House of Commons - Culture, Media and Sport

Select Committee on Culture, Media and Sport Written Evidence

Memorandum submitted by the Parliamentary Office for Science and Technology

TECHNICAL AND POLICY BRIEFING

INTRODUCTION

This briefing was produced for the Culture, Media and Sport Select Committee to inform its inquiry into the use of drugs and other doping methods in sport. It examines the following questions:

— What drugs/doping methods are used?

— What are the potential harmful effects?

— What anti-doping measures are in place?

— What is the extent of use?

— What are the main policy implications?

DOPING METHODS AND THEIR SIDE EFFECTS

Doping is the use of artificial substances or methods to enhance performance. As outlined in the box below, stimulants such as cocaine and amphetamines were among the first substances to be used to enhance performance. By the 1950s and 60s anabolic steroids were widely used to build muscle strength. Since then, new blood doping methods have been developed and new "designer" steroids have emerged as issues of concern. Different doping methods are summarised in the table on page 2; those most commonly used are discussed in more detail below.

MUSCLE BUILDING

Various drugs are available that promote muscle growth. These include anabolic steroids that mimic the action of the naturally occurring hormone testosterone. These hormones stimulate the body to make new proteins, thus building muscle strength and enabling athletes to train harder. Examples include testosterone, and derivatives such as dihydrotestosterone, nandrolone and stanozolol. Some of these are active when taken orally (eg as pills or in dietary supplements)[3] while others are active only if injected. Harmful side effects include damage to the liver and cardiovascular system, mood swings, aggression, and the possibility of infection (if the drugs are injected using a shared needle). In addition, anabolic steroids can cause baldness, infertility and breast development in men, and growth of body and facial hair, and other masculinising effects in women.

A BRIEF HISTORY OF DOPING IN SPORT

In the 19th century stimulant use was common among endurance athletes and cyclists.

1928 International Amateur Athletic Federation ban the use of stimulating substances. Other federations follow, but the bans are ineffective due to lack of tests.

1930s Synthetic hormones invented.

1950s Synthetic hormones used for doping purposes.

1960 Danish cyclist Knud Jensen dies at the Rome Olympics; an autopsy reveals traces of amphetamines.

1966 International cycling (UCI) and football (FIFA) federations test for drugs at their world championships.

1967 International Olympic Committee (IOC) draws up the first list of prohibited substances.

1968 Drug tests first introduced to the winter (Grenoble) and summer (Mexico) Olympic Games.

The early 1970s sees marked growth in use of anabolic steroids due to lack of a reliable test.

1974 Reliable test for anabolic steroids introduced.

1976 IOC bans use of anabolic steroids.

1986 IOC bans blood doping as a method.

1988 Ben Johnson, the 100 metre champion, disqualified at the Seoul Olympics after testing positive for stanozolol.

1989 Confirmation of state-sponsored doping in the German Democratic Republic during 1970s/80s.

1990s New doping agents developed (eg EPO, hGH); anti-doping efforts restricted by lack of tests.

1998 Large quantities of prohibited substances found during the Tour de France. The scandal highlighted the need for an independent international agency.

1999 World Anti-Doping Agency (WADA) established.

2003 WADA adopts the World Anti-Doping Code to harmonise anti-doping measures.

The US Anti-Doping Agency announces a test for a new designer steroid—THG; several high-profile athletes test positive for the drug.

August 2004—deadline for national anti-doping agencies and international sports federations to adopt WADA Code before the Athens Olympics.

More recently, some athletes have started using other types of hormones to increase muscle strength. Some of these (eg hCG and LH)[4] work by stimulating the body to make greater quantities of sex hormones such as testosterone, and thus have similar side effects to anabolic steroids. Others such as human Growth Hormone (hGH) and insulin-like growth factor (IGF-1) stimulate muscle growth directly, and reduce body fat. Side-effects include over-growth of various parts of the body, as well as heart problems. Insulin, a hormone that regulates blood sugar levels, can also increase muscle mass by boosting protein synthesis. Side effects relate to problems caused by low levels of sugar in the blood such as nausea, weakness, and even coma and death.

Beta-2 agonists are drugs such as clenbuterol, salbutamol and fenoterol that were designed to relax muscles in the airways of asthma sufferers when inhaled. But when injected, the drugs can build muscle mass and reduce body fat. Side effects (dizziness, nausea, headaches and muscle cramps) stem from the drug constricting blood vessels in the brain and elsewhere.

INCREASING OXYGEN SUPPLY

Increasing the supply of oxygen to tissues such as muscles can significantly enhance an athlete's performance. One (legitimate) way of achieving this is through prolonged training at altitude; the body responds by increasing the number of red (oxygen carrying) blood cells. Another (prohibited) way is through the use of blood doping methods. The first such methods simply involved infusing an athlete with blood previously taken from him/her and stored. Such methods carry a general risk of infection and of circulatory and heart problems caused by the increased volume of blood. Alternatively an athlete can infuse someone else's blood, in which case they run the additional risk of potential infection with viruses such as hepatitis and HIV/AIDS.

More recent years have seen the emergence of hormones such as erythropoietin (EPO), which stimulate bone marrow to produce more red blood cells. Since EPO thickens the blood, side-effects include increased risk of stroke and heart attack. Finally, some athletes seek to increases the oxygen carrying capacity of their blood by using artificial oxygen carriers. These were developed to treat breathing difficulties in premature babies and patients with serious lung injuries. Side-effects include the risk of severe allergic reactions.

SUMMARY OF DOPING METHODS

Effect	Examples	Main Side-Effects
Muscle building Increase strength by encouraging muscle growth, thus allowing athletes to train longer and harder	Anabolic steroids Beta-2 agonists Hormones that stimulate natural steroid production Hormones that stimulate growth Insulin	Jaundice, liver damage, mood swings Nausea, headache, raised heart rate As for anabolic steroids Overgrowth of hands, feet and face, heart problems Low blood sugar
Increasing oxygen Enhance performance by increasing the supply of oxygen to tissues	Protein hormones (EPO) Artificial oxygen carriers Blood doping	Thickens blood leading to increased risk of heart failure and stroke. Immune system problems, iron overload and kidney damage Infection, increased risk of heart failure and stroke
Masking pain Allow athletes to train through injuries by masking the pain	Narcotics Inflammation reducing hormones Local anaesthetics	Addictive, impair mental abilities Stomach irritation, ulcers, long-term effects on bone and muscle Aggravated injury
Stimulants Make athletes more aggressive and alert and less fatigued	Caffeine, amphetamines, ephedrine and cocaine	Irregular heartbeat, high blood pressure, and convulsions
Relaxants Help athletes relax, and may be used to steady hands	Alcohol, cannabinoids Beta blockers	Impaired mental functions Low blood pressure, slow heart rate, fatigue
Weight control Help athletes lose weight	Diuretics	Dehydration, dizziness, cramps, heart damage and liver failure
Masking drug use Work to reduce levels of drugs in the urine or to mask their detection	Diuretics Epitestosterone Plasma expanders Secretion inhibitors	As above None Allergic reactions Nausea, vomiting, kidney damage

ANTI-DOPING MEASURES

Anti-doping bans were first introduced in the 1920s, but were largely ineffective until testing was introduced in the 1960s and 70s (box, above). Such measures were introduced in a somewhat piecemeal manner, with different bodies setting different anti-doping standards for different sports. By the mid 1990s, the need to harmonise anti-doping standards was widely recognised. The World Anti-Doping Agency (WADA) was established as an independent, non-governmental organisation in November 1999. A principle aim of WADA is to set unified standards for anti-doping that would be adopted by all countries, organising bodies, sports federations and anti-doping authorities.

THE WORLD ANTI-DOPING CODE

A key plank in the WADA programme is the World Anti-Doping Code. This was published in March 2003 following extensive consultation.[5] All major sports federations have accepted the Code and some 97 governments (including the UK) have signed a declaration to formally accept and implement it. The Code covers anti-doping controls, research, education and the roles and responsibilities of signatories, governments and athletes. Sports federations and national anti-doping agencies such as UK Sport have until the start of the Athens Olympics in August 2004 to implement the Code. It defines:

— what constitutes a violation and what proof is required to establish that a violation has taken place;

— testing regimes (these require athletes to be available for testing both in and out of competition);

— standards for the taking of samples, for their analysis in the laboratory and for managing test results;

— procedures to ensure that test results are kept confidential, that athletes who fail tests are given a fair hearing and have the right of appeal;

— sanctions to be taken against athletes who fail tests.

TESTING REGIMES

Different drugs remain detectable for different periods of time after they are taken, and this may vary according to the mode of administration. For instance, injected steroids can remain detectable for weeks or months, whereas those taken as pills or in supplements are often detectable for just a few days or weeks. To deter athletes from using drugs while training up for competitions, WADA runs an out of competition testing programme. This can require athletes to give a urine (and sometimes a blood) sample at any time and any place. Athletes also face in-competition testing. Details of the tests conducted are given in the box opposite. While current tests are capable of detecting most of the substances outlined in the table, there are still some gaps in the test menu.

Tests under development

Until recently one of the biggest gaps was the lack of a test to detect EPO. While an EPO test has now been developed, it is time-consuming and not widely available (only two WADA accredited laboratories offer it). It relies on a two-pronged approach where athletes are first given a blood test. If the proportion of red blood cells exceeds a certain threshold, a urine test is then undertaken to look for abnormally high levels of EPO.

At present, there are still no validated tests to detect hGH, IGF-1 or blood based oxygen carriers. Although research is under way to develop tests for these substances there are two main problems: all are naturally present in the body; and levels vary significantly between individuals. WADA is funding the validation of an hGH test and has suggested that it may be introduced at the Athens Olympics.[7] However it is being somewhat secretive about its plans in the hope of catching out athletes using hGH and similar substances.

Designer steroids

Designer steroids such as THG (tetrahydrogestrinone) are another potential gap in the testing menu. These substances are chemically similar enough to anabolic steroids to have similar effects on the body, but different enough not to show up on current steroid screening tests. WADA has approved a new test for THG and passed details of the protocol on to each of its accredited labs, but not all are currently able to offer the test.

Anti-doping authorities did not discover THG abuse through testing; rather they were tipped off anonymously by someone who supplied them with a used syringe containing THG. It took a team of researchers weeks to identify the novel steroid and months to devise a test for it.[8] There is no way of knowing if there are other "undetectable" designer steroids in widespread use.

Gene therapy

Researchers have long been interested in using IGF-1 and similar factors to treat patients with muscle wasting diseases such as muscular dystrophy. In practice however, it has proved difficult to find a way of delivering high enough doses of IGF-1 to the sites where it is most needed. To get round this problem researchers have developed a gene therapy approach using a virus to deliver copies of the gene for IGF-1 to nerve cells deep in the spine. Once there, the nerve cells use the gene to make IGF-1 in situ. [9]

In rats and mice, IGF-1 gene therapy has led to animals with 15-30% bigger muscles. While the research is still 5-10 years away from being clinically useful in humans, the researchers have already been approached by athletes interested in using IGF-1 gene therapy for doping. Devising a test that could distinguish between a naturally produced growth factor and one made in situ using gene therapy would be very difficult. WADA is aware of the potential problem and has already held talks with geneticists to discuss whether genetic markers can be included in the treatment to aid detection.[10]

ANTI-DOPING TESTS

Most testing for performance enhancing drugs is carried out by analysing urine samples. Under the WADA code, athletes can be tested in competition, or at any other time (out of competition). In both cases athletes will be asked to give a sample of urine under supervision, which is then split into an "A" and a "B" sample. Both are couriered to a WADA accredited laboratory (there are 31 labs in 30 countries) which uses standard tests to look for drugs on the WADA prohibited substance list. Tests are initially carried out on the "A" sample, with the "B" sample being used only to confirm a positive result (both samples must be positive for a violation to have occurred).

The actual tests conducted will vary; certain methods/substances are only prohibited in-competition, and some only in certain sports. Others are prohibited both in- and out-of competition. Most of the tests use one of two basic analytical techniques. The first is gas chromatography, where the sample is dissolved in a gas and passed through a long column, to separate out the complex mixture into its individual components. A detector at the end of the column can identify drugs or their breakdown products by the amount of time they take to pass through the column. Second is mass spectrometry, where the sample is bombarded by an electron beam which breaks components down into fragments. The fragments are separated out by a powerful magnet to produce a characteristic fingerprint from which drugs can be identified.

THERAPEUTIC USE EXEMPTIONS

Some of the substances on WADA's prohibited substances list have legitimate uses as medicines. Athletes using such medicines run the risk of failing anti-doping tests. The WADA code thus allows athletes and their doctors to apply for permission to use substances on the prohibited list for therapeutic purposes. WADA published an International Standard for Therapeutic Use Exemptions (TUEs) in September 2003.[11] An athlete must apply in advance to a TUE committee for permission to use a prohibited substance. The Standard defines the criteria for allowing such use, the application process and how the TUE committee should be constituted. It also sets out an abbreviated form of the process for those substances that may need to be used on a more frequent basis. The abbreviated form is restricted to two classes of substance:

— the Beta Agonists when inhaled (these are used to treat asthma and similar conditions);

— localised use of glucocorticosteroids (these may be used to reduce inflammation).

EXTENT OF USE

Elite athletes

The UK anti-doping agency UK Sport runs a testing programme that covers national and international competitions held in the UK, squad training sessions and out-of competition testing. It has increased the number of samples tested from around 3,000 in 1993-94 to over 7,000 in 2002-03 (see figure opposite) covering more than 40 sports. The number of reports made (ie where samples tested positive or the athlete was unavailable for testing) has also risen over this period, roughly in proportion with the increasing number of samples analysed. In the year between April 2002 and March 2003, UK Sport reported 97 cases involving 90 athletes out of a total of 7,240 samples analysed. Of these, 49 reports involved stimulants, 26 anabolic agents and 16 unobtainable samples.[12] In comparison, the US Anti Doping Agency analysed 5,697 samples in 2002, 62 of which tested positive for a prohibited substance.[13]

Grassroots

At the grassroots level, the main concern has focused on use of anabolic steroids by gym users in general and by body builders in particular. The Home Office has been quoted as estimating that 42,000 people used steroids in the UK in 2001-02.[14] A survey in 1993 suggested that around 5% of gym-users were using anabolic steroids for performance enhancing or cosmetic reasons.[15] More recent surveys suggest that steroid use is higher (in the region of 25-50%) among those attending gyms equipped for competitive body building.[16]

A long-term survey of users of three body building gyms in the Mid-Glamorgan area suggested that 58% of the clientele were using anabolic steroids.[17] One in five of those using steroids reported that they shared needles when injecting the drugs. A follow up study of people in the survey who had used steroids for 20 or more years found evidence of increased risk of cardiovascular disease. Indeed, a further follow up in 2002 showed that three of the 20 subjects had died since the tests were conducted, two from cardiovascular problems.

TRENDS IN UK TESTING, 1993-94 TO 2002-03

POLICY IMPLICATIONS

A detailed analysis of the policy implications of doping in sport are beyond the scope of this briefing. Issues that might be of interest to the Committee during the course of its inquiry include:

— The role of UK Sport in UK anti-doping policy. Some see a potential for conflict between UK Sport's role as a promoter of sporting excellence on the one hand, and as the UK anti-doping agency on the other. This has led to calls for a new, independent, UK anti-doping agency to be set up which is accountable to Parliament.

— Is the current emphasis on detection and sanctions the only approach? For instance, the international federations responsible for cycling and Nordic skiing have announced that athletes exceeding a certain threshold for red blood cells will not be sanctioned, but will not be allowed to compete on health grounds.

— Education about the harmful affects of doping. UK Sport maintains a Drugs Information Database and a Drug Helpline, but both approaches put the onus on users to find information for themselves. Some see a need for more emphasis on proactive approaches, taking drugs education into gyms and classrooms.

— Extent of use. It is widely agreed that there is a need for more comprehensive, national, figures on the use of performance enhancing drugs at the grassroots level in sport. While steroids are the current focus of concern, this may change as the internet makes a wider range of drugs accessible.

— Research. Assessing the likely public health impact of widespread use of performance enhancing drugs at grassroots level requires not only data on the extent of use, but also more detailed information on the harmful effects. For instance, virtually nothing is known about the health risks of designer steroids.

— Compliance with the WADA code and the London Olympics bid. To what extent has progress towards compliance been affected by the recent replacement of the head of UK Sport's anti-doping programme? Is this likely to affect the 2012 Olympics bid?

June 2004

3 Some dietary supplements contain steroid precursors that are broken down into active steroids in the body. Back

4 hCG, human Chorionic Gonadotrpin; LH luteinising hormone. Back

5 www.wada-ama.org/wfCodeOrders.aspx Back

6 The WADA list of prohibited substances came into effect in January 2004 (http://www.wada-ama.org/docs/web/standards_harmonization/ code/list-standard-2004.pdf). Back

7 The university of Southampton is validating a test based on detecting proteins produced in the liver following injection of hGH. Further details can be found at www.the-ba.net/the-ba/sciandpubaffairs/uploads/feature_growthhormone.pdf Back

8 www.spectroscopynow.com/Spy/basehtml/SpyH/1,1181,4-1-1-0-0-news_detail-0-2600,00.html Back

9 T Miller and D Cleveland, Nature Medicine, 9, 1256-57, 2003. Back

10 www.guardian.co.uk/uk_news/story/0,3604,1149791,00.html Back

11 www.wada-ama.org/docs/web/standards_harmonization /code/tue/tue_v3. pdf Back

12 www.uksport.gov.uk/images/uploaded/UK_Sport_Anti-Doping_Jan-Mar_2003_and_Full_Year_Figures.pdf Back

13 www.usantidoping.org/files/2002_AR_Final.pdf Back