Paul (Drugs in sport)

Earliest recorded examples in 1903- cocaine, strychnine, champagne Elevating levels of things naturally found in the body e.g. Erythropoietin (EPO) and anabolic steroids EPO increases VO2 max by 30%

Anabolic steroids- diverse side effects- timers, depression, sex changes EPO- Belgian and Dutch cyclists diet from nocturnal heart attacks

In 1967 the IOC published a list of banned substance classes and methods. Things added to this list as time went on - anabolic steroids - caffeine restricted plus testosterone ratio - probenecid and diuretics and blood transfusions - hormones - EPO In 2004 the first WADA list came out which was evidence based

Androgens- masculinisation/protein Controlled drugs, but readily supplied Most common finding by testing Performance enhancers Myotrophic vs androgenic ratio Motivates training by behavioural changes “Designer steroids” May be marketed as nutritional supplements

• Breast atrophy (shrinking) in women • Gynaecomastia (enlargement of breasts) and enlarged nipples in men • Cardiovascular • Increase in thrombotic events • MI or stroke • Raised LDL/Reduced HDL • Lowered plasma fibrinogen • Cardiacs damage and hypertrophy • CNS • Increase libido • Hypomania, aggression, self-harm • Hirsutism/male pattern baldness • Liver function • Acne • deepening of voice • Clitoral hypertrophy/testicular atrophy

Early methods to increase availability - altitude training (to increase RBC) - transfusion of packed RBC Erythropoietin primary regulator of RBC formation (synthesised in kidney) - direct relationship between Hb levels and performance EPO gene has allowed rHuEPO (used to treat anaemia) Attractive to running/cycline

• Anecdotal evidence of use • Little evidence of improved performance • Detection is challenging • Biomarkers of GH • IGF-I and Insulin abuse challenging

Beta 2 is main target receptor. Agonists - Bronchodilation - Anabolic actions - Increased blood flow to muscles - Enhance anti-inflammatory actions of corticosteroids (mast cell stabilisation)

Decrease heart rate and hand tremor - No benefit to insurance sport - Benefit in shooting, archery, gymnastics, etc Indirectly acting sympathomimetics Uptake 1 inhibitors - Some banned, some allowed within specific plasma levels

• Increase alertness • Reduce fatigue • Activate the CVS • 62 drugs listed • Mainly monoamines • ‘Inadvertant’ use in OTC medicines • Deliberate consumption • Recreational use • Performance enhancement

• There is currently much interest in the theoretical prospect rather than the current application of gene doping • Genetic modification • May be undetectable