SELF-CARE

PUMPING MEDICINE

Coinciding with the Olympics, R.Ph.s should caution athletes about performance-enhancing drugs

As athletes begin to display their physical prowess at the winter Olympic Games in Salt Lake City next month, some observers may consider taking sports-enhancing supplements or drugs in an effort to emulate the outstanding performance of these Olympians. There's no better time for pharmacists to caution the public about the dangers lurking in these products.

According to Gary Wadler, M.D., associate professor of medicine, NYU School of Medicine and member of the health medical research committee of the World Anti-Doping Agency, as well as a medical advisor on doping to the White House Office of National Drug Control Policy, ephedrine, pseudoephedrine, phenylpropanolamine (PPA), and caffeine in excess top the list of substances that are officially off limits for U.S. Olympic athletes. While these types of OTC stimulants may have been taken for legitimate medical purposes, such as colds and allergies, the substances are banned to prevent unfair athletic advantage as well as to protect athletes' health.

Explaining that there have been several deaths in the past year related to the use of dietary supplements containing ephedra and ma huang, Wadler said that since dietary supplement manufacturers are not required to guarantee the purity of their products, people taking these supplements may not be getting what the product label states. While athletes may think they are taking a product that contains a small amount of a banned stimulant, random testing may show otherwise.

"Ephedra is of concern because of the number of deaths, heart attacks, and strokes associated with this substance which has been reported over the years, particularly in the New England Journal of Medicine," he said.

Another caution for athletes involves the use of decongestants. Wadler said that while some athletes might think a large dose of decongestants offers some advantage, there is still a question as to whether these substances actually do enhance performance.

Besides short-acting stimulants, drugs such as anabolic steroids, which might have been taken prior to the event, are a substance banned by the Olympics. Although these drugs may be absent from the athlete's body at the time of the competition, the effect of the drug remains. "The answer to that problem is to test these people year-round so they never know when they are going to be drug-tested," he said.

A new drug having the potential for abuse is Aranesp (darbepoetin alfa, Amgen), a long-acting erythropoietin (EPO) that raises red blood count and provides more oxygen to working muscles. "They are now testing for EPO," Wadler said. "We haven't had much experience with Aranesp as of yet. We now have a way of detecting EPO by using a combination of blood screening and urine testing, " he said.

Linn Goldberg, M.D., professor of medicine and head of the division of health promotion and sports medicine at the Oregon Health Sciences University, Portland, is also a doping control officer for the U.S. Anti-Doping Association. "EPO has been responsible for a number of deaths because the blood gets so thick that it clots and causes heart attacks and strokes," he explained.

Goldberg went on to say that growth hormones that are used to improve performance are also abused; their adverse effects include misshapen heads and jaws, early diabetes, and thick hands. Adverse effects of steroids on boys include breast enlargement and testicle shrinking; on females, there is deepened voice, growth of facial hair, male-pattern baldness, and cessation of menstruation. Both boys and girls risk stunted height, uncontrolled aggression, an increased risk for heart disease, and cancer.

Wadler echoed Goldberg's warning that pharmacists should be aware of the wide array of substances—including dietary supplements—abused by athletes as well as nonathletes. "Supplements are a backdoor to getting some of these various products," he said.

Iris Shaffer, executive director, Blue Cross and Blue Shield Association Healthy Competition Foundation, Chicago, shares Wadler's concern. "Pharmacists need to be aware of what we at Blue Cross and Blue Shield think is a growing public health crisis, because these things are mostly OTC and because they are next to vitamins and other products we associate with good health. People don't understand the health risks. We are concerned about youth. No public or corporate entity is taking the problem on. It's very closeted," she said. She explained that professional athletes don't admit they have taken steroids or performance-enhancing drugs and don't discuss the adverse effects because they have broken the rules and don't want to tarnish their image.

The foundation has provided 1,200 teachers in grades six to eight with a week-long curriculum guide that coincides with the Olympics. The curriculum explains the potential risks of these substances. The foundation also sponsored a poster contest on the meaning of healthy competition. Children who entered the contest and took a pledge to be drug-free received a special U.S. Olympic trading pin with a "drug-free" message. The winner will receive a trip to the Olympics. This summer the foundation is kicking off a major league baseball healthy-competition day at 20 ballparks. The foundation's Web site is atwww.healthycompetition.org .

Sandra Levy

Sandra Levy. Pumping Medicine.

Drug Topics

2002;2:30.