This is Part Two of a three-part article. The first part focused on the formal process of drug testing in sports, primarily at the international level. This part continues with the formal process and part three will discuss the tactics used by athletes to avoid drug detection. The article reflects the personal and cumulative experiences of the author who was intimately involved in drug testing for a variety of sports. While the arsenal of drugs available to athletes includes far more agents, the coverage here will focus on anabolic-androgenic steroid (AAS) use.
Labs Approved for Drug Testing
To date, the IOC has accredited 25 testing laboratories around the world. There are 3 in North America (1 in the University of California at Los Angeles School of Medicine, 1 in the Indiana University School of Medicine, and 1 in Montreal, Quebec), 1 each in China, Korea, Australia, Japan, and South Africa, and the rest are in Europe. Once the commitment is made to develop a laboratory, 2 to 3 years are necessary to develop the necessary methods and gain the appropriate experience. Currently, laboratories are developing in Hungary, Poland, Malaysia, Puerto Rico, Brazil, Zimbabwe, Indonesia, and Turkey.
Several requirements are made of the IOC laboratories. They must organize a proficiency program, an annual accreditation examination (which is designed to be quite difficult), and a week-long scientific meeting. The IOC laboratories in the United States and several commercial laboratories are also accredited by the College of American Pathologists for athletic drug testing. The IOC is planning to require the laboratories to join the International Standards Organization accreditation program. In addition to adhering to the testing protocols, the IOC program requires adherence to a code of ethics that forbids testing samples unless they are from a bona fide sports program. Labs found guilty of violating this code may be sanctioned. Thus, the IOC laboratories are prohibited from drug testing athletes who want to learn how to evade detection of drug use.
Positive Drug Tests and Confidentiality
Panels of officials and athletes usually review positive drug tests. Disputed cases may lead to hearings, to arbitration, and to courts at the national and international level. Sports, particularly in the United States, place great emphasis on refining and executing the collection, transport, and testing procedures. In the case of a positive report after screening and confirmation on the “A” urine sample, the athlete may choose to be present to verify that the “B” sample is intact as they last saw it, or may send a representative to do so before the “B” sample is tested.
Generally speaking, athletes are notified by their governing body of any breach of the medical code and have the right to a disciplinary hearing and legal representation. The name of the offending athlete should be kept confidential. However, given the media frenzy over the reporting of positive drug tests, this has been difficult to maintain. The reason for maintaining confidentiality is that new evidence can always overturn the decision. Historically, even when guilt has been proven beyond reasonable doubt, the procedures have occasionally been challenged in the light of new scientific evidence. There are published accounts of unwitting intake of drugs via consumption of natural products such as opioids, which have been detected in urine as the result of eating poppy seeds on bagels. After this discovery, subsequent drug tests were modified to detect opioid metabolites that are derived only from administered drugs. Positive test results have been reported after consumption of chickens that have been injected with preparations of anabolic steroids into fat stores and farm animals treated with clenbuterol. It is for these reasons that the laboratory data should undergo a thorough scientific review before proceedings are instigated through administrative channels and sanctions imposed on athletes suspected of a doping offense.
The Responses of Organizations to Positive Drug Tests
What happens to an athlete once a positive drug test is reported depends on the drug detected and the testing organization. Anabolic-androgenic steroids (AASs), beta-blockers, and amphetamines are considered the most serious offenses and, consequently, the penalties are high. Another consideration is what to do when an athlete’s urine reveals traces of a banned substance that is available OTC or can inhibit performance. As an example, stimulants would most likely impair shooting performance, yet they are still banned. In these cases, different sports organizations considering these possibilities may reach opposite conclusions. This point elucidates how complicated and confusing testing can be for athletes competing in different organizations. Such discrepancies in how athletes may be sanctioned potentiate the possibility of positive doping results for OTC banned substances. The burden is placed upon the athlete to know and understand the rules and sanctions for their sport and the specific organization they are competing in.
At the Olympic level, while the IOC rules may be clear, they only apply to the Olympic Games. Outside Olympic competition, each international or national sports organization sets their own rules. While all sports in theory could and should operate under the IOC rules, in practice this has yet to be achieved. Presently the IOC has a group working on rules agreement within Olympic sports. Further problems at the national level include having to get agreement across the various national governing bodies and between the national governing bodies and their international federations on the rules of drug testing. Some national governing bodies carefully follow the rules of their international federations, but some may not because of lack of clear international federation rules. The final verdict depends on the type or level of competition and the particular sport. In the Olympics, the judgment process takes a few hours. In the United States, an athlete who is not satisfied with the decision of the initial hearing may appeal to the American Arbitration Association. At the international level, an athlete may appeal to the International Court of Arbitration for Sport.
Defenses Used Against Positive Drug Test Results
In the event of a positive sample, some athletes may admit drug use, but most will deny use and attribute the positive result to collection mistakes, breaks in the chain of custody, laboratory error, or sabotage. Sample collection is a possible area of vulnerability, but errors are usually minor (e.g., incorrect date) and do not materially affect the results. Transport and receiving are simple processes and, in general, are not a problem area. Experts have never successfully refuted the data from US laboratories, despite careful scrutiny. While sabotage is possible and should not be excluded, it rarely can be proven. As a precaution, athletes are warned to drink only from sealed containers provided by the collection officials. While sports authorities are skeptical of the sabotage defense, they would consider evidence offered to support it. There are no documented cases of sabotage in the legal or medical literature.
As far as testing positive for a banned substance contained in an over the counter (OTC) drug, athletes often accept the results, but ask for leniency on the basis of unknowing use or lack of understanding that the product contained banned substances. Depending on the circumstances and the amount of drug found in the urine, this explanation may or may not be accepted. If a second offense occurs, then a sanction is usually imposed. In past cases where the testosterone to epitestosterone ratios (T/E) are elevated, athletes have attributed the results to OTC natural products that claim strength enhancements and sometimes are labeled as containing “orchic” or, most recently, prohormones. The amount of testosterone in orchic-type products is very low and the bioavailability of these oral preparations is also low. So while it would seem unlikely that these products could increase T, the mere availability of such products may be used to raise questions. Recently, positive doping tests have been attributed to prohormones and various organizations have clearly indicated that these supplements are banned. So future positive tests are unlikely to receive much leniency.
Results of Drug Testing
The IOC-accredited laboratories annually report the number of samples tested and the number of positive tests by sport and substance. Efforts have been made to increase the number of samples collected each year using short- and no-notice testing. Presently the percentage of samples that test positive for AASs has plateaued at about 1.0%.
At the 1996 Olympic games for the first time, AAS screening was done using high-resolution mass spectrometry (HRMA). About 18% of the athletes were tested immediately following their events. In addition, before traveling to the games, many athletes were tested by their national testing authority, and some elite athletes were tested on short notice by their international federation immediately prior to the games. At the games, virtually all medalists were tested and 1 or 2 nonmedalists were selected at random for testing. At preliminary events, winners and losers were randomly selected with each having an equal risk of testing. For team events, the final and semifinal rounds were tested with 2 members of each team selected at random from the athletes who dressed for the event. At preliminary team events, matches were randomly selected for testing and 1 athlete was selected per team. The randomization procedure typically took place near the end of a team event and immediately after the individual competition. The process used an electronic random number generator and was supervised by IOC-appointed officials.
After selection and positive identification by inspection of the athlete’s identification badge, and an escort was assigned to observe the athlete at all times until they reported to the doping control station. The athlete had to report to the station within 1 hour of notification. The urine sample was collected under direct observation and rapidly transported to the laboratory under strict chain-of-custody procedures. Within 24 hours the laboratory reported the results to the chair of the IOC Medical Commission. The IOC Medical Commission then conducted a hearing for positive sample tests with the athlete and representatives of the international federation and the country involved. After all sides presented their case, the IOC Medical Commission discussed the case and recommended a course of action to the IOC Executive Board based upon their decision. In serious cases, such as detection of an anabolic steroid, the recommendation was to remove the athlete or responsible individual from the Olympic Village.
In 1984, the USOC became the first sports organization to conduct testing in the United States. Since its inception, the USOC has conducted announced testing for all major events at a minimal rate of 3500 samples per year. About 70% of the tests are performed on men. The number of steroid and related cases in men has gradually declined from 1992 through 1995. From 1984 to 1996, the announced testing program has detected 128 samples positive for steroids and steroid blocking agents (including 10 for women), 12 samples positive for diuretics, 7 for beta-blockers, 15 for narcotics (mostly codeine and propoxyphene), and 365 for stimulants (0.89% of all tests). Because the USOC conducts testing for both national and international events held in the United States, some of the positive results were not among US athletes. Alternatively, USOC athletes are tested in other countries and these results are not included.
The NFL began testing for illegal drugs and AASs around 1985-1986. Since 1990, UCLA and Indiana University together have tested approximately 8000 samples per year for AASs collected year-round from approximately 2400 players. The selection process is random and all players are at risk for selection at any time. During the season (August to January), an equal number of players are selected from each team once or twice per week. During the off-season, random testing continues with each player eligible to be tested at any time. In addition, all players are tested at the preseason training camp. The random selection process results in a testing rate of approximately 4 tests per player per year (minimum, 1; maximum, 8).
In general the NCAA policy and procedures are executed in accordance with a strict set of guidelines. Athletes are tested for steroids at major events like a national championship game. In addition, athletes are also tested for other categories of drugs like marijuana, cocaine, and stimulants. In the past, schools have gotten publicly embarrassed when a player(s) tested positive, so some schools initiated their own in-house drug testing program. Data from a variety of sources points to the fact that at the college level, men’s sports like football, basketball, track and field, baseball, and swimming and women’s sports like track and field, swimming, diving, and softball all have steroid use present. From various studies done over the years, figures as low as 5% (1994) and as high as 15% (1995) have been presented for the fraction of college athletes using AAS. The low number was from a study funded by the NCAA in 1994. Many researchers claimed that the percentage underreported steroid use because of self-reporting. The latter study proved that their assumption may have been correct.
In 1985, 32 Vanderbilt football players were indicted in a case involving the sale and distribution of steroids. In 1986, after years of rumors of widespread drug abuse, the NCAA voted to institute drug testing at major football bowl games and championships in other men’s and women’s sports to detect AAS as well as illegal street drugs and amphetamines. Prior to this, athletes could get steroids from a coach, team physician, or athletic trainer. If you talk with athletes from that time period (1970’s to early 1980’s), many can tell you how they got their AAS from their trainers. When the statistical data is looked at however, the results from several surveys indicate that most athletes obtained AAS from outside physician sources. I think this discrepancy is due to the fact that athletes don’t want to implicate themselves or their sources. It also points out the possible flaws that can be associated with survey-type studies. When you ask a group of athletes if they are taking something, or if they think someone else in their sport is taking something, it is difficult to get unbiased answers. With all the negative press around steroid use, the fact that it is illegal without a doctor’s prescription, and not to mention banned in the NCAA, athletes are conditioned to say they don’t take anything. They also realize that if they report their teammates, then they also become guilty by association.
Prior to 1990, a typical scenario was that an athlete was told he would get drug tested on a given date. This meant he knew in advance when to come off whatever he was taking so he could beat the test. If he didn’t think he was going to beat the test, he could simply go to the team physician, and say he didn’t feel well. The doctor would send him home to get some rest and sleep and get the athlete excused from testing. These tests were done very infrequently so it could be a month or longer before the athlete was called back for a test. Plenty of time for the athlete’s system to clear out anything he was on. In addition, most of the testing was done out of season. So if an athlete was taking something early in the season, he could just go off before the bowl game or out of season testing and then pass every time.
In 1990, the NCAA knew that their drug testing program was not working. The fear tactic had worn off and educated athletes now knew that several agents could be taken up to days before the drug test date to allow their urine sample to test negative. So to discourage AAS use further, the NCAA implemented year round spot-checking in Division I-A and I-AA football. But by the time the NCAA had implemented this testing practice, athletes were already using probenecid (a renal tubular transport blocking agent), epitestosterone (E), diuretics, growth hormone (GH), and other masking agents. The chemical actions of these substances will be covered in part three. For now I will just point out that probenecid prevents the kidneys from excreting steroids and other drugs, E administration lowers the T:E ratio so that the athlete’s drug test shows up negative, diuretics dilute the urine sample, and GH was undetectable by the lab test protocols at that time.
Presently, drug testing for the NCAA is divided between the IOC-accredited laboratories at UCLA and Indiana University. In recent years, 78% to 83% of all NCAA tests (9000-12 000 per year) were short-notice tests (notification of the test was in 48 hours or less). The remaining tests (announced) are divided between male athletes competing in football and other sports and female athletes, who account for approximately 14% of those tested. More than 90% of football and track and field athletes are tested using the short-notice program.
Part Three - The tactics used by athletes to avoid drug detection.