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Performance-enhancing substances will remain utilized and their ethical existence will spur debate as long as desire and pressure to win and the financial reward for winning remain key incentives. As competition in athletics grows and becomes more lucrative, so does the temptation to use chemical performance enhancers. The use of drugs and supplements to enhance performance is almost ubiquitous across athletic competition. The use of ergogenic aids stretches from the professional athlete to adolescent competitors without regard to gender.1-4 This large prevalence suggests education and monitoring is required at all levels.


Ergogenic aid (EA)—chemical, pharmaceutical, or neutraceutical product introduced into the body for the specific purpose of enhancing athletic performance

Exogenous substance—substance not ordinarily capable of being produced by the body naturally (xenobiotic); or a naturally occurring substance administered externally in addition to that produced internally

Endogenous substance—substance capable of being produced by the body naturally

Masking agent—substance used to hide or mask the substance in question from detection

Doping control—regulating, restricting, and testing for substances determined to be illicit for an athlete or competition

Analytical/testing methods—methods used to detect EA in blood, urine, or other body fluids that include, but are not limited to, gas chromatography, mass spectrometry, liquid chromatography, and isoelectric focusing

World Anti-Doping Agency (WADA)—multinational organization created to develop standards, definitions, testing, and regulations with regards to doping control on a world wide basis for athletic competition5,6

The WADA stance on the presence of a prohibited substance or its metabolite(s) or marker(s) in an athlete's bodily specimen(s) or sample is clear: it is each athlete's personal duty to ensure that no prohibited substance enters his or her body.6 WADA also informs athletes about drug testing programs and provides a prohibited drug list, information about drug use, drug actions, adverse drug actions, side effects, and ethics.5,6 Different compounds may represent banned substances in different competitive sports and, thus, prohibitive lists are sport specific. For example, archers and competitive marksmen are banned from using antiadrenergic agents such as beta-adrenergic-blocking agents,5 whereas other athletic endeavors may suffer from the negative inotrope or chronotrope properties of beta-adrenergic-blocking agents. (See Table 68-1 for a partial list of agents.)

TABLE 68-1 Partial List of Prohibited Substances and Methods

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