The Anabolic Steroid Control Act: The Wrong Prescription?

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According to the body of common knowledge, anabolic steroids are dangerous and deadly drugs. The mainstream media have thoroughly vilified these hormones for several decades. The use by mature adults of any amount of anabolic hormones to enhance physical appearance is invariably labeled anabolic steroid "abuse" and, consequently, the average American lumps the athletic steroid user into the same depraved category as the heroin or cocaine user. Law enforcement agents and prosecutors readily proceed accordingly in furtherance of our national "War on Drugs." Only the most progressive physicians accept the legitimacy of anabolic steroid use for any but the most limited medical purposes. Understandably then, the proposition that our current approach to the non-medical use of anabolic steroids is flawed, failing and in need of reform is provocative to many.

While rarely reported in the lay press, there are actually very compelling reasons to revisit the legitimacy of our current anabolic steroid laws. There is mounting evidence that the actual health dangers associated with anabolic steroids for mature adults are significantly less than were suggested to Congress or are commonly perceived by the public. There is evidence that the tight regulations have stifled research, undermined beneficial applications, and effectively severed any connection between physicians and most steroid users. Further, there are strong arguments that the legislation has failed to solve the very problems for which it was enacted; rather, it has exacerbated the situation.

The Congressional Hearings

In the mid 1980’s, media reports of two problems came to the attention of Congress: the increasing use of anabolic steroids in professional and amateur sports, and a "silent epidemic" of high school steroid use. Between 1988 and 1990, Congressional hearings were held to determine the extent of these problems and whether the Controlled Substances Act should be amended to include anabolic steroids along with more serious drugs such as cocaine and heroin. It is sometimes overlooked that the reported adverse medical effects of steroid use, such as potential liver damage and endocrinological problems, were completely irrelevant to the criteria for scheduling under the Controlled Substances Act.

Many witnesses who testified at the hearings, including medical professionals and representatives of regulatory agencies -- including the FDA, the DEA and the National Institute on Drug Abuse -- recommended against the proposed amendment to the law. Even the American Medical Association repeatedly and vehemently opposed it, maintaining that abuse of these hormones does not lead to the physical or psychological dependence required for scheduling under the Controlled Substances Act. However, the records from the hearings suggest that any "psychologically addictive" properties of steroids were secondary considerations to Congress. The majority of witnesses called to testify at the hearings were representatives from competitive athletics. Their testimony, and apparently Congress’ main concern, focused on legislative action far less to protect the public than to solve an athletic "cheating" problem. Congress wanted steroids out of sports and classified steroids as Schedule III controlled substances. As a result, these sex hormones stand out as a strange anomaly among the codeine derivatives, central nervous system depressants, and stimulants that form the rest of Schedule III.

The Anabolic Steroid Control Act of 1990

The Anabolic Steroid Control Act of 1990 added anabolic steroids to the federal schedule of controlled substances, thereby criminalizing their non-medical use by those seeking muscle growth for athletic or cosmetic enhancement. It places steroids in the same legal class as barbiturates, ketamine and LSD precursors. Those caught illegally possessing anabolic steroids even for purely personal use face arrest and prosecution. Under the Control Act, it is unlawful for any person knowingly or intentionally to possess an anabolic steroid unless it was obtained directly, or pursuant to a valid prescription or order, from a practitioner, while acting in the course of his professional practice (or except as otherwise authorized). A first offense simple possession conviction is punishable by a term of imprisonment of up to one year and/or a minimum fine of $1,000. Simple possession by a person with a previous conviction for certain offenses, including any drug or narcotic crimes, must get imprisonment of at least 15 days and up to two years, and a minimum fine of $2,500, and individuals with two or more such previous convictions face imprisonment of not less than 90 days but not more than three years, and a minimum fine of $5,000. Distributing anabolic steroids, or possessing them with intent to distribute, is a federal felony. An individual who distributes or dispenses steroids, or possesses with intent to distribute or dispense, is punishable by up to five years in prison (with at least two additional years of supervised release) and/or a $250,000 fine ($1,000,000 if the defendant is other than an individual). Penalties are higher for repeat offenders.

The Health Risk Issues

Although the purported health risks of anabolic steroids are irrelevant to the criteria for scheduling controlled substances, they have provided a seemingly valid public basis for the enforcement of the legislation, justifying a policy favoring prosecution of mature adults involved with steroids over allowing them to "destroy themselves" with these substances. It is curious whether the policy would be publicly supported if the actual dangers to healthy adult males were significantly less than the general public has been led to believe. While a comprehensive review of the medical and scientific evidence of health risks is beyond the scope of this article, a few words on the subject are in order.

Without question, there are health risks involved in the self-administration of any prescription medicine, particularly in the absence of a physician's advice with respect to dosages and duration of use. Further, without regular monitoring by a doctor, some side effects may go unnoticed or untreated until it is too late. Anabolic steroids can have adverse effects upon the body, with particular risks for teenagers, who are more likely than adults to abuse anabolic steroids in dangerously high dosages and without any medical supervision.

But while steroids can have adverse side effects, including serious ones, to mature adult users as well, the scientific literature is far less conclusive than is claimed by government-sponsored physicians and anti-drug officials. Despite a virtually one-sided presentation in the lay press, the position that anabolic steroids are such dangerous substances as to warrant militaristic government enforcement tactics is surprisingly controversial. Mounting research strongly suggests that the actual health risks have been overstated to the public. A landmark 1996 study, for example, found virtually no adverse effects when anabolic steroids were administered at a dosage of 600 mgs per week (about six times natural replacement dose) for ten weeks. The actual risk levels for mature adult males using steroids are related to various factors, such as the dosages and duration of use, the specific types of compounds administered, the existence of any preexisting pathologies, etc. Some highly knowledgeable authorities who have objectively reviewed the medical literature pertaining to mature adult users have concluded that "[a]s used by most athletes, the side effects of anabolic steroid use appear to be minimal."

The public has been led to believe that "roid rage" -- the descriptive term for steroid-induced spontaneous, highly aggressive, out-of-control behavior -- is rampant among steroid users. While a handful of researchers have claimed that psychiatric symptoms including increased aggression are a common side effect of anabolic steroid use, these claims have been regarded with skepticism by experts. Indeed, the relationship between anabolic steroids and aggressive behavior is far more complex than the press has reported, and the most exhaustive review of the medical literature did not find consistent evidence for a direct causal relationship between steroid use and aggression even in those affected.

Personal Freedom and General Comparative Risks

The law does not prevent individuals from skiing, scuba diving or even hang gliding, although all are extremely dangerous activities. As one reviewer noted: "People in this country can choose to have tummy tucks, breast implants, nose jobs, smoke cigarettes, drink alcohol excessively, or watch strippers as long as they don't hurt other people. Actually smokers are allowed free reign to harm others with second hand smoke in most places in the country except California, so why aren't people allowed to exert their freedom of choice in regards to use of things like marijuana and anabolic steroids, either of which can be credibly argued to be less dangerous or no more dangerous than cigarettes and alcohol." Smokers are not subjected to arrest and criminal prosecution, even though many, many more deaths result from tobacco annually than in all fifty years of non-medical steroid use. Each year, the use of non-steroidal anti-inflammatory drugs – including over-the-counter aspirin and ibuprofen – accounts for an estimated 7,600 deaths and 76,000 hospitalizations in the United States. Although the inherent risks of dangerous sports and cosmetic surgery are unnecessary, and may well outweigh the benefits, we do not proscribe these activities. Is it appropriate, then, to prevent mature, informed adults from choosing cosmetic enhancement through physician-administered hormones?

Comparative Risks to Cosmetic Surgery


Commentators from both the legal and medical communities have noted an interesting cultural irony in the comparison of anabolic steroid administration to cosmetic surgery procedures. Under a physician’s supervision, these represent different approaches toward a similar goal. In a society preoccupied with physical appearance, confidence and self-image are often intertwined with body shape and condition. Interestingly, under the current views and laws of our society, it is criminal for a physician to administer anabolic steroids to a healthy adult for purposes of cosmetic physical enhancement. However, it is perfectly acceptable (and quite lucrative) to perform the much more radical and dangerous procedure of surgically implanting foreign prosthetics into virtually all parts of the human anatomy for the same purpose, subjecting patients to the potentially fatal risks associated with general anesthesia and post-surgical infection. Many more people have died or been permanently injured from botched liposuctions, breast augmentations and other cosmetic surgery procedures in the past few years than in nearly fifty years of anabolic steroid use by athletes. Liposuction, for example, is now the most popular cosmetic surgical procedure in North America despite the fact that it has resulted in significant incidences of blood vessel blockage and death. Given the comparative risks, it would seem that the current state of legality regarding non-medical steroid use and these procedures might best be reversed.

The Goals of Criminalization for Non-Medical Usage

Whether providing criminal penalties for illegal steroid use is the proper and most effective way of dealing with the "steroid problem" has been debated for quite some time. Proponents of criminalization and law enforcement authorities say that the Control Act and similar state laws: (1) help to deter trafficking, (2) protect young people, and (3) preserve fair competition in sports. Against criminalization are arguments that such penalties have proven to be a failure in stemming abuse of other drugs and alcohol, that criminalization only increases the underground black market, and that efforts are best confined to education and rehabilitation.

Deterring Steroid Trafficking

Proponents of criminalization contend that stiff penalties help deter trafficking, and that the strict controls associated with controlled substance status prevent pharmaceutical companies from manufacturing more product than could be legitimately used for FDA approved purposes. Indeed, it was the allegation of such a "diversion" problem that helped sway Congress to classify steroids even against the advice of medical authorities. The Control Act addresses the diversion problem by the triplicate "paper trail" that is associated with controlled substances. Every person who manufactures, distributes, or dispenses a controlled substance is required to register annually with the Attorney General. But while the paper trail requirements have reduced the amount of legitimate steroids diverted, they have helped foster a booming counterfeit trade where underground labs make and label steroid products to mimic legitimate pharmaceuticals. An even bigger problem is the tremendous increase in production and importation of non-FDA-approved foreign products that have come to replace domestic preparations. All of these products completely bypass the Control Act’s paper trail.

In a 1990 statement to Congress, Department of Justice officials estimated the black market to be a 300 million dollar per year industry. In January 2001, federal law enforcement officials announced that they seized more than 3.25 million anabolic steroid tablets in the single-largest steroid seizure in U.S. history. Last year, U.S. Customs agents made 8,724 seizures, up 46 percent from 1999 and up eight-fold from 1994. Public health experts estimate that the steroid black market has grown larger – perhaps far larger – than the $300 million to $400 million estimated in 1988. But as officials from the Office of National Drug Control Policy issue statements supporting even broader interdiction, the Congress takes steps toward further regulations, and prosecutors and lawmakers decry the dangers of this huge black market of illegitimate steroids, it seems only sensible to deride the "deterrent" effect of our approach.


Protecting Young People

Protecting young people from danger is a worthy goal of any legislation. The Control Act appears to have had the opposite effect. A primary effect of the Control Act’s restrictions upon legitimate product has been the increased manufacture and distribution of black market counterfeit products and substandardly made veterinary steroids never intended for human consumption. Some of these black market products are tainted with impurities or contain other foreign substances, supporting the assertion that "continued enforcement of steroid legislation will worsen health risks associated with steroid use. An investigation by The Atlanta Journal and Constitution concluded that ‘tougher laws and heightened enforcement’... have fueled thriving counterfeit operations that pose even more severe health risks."

A second major effect of the criminalization approach has been to discourage illegal users, including teens, from admitting their steroid usage to physicians. Since some of the greatest dangers inherent in self-administered steroid use involve the failure to be monitored by a doctor, the Control Act has succeeded in greatly escalating this danger and has created an even wider gap between the users and the medical community. Because the self-administration of anabolics is a federal crime, few users are willing to confess their steroid use to physicians. And because federal enforcement efforts have targeted physicians, few doctors want anything to do with athletes taking steroids. Other than in legitimate and authorized research, physicians must prescribe steroids "for a legitimate medical purpose" and "in the usual course of professional treatment" or risk prosecution as a common drug dealer. Doctors caught distributing steroids for bodybuilding have been criminally prosecuted. The end result is that the people, including minors, using steroids illegally rarely get regular blood pressure checks, cholesterol readings, prostate exams and liver enzyme tests. "Thus, the risks involving the use of anabolic-androgenic steroids have increased well beyond those of the drugs themselves." As one reviewer concluded: "By forbidding trained physicians from administering steroids in a controlled manner, the Legislature has forced athletes to either buy steroids off the black-market or seek out un-ethical and possibly incompetent physicians to supply them steroids.... [I]t appears that Congress’ attempt at preventing steroid prescription has at best been futile and at worst harmful."

Preserving Fair Competition in Sports

Issues of cheating, "hollow victories," "winning at any cost," etc., were probably the primary ideological foundation for the Control Act. "Permitting steroid users to compete with drug-free athletes reflects on the fairness of athletic competition at every level. Allowing those with an unfair advantage to compete can pressure drug-free athletes to use anabolic steroids to remain competitive."

The Control Act has been of extremely limited value in addressing this "cheating" problem. Elite athletes are almost never prosecuted under the Control Act, obtaining their steroid supplies through sophisticated channels that avoid detection by law enforcement. The extremely remote possibility of criminal prosecution deters few if any Olympic and professional level athletes. The most effective way to eradicate anabolic steroids from competitive sports is through systematic drug testing. Athletes who fail the steroid test are prohibited from competing. While testing for anabolic steroids is not perfect, it does remove identified steroid-users from the sport and also serves as the most effective deterrent today. Serious athletes devote huge amounts of time, energy and resources into training for an event. The effect of drug testing -- preventing steroid-using athletes from competing -- is both a more effective and more appropriate deterrent than the Control Act’s threat of making overly ambitious athletes into convicted felons. This is especially true because the vast majority of anabolic steroid users are not competitive athletes at all, but merely otherwise law-abiding adults who are using the hormones for physical appearance.

Problems Created or Worsened by the Control Act

The Control Act has made it much more difficult for those who might legitimately benefit from steroid therapy to have access to it, such as in geriatric medicine. There are many who believe that hormones may an antidote for aging. Serum testosterone levels decline in men as they age: replacement is being suggested as a beneficial therapy with few adverse effects. The restoration of strength, muscle mass and libido in the elderly would greatly benefit society. However, the sweeping stroke with which the Control Act is applied has precluded many favorable applications for the elderly. When "physicians prescribe steroids for other than approved illnesses, they open themselves up to a presumption of illegality based upon the reading of the Anabolic Steroids Control Act." "By respecting the federal law, physicians may not prescribe steroids to advance the physical strength and condition of the elderly. By subverting a doctor's determination concerning the best interests of a patient, elders are penalized as well -not for violating the law, but by submitting to it." "Many illnesses requiring managed care possibly could be eliminated with hormone treatments. This would not only trigger a social benefit but a financial benefit as well. Congress has created a barrier for the revitalizing effects of steroids for the elderly."

The prudent use of anabolic steroids is also becoming extremely attractive to middle-aged men, the tail end of the so-called "baby boom." As endogenous testosterone production decreases with age, the use of anabolic steroid therapy ("androgen replacement therapy") can be a godsend to men in their forties and fifties suffering from low libido and other ailments. Recent research supports the safety and effectiveness of this hormonal replacement therapy, and public awareness has begun. The judicious use of androgens can improve age-related decreases in sexual desire and sexual arousal in many men, and would seem to have a positive effect toward lowering serum cholesterol when used in appropriate dosages. Some progressive experts anticipate that within a few years, androgen replacement therapy with anabolic steroids will be as common for men as estrogen replacement therapy is for women.

In a different area of medicine, specialists are coming to consider anabolic steroid therapy an essential component of the treatment of HIV+ men, greatly improving quality of life by increasing protein utilization for muscle growth (actually stopping or reversing AIDS-related wasting), increasing appetite, stamina and libido, and promoting a general feeling of well-being. The Control Act has sadly hindered the expansion of use for HIV+ and AIDS patients.

Reforming Our Anabolic Steroid Laws

The Anabolic Steroid Control Act has been a prescription for failure. Illegal use has continued unabated and the potential dangers associated with anabolic steroid use have been significantly increased because of the Act. Meanwhile, legitimate uses and vital research have been suppressed. While anti-steroid experts try to minimize the real life effects of the criminalization approach upon those apprehended for merely personal use, the effects of arrest and prosecution, even where a sentence of incarceration is averted, can be quite devastating. This is especially true since most adult steroid users lead otherwise responsible, law-abiding lives.

Steroid prohibitionists have met any challenges to the status quo with resistance, maintaining: "However imperfect our present systems might be, it would be a terrible mistake to consider legalizing performance-enhancing drugs... We cannot depend on athletes making judicious use of steroids during their athletic careers. From the earliest times, the pattern has always been one of excess. Alcohol regulation does not entirely prevent alcohol abuse by youngsters but it serves as a check that is in the best interests of society." The argument invites two responses. First, the observation about athletes themselves being incompetent to judiciously use steroids more persuasively supports the contrary position. Reforming the law to again allow doctors to be involved in the dosage regulation, administration, and health monitoring of athletes using anabolics would vastly reduce the patterns of "excess." Second, the analogy to alcohol is well taken in a way that must have been overlooked. Recognizing the failure of Prohibition, Congress changed our national laws regarding alcohol use from prohibition to restriction, permitting use by mature adults but banning sales to minors. Just as our society views alcohol and tobacco as requiring maturity for responsible use, so too should any relaxation of laws regarding anabolic hormones be reserved for adults only.

An alternate solution to the problem is sorely needed, and discourse must begin on the details of the reformation. Regulation as prescription drugs and removal of criminal penalties for adult personal use with a prescription would solve some of the problems created by the Control Act itself. Physicians would no longer fear being arrested for dispensing moderate amounts of anabolics to mature adults for cosmetic purposes. Steroid users would no longer be discouraged from continuous health monitoring. Responsible cosmetic users would no longer be imprisoned or transformed into criminals. Those suffering from AIDS or age-related infirmities would have greater access to needed medications. Funding for anabolic steroid research would certainly increase. There would be a major shifting of the steroid supply to favor legitimately produced, FDA regulated products. Clearly, the two greatest dangers in the use of anabolic steroids today - the use of tainted black market substances and the failure to be medically monitored and supervised - would be averted by this approach. Of course, anabolic steroids would be restricted to adults, and non-physicians caught trafficking in steroids, especially selling steroids to minors, would be subjected to stiff criminal sanctions. Organized sports bodies could continue to ban steroids for participating athletes, with more aggressive testing and punishments.

While there are obvious political hurdles standing in the way of such reformation, it is time for our laws to discard the unqualified view of anabolic steroids as "deadly drugs" for mature adults, based on the medical and scientific truth. The current scheme, with its unsupervised self-administration of potentially dangerous black market pharmaceuticals and the arrest and prosecution of mature adults seeking physique enhancement, is the wrong prescription indeed.

The author has been involved in the defense of numerous anabolic steroid cases in a variety of jurisdictions. He has written extensively and been interviewed by the media concerning anabolic steroid legal issues.

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Comparative Risks to Cosmetic Surgery


Commentators from both the legal and medical communities have noted an interesting cultural irony in the comparison of anabolic steroid administration to cosmetic surgery procedures. Under a physician’s supervision, these represent different approaches toward a similar goal. In a society preoccupied with physical appearance, confidence and self-image are often intertwined with body shape and condition. Interestingly, under the current views and laws of our society, it is criminal for a physician to administer anabolic steroids to a healthy adult for purposes of cosmetic physical enhancement. However, it is perfectly acceptable (and quite lucrative) to perform the much more radical and dangerous procedure of surgically implanting foreign prosthetics into virtually all parts of the human anatomy for the same purpose, subjecting patients to the potentially fatal risks associated with general anesthesia and post-surgical infection. Many more people have died or been permanently injured from botched liposuctions, breast augmentations and other cosmetic surgery procedures in the past few years than in nearly fifty years of anabolic steroid use by athletes. Liposuction, for example, is now the most popular cosmetic surgical procedure in North America despite the fact that it has resulted in significant incidences of blood vessel blockage and death. Given the comparative risks, it would seem that the current state of legality regarding non-medical steroid use and these procedures might best be reversed.
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Thats cannon fodder right there. Use that against those ethically un-sound idiots that think because it's "illegal" it's wrong.