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While the use of amphetamines such as dextroamphetamine and methamphetamine has declined, there has been an increase in the use of “designer” stimulant drugs such as Ecstasy, (MDMA, methylenedioxmethamphetamine),^2,3 which mimic the effects of amphetamines.⁴ Pseudoephedrine — sold over the counter in cold medicines — and ephedrine — marketed aggressively to athletes as a dietary supplement — also mimic amphetamines in high doses.^1,5

Erythropoietin, a prescription subcutaneously administered medication for anemia, is a glycoprotein that stimulates red blood cell production. The increase in red blood cells is believed to improve oxygen consumption and benefit endurance. Complications include hypertension, congestive heart failure, and death.¹

Anabolic steroids are synthetic derivatives of the male sex hormone testosterone. Attempts to separate the anabolic form from the androgenic, or masculinizing effects, have been unsuccessful and these agents are referred to as anabolic-androgenic steroids.

Therapeutic use of steroids include hypoplastic anemia and growth disorders. Athletes administer 10 to 200 times the therapeutic dose in an effort to increase muscle mass and enhance performance.¹

Cardiovascular events linked to anabolic steroid abuse include fatal and nonfatal MI. Steroid abuse increases the risk of sudden death by increasing left ventricular mass and responsiveness to catecholamines. Steroid abuse also causes increased low-density lipoprotein, decreased HDL, and sodium and water retention.¹

The danger of supplements

Athletes often buy products marketed as “nutritional supplements,” which are unregulated and may contain varying amounts of androgens, pro-hormones or steroid precursors, such as dehydroepiandrosterone and androstenedione.⁵

Human growth hormone (HGH) is a naturally occurring pituitary hormone responsible for growth. Athletes may use it for its anabolic effect, but data on its effects are limited. The most common side effect of HGH excess is acromegaly — a serious systemic condition typically caused by a benign tumor of the pituitary gland that secretes excessive growth hormone. Coronary artery disease and cardiomyopathy have been described with its use.^1,4 HGH, or somatotropin replacement therapy, is a biosynthetic growth hormone administered by injection under a physician’s supervision for medically indicated cases.

However, HGH “precursors” are marketed as homeopathic remedies in pill or powder form for weight loss, increased muscle mass, energy, performance, and anti-aging properties, with dubious effects. Injectable HGH as prescribed by physicians is touted and offered on some websites as the real thing.

A 2001 study by the National Collegiate Athletic Association of nearly 14,000 student-athletes regarding the use of alcohol, amphetamines, anabolic steroids, cocaine, ephedrine, marijuana, psychedelics, and smokeless tobacco reported that a majority of student athletes engage in substance abuse, especially alcohol.⁶ Being educated on the facts of substance abuse in the sports world can only improve the care provided to this “majority.”

Patricia Agostino, RN, CEN, CCRN, is a staff nurse in the ICU of Stamford Hospital, Stamford, Conn.

References

1. Cregler L. Substance abuse in sports: The impact of cocaine, alcohol, steroids, and other drugs. In: Williams RA, ed. The Athlete and Heart Disease. Philadelphia, PA: Lippincott Williams & Wilkins; 1999:131-153.

2. American Academy of Family Physicians. American College of Sports Medicine Current Comments: Statement on Cocaine Abuse Among Athletes. Available at: www.aafp.org/afp/20001015/clinical.html. Accessed November 3, 2004.

3. Lange R, Hillis D. Cardiovascular complications of cocaine use. NEJM. 2001; 345(5): 351-357.

4. Tricker R, et al. Drugs in sports. Available at: www.drugfreesport.com/ choices/drugs/index.html. Accessed November 3, 2004.

5. Pipe A, Ayotte C. Nutritional supplements and doping. Clin J Sport Med. 2002; 12(4):245-249.

6. Green GA, et al, NCAA study of substance use and abuse habits of college student-athletes. Clin J Sports Med. 2001; 11(1):51-56.