This is Part Three of a three-part article. The first part focused on the formal process of drug testing in sports, primarily at the international level. The second part continued with the formal process of drug testing. This part presents anecdotal stories and discusses 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.
The dosages of anabolic-androgenic steroids (AAS) that athletes take greatly exceed the normal therapeutic amounts and typically several different types of AAS are taken together (stacked) or used at different times (cycled). Most athletes use AAS as training aids for recovery and discontinue use before an event so that they can later pass the competition drug test. During a typical steroid cycle, it is common for athletes to use other drugs such as diuretics to reduce fluid retention, thyroxine to promote weight loss, and tamoxifen to prevent gynecomastia. In the US and other countries, these agents are freely available in gyms and fitness clubs, regardless of their legal status.
Athletes with access to the right resources can beat the drug tests. Other athletes can not. The whole idea behind drug testing is to have a level playing field. Yet, in reality, this system is inherently unfair. If one athlete has the money and appropriate support personnel around them, they could certainly challenge a test. If another athlete has little money and knowledge, they will be at a serious disadvantage.
About 2-3 years before working as a drug test official, I was at a party being thrown by some collegiate athletes. People were lighting up joints everywhere and drinking alcohol like crazy. I knew my one buddy was going to get drug tested, because he was a big guy (almost 300 pounds) and he was always tested. Even though he wasn’t smoking anything (at least at that party) he wasn’t worried. He said he never tested positive for marijuana even though he got stoned plenty of times the night before a drug test. He figured that because he was so big he just got rid of any residues really fast. While that didn’t make that much sense to me, the fact was that he still had negative lab results. Based on the formal proceedings this didn’t seem possible. This became clear to me years later.
If you ever saw the movie “The Program,” then you were treated to the various non-chemical means by which athletes have tried to beat the drug tests. I have seen or heard of athletes getting caught trying to use someone else’s urine by planting hidden vials in the bathroom, keeping a plastic bag and a catheter down their pants, etc. I have never seen or heard of collegiate athletes infusing someone else’s urine into their own bladder in order to beat the drug test. I have heard of this at the professional and elite levels of competition, though. To get around all the mechanical methods that athletes used to beat AAS tests, several key checks were done on every urine sample, as it was produced. By 1995, the procedure had evolved to the following: an athlete goes into his locker room and sees a notice on his locker to show up for drug testing. The notices were supposed to be put out right before practice, so the athlete knows not to use the bathroom. After practice the athlete shows up to the drug test site, which was usually in or near the locker room. From that point on the athlete has a monitor assigned to him. The athlete selects his own container to urinate in. ID labels are placed on the cup and on other documents. The athlete and monitor go to the bathroom where the athlete urinates in front of the monitor. The monitor must witness the flow of urine into the specimen container. After the appropriate volume is collected and capped, the athlete and monitor return to the drug-testing site where documentation is completed and signed by the athlete. At this time, the pH, temperature, and specific gravity of the urine are measured using indicator strips on the sample container. (This would serve to eliminate the use of vials of urine and prevent tampering with the actual urine sample.) If all of the three measurements are within the appropriate range, then the athlete can sign off and leave. If even one is off, then another sample must be collected.
That was the routine stuff that the athlete saw. Now let’s talk about what really happens with the urine results. NCAA athletes are told that they will be tested for cocaine, marijuana, AAS, and amphetamines. They are led to believe that each sample will be tested for each and every drug. Remember my big buddy who never tested positive for marijuana? The reason is simple: they never tested his urine for marijuana. The rule of thumb that I learned years later was as follows: Since drug testing costs so much, the big guys like linemen, fullbacks, and shot putters would be tested for steroids, while smaller guys would be tested for other drugs, like marijuana. So to spell it out, it was totally possible that a wide receiver, light-weight wrestler, or some other small or thin looking athletes could use steroids and never get caught ,even though he was drug tested. On the other hand, a lineman could get stoned all the time and theoretically not test positive for marijuana or cocaine because they always tested his urine for steroids.
If you’ve followed weightlifting for years then you know how dominant the Bulgarian weightlifting team once was. How were they able to compete at the international level so successfully? I’ll say it for you: DRUGS. Never mind all of the bullshit with training and restorative means. Today they still have access to the same type of training and recovery methods, yet they are not nearly as dominant as they once were. The reason that the Bulgarians were able to train six times per day at very high intensities and make consistent progress is that they had figured out how to hide their drug use. While they used a variety of tricks, here are some of the methods we have been able to verify. The Bulgarian weightlifting team would fast about 2-3 days before a competition. Fasting lowers the amplitude and pulsatility of luteinizing hormone. This, in turn, would lower endogenous production of testosterone (T). In addition, fasting also causes an increase in the excretion of steroids. As a result, their urine samples would show lower levels of T and other steroids because by the time they were tested, they virtually excreted most of the evidence away. Now this trick was not the only one the Bulgarians were known for. Their real ace in the hole was the use of diuretics. They would use the diuretics to urinate out lots of fluid. By ingesting an abundance of water, the diuretics would just accelerate the clearance of steroids or other banned substances from the blood. This offered two advantages: the first was that now the athlete would avoid detection for a banned substance and the second was that the athlete could lose weight and compete at a lighter weight class. But the diuretics proved to be their downfall, as this is how they got caught. At one Olympics, the whole team was forced to withdraw from competition because every member of the lighter weight classes had tested positive for diuretics. To avoid further embarrassment, the rest of the team was withdrawn. So next time someone tells you about what the Bulgarian’s do for training, slap them in the face and wake them up. Then remind them that Bulgaria is not the dominant power it once was in weightlifting. The only thing that changed was that the drug testing got better.
So how about the boys from the US? Are they clean? Clean is such an ambiguous term, so let’s be more precise: Are they taking anabolic-androgenic steroids? I have never seen or heard about first-hand any athlete on the Olympic team using AAS (we all know about the 1976 athletes and subsequent athletes testing positive). However, I have heard of AAS, growth hormone, and other agents, being used by lower caliber athletes. I also know of athletes that took prohormones and tested negative. The tests, as far as I could tell, were complete and nothing like the “insurance policy or sink-test” type tests Dr. Voy has written about in his book (where athletes’ urine samples are dumped down a drain and then the results are reported as negative). These athletes did not use any type of strategies to avoid detection. There can be several reasons for the negative results. Perhaps the athletes ingested pills that did not contain sufficient quantities of DHEA or androstenedione (A). Perhaps the amounts of DHEA or A in the pills were not enough to result in a positive test. Lastly, maybe the conversion of androgens to estrogens is so rapid that the current tests can not detect the androgens (elevated urinary estrogen levels would not matter since these were not tested for). Typically athletes would take 100-200 mg of A before a workout. The rationalization was that the sudden elevation of T from the conversion of A would result in a more aggressiveness and a better workout. While we may ponder whether or not these tactics work, consider what one athlete did with access to more sophisticated means. He simply designed his own “study” using himself as the sole subject. On different days he would take increasing dosages of DHEA, A or some combination. So one day he might take 100 mg of A, another day he might take 100 mg of DHEA and 100 mg of A, then another day he would take 200 mg of A, etc. He would have his blood hormone levels measured and his urine analyzed. He found that at around 800-1000 mg of A by itself, he could get enough of an increase in T to increase his training performance. If he was ever drug tested, the conversion of A to estrone (and T to estradiol) would also serve to lower his A and T levels, thus offering a “negative” urine sample. This may have worked for him, but other athletes should not be gullible and follow the same strategy. Unless they undergo the same type of self-study, they have no way of knowing if the androgen elevations and conversions will be the same for them. In short, you can not rely on another athlete’s hormonal and urinary data and adopt it as your own.
The less sophisticated athletes simply make use of the loop hole in USA Weightlifting’s drug testing policy. An athlete has to be enrolled in their no-notice drug-testing program for at least six months prior to the local, regional, or national competition that would qualify the athlete for international competition. So you could take AAS for three years, get stronger and lift more, then enroll in the program after you come off, test negative, post a qualifying total, and then go on to international competition (providing of course you earn that right by lifting some big weights). This is not a slight against USA Weightlifting in any way, obviously there is no way you can know who to test before they tell you they wish to be considered for international competition. It merely points out that athletes can, and always will, maintain a few paces ahead of drug-testing efforts.
General Methods Used To Avoid Detection
The next series of tactics are not limited to any particular sport. They will be presented in terms of the rationale behind their use and what was done to prevent or curb their use. Initially when athletes were first exposed to drug testing, they were caught off guard. Analytical chemistry was not something most athletes specialized in. After consulting with more qualified personnel, coaches and athletes realized that simply going of AAS so that sufficient time would pass, thus clearing the AAS from their system, and would result in a negative drug test. This was done by simply submitting urine samples to a lab with the appropriate analytical equipment. Each day the athlete would find out the results of the previous day’s drug test. At some point he/she would know exactly how many days it would take to pass a drug test. Then going into a meet, the athlete would feel calm that they already knew the results and would test negative. This worked well until the introduction of different methods for AAS detection.
The uncertainty of not knowing which type of equipment would be used or the methods that would be followed created a demand by athletes for some other methods to avoid detection. As mentioned previously, diuretic use was one type of strategy. Diuretics have been abused in sports with weight classes and are used to shed weight quickly. (In the old days of powerlifting, it was common to see athletes using diuretics to make weight and then rehydrate using an intravenous drip.) Diuretics are also used to increase urine volume and dilution, thus making small quantities of banned substances more difficult to detect. Although drug testing started in 1976, it was not until 1988 that testing for diuretics began. So now with diuretics on the banned list, other alternatives had to be found. Physical methods such as catheterization and urine substitution continued to be practiced.
Alternatively, renal blocking agents were sought out. The premise is simple enough: If you can’t urinate the conjugates and other metabolites of AAS out of your system, then you can’t get caught. Probenecid was the most common offender in this category of agents. It retards the excretion of a variety of drugs, including AAS. Athletes taking masking agents could continue taking AAS closer to competition before discontinuing their use and still pass the drug tests. Once it was realized that athletes were using probenecid and related agents, these drugs were added to the banned substance list.
The use of testosterone is also another method for avoiding detection. At this time, the current methods do not distinguish between exogenous and endogenous testosterone. To control for this, drug testing includes standards for the detection of testosterone abuse, with a 6:1 ratio of testosterone (T) to its free analogue, epitestosterone (E). The ratio of T to E in the urine is normally less than two. Athletes responded to this test by simply taking epitestosterone in order to maintain the 6:1 ratio. So then of course, epitestosterone was added to the banned substance list.
Research has been done on a variety of fronts to prevent and eliminate the use of banned substances. Unfortunately, even before many tests are implemented, athletes are aware of the means to beat the test. One such example is that the use of longitudinal data, in order to get an accurate hormonal profile of the athlete, has been investigated. If the urinary T:E ratio for an athlete is consistently in a given range and then increases beyond normal limits, may be an indication of substance use. While such testing has yet to be implemented, athletes are already using sublingual cyclodextrin-testosterone preparations. Such preparations allow the T:E ratio to return to normal within a few hours.
Another technique under investigation measures the ratio of the carbon isotopes C 12 and C 13 in testosterone and in two of the hormone’s precursors contained in a urine sample. Research in this area suggests that the use of banned substances should be suspected when the ratios don’t match. Endogenously produced T differs in the carbon isotope ratios from exogenously administered T, which is normally synthesized from plant sources. Again, athletes are a step ahead by using bovine/porcine/equine testosterone preparations, which are believed to contain carbon isotope ratios very similar to that of endogenous T.
It is believed that peptide hormones will be the most widely used banned substance in the 2000 Olympic games. None of these hormones can be detected with the existing IOC methods. So before the games, GH2000, an international project hoping to develop a legally sound methodology to detect and validate use and abuse of exogenously administered growth hormone and related substances, was developed. Presently the detection methods are still undergoing validation and have not been implemented. Athletes have already been using GH nasal preparations, which once inhaled, have a very short half-life in the blood.
Perhaps the final war between athletes avoiding detection and drug testers will be in the legal system. Immunoassays for some drugs have been automated in order to keep the cost low for screening purposes. However, a positive result by immunoassay is by itself is insufficient, so confirmation by a more accurate method is required. Gas chromatography combined with mass spectrometry is regarded as the reference method because the end result is a “fingerprint” for the drug or metabolite. The results are usually accepted as a high degree of evidence of the presence of a compound. The weak link lies in the fact that the equipment is very expensive and the interpretation of the data requires a great degree of skill. When labs subcontract out labor for drug testing, it may be possible to get a poorly skilled individual interpreting the data. While researches may agree that an athlete was using a banned substance, legally an attorney could raise sufficient suspicion as to the validity of the results, ultimately allowing the athlete to “beat” the test.
After reading these series of articles you have seen how difficult it is to establish and implement a valid drug-testing program. Athletes that have access to the appropriate resources will always have an unfair advantage over those that do not. It is for this reason that philosophers have sometimes argued that drug testing is not fair. Whether it is fair or not is a debate better left to the philosophers.