J . TOXIC0L.-TOXIN REVIEWS, 17( l) , 73-83 (1998)

TRENDS IN DRUG ABUSE IN COMPEllTIVE SPORTS, AND THE

INTERNATIONAL ANTI-DOPING MOVEMENT.

Makoto Ueki*, Tomomi Hiruma, Ayako Ikekita and Masato Okano

Doping Control Laboratory, Mitsubishi Kagaku Bio-Clinical Laboratories, Inc.

3-30-1 Shimura, Itabashi-ku, Tokyo 174, JAPAN

Tel:+8 1-3-5994-2990, Fax:+8 1-3-594-2990

E-mail: wd3m-uek@asahi-net.or.jp

ABSTRACT

The results of our twelve years drug abuse survey in competitive sports is

discussed. The most typically abused drug among the Japanese general public is

methamphetamine, and the problem has been escalating during the last few years especially

among female adolescents. Throughout our survey period, the major dope agents abused

by sportsmen have been ephedrines and injectable anabolic steroids. As detection of

synthetic anabolic steroid is relatively easy, doping with naturally-occurring steroids has

become the major doping agent in sports.

In some countries, a governmental or non-governmental co-ordination agency has

been founded to promote, develop and co-ordinate the national anti-doping program in

73

Copyright 'C 1998 hy Marcel Dekker. Iiic.

Tox

in R

evie

ws

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

UB

Gie

ssen

on

12/1

7/14

For

pers

onal

use

onl

y.

74 UEKl ET AL.

sports, and out-of-competition testing (oocr) is now frequently conducted by the agency

independently from sports federation. It is thought that it would be helpful for society to be

ready for the growing problem of hormone abuse among the general public if the

international anti-doping movement against doping in sport is taken into account

INTRODUCTION

According to an official report by the ministry of health and welfare, recently

misuse of methamphetamine among adolescents has been increasing in Japanese society

(1). The number of students arrested was 207, which was 96 larger than those in the

previous year. Other abused drugs were marijuana, cocaine, heroin and LSD (2). No

remarkable increase of hormone abuse in society was reported; however, various types of

biologically active hormones including melatonin, DHEA, pregnenolone, etc. are actually

brought into Japan by tourists as souvenirs. Another route of trafficking using the hternet

has become popular in Japan. Anabolic steroid use by world-class athletes was reported in

the early 1950s. Then the hormone abuse problem has spread to some European societies

and to the US society (3). The statistics on our athletic drug testing indicates that hormone

doping is escalating in other Asian countries without an exception.

The aim of this study is to review the international strategies against doping in

sports, and to seek any suggestions for countermeasures to growing hormone abuse in

society.

TRENDS OF DOPING TEST RESULTS IN JAPAN

Testing System

Drug screening testing in society is usually based on imrnunoassay with positive

results confirmed by gas chromatography/mass spectrometry (GUMS). On the other

hand, doping control tests in sports generally rely on G C I M S , and the analytical procedure

Tox

in R

evie

ws

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

UB

Gie

ssen

on

12/1

7/14

For

pers

onal

use

onl

y.

DRUG ABUSE IN COMPETITIVE SPORTS 15

has been periodically modified in order to adjust to trends in drug abuse. The different

testing system is used in sports because of the large array of compounds that need to be

detected and the need for a rapid evaluation of test results. Workplace drug testing is

usually based on cost-benefit considerations, and is performed on a few target compounds

only, e.g., cocaine, amphetamines, opiates, PCP, and marijuana (4).

Laboratory Statistics

Figure 1 shows the results of our amphetamine class test done on suspects that was

requested by hospitals. AU these cases were confirmed methamphetamine positive. As

shown in Figure 1, the number of requests and the rate of positive tests have been

increasing gradually over the last five years. This is probably because of a trafficking route

via illegal immigrants, and a decrease in the price of amphetamines.

The current IOC definition of doping covers a large array of compounds (Table 1).

The author's laboratory has been responsible for undertaking international doping testing

since 1985 as an IOC accredited laboratory. Japan's official doping testing was initiated

with doping tests on 200 athletes (800 tests) per year, and the scale was expanded to about

2,000 subjects (14,000 tests) during the last several years. The purpose of the OOCT

program is educational and to follow the steroid profile of a candidate for an approaching

international sports event, because a few cases with elevated urinary testosterone to

epitestosterone ratio (T/epiT > 6 is indicative of testosterone doping) were considered to be

due to a normal physiologic condition (5).

Figure 2 shows the trends in the frequency of doping tests that were divided by

occasion; national games, international games, major sports events and OOCT of which

about 1% proved positive.

The major part of the testing earlier than 1995 consisted of international competition

and OOCT, whereas incompetition testing at national sporting events has been increasing

very rapidly since 1995. It was thought by the Japanese sports authorities that the doping

problem in Asian spots is relatively smaller than that in European countries and in the USA.

Tox

in R

evie

ws

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

UB

Gie

ssen

on

12/1

7/14

For

pers

onal

use

onl

y.

76 UEKI ET AL.

e c

0 0 0 0 0 m m - t m

Tox

in R

evie

ws

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

UB

Gie

ssen

on

12/1

7/14

For

pers

onal

use

onl

y.

DRUG ABUSE IN COMPETITIVE SPORTS 77

Table 1. Current IOC definition of doping

I. Prohibited classs of substances

A. stimulants

B. narcotics

C. anabolic agents

D. diuretics

E. peptide and glycoprotein hormones and analogues

II. Prohibited methods

A. blood doping

B. pharmacological, chemical and physical manuplation

ID. Classes of drugs subject to certain restrictions

A. alcohol

B. marijuana

C. local anaesthetics

D. corticosteroids

E. beta-blockers

All substances belonging to the prohibited classes can not be used even if they are not listed

as examples.

Tox

in R

evie

ws

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

UB

Gie

ssen

on

12/1

7/14

For

pers

onal

use

onl

y.

2500

2000

1500

1000

500 0

1985

19

86

1987

19

88

1989

19

90

1991

19

92

1993

19

94

1995

19

96

Yea

Figu

re-2

Tr

ends

in th

e fre

quen

cy o

f dop

ing

test

div

ided

by

occa

sion

. C

rn B rn

4

Tox

in R

evie

ws

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

UB

Gie

ssen

on

12/1

7/14

For

pers

onal

use

onl

y.

DRUG ABUSE IN COMPETITIVE SPORTS 19

However, actual circumstances of doping problems in Asian sports became known to the

public in late 1994 when the Olympic Council of Asia (OCA) gave information concerning

the test results in a press release. According to the OCA news the problem of hormone

doping is escalating also in some Asian countries. After that, in 1995, some Japanese

sports federations, both amateur and professional sports, intensified their anti-doping

program, and this has resulted in an increase in the frequency of the testing at the national

level.

Throughout the survey period, the major abused drugs have been stimulants and

anabolic steroids. Table 2 shows the partial list of the positive results broken down by the

name of compounds. At the national level, the major stimulants are ephedrine,

methylephedrine and phenylpropanolamine that are commonly contained in many over-the-

counter drugs. Interestingly, a l l positive results in the amphetamine class in sports are

confirmed to be due to amphetamine abuse by non-Asian citizens. In contrast, the positive

cases from Japanese addicts are all confirmed as methamphetamine positive. The most

frequently abused two of the identifed steroids, namely, nandrolone and testosterone m

usually prescribed for medical treatment as depot injection in the ester form.

Dihydrotestosterone @HT) is an active and most potent metabolite of testosterone, but the

commercial product had already been withdrawn from the Asian market over 10 years

because of side-effects. Only few DHT products in forms of cream are available in France,

etc. DHT abuse is, therefore, not likely to occur in Asia if any unofficial supply system of

the products does not exist. However, the problem of DHT doping in world-class athletes

was known to the public by our tests that were performed during the Asian Games in

Hiroshima 1995. The results indicated the need for immediate countermeasures against

natural hormone in this area (6). One determent and educational strategy against doping

with naturally occurring steroids is out-ofcompetition testing (OOCT), and the final

decision may be made by the review of previous and subsequent test results on steroid

profiles of a suspected athletes.

Tox

in R

evie

ws

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

UB

Gie

ssen

on

12/1

7/14

For

pers

onal

use

onl

y.

Ta

ble

- 19

85 4 1 2 7 1 1 0 0

Stirn

uran

t, N

arco

tics

& T

HC

A

mph

etam

ine

Caf

fein

e C

odei

ne

Ephe

drin

e Et

ilefri

ne

Fenc

amfa

rnin

e M

etha

nphe

tam

ine

Met

hoxy

fena

rnin

e M

ethy

leph

edrin

e Ph

ente

rmin

e Ph

enyl

prop

anol

arni

ne

Pseu

doep

hedr

ine

Strv

chni

ne

Par

tial lir

19

8€

1

1

1 1 1E 1

1

25 a 27

THC

Subt

otal

St

eroi

ds

of th

e 19

87 1 1 2 1 1 0

3

B o I d

e n o n

e D

ih yd

rote

stos

tero

ne

Dro

stan

olon

e Fl

uoxy

rnes

tero

ne

Met

hand

ieno

ne

Met

heno

lone

M

ethy

ltest

oste

rone

N

andr

olon

e O

xand

rolo

ne

Oxy

met

holo

ne

Stan

ozol

ol

test

rc

198E

i 1 E 1 4 1 1 11

Test

oste

rone

ults

19

89 2 1 2 5 3 1 1 2 7 1 1 13

1 Fr

oser

nide

brok

en (

199C

1 1 2 4 1 1 2 0 6

'wn

by

1991

1 1 1 2 2 1 1 9 1 2 1 4 0 13

the

n;

1992

1 1 1 1 1 3 1 3 0 0 11

mpo

unds

. 19

94 1 1 5 1 1 1 1 11

17 1 1 2 5 26 0 37

1995

1 2 1 4 1 1 2 2 2 0

ie o

-

195 -

-

1996

5 1 1 3 1

11 3 1 4 0 15

Tota

l 2 3 2 26 1 2 1 1 11 1 9 2 3 2 66 2 17 1 1 4 5 2 32 3 1 1 19

00 5 1 6

160

Tox

in R

evie

ws

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

UB

Gie

ssen

on

12/1

7/14

For

pers

onal

use

onl

y.

coun

try

Sou

th A

fria

Ger

man

y

P.R

.Chi

na

Den

mar

k

US

A

Nor

way

Por

tuga

l

Rus

sia

..........

..........

..........

.

..........

..........

..........

.

........

........

........

.......

..........

..........

..........

.

..........

..........

..........

.

..........

..........

..........

........

........

........

......

..........

..........

..........

S

wed

en

........

........

........

.....

Sw

itzer

land

Cze

cho

Aus

tralia

..........

..........

..........

........

........

........

.....

Tabl

e-3

Ove

rvie

w o

f the

nat

iona

l ant

i-dop

ing

orga

niza

tion

in tw

elve

cou

ntrie

s

kgan

izat

io

3ack

grou

ni

NG

O

NG

O

NG

O

GO

V

NG

O

..........

..........

.......

..........

..........

.......

NG

O

GO

V .....

..........

..........

.. N

GO

..........

..........

.......

NG

O

........

........

........

. N

GO

NG

O

GO

V

i 3,

600

4,00

0 i

820,

000

<.. i

......

......

....I

< *

........

........

........

.......

........

. ....

........

........

........

.....

........

........

........

........

... ....

........

........

........

........

........

........

........

.....

..........

..........

..........

. <

;o

r

2,00

0 I

GO

V

,......

........

........

........

........

........

........

........

... <

GO

V+O

wn:

0

I

..........

..........

..........

. : ........

........

........

........

........

........

........

........

: ....

..........

..........

..........

. ....

........

........

........

........

........

........

........

.....

GO

V+O

wni

0

0

0

j 20

9 f

723

........

........

........

........

........

........

........

........

........

........

........

........

........

........

........

........

.. ....

........

........

........

........

........

........

........

........

........

........

........

....

370,

000

f D

onat

ion

0

0

i 0

25

.000

:

GO

V ~ ....

........

........

........

........

........

........

........

......

i 5000

i 20

000

I 1,

600,

000

j i

i i

!

I !

i

GO

V+O

wni

. 0

; 0

0

, ........

..........

..........

4 ! ...

! 080 ........

........

.......

2,40

0 I

1,68

0 i

1,85

0,00

0 ~ i

! 2,

500

I 0

150,

000

I ~

(.

..........

..........

..........

.....

........

... ......

............

.. ....

........

. ....

........

......

..........

..........

..........

. ....

........

........

........

........

........

........

........

.. .....

..........

..........

........

........

........

........

.......

..........

..........

..........

.....

..........

..........

... 1 ....

........

........

........

....

I .........

..........

..........

... i

GO

V

GO

V

j 0

j 2

500

GO

Vi

0

0

j 0

f

1,61

2 :

GO

V

..........

..........

........

! ..........

..........

..........

......

I

........

........

........

........

........

........

........

........

........

........

........

........

........

........

........

........

... ....

........

........

........

........

........

........

........

.....

........

........

........

.......

........

........

........

........

........

........

. I

1,41

1 20

1 i

227,

000

:

:

- ....

........

........

........

....

........

.....

:o

;

2,30

0 j

NG

O

........

........

........

........

........

........

........

........

G

OV

j

X

i ....

........

........

........

........

........

........

........

.. ....

........

........

........

... ....

........

........

........

.......

..........

..........

..........

.. ....

........

........

........

... ......

............

............

.. 10

0,00

0 i

: 2

i

:

i

GO

V+

Ow

n~ 0

j 0

; 0

;

2 ! 00

0 <

GO

V;

0

0

I0

f ) ........

........

........

........

........

.. 90

0 .....

..........

........

~

100,

000

; :.

:. ! G

OV

.....

..........

..........

... ....

........

........

........

........

i

16

00

40

0 I

........

........

........

.......

........

........

........

.....

........

........

........

........

. ....

........

........

........

.......

........

... ....

........

........

........

........

........

........

. .....

..........

..........

......

750,

000

< i i

i i

!

<

i 79

0 /

710

i i G

OV

GO

V!

0

0

j 0

3,07

0 ....

: 3,

670,

000

i j

1,53

0 I

1,54

0 j

........

........

........

........

........

........

........

. ....

........

........

........

.....

........

........

........

........

........

.....

..........

..........

..........

. ....

........

........

........

........

........

........

........

.

u

Fund

s re

sour

ces

GO

V

GO

V+O

wn

..........

..........

.........

..........

..........

.........

GO

V

GO

V+O

wn

Uni

vers

ity

GO

V+O

wn

GO

V .....

..........

..........

....

..........

..........

.........

GO

V

GO

V+O

wn

GO

V+

Pro

.-spo

rts

Tox

in R

evie

ws

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

UB

Gie

ssen

on

12/1

7/14

For

pers

onal

use

onl

y.

82

INTERNATIONAL ANTI-DOPING MOVEMENT

UEKl ET AL.

A postal survey concerning the national anti-doping movement was undertaken by

the Japanese Olympic Committee in 1996 with the help of 24 IOC accredited Olympic

laboratories, of which 12 organizations sent back a positive response to our questionnaire

from 12 different countries (Table-3).

The twelve national sports authorities consist of three governmental and nine non-

governmental organizations. In eleven organizations, the fund is sponsored by their

responsible government in addition to their normal income. Nine of the counmes have

already enforced a special anti-doping law, and nine have co-ordination agencies which are

actively working in this field. In all countries, except South Africa, there is an exchange

agreement on the anti-doping movement with foreign countries. Thus, the international

OOCT program can be conducted without any difficulties. Eight IOC accredited

laboratories out of I2 are governmental and the others are universities or private

laboratories.

In the countries which have a co-ordination agency, the test results are sent only to

the independent co-ordination agency for further evaluation. In this way, the athlete's

privacy can better be kept and it will enable a more rapid conclusion of hearings and thus

avoid leaving the weight of suspicion on an innocent athlete for longer than necessary.

In summary, the major activities of the existing co-ordination agencies are testing,

education and information concerning sports doping. No serious problem of hormone

doping has been reported in Japanese society yet, but our sports drug test results shows

that some Asian countries are already in a worse situation.

In Japan, a provisional national co-ordination agency, the so-called "Japan Anti-

doping Agency" was established in 1996 at the institute of sports science of JASA. The

recent progress of the anti-doping movement in sports has promoted the overall anti-doping

program, and it may keep the drug abuse problem in sports to a minimum.

Tox

in R

evie

ws

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

UB

Gie

ssen

on

12/1

7/14

For

pers

onal

use

onl

y.

DRUG ABUSE IN COMPETITIVE SPORTS 83

Acknowledgment

Part of this work was performed in co-operation with the anti-doping commission

of the Japanese Olympic Committee and that of the Japan Amateur Sports Association.

REFERENCES

1 .

2 .

3.

4.

5 .

6 .

Ministry of Health and Welfare, Increasing of the arrested cases due w ampheramines among adolescents, Official report of the Ministry of Health and Welfare on Narcotics (Mayaku Hakusyo) 1995

Ministry of Health and Welfare, Statistics on the seized illegal drugs, official report of the Ministry of Health and Welfare (Hanzai hakysyo in Japanese) 1995

D. Scott, J. Wagner, T. Barlow, Anabolic steroid use among adolescents in Nebraska schools, Am. J Health Syst. Pharm, 53,2068-2072, 1996

US Department of Health and Human Services, Federal Workplace Drug Testing, Federal Register, 11970-11989, 1988

M. Ueki; Editors T. Matsuo, R. Caprioli, M. Gross, Y. Seyama, Chemical analysis in sports medicine, In Biological Mass Spectromeq "Present and Future", John Wiley and Sons, ChichesterJ994

M. Donike, M. Ueki, Y. Kuroda, H. Geyer, E. Nolteernstbg, S . Rauth, W. Schaenzer, U. Schindler, E. Voelker, M. Fujisaki, Detection of Dihydrotestosterone Doping: alteration in the steroid profile a.nd reference ranges for DHT and its 5-alpha- metabolites, J. Sports Med. Phys. Fitness., 35, 235-50, 1995

Tox

in R

evie

ws

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

UB

Gie

ssen

on

12/1

7/14

For

pers

onal

use

onl

y.