Drug Testing in Sports Chapter 17 Pharmacology

Drug Abuse in Sports The history of taking drugs to improve performance dates back to World War II when German soldiers were given steroids to increase their strength and aggression.

Self-Administration Quacks Athletes take drugs By purpose Accidentally Self-Administration Quacks Couch Advice Doctors Paramed

What is Drug Testing? Drug testing generically refers to the analysis of bodily tissues or fluids to determine the presence and/or concentration of a particular substance Drug Testing vs. Drug Screening Drug Screening is the qualitative analysis of body tissue or fluid to broadly determine the presence of particular substances Drug Testing in the most precise sense refers to quantitative analysis of bodily tissues or fluids to determine concentrations of particular substances

History of Drug Testing First drug testing was for alcohol during prohibition Another early use of drug testing was in sports First used to detect if horses were being given morphine thought to be a performance enhancer Human athletes were being tested by the 1960’s The military began testing during the Vietnam war. However systematic testing did not begin until the 1980’s Private industry began drug testing of employees in the 1980’s Practice became widespread following Executive Order #12564, by President Reagan, establishing Drug Free Work Place First drug testing was for alcohol during prohibition These were originally done in the 1920’s with kits that tested for alcohol in blood The breathalyzer technology was developed in the 1930’s Another early use of drug testing was in sports First used to detect if horses were being given morphine thought to be a performance enhancer—this was in the 1930’s Human athletes were being tested by the 1960’s International Olympics committee began testing for drugs in urine in the 1960’s following the death of a cyclist who had been using amhetamines Systematic testing began with the 1972 games, the purpose being to establish a level playing field for amateur sports competition Professional sports has been very slow to adopt drug testing, primarily because of the strong lobby of the players unions. The military began testing during the Vietnam war. However systematic testing did not begin until the 1980’s The problem of drug addiction among soldiers was recognized as early as the civil war, when soldiers were returning home with “soldiers disease” (addiction to morphine) It was heroin addiction among soldiers returning from the Vietnam war, however, that motivated the government to begin testing; even then, however, this testing was only sporadic An incident on the USS Nimitz in 1981 involving the crash of a jet fighter on the deck of the aircraft carrier, killing 14 people and injuring 48 others is what stirred the military to test systematically 6 of the deck crew who were killed tested positively for drugs As a result the military instituted mandatory drug testing in all military branches Private industry began drug testing of employees in the 1980’s Practice became widespread following Executive Order #12564, by President Reagan, establishing Drug Free Work Place in 1986 While this was mandated for federally funded organizations only, private industry closely followed Workplace testing takes one or more of three forms: Applicant screening—involves all applicants Random testing of current employees Reasonable suspicion testing—must be able to show cause

Examples of Athletes using drugs Ben Johnson: The American 100-meter gold medal winner was disqualified in Seoul Olympics 1988 due to Stanozolol abuse. Then lifetime ban in 1993 due to Testosterone abuse.

Examples of Athletes using drugs Ronnie O'Sullivan: The British snooker player has forfeited prize money of $100,000 after a positive test for cannabis.

Examples of Athletes using drugs Dieter Binus: Accused of causing bodily harm to female East German swimmers by giving them anabolic steroids.

Effectiveness of Drug Testing Difficult to evaluate effectiveness because of multiplicity of goals of drug testing: Identification of drug users in an organization Deterrence of drug use Improvement of worker morale Increased productivity Decreased workplace accidents Overall cost-effectiveness Difficult to evaluate effectiveness because of multiplicity of goals of drug testing: Identification of drug users in an organization Effective here; drug testing data tends to mirror what is found in anonymous surveys Deterrence of drug use Results in various settings suggest that drug testing has had a deterrent effect Researchers caution that as drug testing is more common, in a greater variety of settings, and more frequently done on a random basis, deterrence effectiveness will probably be reduced. Improvement of worker morale Has been great concern about effect of drug testing on morale Studies do not show such an effect Could be a reason to argue that it actually increases morale among conscientious workers Increased productivity Reasons for increased productivity: More attentive, focused workers; Less absenteeism; Self-selection of better workers Reasons for reduced productivity: tests are time consuming; learning curve for replacement workers Research provides minimal support at best for premise that drug testing increases productivity Decreased workplace accidents Research suggests that testing does reduce accident rates, though mcuh more research needs to be done I this area. Overall cost-effectiveness While drug testing has had positive results in most ways listed above, overall cost effectiveness is somewhat questionable because of high cost of drug testing. Research suggests that where there are high levels of drug use, testing is probably cost effective. Otherwise, it is questionable.

Controversies Surrounding Drug Testing Reliability of Drug Testing Great potential for false positives, particularly on EMIT This is most commonly used test The problem is one of cross-reactivity; many substances, often legal, will also provide a positive Not all companies follow up on positives with more accurate blood tests. Most drug tests do not measure current level of drug use/impairment Hence, very difficult to determine that drugs are the cause of an accident Constitutionality of Drug Testing Violation of Fourth Amendment protections? Issue of unreasonable search and seizure Use of urine, blood, etc. certainly is invasive; practice has even been called by some to be Chemical McCarthyism Constitutional questions are: (1) is this an unreasonable search; and if so, (2) who should be restricted from engaging in it? Supreme Court has established that mandatory testing without cause is unconstitutional; testing for cause is not unconstitutional mandatory general testing is acceptable where general public safety is at stake (e.g., airline pilots) (compelling interest argument) private organizations are not governed by constitutionality issues (because it is not the government invading privacy) Violation of Fifth Amendment protections? Logic here is that one’s bodily fluids are a form of self-incrimination Courts have generally rejected this argument Violation of Fourteenth Amendment protections? 2 challenges here: “due process clause” and “equal protection” clause Due process clause has been upheld insofar as confirmatory analysis is required for EMIT positives Equal protection clause invoked to (1) challenge refusal of employment to methadone patients; and (2) to define drug and alcohol dependency as a handicap, ultimately holding that individuals with a past history of addiction are protected under the Americans with Disabilities Act. Reliability of Drug Testing Great potential for false positives, particularly on EMIT Most drug tests do not measure current level of drug use/impairment Constitutionality of Drug Testing Violation of Fourth Amendment protections? Violation of Fifth Amendment protections? Violation of Fourteenth Amendment protections?

Drug Testing NCAA goals of drug testing programs: Promote fair and equitable competition Compete on a “level playing field” No athlete should feel pressured to consume drugs to have a chance to win Safeguard the health and safety of athletes by discouraging drug use through testing Hope of athletes using drugs to be caught so they can be counseled and receive treatment

What is being testing during a drug test? A list of banned drugs have been established by NCAA and an Olympic Committee. These lists are composed of substances that are generally reported to be performance enhancing and/or potentially harmful to the health and safety of the student athlete

Selection of Athlete Random selection of athlete by sport Random selection of athlete by position Random selection of athlete by playing time or finish position Random selection of athlete by financial aid status Random timing-no notice Reasonable suspicion

Methods of Drug Testing Breath tests Used exclusively for alcohol Least invasive Blood, urine, saliva test Testing of these 3 body fluids involves same basic technology Problems identified with all 3 Hair analysis Can preserve record of drug use for an indefinite period of time Also because of the way hair grows, can determine approximately when drugs were taken (within about a month) More precise determination, however, is not possible Breath tests Used exclusively for alcohol A ratio of 2100:1 between BAC in blood and in breath Least invasive—also least costly Blood, urine, saliva test Testing of these 3 body fluids involves same basic technology Chromotography—uses other chemicals to react with body fluids on principle that different substances react with other (known substances used in the test) at different rates and when forced together will separate at different rates Immunoassays—introduced in 1970’s; utilize antibodies produced by animals injected with antigens consisting of drug protein compounds. These antibodies are specific to specific drugs. Most commonly used of this type is enzyme multiplied immunotechnique (EMIT) Problems identified with all 3 Extracting blood especially is highly invasive Risk of HIV/AIDS Evidence of drugs in bloodstream is extremely temporary Urinalysis is less invasive, and stays in system longer; however, cannot measure levels of concentration (e.g., to determine if sufficient to consider impaired) Hair analysis—princple is that hair follicles absorb substances from the bloodstream and deposit them in the hair as it grows. Can preserve record of drug use for an indefinite period of time—much like determining the age of a tree by its rings Also because of the way hair grows, can determine approximately when drugs were taken (within about a month) Hair grows at approximately 1 to 1.3 centimeters per month. Hence, a strand of hair 12 inches long represents a record of 9 to 12 months More precise determination, however, is not possible

Drug Testing Methods Urinalysis is most common method Enzyme multiplied immunoassay technique (EMIT): Light absorption to establish level of drugs present in urine Gas chromatography-mass spectrometry (GC-MS): EMIT positive tests must be followed up by GC-MS Separates compounds in urine and developing fingerprints for each compound.

Drug Testing Methods Cont. Athletes will be observed by a drug testing crew member of the same gender Length of collection process depends on the athlete’s ability to provide adequate specimen Entire process is usually completed in 20 mins.

Can large amt. of fluids mask drug test? NO!! NCAA requires athlete’s urine sample to be analyzed on site before sending to lab Diluted specimen- athlete will be required to remain in drug testing until an adequate specimen is collected

NFL Drug Testing NFL tests for recreational drugs Athletes given specified date and plenty of advanced warning Positive tests athlete is given a second chance before suspension League treats recreational drug use as a medical issue and wants to get athlete help

NFL Drug Testing Cont. Steroid Testing Random testing given each week Computer randomly selects the athlete 1st positive test, athlete suspended for four games 2nd positive test, suspended for six games 3rd positive test, suspended for at least one year

NFL Drug Testing Cont. Testing for masking agents If athlete tries to pass a drug test using these agents, they are suspended, even if a steroid is not detected

NBA Drug Testing Notification during practice on the day of testing that they must provide a urine sample Everyone will be tested at least once during the four week preseason… rookies will be tested three more times, randomly and without notification each season Veterans will be tested during preseason only

NBA Positive Testing Results Positive tests for cocaine, heroin or other “hard drugs” will be barred from the NBA for two years Positive tests for marijuana will go into a treatment program after the first offense 2nd offense they will be fined Additional offenses will lead to more fines and subsequent suspension

MLB Drug Testing Players undergo two unannounced test An initial test and a follow-up five to seven days later Failing to take test counts as a positive test, as will attempting to alter a specimen or using a masking agent Banned substances are those listed by the FDA Includes 27 types of steroids

High School Drug Testing Consent form must be signed by athlete and parent/guardian prior to season If athlete refuses they may not participate that season Incoming athletes during a season must sign consent before participating

High School Cont. Drug Testing: Done without prior warning to student Positive tests-Medical Review Officer must contact parents/guardian and school admin. This results in immediate dismissal from team If not currently participating in sport, then the student shall be required to miss the entire season for the next sport in which the student normally participates in. Required to undergo drug counseling 2nd violation-permanently prohibited from participating in sports