antipyretic effects Less useful as an anti-inflammatory drug Causes less gastric bleeding Overuse of acetaminophen can cause serious liver disorders Not safer than aspirin if recommended dose is exceeded As of 2009, the FDA limited the maximum single adult dose to 650 mg for OTC products Analgesics Ibuprofen is an aspirin-like analgesic and anti-inflammatory; it also inhibits COX enzymes Potential side effects Nausea and stomach pain Liver damage (if taken in large amounts) Class of drugs is known as nonsteroidal anti-inflammatory drugs (NSAIDs) Originally available by prescription, but now also available over the counter All-too-common cold Colds are viral infections, caused by viruses in the rhinovirus or coronavirus families Viruses damage or kill the cells they attack In the case of colds, the affected cells are on the upper respiratory tract Symptoms include coughing, sneezing, and production of fluid by the mucous membranes All-too-common cold Most cold viruses enter the body through the nose or eyes; they are usually transmitted via an infected person’s hands Frequent handwashing is a good strategy to reduce the risk of contracting a cold Treatment of cold symptoms—no cure Modern cold remedies contain three common types of ingredients Antihistamines for temporary relief of runny nose and sneezing Of questionable benefit for cold symptoms Nasal decongestants for temporary relief of swollen nasal membranes Analgesic-antipyretics for temporary relief of aches and pains and fever reduction Allergy and sinus medications Rely mainly on antihistamines May also include an analgesic CHOOSING AN OTC Most products contain one or more of only a small number of ingredients, in different combinations An informed consumer can understand a large proportion of these products by being familiar with only a few drugs Single ingredient medications may be preferable to combination products Avoid medication interactions and side effects of drugs that are designed to treat symptoms you may not have
- Two basic types of analgesics: External analgesics, such as Ben-Gay and Absorbine, applied to the skin for sore muscles Internal analgesics such as aspirin, acetaminophen, ibuprofen, naproxen sodium, and ketoprofen In 2009, 53,000 people went to emergency rooms due to acetaminophen, and 27,000 people went to emergency rooms due to ibuprofen Aspirin (acetylsalicylic acid) Similar to a chemical in willow bark Developed by Bayer Alters synthesis of prostaglandins Reduces inflammation, especially rheumatoid arthritis Antipyretic (fever-reducing) Reduces risk of heart attack and several diseases Increases bleeding risk Inhibits interferon Avoid use by children Children with chicken pox or flu-like symptoms should not be given aspirin Acetaminophen (Tylenol) Byproduct of phenacetin Reduces pain and fever Interferes with prostaglandin synthesis Adverse effects on liver and kidneys Irritates stomach less than aspirin Does not prolong bleeding Can cause death Ibuprofen (Advil) Reduces pain Lessens inflammation Produces less stomach upset May reduce risk of breast cancer and Alzheimer’s Prolongs bleeding time Can cause allergic reaction Numerous side effects May increase risk of peptic ulcers and enlarged prostate Can cause death Naproxen sodium (Aleve) Comparable to ibuprofen in effectiveness Long-term pain relief Ketoprofen (Orudis KT and Actron) Effective as ibuprofen More effective than acetaminophen for reducing fever in children COLD/ALLERGY OTC drugs relieve symptoms of colds and allergies Many people overcome colds more quickly when physicians prescribe medications, even placebos Cough and cold remedies for children can be hazardous ANTIHISTAMINES When allergens are present, the body releases histamines that normally help fight infections Antihistamines are effective for relieving itching, nasal inflammation, and skin allergies Antihistamines are found in cough syrups, hay fever and motion sickness preparations, and decongestants Dizziness Weakness Nervousness Poor concentration Headache Drowsiness Blurred vision Difficulty urinating Constipation Hives Dry mouth, nose, and throat COUGH A cough can be productive (produce secretions) or nonproductive Drugs that suppress or prevent coughing are antitussives Codeine provides relief within 15 to 30 minutes, and the effects last 4 to 6 hours Dextromethorphan (Delsym) is nonnarcotic , but can induce drowsiness, nausea, and dizziness A productive cough helps respiration by removing mucous secretions and foreign matter Cough syrups that increase mucous secretions, making a cough productive, are called expectorants The most common expectorant is guaifenesin Decongestants constrict blood vessels of the nasal passages, improve air flow, and obstruct secretions Some produce a rebound effect, in which the congestion becomes worse than it was originally Dependency is possible – nasal sprays should not be used for more than three consecutive days Pseudoephedrine is the active ingredient in the OTC decongestant Sudafed ANTACIDS Neutralize stomach acid (hydrochloric acidr) reducing the symptoms of the upset stomach OTC products contain such drugs as: Sodium bicarbonate Calcium carbonate Salts of magnesium Salts of aluminum Product examples include: Tums, Rolaids, Alka Seltzer Newer heartburn remedies include histamine (H2) blockers and proton pump inhibitors (PPIs) H2 blockers (Tagamet HB and Zantac) are effective in less severe cases The American College of Gastroenterology recommends PPIs (Prilosec and Nexium) because they are more effective
- Early concoctions May not have provided any true physical performance enhancement Could have placebo value that boosted a competitor’s self-confidence Ancient Greek Olympians and Aztec athletes used plant-based stimulants Athletic competitions probably developed in tribal societies as a means of training for war Strychnine At low doses = a CNS stimulant At higher doses = convulsions and death Use reported in boxers, possibly to make them more aggressive and keep them from tiring quickly 1904 St. Louis Olympic marathon winner Fueled by a mixture of brandy and strychnine Collapsed and had to be revived after the race Some use of strychnine in world competition may have continued into the 1960s Cocaine: Available beginning in the 1800s Mariani’s coca wine was used by the French cycling team Athletes later used pure cocaine Caffeine: Many athletes used coffee and/or pure caffeine “Doping” initially referred to a cheap brandy given to racing dogs and horses to slow them down Term came to refer to the opposite—an effort to improve rather than impair performance Amphetamines: More potent than caffeine, safer than strychnine Probably in use by athletes soon after they were introduced in the 1930s Many early reports of the use of “pep” pills by boxers, cyclists, and soccer players 1950s Olympics: Many reports of amphetamine use, a few deaths 1960 Rome Olympics: One cyclist died, several others hospitalized due to amphetamine use International regulations/TESTING Ergogenic = “energy producing,” a general term for performance enhancement 1960s: Some sports began testing athletes, but problems continued 1967: Tommy Simpson died during the televised Tour de France Amphetamines found in his system 1968: International Olympic Committee established rules to disqualify any athlete who used banned drugs or refused to be tested The scope of testing at the Olympics has continued to expand over time Football 1960s: Many football players used amphetamines during games Attitudes toward amphetamines changed National Football League (NFL) banned the distribution of amphetamines by team physicians and trainers in 1971 But initially no testing of players, who could still obtain the drug on their own Current NFL policy restricts all use of amphetamines and many other drugs STEROIDS Established medical use for weight gain in malnourished people Soviets began to use testosterone to build up athletes in the 1950s Many U.S. athletes in certain sports used steroids in the 1960s Weight lifters and bodybuilders Track and field athletes Testing began in the 1970s Athletes began to be caught and banned from competition for steroid use Some individual use among Western athletes Widespread use by athletes from some Eastern European countries BALCO Rumors of steroid use circulated around certain professional baseball players June 2003: Evidence surfaced that athletes were using tetrahydrogestrinone (THG) Previously unknown steroid that did not show up in tests developed by the U.S. Anti-Doping Agency BALCO Laboratories founder Victor Conte was implicated, along with a number of professional athletes from several different sports Fallout from the BALCO/THG scandal continues TESTING 1980s: Reports of drug use among athletes grew Most amateur and professional sports organizations adopted more strict testing guidelines and longer lists of banned substances Despite extensive and expensive tests, use of performance-enhancing substances continues Ongoing development of new drugs and strategies to help athletes avoid detection STIMULANTS Effectiveness Studies indicate that most athletes perform better on amphetamines, but the improvement is small Small improvements can make a big difference at high levels of competition Underlying mechanism of improvement is unclear Increased physical ability (increased strength, masking of fatigue) Effects on the brain (increased confidence, winning attitude) At legal levels, caffeine may provide a slight improvement in endurance performance Cocaine No experiments have been carried out on its performance-enhancing abilities In the 1980s, many athletes believed it did improve performance Similar to amphetamine in its properties Shorter duration of action, so it would likely have only brief effects Ephedrine (available in pure form or in ephedra extract or ma huang) On Olympic and NCAA lists of banned substances Professional sports organizations were slower to ban it NFL eventually banned it but Major League Baseball did not Players continued to use it for its stimulant effects and for weight loss Death of Baltimore Orioles pitcher Steve Bechler in 2003 was attributed to heat stroke brought on by ephedrine FDA was able to ban ephedra and ephedrine in dietary supplements in 2004 Current use Some athletes continue to use stimulants during training and then discontinue use several days before competition to avoid testing positive Risks of use Unknown effects of use during training on competitive performance Possible overexertion or injury due to fatigue-masking effect of stimulants Dependence, paranoid patterns and withdrawal symptoms STEROIDS Physical effects of natural testosterone Androgenic effects (masculinizing) Growth of the penis and other male sex glands Deepening of the voice Increased facial hair Anabolic effects (tissue building) Increased muscle mass Control of the distribution of body fat Increased protein synthesis Increased calcium in the bones Synthetic anabolic steroids Drug companies synthesized types of steroids that have fewer of the androgenic effects and more of the anabolic effects of steroids Not entirely free of androgenic effects EFFECTIVENESS Mixed and controversial research findings Testosterone builds muscle mass and strength during puberty Animal studies: Synthetic anabolic steroids build muscle in castrated animals Unclear if giving additional anabolic steroids to adolescent or adult males who already have normal circulating levels of testosterone will have a significant effect Laboratory research on healthy men Steroids can produce small increases in lean muscle mass and sometimes small increases in muscular strength No evidence for an overall increase in aerobic capacity Research findings may not match word-of-mouth ISSUES IN RESEARCH Difficult to extrapolate laboratory findings to athletes Athletes may use much higher doses Athletes may use combinations of steroids (“stacking”) Psychological effects of steroids may affect results Users report that they feel stronger—that they can lift more or work harder Possible active placebo effect—a belief in the power of steroids enhanced by the sensation that the drug is doing something because one can “feel” it PSYCHOLOGICAL EFFECTS Steroids produce a stimulant-like high and increased aggressiveness May allow more work done during training and increased intensity of effort during competition Risks, especially at high doses Psychological dependence, resulting in mood swings and depression when users don’t take the drugs Interference with social relationships and other areas of life “Roid rage”: Stories may be exaggerated, but the number of reports of violent feelings and actions among steroid users is a key area of concern NEGATIVE EFFECTS Peliosis hepatitis Bloody liver cysts Unhealthy changes in blood lipid levels May contribute to atherosclerosis, high blood pressure, and heart disease Acne Baldness Special risk for young users Premature closure of the growth plates of the long bones, thus limiting adult height Special risks for men Atrophy of the testes Breast enlargement Special risks for women, who normally have only trace amounts of testosterone Decreased breast size Enlargement of the clitoris Increased facial hair Deepening of the voice Some effects may be irreversible REGULATION Issues leading to regulation Large black market for the drugs Concerns about use among adolescent boys, even nonathletes Anabolic steroids are listed on Schedule III Limited prescription refills More record-keeping COLLEGE STIMULANT USE Low doses of stimulant drugs can improve performance that has been disrupted by fatigue or sleep-deprivation Recently there has been a renewed interest in using stimulants as nootropics and cognitive-enhancers Some stories imply that the majority of college students take these drugs to enhance their performance. The actual percentage is 4-7 % Drugs maybe useful in increasing alertness and assisting one to study for a longer period of time, but they wont increase critical thinking or creativity Health risks associated with nootropics All stimulants increase cardiovascular activity, which, at large doses, can increase the likelihood of heart attack or stroke These drugs can also disrupt sleep and excessive loss of sleep can lead to the development of physical and mental health problems. Fairness Some students may not have access to a physician Some students may not want stimulants due to health risks. HGH A pituitary hormone that can potentially increase the height and weight of an individual to gigantic proportions Rare instances of excessive body production of the hormone produces “giants” over 7 feet tall Condition usually results in early death Administration of doses of human growth hormone and related hormones may produce a more controlled increase in body size Experiments have shown HGH may increase lean body mass but may not improve strength It is illegal to distribute human growth hormone for nonmedical purposes BETA2 AGONISTS Action and effects Selective stimulation of the beta-2 subtype of adrenergic receptors Sympathomimetic effects on the bronchi of the lungs Used in treating asthma Animal studies showed a possible effect on muscle mass No evidence for improved athletic performance Banned for use in competition Example: Clenbuterol CREATINE A natural substance found in meat and fish, sold legally as a dietary supplement Actions and effects Helps regenerate ATP, which provides the energy for muscle contractions Users tend to gain weight, some of which is water weight Creatine may improve strength and short-term speed in sprinting No evidence for improvement in longer-distance events Performance may decrease due to weight gain GETTING “CUT” Weight challenges in sports Wrestlers and jockeys need to build strength and train hard but also need to make a specific weight Athletes in these sports may engage in extreme methods to achieve short-term weight loss Purging Diuretics Sweating (exercising in heat or while wearing nonporous clothing) Bodybuilding terms and strategies “Cut” refers to a lean, strong body, a “sculpted” body “Ripped” or “shredded” refers to a more extreme version of looking cut Every muscle fiber and vein is visible Body fat percentage may be as low as 6 to 9 percent 14-20% is ideal for a healthy male Many bodybuilders take “fat burning” supplements of questionable safety and effectiveness Performance-enhancing drugs, also known as ergogenic aids, are used to gain a competitive advantage As early as 300 BC, some Greek athletes ate mushrooms to enhance their performance Drug abuse in sports has become more publicized in the last few years – e.g. Major League Baseball The type of sport and gender of the athlete influence the drug of choice Anabolic steroids Substances used to increase muscle mass Related to male sex hormones Testosterone during puberty augments muscle mass and strength, but later in adolescence stunts growth Users may engage in stacking – ingesting and injecting several steroids at the same time Users display symptoms of depression, panic, anxiety, paranoia, mania, and suicidal behavior (roid rage) Steroid effects on men and women: Acne Increased susceptibility to infections Abrupt mood changes Hypertension Decreased HDL (good cholesterol) Effects on liver Stunted growth Men: More frequent erections Atrophied testicles Enlarged breasts Enlarged prostate Infertility Baldness Women: Baldness Decreased breast size Enlarged clitoris Increased facial hair Fluid retention Menstrual irregularities Deepened voice Human growth hormones (HGH) Hormones that stimulate protein synthesis Used by athletes to enhance performance Erythropoietin (EPO) Hormone that enhances cardiovascular endurance by increasing red blood cell production Can lead to blood clots, increasing the risk for heart attacks, stroke, and pulmonary embolism Creatine monohydrate Natural substance used to increase strength and short-term speed Sold over-the-counter as a nutritional supplement Believed to increase water content in muscles, adding to their size and ability to function Reduces range of movement Reported side effects include muscle cramping, dehydration, water retention, and kidney problems Not regulated by the FDA Tetrahydrogestrinone (THG) Designer drug, closely related to the banned anabolic steroids gestrinone and trenbolone Used by many professional athletes Not approved by FDA May cause some of the same side effects as steroids Androstenedione Food supplement used for muscle development Precursor molecule, one step away from testosterone Banned by NCAA, NFL, and IOC Effects are similar to those of anabolic steroids In January 2010, the FDA recalled androstenedione because of its potential side effects STIMULANTS Cocaine impairs performance requiring hand-eye coordination and concentration Amphetamines have been used in sports to reduce fatigue and sustain intense exercise Caffeine is used to improve endurance, especially short-term endurance Many sports and energy drinks are high in caffeine and calories DEPRESSANTS Barbiturates inhibit performance Benzodiazepines (minor tranquilizers) impair psychomotor performance Alcohol reduces psychomotor skills and aerobic capacity – also impairs reaction time, fine and complex motor coordination, balance and steadiness, visual tracking, and information processing SEXUAL PERFORMANCE Many prescribed and over-the-counter drugs alter sexual functioning Drugs such as methamphetamines and alcohol lead to unsafe sexual practices Drugs are commonly used, especially in clubs, to make the user less sexually inhibited Alcohol and narcotics can adversely affect sexual desire, performance, and satisfaction