Everything you ever wanted to know about doping (and then some)

Paid millions to perform (or hoping to be paid millions someday), the pressure to win can be staggering for professional athletes. It’s no coincidence that steroids and supplements are so widely used by elite athletes – and often makes appearances in the headlines in the form of salacious scandals.

We all know a bit about steroids, but what’s the real scoop? Why are they so prevalent? When are they illegal? How, if at all, do they differ from performing enhancing drugs and supplements?

These questions aren’t simple ones. Even in an organization as well regulated as the NCAA, there is no exhaustive list of illicit substances. Here we’ll delve into the answers to some of these oft-asked questions alongside some of the juiciest stories to hit headlines in recent years.

Historically, if an athlete wanted a competitive edge, he or she might turn to anabolic steroids. This class of medication – created to treat delayed musculoskeletal growth or excessive inflammation – represents a synthetic alternative to the male sex hormone, testosterone. In athletes, this medication enhances protein synthesis to permit rapid increases in muscle size, gains in strength, enhanced endurance, and faster recovery. Athletes taking anabolic steroids are able to quickly gain an edge over their non-steroid-using competitors.

The downside? Long-term use of anabolic steroids causes a broad range of symptoms – both psychological and physiological. Over time, repeated use of steroids weakens the body’s natural immune system and makes users susceptible to osteoarthritis, liver disease, and cancer. It also causes a variety of hormonal changes, weight gain, and hair loss in both men and women. Psychologically, it can cause unchecked aggression (endearingly termed ‘roid rage’), depression, and anger. Despite numerous downsides and the high potential for abuse, sometimes the pressure to perform is so great that athletes turn to steroids.

American cyclist Floyd Landis, pictured above, is the first disgraced athlete we'll investigate.

Floyd Landis, the American Cyclist and 2006 Tour de France victor, was a classic underdog story to the undiscerning eye. In Stage 16’s infamous climb up La Toussiere, Landis failed spectacularly – losing 10 minutes, his yellow leader jersey, and seemingly all potential for victory. Stage 17 (of 20) was a different story. In a move deemed ‘suicidal’ and ‘irrational’ by commentators and competitors, Landis staged a bold and seemingly miraculous comeback to win Stage 17 by a full seven minutes and, a few stages later, the Tour. He was a true American hero – a bold, confident dark horse – and the world of cycling rejoiced.**

Less than a week later, Landis’s reputation and victory went up in flames as he left both American cyclists and the sport disgraced. A urine sample, taken after his historic Stage 17, contained evidence of synthetic testosterone use, with his numbers almost tripling the permissible amount. Although he maintained his innocence, Landis was subsequently suspended from professional cycling. Years later, in 2010, he admitted to persistent doping and testosterone use and released allegations of doping among his American teammates (including cycling legend Lance Armstrong).**

Interestingly, Landis is still cycling. In fact, while cheering on our rock star beta tester, Luke Pearson, in the Levi’s GranFondo, we saw Landis finish the 160 mile Il Regno race in a mere 7 hours and 9 minutes. Fun fact: in addition to his cycling pursuits, Landis now sells high-grade cannabis products for athletes in Colorado.**

While all anabolic steroids are classified as performance enhancing drugs (PEDs), not all PEDs are steroids. The once-pervasive steroid is now being replaced by other medications and supplements. Some of these drugs serve a relatively simple function, like increasing production of red blood cells in order to train longer and harder (Erythropoietin and/or blood doping), while others are far more complex. Some of the most common of these non-steroidal PEDs are human growth hormone (hGH), ephedrine, creatine, and albuterol. While the physiological effects differ for each of these PEDs, they functionally work to build muscle, extend endurance, and accelerate recovery – much like an anabolic steroid.

The lines become blurred, however, when it comes to the legality of these drugs. Many of these medications can be taken for valid medical reasons but also have a performance enhancing effect. For the average, non-professional athlete, a number of these drugs and supplements are legal (although many require a prescription).

For professional athletes, however, medications like albuterol are screened for and prohibited because of the potential enhancement of lung capacity (although the data supporting this claim are mixed). Regulating these drugs becomes more complicated by cases in which the athlete requires albuterol or another restricted medication for valid medical purposes. In these cases, the athlete must apply for a therapeutic use exemption or risk testing positive for PED use and face fines, suspensions, and worse.

While Landis's case seems fairly cut and dry, Maria Sharapova's suspension raised a lot of questions about what qualifies as doping.

In June of 2016, Maria Sharapova was banned from the sport of tennis for two years after testing positive for the banned substance ‘meldonium’ at the Australian Open – immediately following her match against long-time tennis arch-rival, Serena Williams. Meldonium, designed to treat ischemia (inadequate blood flow), increases blood flow throughout the body -- increasing exercise capacity and recovery.**

When Sharapova took her first dose of meldonium in 2006, a full ten years prior to her doping ban, she was doing nothing wrong. At that time, meldonium was just one of numerous medications being monitored by the World Anti-Doping Agency (WADA). Eventually it was added to the official WADA watch list in 2015. Unlike some drugs that remain on this watch list for years without end, meldonium was upgraded to a banned substance in 2016 – due primarily to large-scale use in professional sports.**

Sharapova’s case is a particularly convoluted one. In a verbose 33-page tribunal, the factors playing into the charges are enumerated and evaluated. Here’s the gist: Sharapova had been taking meldonium legally for 10 years. When 2015 became 2016, the drug was no longer on a watch list but was rather listed as a banned substance. No formal decree stating this change was issued, nor was this information actively communicated to athletes, but it was findable. Although meldonium is not FDA approved in the United States, it is sold as an over-the-counter substance in Eastern Europe, so Sharapova’s use of the drug was not under the care of a doctor. All these defenses aside, she took an illicit substance and did not disclose its use, so she was subsequently banned from tennis for two years. Interestingly, a later ruling by the Court of Arbitration for Sport (yes, that’s a real thing) reduced the ban by 9 months (to a 15-month ban) after determining that her infraction was unintentional.**

The challenge in a case like Sharapova’s (and many of the recent cases) lies in justifying such harsh penalties as the rules surrounding PEDs become more and more hazy. Long gone are the days of testing for a single marker like testosterone. Now PEDs come in all shapes and sizes. Some, like energy drinks, caffeine, and anti-inflammatory drugs, appear benign and are legal according to WADA, though by definition can still be considered performance enhancing. Others are more obviously nefarious – meaning they both clearly enhance performance and pose a health risk. But many substances, including meldonium, fall into a gray area somewhere in the middle. Virtually all athletes are constantly devising new ways to enhance their performance, some through perimissable methods and others through banned ones.

Technology to detect PEDs improves by the day, but advances in technology also introduce new means of enhancing performance. Some are drug-based or artificial, but there are also environmental and more natural manipulations, such as hypoxic air tents (simulating sleeping at high altitude) and altitude trainers (allowing for exercise with thinner air conditions), that ultimately perform virtually identical functions to certain PEDs, just without the use of drugs.

The role of PEDs and bio-hacking technology in the future of sports has yet to be determined. Many passionately argue for legalized PEDs in pro sports – while equal numbers advocate for further enforcement. The decisions we make over the next few years will dictate a great deal.

Outside the realm of professional sports

The legality of steroids and supplement usage in professional and collegiate athletics is determined by a designated organization, but what about the rest of us?

There are technically rules for most athletes competing in amateur athletic events, but they are very rarely tested and even more seldom enforced. Just like the pros, there is no rule against taking creatine, prescribed medications, or pounding Red Bull before a race. Although many amateur athletes may get away with questionable medication use (say, a Sudafed habit or an unnecessary inhaler), there are more also more natural, healthy, and ethical ways to supplement training.

Outside of sports altogether? Well, that’s a different story.

There is no rule-book for the game of life, and stories of media luminaries, CEOs, and other high-achievers using performance enhancers are becoming increasingly common.

While the workplace is vastly different from the sports arena in many ways, there are similar demands of vigilance, attention, performance, and efficiency. To date, no drugs are specifically approved or marketed for performance enhancement in this arena, but like athletes, some people engaging in “work-doping” take advantage of the off-label uses of certain medications. The most common of these workplace PEDs? Adderall and Ritalin (prescribed for ADHD) and Modafinil (a drug commonly used to treat narcolepsy). Micro-dosing (taking approximately 1/10th of a typical recreational dose) of the illegal psychedelic, LSD, is also becoming increasingly common as a means to enhance productivity. A limited body of research provides evidence supporting this claim, but LSD is still far from becoming a legal, regulated medication in the workplace.

There are a number of alternatives to enhance workplace productivity that are seemingly more benign. Biohacking, a term that once exclusively referred to genetic tampering, has emerged as a recent trend akin to ‘do-it-yourself-biology,’ or curiosity-based experimentation based on biological principles. A subset of biohackers extend this practice to hacking their own biology in attempts to gain increased control over their own bodily systems. Biohackers’ practices range from the mundane to the extreme -- from a low-toxicity coffee habit to applying direct electrical current to the scalp to influence neural activity. We’re likely only beginning to see the ways in which people will use both natural and synthetic products in attempts to unleash their full potential.

49-year old venture capitalist, early investor in Facebook and Co-Founder of PayPal, Peter Thiel, is outspokenly passionate about trying to prevent aging and increase longevity. In addition to investing in various companies he believes to be working toward biological advances that will extend human life, Thiel admits to taking human growth hormone as a part of his quest to live to 120.**

His quest may not end there. Thiel has conveyed fascination with the notion of ‘parabiosis’, an experimental fusing of blood vessels between two different mice. According to an article published in ‘Nature,’ joining the circulatory system between two mice, one young and one old, results in rejuvenation of the aging mouse’s organs. Thiel isn’t alone in this enthrallment. A start-up, Ambrosia LLC, buys blood from blood banks and transfuses this blood into adults over the age of 35. Although Thiel is not an Ambrosia customer (and it is unknown whether he actually engages in this practice), HBO’s ‘Silicon Valley’ and its ‘blood boy’ is not too far from the rapidly approaching future of performance enhancement in the workplace.**

The future of PEDs

In some ways, the future is already here. ‘Juicing’ in the traditional sense still occurs, but we now live in world rife with creative alternatives for performance enhancement. People inject themselves with their own stem cells, and some use neurofeedback to tinker with their brains to optimize performance. There are supplements that replenish the tips of chromosomes in an attempt to combat aging (although the evidence is tenuous), canisters that flash-freeze the body to enhance recovery, and pods that can mimic the altitude on the top of Everest to increase red blood cell volume. Perhaps the near future will bring engineered DNA for the ultimate performer.

The question is not if these technologies will exist, but rather, how they will be used. Will they remain contained among professional athletes and wealthy high-achievers? Or will performance enhancers become commonplace among average working Americans? Perhaps they will find a home in the tactical athletic realm with soldiers and first responders.

Assuming PEDs become prevalent, what ethical ramifications accompany this development? Will non-users be left in the dust? One key question will determine the answer to all the previous ones – what role, if any, should PEDs play in our future?