Chapter 17: Pharmacology, Drugs
and Sports
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• Pharmacology is the branch of science that
deals with the action of drugs on the biological
systems
• Specifically those that are used in medicine for
diagnostic and therapeutic purposes
• Used to achieve definite outcomes that improve
quality of life
• Various drugs and other substances are being
used widely for performance enhancement or
mood alteration
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What is a drug?
• Chemical agent used in prevention, treatment, &
diagnosis of disease
• Ancient practice dating back to the Egyptians
• Many are derived from natural sources
• Drugs which have in the past come from nature
are now produced synthetically
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Pharmacokinetics
• Method by which drugs are absorbed,
distributed, metabolized and eliminated from the
body
• Pharmacodynamics is the actions or effects of
drugs on the body
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Administration of Drugs
• Must first enter the system and reach receptor
tissue to be effective
• Drug vehicles
– Therapeutically inactive substance used to transport drug
(solid or liquid)
• Internal administration
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Inhalation (medication through respiratory tract)
Intradermal (into the skin)
Intramuscular (medication directly into muscle)
Intranasal
Intraspinal (medication injected into the spine)
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Intravenous (into a vein)
Oral (most common form)
Rectal (limited due to dosage regulation)
Sublingual/buccal (dissolvable agents placed under tongue
Intravaginal (placing drug device inside vagina)
• External Administration
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Inunctions (oil based medication rubbed into skin)
Ointments (long lasting topical medication)
Pastes (ointments with nonfat base)
Plasters (thick ointment, counterirritant for pain &
inflammation relief, increasing circulation)
– Transdermal patches (patch with slow release mechanism)
– Solutions (administered externally)
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Absorption of Drugs
• Drug must dissolve before absorption
• Rate and extent determined by chemical
characteristics of drug, dosage, and gastric
emptying
• Bioavailability
– How completely a drug is absorbed by the system
– Dependent on characteristics not dosage
– (Absorption rate dependent on dosage form)
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• Distribution
– Once absorbed, drug is transported through blood to target
tissue
– Volume of distribution: volume of fluid/plasma in which drug is
dissolved and indicates extent of distribution of that drug
– Efficacy: capability of producing therapeutic effect
– Potency: dose of the drug required to produce a desired
therapeutic effect
• Metabolism
– Biotransformation of drug to water soluble compounds that
can be excreted
– Most takes place in liver, rest in blood and kidneys
– Liver detoxifies active agents
– Metabolites may be toxic
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• Excretion
– Excretion of drug or its metabolites is controlled by
kidneys
– Filtered through kidneys and usually excreted in the
urine (some is reabsorbed)
– May also be excreted in saliva, sweat and feces
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Drug Half-Life
• The amount of time required for the plasma drug
level to be reduced by one half
• It is either measured in minutes, hours, or days
depending on the drug
• Critical information in determining how much of
what drug to utilize
• Drug steady state
– The amount taken is equal to the amount excreted
– Drugs with long half-lives may take days or weeks to
reach steady state
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Effects of Physical Activity on
Pharmokinetics
• Exercise decreases the absorption after oral
administration
• Exercise increases absorption after intramuscular or
subcutaneous administration due to the increased
rate of blood flow
• Exercise has an influence on the amount of a drug
that reaches the receptor site
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Legal Concerns in Administering
Versus Dispensing Drugs
• Defined as a single dose of medication to be
used by a patient
• Dispensing constitutes providing a sufficient
quantity to be used for multiple doses
– By law, only licensed persons may prescribe or
dispense prescription drugs for an athlete
– Athletic trainers are not allowed to dispense
medication unless allowed by state licensure
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• Administering Over the Counter Drugs
– Athletic trainer may be allowed to administer a single
dose of nonprescription medication
– Rules relative to secondary schools
• Oral medications vs. wound medication
– College and professional athletes
• Most are of legal age and are allowed to use whatever
nonprescription drugs they choose
• Athletic trainer must still use reasonable care and be
prudent about types of medication provided
• In all cases, actions should be performed under the
supervision of a physician
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General Guidelines for Administration
(Focus 17-1)
• Should be taken as directed
• Should not be used in
combination without direction
of physician
• Do not use past expiration
• Labels should not be
removed
• Take medications with water
unless directed otherwise
• Take with food or as directed
• Containers should be childproof
• Provide verbal and written
instructions
• Patient should read label
information and know dosage
schedule
• Medications should not be
shared with other individuals
• Ensure that the patient is
aware of side effects and
possible addictions
• Be aware of interaction
between meds and exercise
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• Record Keeping
– Must maintain accurate and up to date medical
records
– Should include the following in log
• quantity of medication given
• method of administration
– Should be aware of state regulations relative to
ordering, prescribing, distributing, storing and
dispensing of the medications
– Obtaining legal counsel, working w/ state boards of
pharmacy, student health clinic, physicians and
establishing policies to minimize violating state laws
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•Record Keeping
-ATCs must maintain accurate and up to date
medical records
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Name
Complaint
Current medications
Any known drug
allergies
• Name of medication
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Lot number
Expiration Date
Quantity of medication given
Method of administration
Date and time of
administration
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•Labeling Requirements (federally mandated)
• Name of product
• Name and address of
manufacturer, packer or
distributor
• Net contents of package
• Name of active
ingredients and quantity
of certain other
ingredients
• Name of any habit
forming drug contained
• Cautions and warnings
to protect consumer
• Adequate directions for
safe, effective use
• Expiration date and lot
number
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– Nonprescription drugs should not be repackaged
w/out meeting labeling criteria
– All drugs dispensed from the athletic training room
must be properly labeled
– Legal liability if drugs removed from original
packaging and dispensed
• Unable to review contents, dosage, directions and
precautions (information needed for safe use)
• Same liability associated with providing prescription
medication
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• Safety in Use of Pharmaceuticals
– No drug is completely safe and harmless
– Any drug under the correct conditions can be potent
and dangerous, w/ every individual reacting differently
– Patient must be instructed on specifics of medications
(when to, how to and w/ what medication should be
taken with)
– Drug Responses
• Individuals react differently to the same medications, w/
different conditions causing altered effects of drugs
• Drugs can change with aging and relative to how they are
administered
• Alcohol ingestion w/ medications should be avoided
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• Alcohol is a CNS depressant and can increase or decrease
effects of other drugs
• Also used in many liquid preparations
• Medication can potentially effect certain physiologic functions
related to dehydration (sweating, urination, and the ability to
control and regulate body temperature)
• Can cause fluid depletion, further complicating illness, or
make individuals sensitive to sunlight increasing risk of
sunburn and allergic reactions
• Different diets may impact absorption rate
• Consumption of acidic foods such as fruit, carbonated drinks
and vegetable juice may cause adverse reactions
• Athletic trainer must know their patient’s in order to avoid
potential adverse reactions
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• Buying Medication
– Pharmacist is a vital resource, assisting in selection and
purchase of nonprescription drugs, suggesting less
expensive generic drugs, and acting as a general
advisor
– Properly storing medication is critical
• Keep in locked cabinet
• Maintain original container
• Store away from direct light, heat, damp places and extreme
cold
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• Traveling with Medications
– When traveling with a team or individually the
individual should be advised to do the following
relative to medications
• Medication should not be stored in a bag/luggage but
carried by the athlete taking it
• Sufficient supply should be packaged in case of
emergency
• Make sure there is a source of medication while traveling
• Take copies of written prescriptions
• Keep medication in original container
• If traveling internationally, understand restrictions of
individual boundaries
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Selected Therapeutic
• Widespread use in athletics and general society
• Pharmaceutical labs develop compounds in vitro
and then test, retest, and refine drugs in vivo
before submitting it to the Food and Drug
Administration (FDA)
• Number of texts and databases are available for
reference to determine appropriateness and
effectiveness of medications for different
conditions
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Drugs to Combat Infection
• Local Antiseptics and Disinfectants
– Antiseptics are substances that can be placed on
living tissue for killing bacteria or inhibiting growth
– Disinfectants are used to combat microorganisms
but should be applied to non-living objects
– Germicides (generic name) designed to destroy
bacteria, fungicides, sporicides and sanitizers
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– Alcohol
• Most widely used skin disinfectant
• Ethyl alcohol (70% by weight) and isopropyl alcohol (70% by
weight) are equally effective
• Inexpensive and nonirritating, kill bacteria immediately with
the exception of spores
• No long lasting germicidal action, can be used as an
antiseptic or astringent
• 70% solution can be used to disinfect instruments
• Also can be utilized as mild anesthetic and topical skin
dressing when combined with 20% Benzoin
– Phenol
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Early antiseptic and disinfectant in medical profession
Used to control disease organisms
Found in various concentrations and emollients
Derivatives include, resorcinol, thymol, and common house
cleaner Lysol
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– Halogens
• Chlorine, bromine, fluoride (used for antiseptic effect)
• Iodophor or halogenated compounds create a much less
irritating solution than tincture of iodine
• Betadine solution- excellent germicide, very effective for skin
lesions, abrasions and lacerations
– Oxidizing agent
• Hydrogen peroxide is commonly used in the athletic training
• Readily decomposes in presence of organic substances and
has little use as an antiseptic
• Cleanses infected cutaneous and mucous membranes
• Dilute solution can be used to treat inflammatory mouth and
throat conditions
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• Antifungal Agents
– Medicine used to treat fungi (Epidermophyton,
Trichophyton, and candida albicans)
– Numerous antifungal agents
– Some can be used against deep seated fungal
infections
– Others are administered orally
• Must be carefully monitored by physician
• Antibiotics
– Chemical agents that are produced by
microorganisms
– Interferes w/ necessary metabolic processes of
pathogenic microorganisms
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– Used topically or as systemic medication
– Indiscriminate use can produce hypersensitivity and prevent
development of natural immunity or resistance to
subsequent infections
– Must be carefully controlled by physician
– A number of antibiotics are available
– Penicillin and Cephalosporins
• Most important antibiotic
• Useful in skin and systemic infections
• Interferes w/ metabolism of bacteria
– Bacitracin
• Antibacterial agent
– Tetracycline
• Wide group of antibiotics that have broad antibacterial spectrum
• Usually oral, modifies infection rather than eradicating it completely
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– Erythromycin
• Used for streptococcal infection and mycoplasma
pneumoniae
• Same general spectrum as penicillin but can be used with
individuals allergic to penicillin
– Sulfonamides
• Group of synthetic antibiotics
• Make pathogens vulnerable to phagocytes and certain
enzymatic actions
– Quinolones
• New group of antibiotics with broad spectrum of activity
• Must be carefully monitored for adverse effects
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Drugs for Asthma
• Used to treat chronic inflammatory lung disorder
• National Asthma Education and Prevention Program has
established guidelines for diagnosis and treatment; NATA
also has position statement
• Goals of asthma therapy are to prevent chronic and
troublesome symptoms, maintain normal lung function,
prevent exacerbation and provide adequate
pharmacotherapy with minimal adverse effects
• Portable hand-held inhalers are available
– Meter dosed inhalers (pressurized canister)
– Dry powder inhalers
– Nebulizer
• Often individuals become dependent on inhalers
• Treatment should not just be drug based
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Figure 17-1
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Drugs that Inhibit Pain and
Inflammation
• Pain Relievers
– Numerous drugs and procedures can be used
– Reasons for effectiveness
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Excitatory effect on an individual impulse is depressed
Individual impulse is inhibited
Perceived impulse is decreased
Anxiety created by pain or impending pain is decreased
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• Counterirritants and Local Anesthetics
– Analgesics give relief by causing systemic and topical
analgesia
– Application causes local increases in circulation, redness,
rise in skin temperature
– Mild pain can often be reduced w/ counterirritants
– Examples include
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Liniments
Analgesic balms
Spray coolants
Alcohol
Menthol
Cold
Local anesthetics (injected by physician)
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• Narcotic Analgesics
– Most derived from opium or are synthetic opiates
(morphine and codeine)
– Depress pain impulse and respiratory center
– Examples include
• Codeine (morphine like action, found in cough suppressants;
Vicodin)
• Morphine (dangerous due to respiratory effects, habit
forming qualities)
• Propoxyphene hydrochloride (slightly stronger than aspirin
and can be fatal if mixed with sedatives or depressants)
• Meperidine (Demerol - substitute for morphine, effective
when given intravenously or intramuscularly)
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• Non-narcotic Analgesics and Antipyretics
– Designed to suppress all but most serious pain w/out
losing consciousness
– Acetaminophen
• Tylenol - effective analgesic and antipyretic but has no
anti-inflammatory activity
• Does not irritate GI system and is often replacement for
aspirin in non-inflammatory conditions
• Over-ingestion can lead to liver damage
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Drugs to Reduce Inflammation
• Acetylsalicylic Acid (Aspirin)
– Widely used analgesic, anti-inflammatory, antipyretic and
abused drug
– Helps reduce pain, fever and inflammation
– Adverse reactions generally GI related
– Over-ingestion can lead to ear ringing and dizziness,
Reye’s syndrome (adolescents)
– Allergic reactions result in anaphylaxis -- asthmatics may
be at risk for reactions
– Should be avoided w/ contact sports as it prolongs
clotting time
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• Nonsteroidal Anti-inflammatory Drugs
(NSAID’s)
– Anti-inflammatory, antipyretic and analgesic
properties
– Inhibit prostaglandin synthesis and effective for
osteo- and rheumatoid arthritis
– Used primarily to reduce pain, stiffness, swelling,
redness, fever associated w/ localized inflammation
– Fewer side effects and longer duration than aspirin
– Should not be used in place of acetaminophen or
aspirin for headaches or increased temperature
– Individuals w/ nasal polyps, associated
bronchospasm or history of anaphylaxis should not
receive NSAID’s
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– Can cause GI reactions, headache, dizziness,
depression, tinnitus,
– Taken in conjunction w/ heavy alcohol use
can produce stomach bleeding
– NSAIDs are associated with increased risk of
adverse cardiovascular events
• Myocardial infarction, stroke, new onset or worsening of
existing hypertension
• If necessary - should use the lowest effective dose for
shortest duration of time, consistent with patient goals
– NSAIDS may increase risk of GI bleeding,
ulceration and perforation
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• Corticosteroids
– Used primarily for chronic inflammation of
musculoskeletal and joint problems
– Prolonged use can create complications
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Fluid and electrolyte disturbances
Musculoskeletal and joint impairment
Dermatological problems
Neurological impairment
Endocrine dysfunction
Ophthalmic conditions
Metabolic impairment
– Cortisone is primarily injected
• Can have negative effect on ligaments and tendons
– Also administered through iontophoresis and
phonophoresis
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Drugs that Produce Skeletal Muscle
Relaxation
• Include methocarbamol (Robaxin) and carisoprodol
(Soma)
• Due to overall relaxation effect, physicians believe
these are less specific to muscle relaxation than once
believed (also cause drowsiness)
• Used to eliminate muscle guarding and spasm
• Do not appear to be superior to analgesics or sedatives
in either acute or chronic conditions
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Drugs Used to Treat Gastrointestinal
Disorders
• Includes stomach upset, gas formation due to
food incompatibilities, acute or chronic
hyperacidity
• Poor eating habits may lead to digestive
dysfunction such as diarrhea or constipation
• Antacids
– Neutralize acidity in upper GI, reducing pepsin
activity (particularly on mucosal nerve endings
– Relief of acid indigestion, heart burn, peptic ulcers
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Sodium bicarbonate or baking soda are popular
Antacids w/ magnesium tend to have laxative effect
Those w/ aluminum and calcium cause constipation
Overuse can cause electrolyte imbalance
• Antiemetics
– Used to treat nausea and vomiting
– Working locally
• Work on mucosal lining of stomach (may be more placebo)
– Working centrally
• Affect brain, making it less sensitive to nerve impulses from
inner ear and stomach
– Variety of meds available, but may cause drowsiness
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• Carminatives
– Provide relief from flatulence (gas)
– Inhibit gas formation and aid in expulsion
• Cathartics (laxatives)
– Must be under direct supervision of physician
• Constipation may be symptomatic of serious disease
– Indiscriminate use may render individual unable to
have normal bowel movements
– May cause electrolyte imbalance
• Antidiarrhoeals
– Diarrhea tends to be a symptom, not a disease
– Result of emotional stress, allergies, adverse drug
reactions, or different intestinal problems
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• Antidiarrheal (continued)
– Acute diarrhea
• Accompanied by chills, vomiting, intense abdominal
cramps/pain
• Will typically run course and stop when irritating agent removed
from system
– Chronic diarrhea
• May lasts for days or weeks and may be the result of more
serious disease states
– Treat with Kaolin (absorb chemicals and pectin),
substances that add bulk to stool
– Systemic agents (except Imodium AD) are prescription
drugs
• Most are opiate derivatives and will cause drowsiness, dry
mouth, and constipation
• Do not treat antibiotic induced diarrhea as it may be protective
symptom in antibiotic induced pseudomembranous colitis
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• Histamine-2 Blockers
– Reduce stomach acid output by blocking histamine on
certain stomach cells
– Used to treat peptic and gastric ulcers and GI
hypersecretory conditions
– Drug examples include Cimetidine (Tagamet) and
ranitidine (Zantac)
• Protein Pump Inhibitors (Prilosec)
– Used to suppress gastric acid secretion
– Treats erosive esophagitis, symptoms of
gastroesophageal reflux disease
– Also used in prevention of gastric ulcers, part of
multidrug regimen for Helicobacter pylori in patients with
duodenal ulcers
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Drugs Used to Treat Colds
and Allergies
• Nasal Decongestants
– Number of topical nasal decongestants available
– Prolonged use may cause rebound congestion and
dependency
– Combat Methamphetamine Epidemic Act
• Bans over-the-counter retail sales of cold meds with
pseudoephedrine
• Limits amount of pseudoephedrine that can be sold to an
individual each month
• Regulated sellers also must go through federally mandated
self-certification process
• Athletic trainers must be familiar with new state laws in order to
remain compliant
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• Cough Medications
– Suppress cough (antitussives) or produce fluid in
respiratory system (expectorant)
– Few side effects from nonnarcotic antitussives and
are not addictive
– Narcotic antitussives contain codeine
– Little evidence that expectorants are any more
effective on reducing cough than simply drinking
water
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• Antihistamines
– Often added to decongestants
– Opposes histamine actions, but have little effects on the
common cold
– Beneficial in allergies
– Impairs body’s ability to dissipate heat
– Non-sedating antihistamines pose less risk for heat-related
illnesses
• Sympathomimetics
– Often used to reduce spasm of bronchiole smooth muscle
– May cause heat related problems
– Epinephrine (EpiPen)
• Athletic trainers can receive instruction on use
• Used to treat anaphylaxis resulting from food or insect bites
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Drugs to Control Bleeding
• Vasoconstrictors
– Most often administered externally at sites of profuse
bleeding
– Epinephrine or adrenaline commonly used
– Acts immediately, constricting vessels --very
valuable in instances of epistaxis (nosebleed)
• Hemostatic Agents
– Drugs that immediately inhibit bleeding (under
investigation)
– Thrombin
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• Anticoagulants
– Heparin
• Prolongs clotting time but will not dissolve clot once
formed
• Controls extension of a thrombus already present
– Coumarin derivatives
• Acts by suppressing formation of prothrombin in the liver
– Given orally, they can be used to slow clotting time
in certain vascular disorders
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Drugs that Can Increase the Rate of
Heat Illness
• Some drugs may alter the body’s ability to
thermoregulate
– Anticholinergics and antihistamines (decrease sweating
mechanism)
– Sympathomimetic amines (may predispose athlete to heat
stroke)
– Phenothiazines (impacts hot/cold temp. regulation)
– Diuretics (alters volume expansion and cutaneous
vasodilation)
• Athletic trainer must be aware of potential risk of
medications relative to heat illnesses
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Protocols for Using Over-the-Counter
Medications
• Athletic trainers will be concerned only with
nonprescription medications in most cases
• Does not include prescriptions medications
• Prescription medications pose greater risk for
patient and require clinical skills and judgment of
individuals that are trained and licensed
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Substance Abuse Among Athletes
• Drug use and performance enhancing agents in
athletics
• Substance abuse has no place in athletics
• Use and abuse of substances can have a
profound effect on performance
• Athletic trainer must be knowledgeable about
substance abuse in athletic population and
should be able to recognize signs that athlete
may be engaged in substance abuse
– Focus Box 17-3
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Performance Enhancing Substances
(Ergogenic Aids)
• Stimulants
– Used to increase alertness, reduce fatigue, increase
competitiveness and hostility
– Psychomotor stimulant drugs
• Amphetamines and non-amphetamines
• Produces rapid turnover of catecholamines, which have strong
effect on nervous and cardiovascular systems, metabolic rates,
temperature and smooth muscle
– Sympathomimetic drugs
• Work on adrenergic receptors (those that release catecholamines)
• Cause mental stimulation and increased blood flow but can cause
elevated blood pressure, headache, increased and irregular heart
beat, anxiety and tremors
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– Amphetamines and cocaine are the two
psychomotor drugs most commonly seen in athletics
– Sympathomimetic drugs are a difficult problem for
the USOC as they are often found in cold remedies
– Some products have been approved for asthmatics
(B2 agonists)
– Before engaging in competition a team physician
must notify the USOC Medical Subcommission in
writing about athlete’s use
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• Amphetamines
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Synthetic alkaloids (potent and dangerous)
Injected, inhaled, taken as tablets
Most widely used for performance enhancement
Can produce euphoria w/ heightened mental status
until fatigue sets in, accompanied by nervousness,
insomnia, and anorexia
– In high doses, will reduce mental activity and
decrease performance
– Patient may become irrational
• chronic use causing individual to become “hung up” in
state of repetitious behavioral sequences
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– Can lead to amphetamine psychosis, manifesting in
auditory and visual hallucinations and delusions
– Physiologically, high doses can cause mydriasis
(abnormal pupil dilation), increased blood pressure,
hyperreflexia and hyperthermia
– Believed to improve performance - promote
quickness and endurance, delay fatigue, increase
confidence causing increased aggressiveness
– Studies indicate the opposite --create increased risk
for injury, exhaustion and circulatory collapse
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• Caffeine
– Found in coffee, tea, cocoa and cola
– CNS stimulant, diuretic and stimulates gastric
secretion
– In moderation it will cause cerebral cortex and
medullar centers stimulation, causing wakefulness
and mental alertness
– Large amounts will cause elevated blood pressure,
changes in heart rate, increased plasma levels of
epinephrine, norepinephrine and renin --impacting
coordination, sleep, mood, behavior and thinking
processes
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– Adverse effects include, tremors, nervousness,
headaches, diuresis, arrhythmia, restlessness,
hyperactivity, irritability, dry mouth, tinnitus, ocular
dyskinesia, scotomata, insomnia and depression
– Habitual user that ceases use may go through
withdrawal
• Suffer headache, drowsiness, lethargy, rhinorrhea,
irritability, nervousness, depression and lost interest in
work
– Believed to act as ergogenic aid during prolonged
activity
– Banned by USOC as stimulant in high doses (12
micrograms/milliliter)
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• Narcotic Analgesic Drugs
– Derived from opium or synthetic opiates
– Morphine and codeine are made from alkaloid of
opium
– Used for management of moderate/severe pain
– Risk physical and psychological dependency
• Beta Blockers
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Block of sympathetic nerve ending receptor
Primarily used for hypertension and heart disease.
Used for sports requiring steadiness
Adrenergic agent that inhibits catecholamines
Relax blood vessels, slows heart rate and decreases
cardiac output and heart contractility
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• Diuretics
– Increase kidney excretion by decreasing kidney
resorption of sodium
– Excretion of potassium and bicarbonate may also
occur
– Used for variety of cardiovascular and respiratory
conditions
– In sports, misused for weight loss and decreasing
concentration in urine
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• Anabolic Steroids
– Synthetic chemical (structure resembles sex hormone,
testosterone)
– Androgenic effects
• Growth, development and maintenance of reproductive
tissues, masculinization
– Anabolic effects
• Promote nitrogen retention leading to protein synthesis causing increased muscle mass and weight, general
growth and bone maturation
• Goal is to maximize this effect
– Can have deleterious and irreversible effects causing
major threats to health
– Use most commonly seen in sports that involve strength
and power
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• Tetrahydrogestrinone (THG)
– Believed to be undetectable
– Designer steroid that is structurally similar to
gestrinone and Trenbolone
– Derived from other anabolic steroids
– Banned by USADA
– Cannot be legally marketed without FDA approval
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• Androstenedione
– Weak androgen produced primarily in testes and in
lesser amounts by adrenal cortex and ovaries
– Increases testosterone in men and particularly
women
– Effects last a few hours
– No scientific evidence to support or rebuke efficacy
or safety of using this ergogenic aid
– Banned by IOC, NFL, NCAA, and minor league
baseball
– Contains steroid hormones
• May result in breast enlargement, testicular shrinkage
(males) or facial/body hair, voice deepening, and clitoral
enlargement (females)
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• Human Growth Hormone (HGH)
– Produced in somatotrophic cells of anterior pituitary
and released into circulatory system
– Amount released varies with age
– Can be produced synthetically
– Results in increases muscle mass, skin thickness,
connective tissue in muscle, organ weight
– Can produce lax muscles and ligaments during
periods of growth
– Increases body length, weight and decreases body
fat %
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– Difficult to detect so use is on the rise
– Little current information on the effects of HGH
– No proof that increased HGH and weight training
contributes to strength and muscle hypertrophy
– Can cause premature closing of growth plates,
acromegaly which may also result in diabetes
mellitus, cardiovascular disease, goiter, menstrual
disorders, decreased sexual desire and impotence
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• Blood Reinjection (Blood Doping, Packing or
Boosting)
– Endurance, acclimatization and altitude make
increased metabolic demands for the body, requiring
increased blood volume and RBC’s
– Can replicate physiological responses by removing
900 ml of blood and reinfusing is after 6 weeks
(allows time to replenish supply)
– Can significantly improve performance
– While unethical, it can also prove to be dangerous
– Risks involve allergic reactions, kidney damage,
fever, jaundice, infectious disease, blood overload
(circulatory or metabolic shock)
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Recreational Substance Abuse
• Part of the world of sports
• Desire to experiment, temporarily escape, be
part of the group
• Can be abused and habit forming
• Drug used for non-medical reasons with the
intent of getting high, or altering mood or
behavior
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• Psychological vs. Physical Dependence
– Psychological dependence is the drive to repeat the
ingestion to produce pleasure or avoid discomfort
– Physical dependence is the state of drug adaptation
that manifests self in form of tolerance
• When cease consumption abruptly unpleasant withdrawal
occurs
– Tobacco Use
• Cigarettes, cigars & pipes are increasingly rare in
athletics
• Smokeless tobacco and passive exposure to others
continues to be an ongoing problem
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– Smoking
• Seriously impacts performance for those that are highly
sensitive
• Associated with 4,700 different chemicals
• 10 inhalations can cause average maximum decrease in
airway conductance of 50% (secondhand also)
• Reduces oxygen carrying capacity of blood
• Aggravates and accelerates heart muscle cell stimulation
through over-stimulation of sympathetic nervous system
• Decreases lung capacity and maximum breathing
capacity, also decreases pulmonary diffusion
• Accelerates thrombolic tendency
• Carcinogenic factor in lung cancer and contributes to
heart disease
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– Nicotine is the addictive chemical in tobacco- one of the
most toxic drugs
• Causes elevated blood pressure, increased bowel
activity, and antidiuretic action
– Smokeless Tobacco
• Loose leaf, moist, dry powder, and compressed
• Posses serious health risk
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Bad breath
Stained teeth
Tooth sensitivity to heat and cold
Cavities and gum recession
Tooth bone loss
Leukoplakia
Oral and throat cancer
• Major substance ingested is Nitrosonornicotine
– Absorbed through mucous membranes
• More addictive habit w/out exposure to tar and carbon monoxide
• Will increase heart rate
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• Alcohol Use
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Most widely used and abused substance
Depresses CNS
Absorbed from digestive tract into bloodstream
Absorption affected by drinks consumed, rate of
consumption, concentration and amount of food in
stomach
– Can be oxidized by liver at 2/3 of an ounce per hour
– If excess is in blood stream
• .1% - lose motor function
• .2%-.5% symptoms become more profound and life
threatening
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– Metabolism can not be accelerated
– Individual abusing alcohol may exhibit the following
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Mood and attitude changes
Missed practices
Isolation
Fighting or inappropriate outburst of violence
Changes in appearance
Hostility
Complaints from family
Changes in peer group
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• Drug Use
– Cocaine
• CNS stimulant w/ short duration effects (intense)
• Produces immediate feeling of euphoria, excitement,
decreased fatigue and heightened sexual drive
• Long term use results in psychological tolerance and
dependence
• Long term effects include
– Nasal congestion, damage to cartilage and mucous membranes of
nose, bronchitis, loss of appetite, convulsions, impotence, cocaine
psychosis w/ paranoia, depression, hallucinations, and disorganized
mental function
• Overdose can lead to
– Tachycardia, hypertension, extra heartbeats, coronary
vasoconstriction, strokes, pulmonary edema, aortic rupture and
sudden death
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• Can be taken in many forms including snorted,
intravenously, or smoked (freebased)
• In form of crack - very short term rush, followed by
depression
• Sudden stimulation w/ crack can cause cardiac or
respiratory failure
– Marijuana (carcinogenic drug)
• Formerly most abused drug in Western society
• Similar components and cellular changes as tobacco
• Can lead to respiratory disease, asthma, bronchitis, lowered
sperm count and testosterone levels, limited immune
functioning and cell metabolism
• Causes increased pulse rate and can cause decrease in
strength
• Psychologically causes diminution of self-awareness and
judgment, slower thinking and short attention span
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• Has also been found to alter the anatomical structures
suggesting irreversible brain damage
• Contains cannabinoids (can store like fat cells)
• May remain in the body and brain for weeks and months
resulting in cumulative deleterious effects
• Managing a Drug Overdose
– In the event of an overdose, EMS should be
contacted as well as the poison control center
immediately
– Athletic trainer should be certain that the correct
steps have been taken either by phone or going to
deal with the athlete in person
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Drug Testing in Athletics
• Purpose is to identify individuals who have problems
with drug abuse
• Controversial topic
• NCAA and USOC routinely test
– Began at the Olympics in 1968 and has since expanded
nationally (USOC and NCAA) and internationally
– Institution of testing and education
– Performed to ensure health of athletes and fair practices
– Mandatory and random testing occurs at both levels
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• The Drug Test
– Slight differences between NCAA and USOC,
mostly in area of selection
• NCAA requires all athletes to sign consent form
agreeing to participate in testing throughout the year
• USOC tests randomly throughout the year and
before USOC sanctioned events
• During the test, athlete provides identification, and 2
samples under direct supervision
– One for testing and confirmation, second for reconfirmation
• If positive, athlete is subject to sanctions
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• Sanctions for Positive Tests
– NCAA
• First time positive in NCAA results in minimum one year
suspension; will undergo random testing throughout the
year
• Must test negative prior to reinstatement
• However, additional positives can result in lifetime
disqualification from NCAA
– USOC
• Sanctions range from 3 months - 24 months depending
on the drug for a first time offense
• Lifetime ban for subsequent positive tests
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• Banned Substances
– Both NCAA and USOC have a banned substance list
for athletes
– Includes performance enhancing drugs and street or
recreational drugs, as well as OTC medications
– Includes 4,600 different medications
– USOC is more extensive than NCAA because it is
also subject to IOC rules
– Athletic trainer working w/ athletes who may be
tested for drugs by NCAA or world-class or Olympic
athletes governed by USOC should be familiar w/
the lists of banned drugs and substances
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– In instances where an athlete has a diagnosed
condition that requires use of a banned substance
the athlete can apply for a Therapeutic Use
Exemption (TUE) through USADA
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