Are some athletes using legally available drugs to gain a competitive edge?
Lee Oliver reviews the misuse of a number of legally available ergogenic aids
Dope testing is a bit like the arms race. One side, in this case the testers, is always trying to keep one jump ahead of the cheats, and vice versa. It usually happens that as soon as a new drug testing technology is put in place, the dopers simply move on to a new drug that is undetectable. Before the Atlanta Olympics a lot of attention was focused on drugs such as erythropoietin (EPO) which do not show up in urine tests. Even though the IOC announced just before the Games began that an effective test for EPO had been developed, the tactic of most authorities has been to try to scare athletes out of using drugs.
In the case of EPO, it has been claimed in the past that taking it to enhance performance is likely to result in death. Latterly, the scare-mongering ploy has taken the form of collecting three urine samples, so that an athlete can be retroactively banned once a test for the undetectable drug has been devised. The same technique was used in the earlier on-going battle against anabolic steroids. Any athlete who tested positive for steroids before 1980 was almost certainly not caught because of an incredibly sophisticated test but as a result of his or her own stupidity.
The unreliability of their testing equipment led the governing bodies to warn athletes that if they took steroids they would suffer for it later on. They also claimed that there was no scientific evidence that steroids worked. This tactic has been described as "an overly aggressive educational strategy of emphasising the health risks", one which many athletes simply did not and still does not believe. This is because they have not personally seen large numbers of long-term steroid users dropping dead. The medical community also lost credibility because of their repeated denials that steroids were effective as performance enhancers. Such denials flew in the face of the personal experience of many athletes.
So, what is the current situation?
Because of the high cost of such drugs as EPO, undetectable or not, it is likely that any athlete who decides to resort to doping will pursue one of two other options. The first is to take a banned substance and, if positively tested, to make a legal challenge to the finding. This approach is becoming a less effective technique.
The second option, which has received little media publicity, is to find a substance which has ergogenic properties, but which is either not banned or, at worst, is only subject to certain restrictions. The most commonly abused substance like this is probably caffeine. Another is salbutamol, which is included in asthma medications such as Ventolin. The possible misuse of salbutamol provides a nice example of how a substance subjected to restrictions by the IOC may be used as an ergogenic aid.
Only on bronchial muscle
In the past, the treatment of asthma posed problems for the IOC Medical Commission. Older medications often included ephedrine or related compounds which are banned because they are considered as central nervous system stimulants. However, the IOC allows certain specified drugs to be used in aerosol form. These drugs, which are classed as ß-agonists, include salbutamol but not the pharmacologically similar drug clenbuterol, which came into prominence around the time of the Barcelona Olympics.
Taking such a drug as salbutamol in aerosol form supposedly means that it is "selective" in its action and only has an impact on bronchial muscle. Many, if not most, studies have reported that salbutamol has no ergogenic effect. The IOC, in allowing the use of bronchodilators, has effectively enabled those athletes who suffer from asthma, a disease that causes widespread narrowing of the peripheral airways, to reduce their disadvantage in relation to non-asthmatic competitors. The evidence that salbutamol has no ergogenic effect for non-asthmatics would seem to justify this position. As I have already mentioned, the IOC only permits the use of certain specified ß-agonists.
This suggests that some of them, such as clenbuterol, now banned specifically as a non-steroidal anabolic agent, have a more ergogenic effects than others. Yet there is evidence that ALL ß-agonists have certain ergogenic qualities, other than just that of non-steroidal anabolic agents.
Not as an aerosol
The stimulation of ß-receptors in skeletal muscle, which is what salbutamol and clenbuterol are designed to do, causes vasodilatation and therefore a drop in peripheral resistance to blood flow. A reduced peripheral resistance leads to an increased venous return to the heart or pre-load. This results in a larger stroke volume and therefore cardiac output. Clenbuterol also leads to an increase in lipolysis, which causes a greater availability of fat as fuel in exercise and thus spares glycogen. The implication of these effects is an increase in endurance. It seems reasonable to assume that, because of the pharmacological similarity of all ß-agonists, that salbutamol will also have these effects if taken in large enough quantities or administered by means other than inhalation. Those scientific studies that have dismissed salbutamol's ergogenic effect probably did so because of flaws in the design of the experiments. The ergogenic effect of salbutamol is not derived from inhaling it.
French cyclists use it
Although it is only a supposition that salbutamol is being used as a doping agent, there is evidence that the French Cycling Federation, at least, consider it a possibility. Many prominent cyclists, including a well-known Tour de France winner, have tested positive for salbutamol in France, where it is not allowed to be taken by athletes in any form. This raises many questions e.g. how unified the international doping regulations are, how much salbutamol an asthmatic athlete should be allowed to take, and whether the route by which a drug is taken can be detected.
It seems hard to believe that some of the world's top endurance athletes are also asthmatics. The conclusion must be that some endurance athletes are using ß-agonists as ergogenic aids, and when they are caught they produce evidence from their doctors to say they are asthmatic. Clenbuterol previously proved so popular because it worked, and it was considered as a safe alternative to anabolic steroids. Similarly, salbutamol seems to have quite potent ergogenic qualities but not, apparently, when taken in an aerosol spray. To produce an ergogenic effect, ß-agonists need to be taken in a different manner, such as injection.
This may induce certain side effects, including tachycardia, anxiety palpitations and headache, and, more seriously, even cardiac hypertrophy, dysrhythmia, myocardial infarction and stroke. There seems little doubt that athletes are using legally available drugs to boost performance. Taking salbutamol as an example, it is clear that the dosages required are greater than for normal medicinal purposes, and that the route of administration is often different from that commonly prescribed.
There is no point advising athletes to have four puffs instead of two from their Ventolin inhaler before a 10K race! But, at the risk of engaging in "an overly aggressive educational strategy of emphasising the health risks", any athlete who is tempted to try salbutamol is reminded of the possible hazards outlined in the previous paragraph. Drugs are designed to restore the balance of biomechanical systems in those suffering from disease, not those who are healthy.
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