The History of Drug Testing in Sports & How Athletes Beat the Drug Tests

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This is Part One of a three-part article. This first part will focus on the formal process of drug testing in sports, primarily at the international level. Part two continues with the formal process and part three 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. In order to make sense of it all, a bit of history and background will be presented, as well. This is not intended to be a history of drug use or a complete review of all the tactics used, as it is unlikely that one person could know of every tactic. In cases where published reports (i.e. newspapers, TV, etc) have publicly stated information, the real names of the key players will be given. In other cases, where information has not been publicly stated or presented, names and identities will be changed or omitted. While the arsenal of drugs available to the athletes includes far more agents, the coverage here will focus on anabolic-androgenic steroid (AAS) use.
Drug Testing Nonsense
If I told you I was committed to an effort and was going to spend one million dollars of my money on a project, wouldn’t that seem like a sincere effort? Now let’s say you find out from a reliable source that the one million dollars represents mere pennies to me because I have tons of money. Then you find out that the project I was supposedly committed to is last on my funding list as far as financial commitment. Does it still seem like a high priority? This is the case with drug testing. In general, the International Olympic Committee (IOC) and other organizations talk a good game, but in reality, they are not sincere in their drug testing efforts. The historical evidence shows a repeating sequence of events since the implementation of drug testing: athletes take drugs, organizations develop tests, athletes beat tests, organizations come out with new tests, athletes beats tests, and so on. You get the point. Each time a new test is developed, drug testing officials release statements to the media indicating how sensitive the new techniques are. The tests get implemented and a very small percentage of athletes test positive for some type of banned substance. The drug testing officials then claim that based on their latest information, drug use is declining. This is comical, given all the data that indicates junior high school, high school, recreational, amateur and professional athletes are using steroids and other drugs. Yet somehow the IOC and other organizations want us to believe that they are cleaning things up based on the low number of positive drug test results. Given all the data that indicates drug use is prevalent, I feel that what the low numbers of positive drug tests actually indicate is how inadequate drug testing methods are.
Prohibited and Restricted Drug Categories
Prohibited and restricted drugs fall into three main categories: (1) short- or immediate-acting stimulants and beta-blockers, (2) anabolic agents, and (3) masking agents. Stimulants and beta-blockers tend to affect performance only if taken just before the event. Drug testing for this category of drugs is believed to be very effective. Based on drug testing data, stimulant use has been essentially abolished from high-level sports because they are detected so easily. Anabolic agents usually require weeks to obtain the desired effect and are sometimes referred to as training drugs. The training drugs are inherently more difficult to detect and can be discontinued in time to pass an announced or anticipated test. Masking agents are drugs that affect the detectability of other drugs. Examples of masking agents are diuretics, probenecid, and epitestosterone. These drugs are only useful at the time of the test and, except for epitestosterone, are relatively easy to detect.
Anabolic-Androgenic Steroids (AAS)
Of all the known drugs abused by athletes, anabolic-androgenic steroids (AAS) are probably the most widely publicized. Use of these agents is associated with side effects that have been reported in the literature. Reports from case studies by clinicians stir up the media, which always seem to somehow exaggerate the side effects. The clinical literature reports that AAS possible side effects include psychological and psychiatric disturbances, rupture of the myotendinous junctions, increased blood coagulation, an impaired blood lipid profile, gynecomastia, hypogonadism, cholestasis, skin disease, hypertension, stroke, and myocardial infarction. The negative consequences to the athlete’s health have not deterred the use of these substances, despite the drive to win.
Presently more than 100 different AAS are available. They can be taken either by mouth and swallowed, sublingually, injected, or from transdermal application. The basic chemical structures have been modified to increase the anabolic effects and reduce the androgenic effects. The anabolic effects of steroids lead to muscle-building and increased aggression, which enable people to train harder.
Originally, only power athletes, bodybuilders, and recreational weight trainers were believed to take AAS. Evidence accumulated that endurance athletes used them as a training aid by to improve recovery from high volume training loads. This was later confirmed by the positive tests of Chinese female distance runners for DHT, a topically applied androgen with a fairly short half-life in the blood. This has prompted some researchers to pose the following question: Since medical doctors and other health care professionals have consistently stated that steroids don’t enhance performance, why are we testing athletes for them? If they do work, then why are we telling athletes they don’t? The simple truth of the matter is that early studies on steroids used low dosages. To say that steroids didn’t work in general is based on the data from early research and leads one to draw an invalid conclusion. The more appropriate conclusion is that the particular substance administered did not prove to be anabolic at the dosage tested. However, the latest evidence published in the New England Journal of Medicine does indicate that AAS do work, and unlike what most people will tell you, they can also stimulate muscle growth without having to lift weights. Obviously though, lifting weights increases the potential for gains in muscle size and strength.
Basic Overview of Drug Testing
On an annual basis, over 100,000 drug tests are conducted worldwide at a cost of $30 million. The drug tests are designed to detect and deter abuse of performance-enhancing drugs by competitors. The testing procedures for drug abuse in sport are strict and at times deemed unfair. They are deemed unfair because athletes are responsible for knowing what is banned despite the fact that additions are made almost daily to the list of banned substances. This has prompted researchers to recommend to athletes that the best possible solution is to avoid all drugs unless listed on the allowed substance list. The IOC has decided that drug tests will require confirmation, whenever possible, by gas chromatography and **** spectrometry, which define several chemical features of an abused drug, in effect producing a drug fingerprint. In addition, prior to the 1996 Olympic Games in Atlanta, the IOC required competitors to agree to a contract that prohibited them from taking any action beyond arbitration if they failed a drug test.
Drug Test Timing
When athletes know when a drug test will occur, they can prepare for it and thereby neutralize the effects of drug testing on the use of performance enhancing drugs and/or masking agents. Year-round short-notice and no-notice testing are the most effective means to curtail the use of training drugs because they make athletes always at risk to be tested. Sports have recently begun to invest in this type of testing despite the high cost and difficulty in administration. Some countries claim to have achieved no-notice testing. The IAAF and international federations for swimming and weightlifting conduct year-round, short-notice testing. In the United States, the NCAA and the National Football League (NFL) have short-notice (1-2 days) programs, and the United States Olympic Committee (USOC) has approved the implementation of a no-notice program.
Obtaining a Urine Sample
The drug testing procedure begins with taking a urine sample. While this sounds simple, it initiates a formal and highly regulated procedure to ensure that the urine sample that arrives at the laboratory actually comes from the athlete in question, with no opportunity to tamper with the sample. Why is urine used and not blood or other tissues? There are several reasons. Blood draws would require medical or paramedical staff and hence incur additional costs. Other tissues may not be valid for analysis under all conditions. Once selected for drug testing, the athlete is notified by an official and asked to sign a form acknowledging this notification. The athlete may or may not be accompanied by an official and must attend the testing station within the designated period. The testing station is supposed to be a private, comfortable place where plenty of drinks are available. Many times it is set up inside a specially designed mobile testing unit. Independent sampling officers, whom are trained and appointed by the respective governing body, carry out the collection of urine samples. Each officer carries a time-limited identity card and a letter of authority for the event to which they are allocated.
Before giving a urine sample, the athlete is told to select two numbered bottles. After providing the sample (about 100 ml), the athlete must voluntarily complete a form. The athlete declares any drug treatment taken in the previous seven days and must check and sign that the sample has been taken and placed in the bottles correctly. The urine sample is then sent for analysis to a laboratory currently accredited by the IOC. In the event of a positive test result, the laboratory will notify the governing body of the sport, who will then notify the athlete. The rules of the governing body of the particular sport determine what happens next. The rules vary across governing bodies, sports, and countries. An athlete is usually suspended while a positive result is investigated, but has the right to have a second analysis of the urine sample. This analysis may be observed directly by the athlete or by the athlete's representative. There follows a hearing, at which time the athlete’s case is presented. An appeal can be made, and there have been successful appeals both in the United States and other countries.
The testing procedure must be strictly adhered to so that all athletes receive the same treatment. Collection of the urine sample has to be observed because drug abusers may attempt to falsify the results by tampering with the samples. Volume, pH, and in some cases specific gravity and temperature of the sample are tested immediately. These simple tests check for some of the known methods of cheating the drug tests at this early stage. The urine pH is tested to detect attempts at changing the nature of the sample, which can affect the analysis of certain drugs, as well as their metabolism and clearance. Sodium bicarbonate, for example, can be taken by mouth in order to change urine pH. The pH is also tested to verify that the level of degradation, which a sample may have experienced by the time it is tested, is within acceptable limits. The specific gravity is checked for attempts to dilute the concentration of drugs, as is the case by deliberate diuretic use.
To ensure that the sample actually comes from the athlete, the testing officer must be able to see the urine flow from the athlete into the bottle. Male athletes are asked to strip to their waist and lower their shorts to their knees. Female athletes must also be observed very closely while they void a sample. This procedure can be very awkward, embarrassing, and humiliating. For a young athlete, giving a urine sample under these circumstances can be very traumatizing. Many people, regardless of age, are uncomfortable with the idea of being observed while giving a urine sample. The situation is further complicated if an athlete has been competing in an endurance sport and is dehydrated or competing at a weight category where they are reluctant to drink excess fluid.
At least 75 mL must be given under close scrutiny and the urine is split into 2 portions as "A" and "B" bottles. The athlete chooses the two coded bottles and the samples are sealed by the athlete. In most cases, only the athlete handles the urine and collection containers until sealed. The containers are sealed with tamper-proof strips, placed inside other sealed containers, wrapped in tamper-evident seals, and coded. The independent official observing the sample procedure records all of the information on a document. This initiates a chain-of-custody record to be continued by anyone who handles the specimen until the urine is used up or discarded in the laboratory. The laboratory staff never knows the athlete's name, only the bottle identification number. Everyone who handles the sample must understand the importance of the chain of custody and the essential role of maintaining it. The chain of custody guarantees that the sample content is protected and that the sample tested is from the correct athlete.
The possibility of sabotage of a urine sample has been raised many times by athletes. It is for this reason that that athletes should ensure that the testing procedure is observed rigorously for their own protection. Samples should be dispatched in the appropriate containers and all paperwork completed without any errors. After this the athlete is no longer part of the process and must rely on the integrity and accuracy of the system. The sample is then taken and sent by courier, along with a chain-of-custody document, to an accredited laboratory.
While the test protocol may seem excessive and violate certain rights of privacy and decency, there are important reasons for this protocol. There are many reports of athletes using elaborate arrangements of catheters to provide an alternative sample, bringing condoms filled with drug free urine to the testing station, and even catheterizing themselves and instilling drug free urine. If athletes go to these lengths to avoid detection, the testing protocol must be strict.
At the elite level, athletes are subject to year-round random testing. At any time, an independent sampling officer may call unannounced and request a urine sample. While this comes across straightforward on paper, in practice there are many difficulties. Frequently, athletes travel the world and finding the athlete can be difficult. After the independent sampling officer asks around to find the athlete in question, it is unlikely that the testing remains a surprise.
Storing the Sample
The proper storage of samples is important to the reliability of the tests. Once collected, the sample must be protected so that the fluid, when tested in the laboratory, reflects the composition of the sample as it left the body of the person being tested. As part of sports doping policy, urine is not refrigerated or frozen until it reaches the laboratory. In a clinical setting, great care is taken to ensure that the sample tested is as near as possible to the condition in which it left the body. This is accomplished by adding a preservative or more often by refrigerating or freezing the sample. With worldwide testing in sports, samples are sent all over the world and there can be delays in delivering them to labs.
While refrigeration or freezing of the sample is the usual practice in the clinical setting, note that this is definitely not the case in sports. The addition of chemicals to prevent bacterial growth in the urine could preserve the specimen and may be a more practical alternative. Athletes, however, regard this method with some suspicion and think that this may introduce the possibility of tampering with the sample. Current scientific evidence indicates that their fears are misplaced. Urine contains thousands of bacteria from many different species. This is even more the case for a sexually active female. Urine collected from a female athlete will contain skin cells and microorganisms from the intestine flushed to the vaginal area by sweat. Many bacteria are ubiquitous and survive even in tap-water plumbing; if the water were used to wash any of the sample containers, other microorganisms could be added to the sample. Bacteria, in a container to which urine is added, will flourish in such a medium that is infinitely richer in nutrients than the water in which they have survived. Many constituents of urine support the growth of such bacteria, and metabolism presents a serious problem in drug testing because of the risk of falsifying doping test results. In this regard, urine contains several steroids that are utilized by bacterial enzymes that can interconvert endogenous steroids to the extent of producing testosterone in the urine. Because of the steroid concentrations in the urine, even a low conversion rate of steroids to T will produce a level of T sufficient to distort the test result. So athletes should be more concerned if officials don’t add something to the urine sample and not the other way around.
Laboratory Protocols
Laboratories need to maintain high standards of practice in order to retain the respect of the sports community. In the event of an appeal for a positive test result, the data and procedures may have to withstand scientific and legal scrutiny. This makes accurate and complete presentation of the results essential. Accredited laboratories involved in drug testing may also exchange samples in a quality control program to confirm that they agree on the findings. If a lab comes up with results that are not consistent with other labs, they fail the quality control tests and accreditation can be withdrawn. While these quality control tests are not usually made public, some experts feel that they should be made available to all parties, especially in the case of legal disputes. Examples of quality controls include urine or water samples to which banned drugs have been added. In addition, urine samples from someone who has taken the banned drugs must also be taken. The reason for both procedures is that compounds can behave differently in urine samples derived from the body after drug administration. This procedure and the appropriate use of reference compounds is important for the interpretation of results from the drug tests.

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This is Part Two of a three-part article. The first part focused on the formal process of drug testing in sports, primarily at the international level. This part continues with the formal process and part three will discuss 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.
Labs Approved for Drug Testing
To date, the IOC has accredited 25 testing laboratories around the world. There are 3 in North America (1 in the University of California at Los Angeles School of Medicine, 1 in the Indiana University School of Medicine, and 1 in Montreal, Quebec), 1 each in China, Korea, Australia, Japan, and South Africa, and the rest are in Europe. Once the commitment is made to develop a laboratory, 2 to 3 years are necessary to develop the necessary methods and gain the appropriate experience. Currently, laboratories are developing in Hungary, Poland, Malaysia, Puerto Rico, Brazil, Zimbabwe, Indonesia, and Turkey.
Several requirements are made of the IOC laboratories. They must organize a proficiency program, an annual accreditation examination (which is designed to be quite difficult), and a week-long scientific meeting. The IOC laboratories in the United States and several commercial laboratories are also accredited by the College of American Pathologists for athletic drug testing. The IOC is planning to require the laboratories to join the International Standards Organization accreditation program. In addition to adhering to the testing protocols, the IOC program requires adherence to a code of ethics that forbids testing samples unless they are from a bona fide sports program. Labs found guilty of violating this code may be sanctioned. Thus, the IOC laboratories are prohibited from drug testing athletes who want to learn how to evade detection of drug use.
Positive Drug Tests and Confidentiality
Panels of officials and athletes usually review positive drug tests. Disputed cases may lead to hearings, to arbitration, and to courts at the national and international level. Sports, particularly in the United States, place great emphasis on refining and executing the collection, transport, and testing procedures. In the case of a positive report after screening and confirmation on the "A" urine sample, the athlete may choose to be present to verify that the "B" sample is intact as they last saw it, or may send a representative to do so before the "B" sample is tested.
Generally speaking, athletes are notified by their governing body of any breach of the medical code and have the right to a disciplinary hearing and legal representation. The name of the offending athlete should be kept confidential. However, given the media frenzy over the reporting of positive drug tests, this has been difficult to maintain. The reason for maintaining confidentiality is that new evidence can always overturn the decision. Historically, even when guilt has been proven beyond reasonable doubt, the procedures have occasionally been challenged in the light of new scientific evidence. There are published accounts of unwitting intake of drugs via consumption of natural products such as opioids, which have been detected in urine as the result of eating poppy seeds on bagels. After this discovery, subsequent drug tests were modified to detect opioid metabolites that are derived only from administered drugs. Positive test results have been reported after consumption of chickens that have been injected with preparations of anabolic steroids into fat stores and farm animals treated with clenbuterol. It is for these reasons that the laboratory data should undergo a thorough scientific review before proceedings are instigated through administrative channels and sanctions imposed on athletes suspected of a doping offense.

The Responses of Organizations to Positive Drug Tests

What happens to an athlete once a positive drug test is reported depends on the drug detected and the testing organization. Anabolic-androgenic steroids (AASs), beta-blockers, and amphetamines are considered the most serious offenses and, consequently, the penalties are high. Another consideration is what to do when an athlete’s urine reveals traces of a banned substance that is available OTC or can inhibit performance. As an example, stimulants would most likely impair shooting performance, yet they are still banned. In these cases, different sports organizations considering these possibilities may reach opposite conclusions. This point elucidates how complicated and confusing testing can be for athletes competing in different organizations. Such discrepancies in how athletes may be sanctioned potentiate the possibility of positive doping results for OTC banned substances. The burden is placed upon the athlete to know and understand the rules and sanctions for their sport and the specific organization they are competing in.
At the Olympic level, while the IOC rules may be clear, they only apply to the Olympic Games. Outside Olympic competition, each international or national sports organization sets their own rules. While all sports in theory could and should operate under the IOC rules, in practice this has yet to be achieved. Presently the IOC has a group working on rules agreement within Olympic sports. Further problems at the national level include having to get agreement across the various national governing bodies and between the national governing bodies and their international federations on the rules of drug testing. Some national governing bodies carefully follow the rules of their international federations, but some may not because of lack of clear international federation rules. The final verdict depends on the type or level of competition and the particular sport. In the Olympics, the judgment process takes a few hours. In the United States, an athlete who is not satisfied with the decision of the initial hearing may appeal to the American Arbitration Association. At the international level, an athlete may appeal to the International Court of Arbitration for Sport.

Defenses Used Against Positive Drug Test Results

In the event of a positive sample, some athletes may admit drug use, but most will deny use and attribute the positive result to collection mistakes, breaks in the chain of custody, laboratory error, or sabotage. Sample collection is a possible area of vulnerability, but errors are usually minor (e.g., incorrect date) and do not materially affect the results. Transport and receiving are simple processes and, in general, are not a problem area. Experts have never successfully refuted the data from US laboratories, despite careful scrutiny. While sabotage is possible and should not be excluded, it rarely can be proven. As a precaution, athletes are warned to drink only from sealed containers provided by the collection officials. While sports authorities are skeptical of the sabotage defense, they would consider evidence offered to support it. There are no documented cases of sabotage in the legal or medical literature.
As far as testing positive for a banned substance contained in an over the counter (OTC) drug, athletes often accept the results, but ask for leniency on the basis of unknowing use or lack of understanding that the product contained banned substances. Depending on the circumstances and the amount of drug found in the urine, this explanation may or may not be accepted. If a second offense occurs, then a sanction is usually imposed. In past cases where the testosterone to epitestosterone ratios (T/E) are elevated, athletes have attributed the results to OTC natural products that claim strength enhancements and sometimes are labeled as containing "orchic" or, most recently, prohormones. The amount of testosterone in orchic-type products is very low and the bioavailability of these oral preparations is also low. So while it would seem unlikely that these products could increase T, the mere availability of such products may be used to raise questions. Recently, positive doping tests have been attributed to prohormones and various organizations have clearly indicated that these supplements are banned. So future positive tests are unlikely to receive much leniency.
Results of Drug Testing
Olympic Level
The IOC-accredited laboratories annually report the number of samples tested and the number of positive tests by sport and substance. Efforts have been made to increase the number of samples collected each year using short- and no-notice testing. Presently the percentage of samples that test positive for AASs has plateaued at about 1.0%.
At the 1996 Olympic games for the first time, AAS screening was done using high-resolution **** spectrometry (HRMA). About 18% of the athletes were tested immediately following their events. In addition, before traveling to the games, many athletes were tested by their national testing authority, and some elite athletes were tested on short notice by their international federation immediately prior to the games. At the games, virtually all medalists were tested and 1 or 2 nonmedalists were selected at random for testing. At preliminary events, winners and losers were randomly selected with each having an equal risk of testing. For team events, the final and semifinal rounds were tested with 2 members of each team selected at random from the athletes who dressed for the event. At preliminary team events, matches were randomly selected for testing and 1 athlete was selected per team. The randomization procedure typically took place near the end of a team event and immediately after the individual competition. The process used an electronic random number generator and was supervised by IOC-appointed officials.
After selection and positive identification by inspection of the athlete's identification badge, and an escort was assigned to observe the athlete at all times until they reported to the doping control station. The athlete had to report to the station within 1 hour of notification. The urine sample was collected under direct observation and rapidly transported to the laboratory under strict chain-of-custody procedures. Within 24 hours the laboratory reported the results to the chair of the IOC Medical Commission. The IOC Medical Commission then conducted a hearing for positive sample tests with the athlete and representatives of the international federation and the country involved. After all sides presented their case, the IOC Medical Commission discussed the case and recommended a course of action to the IOC Executive Board based upon their decision. In serious cases, such as detection of an anabolic steroid, the recommendation was to remove the athlete or responsible individual from the Olympic Village.
United States
In 1984, the USOC became the first sports organization to conduct testing in the United States. Since its inception, the USOC has conducted announced testing for all major events at a minimal rate of 3500 samples per year. About 70% of the tests are performed on men. The number of steroid and related cases in men has gradually declined from 1992 through 1995. From 1984 to 1996, the announced testing program has detected 128 samples positive for steroids and steroid blocking agents (including 10 for women), 12 samples positive for diuretics, 7 for beta-blockers, 15 for narcotics (mostly codeine and propoxyphene), and 365 for stimulants (0.89% of all tests). Because the USOC conducts testing for both national and international events held in the United States, some of the positive results were not among US athletes. Alternatively, USOC athletes are tested in other countries and these results are not included.
NFL
The NFL began testing for illegal drugs and AASs around 1985-1986. Since 1990, UCLA and Indiana University together have tested approximately 8000 samples per year for AASs collected year-round from approximately 2400 players. The selection process is random and all players are at risk for selection at any time. During the season (August to January), an equal number of players are selected from each team once or twice per week. During the off-season, random testing continues with each player eligible to be tested at any time. In addition, all players are tested at the preseason training camp. The random selection process results in a testing rate of approximately 4 tests per player per year (minimum, 1; maximum, 8).
NCAA
In general the NCAA policy and procedures are executed in accordance with a strict set of guidelines. Athletes are tested for steroids at major events like a national championship game. In addition, athletes are also tested for other categories of drugs like marijuana, cocaine, and stimulants. In the past, schools have gotten publicly embarrassed when a player(s) tested positive, so some schools initiated their own in-house drug testing program. Data from a variety of sources points to the fact that at the college level, men’s sports like football, basketball, track and field, baseball, and swimming and women’s sports like track and field, swimming, diving, and softball all have steroid use present. From various studies done over the years, figures as low as 5% (1994) and as high as 15% (1995) have been presented for the fraction of college athletes using AAS. The low number was from a study funded by the NCAA in 1994. Many researchers claimed that the percentage underreported steroid use because of self-reporting. The latter study proved that their assumption may have been correct.
In 1985, 32 Vanderbilt football players were indicted in a case involving the sale and distribution of steroids. In 1986, after years of rumors of widespread drug abuse, the NCAA voted to institute drug testing at major football bowl games and championships in other men’s and women’s sports to detect AAS as well as illegal street drugs and amphetamines. Prior to this, athletes could get steroids from a coach, team physician, or athletic trainer. If you talk with athletes from that time period (1970’s to early 1980’s), many can tell you how they got their AAS from their trainers. When the statistical data is looked at however, the results from several surveys indicate that most athletes obtained AAS from outside physician sources. I think this discrepancy is due to the fact that athletes don’t want to implicate themselves or their sources. It also points out the possible flaws that can be associated with survey-type studies. When you ask a group of athletes if they are taking something, or if they think someone else in their sport is taking something, it is difficult to get unbiased answers. With all the negative press around steroid use, the fact that it is illegal without a doctor’s prescription, and not to mention banned in the NCAA, athletes are conditioned to say they don’t take anything. They also realize that if they report their teammates, then they also become guilty by association.
Prior to 1990, a typical scenario was that an athlete was told he would get drug tested on a given date. This meant he knew in advance when to come off whatever he was taking so he could beat the test. If he didn’t think he was going to beat the test, he could simply go to the team physician, and say he didn’t feel well. The doctor would send him home to get some rest and sleep and get the athlete excused from testing. These tests were done very infrequently so it could be a month or longer before the athlete was called back for a test. Plenty of time for the athlete’s system to clear out anything he was on. In addition, most of the testing was done out of season. So if an athlete was taking something early in the season, he could just go off before the bowl game or out of season testing and then pass every time.
In 1990, the NCAA knew that their drug testing program was not working. The fear tactic had worn off and educated athletes now knew that several agents could be taken up to days before the drug test date to allow their urine sample to test negative. So to discourage AAS use further, the NCAA implemented year round spot-checking in Division I-A and I-AA football. But by the time the NCAA had implemented this testing practice, athletes were already using probenecid (a renal tubular transport blocking agent), epitestosterone (E), diuretics, growth hormone (GH), and other masking agents. The chemical actions of these substances will be covered in part three. For now I will just point out that probenecid prevents the kidneys from excreting steroids and other drugs, E administration lowers the T:E ratio so that the athlete’s drug test shows up negative, diuretics dilute the urine sample, and GH was undetectable by the lab test protocols at that time.
Presently, drug testing for the NCAA is divided between the IOC-accredited laboratories at UCLA and Indiana University. In recent years, 78% to 83% of all NCAA tests (9000-12 000 per year) were short-notice tests (notification of the test was in 48 hours or less). The remaining tests (announced) are divided between male athletes competing in football and other sports and female athletes, who account for approximately 14% of those tested. More than 90% of football and track and field athletes are tested using the short-notice program.

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This is Part Two of a three-part article. The first part focused on the formal process of drug testing in sports, primarily at the international level. This part continues with the formal process and part three will discuss 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.
Labs Approved for Drug Testing
To date, the IOC has accredited 25 testing laboratories around the world. There are 3 in North America (1 in the University of California at Los Angeles School of Medicine, 1 in the Indiana University School of Medicine, and 1 in Montreal, Quebec), 1 each in China, Korea, Australia, Japan, and South Africa, and the rest are in Europe. Once the commitment is made to develop a laboratory, 2 to 3 years are necessary to develop the necessary methods and gain the appropriate experience. Currently, laboratories are developing in Hungary, Poland, Malaysia, Puerto Rico, Brazil, Zimbabwe, Indonesia, and Turkey.
Several requirements are made of the IOC laboratories. They must organize a proficiency program, an annual accreditation examination (which is designed to be quite difficult), and a week-long scientific meeting. The IOC laboratories in the United States and several commercial laboratories are also accredited by the College of American Pathologists for athletic drug testing. The IOC is planning to require the laboratories to join the International Standards Organization accreditation program. In addition to adhering to the testing protocols, the IOC program requires adherence to a code of ethics that forbids testing samples unless they are from a bona fide sports program. Labs found guilty of violating this code may be sanctioned. Thus, the IOC laboratories are prohibited from drug testing athletes who want to learn how to evade detection of drug use.
Positive Drug Tests and Confidentiality
Panels of officials and athletes usually review positive drug tests. Disputed cases may lead to hearings, to arbitration, and to courts at the national and international level. Sports, particularly in the United States, place great emphasis on refining and executing the collection, transport, and testing procedures. In the case of a positive report after screening and confirmation on the "A" urine sample, the athlete may choose to be present to verify that the "B" sample is intact as they last saw it, or may send a representative to do so before the "B" sample is tested.
Generally speaking, athletes are notified by their governing body of any breach of the medical code and have the right to a disciplinary hearing and legal representation. The name of the offending athlete should be kept confidential. However, given the media frenzy over the reporting of positive drug tests, this has been difficult to maintain. The reason for maintaining confidentiality is that new evidence can always overturn the decision. Historically, even when guilt has been proven beyond reasonable doubt, the procedures have occasionally been challenged in the light of new scientific evidence. There are published accounts of unwitting intake of drugs via consumption of natural products such as opioids, which have been detected in urine as the result of eating poppy seeds on bagels. After this discovery, subsequent drug tests were modified to detect opioid metabolites that are derived only from administered drugs. Positive test results have been reported after consumption of chickens that have been injected with preparations of anabolic steroids into fat stores and farm animals treated with clenbuterol. It is for these reasons that the laboratory data should undergo a thorough scientific review before proceedings are instigated through administrative channels and sanctions imposed on athletes suspected of a doping offense.

The Responses of Organizations to Positive Drug Tests

What happens to an athlete once a positive drug test is reported depends on the drug detected and the testing organization. Anabolic-androgenic steroids (AASs), beta-blockers, and amphetamines are considered the most serious offenses and, consequently, the penalties are high. Another consideration is what to do when an athlete’s urine reveals traces of a banned substance that is available OTC or can inhibit performance. As an example, stimulants would most likely impair shooting performance, yet they are still banned. In these cases, different sports organizations considering these possibilities may reach opposite conclusions. This point elucidates how complicated and confusing testing can be for athletes competing in different organizations. Such discrepancies in how athletes may be sanctioned potentiate the possibility of positive doping results for OTC banned substances. The burden is placed upon the athlete to know and understand the rules and sanctions for their sport and the specific organization they are competing in.
At the Olympic level, while the IOC rules may be clear, they only apply to the Olympic Games. Outside Olympic competition, each international or national sports organization sets their own rules. While all sports in theory could and should operate under the IOC rules, in practice this has yet to be achieved. Presently the IOC has a group working on rules agreement within Olympic sports. Further problems at the national level include having to get agreement across the various national governing bodies and between the national governing bodies and their international federations on the rules of drug testing. Some national governing bodies carefully follow the rules of their international federations, but some may not because of lack of clear international federation rules. The final verdict depends on the type or level of competition and the particular sport. In the Olympics, the judgment process takes a few hours. In the United States, an athlete who is not satisfied with the decision of the initial hearing may appeal to the American Arbitration Association. At the international level, an athlete may appeal to the International Court of Arbitration for Sport.

Defenses Used Against Positive Drug Test Results

In the event of a positive sample, some athletes may admit drug use, but most will deny use and attribute the positive result to collection mistakes, breaks in the chain of custody, laboratory error, or sabotage. Sample collection is a possible area of vulnerability, but errors are usually minor (e.g., incorrect date) and do not materially affect the results. Transport and receiving are simple processes and, in general, are not a problem area. Experts have never successfully refuted the data from US laboratories, despite careful scrutiny. While sabotage is possible and should not be excluded, it rarely can be proven. As a precaution, athletes are warned to drink only from sealed containers provided by the collection officials. While sports authorities are skeptical of the sabotage defense, they would consider evidence offered to support it. There are no documented cases of sabotage in the legal or medical literature.
As far as testing positive for a banned substance contained in an over the counter (OTC) drug, athletes often accept the results, but ask for leniency on the basis of unknowing use or lack of understanding that the product contained banned substances. Depending on the circumstances and the amount of drug found in the urine, this explanation may or may not be accepted. If a second offense occurs, then a sanction is usually imposed. In past cases where the testosterone to epitestosterone ratios (T/E) are elevated, athletes have attributed the results to OTC natural products that claim strength enhancements and sometimes are labeled as containing "orchic" or, most recently, prohormones. The amount of testosterone in orchic-type products is very low and the bioavailability of these oral preparations is also low. So while it would seem unlikely that these products could increase T, the mere availability of such products may be used to raise questions. Recently, positive doping tests have been attributed to prohormones and various organizations have clearly indicated that these supplements are banned. So future positive tests are unlikely to receive much leniency.
Results of Drug Testing
Olympic Level
The IOC-accredited laboratories annually report the number of samples tested and the number of positive tests by sport and substance. Efforts have been made to increase the number of samples collected each year using short- and no-notice testing. Presently the percentage of samples that test positive for AASs has plateaued at about 1.0%.
At the 1996 Olympic games for the first time, AAS screening was done using high-resolution **** spectrometry (HRMA). About 18% of the athletes were tested immediately following their events. In addition, before traveling to the games, many athletes were tested by their national testing authority, and some elite athletes were tested on short notice by their international federation immediately prior to the games. At the games, virtually all medalists were tested and 1 or 2 nonmedalists were selected at random for testing. At preliminary events, winners and losers were randomly selected with each having an equal risk of testing. For team events, the final and semifinal rounds were tested with 2 members of each team selected at random from the athletes who dressed for the event. At preliminary team events, matches were randomly selected for testing and 1 athlete was selected per team. The randomization procedure typically took place near the end of a team event and immediately after the individual competition. The process used an electronic random number generator and was supervised by IOC-appointed officials.
After selection and positive identification by inspection of the athlete's identification badge, and an escort was assigned to observe the athlete at all times until they reported to the doping control station. The athlete had to report to the station within 1 hour of notification. The urine sample was collected under direct observation and rapidly transported to the laboratory under strict chain-of-custody procedures. Within 24 hours the laboratory reported the results to the chair of the IOC Medical Commission. The IOC Medical Commission then conducted a hearing for positive sample tests with the athlete and representatives of the international federation and the country involved. After all sides presented their case, the IOC Medical Commission discussed the case and recommended a course of action to the IOC Executive Board based upon their decision. In serious cases, such as detection of an anabolic steroid, the recommendation was to remove the athlete or responsible individual from the Olympic Village.
United States
In 1984, the USOC became the first sports organization to conduct testing in the United States. Since its inception, the USOC has conducted announced testing for all major events at a minimal rate of 3500 samples per year. About 70% of the tests are performed on men. The number of steroid and related cases in men has gradually declined from 1992 through 1995. From 1984 to 1996, the announced testing program has detected 128 samples positive for steroids and steroid blocking agents (including 10 for women), 12 samples positive for diuretics, 7 for beta-blockers, 15 for narcotics (mostly codeine and propoxyphene), and 365 for stimulants (0.89% of all tests). Because the USOC conducts testing for both national and international events held in the United States, some of the positive results were not among US athletes. Alternatively, USOC athletes are tested in other countries and these results are not included.
NFL
The NFL began testing for illegal drugs and AASs around 1985-1986. Since 1990, UCLA and Indiana University together have tested approximately 8000 samples per year for AASs collected year-round from approximately 2400 players. The selection process is random and all players are at risk for selection at any time. During the season (August to January), an equal number of players are selected from each team once or twice per week. During the off-season, random testing continues with each player eligible to be tested at any time. In addition, all players are tested at the preseason training camp. The random selection process results in a testing rate of approximately 4 tests per player per year (minimum, 1; maximum, 8).
NCAA
In general the NCAA policy and procedures are executed in accordance with a strict set of guidelines. Athletes are tested for steroids at major events like a national championship game. In addition, athletes are also tested for other categories of drugs like marijuana, cocaine, and stimulants. In the past, schools have gotten publicly embarrassed when a player(s) tested positive, so some schools initiated their own in-house drug testing program. Data from a variety of sources points to the fact that at the college level, men’s sports like football, basketball, track and field, baseball, and swimming and women’s sports like track and field, swimming, diving, and softball all have steroid use present. From various studies done over the years, figures as low as 5% (1994) and as high as 15% (1995) have been presented for the fraction of college athletes using AAS. The low number was from a study funded by the NCAA in 1994. Many researchers claimed that the percentage underreported steroid use because of self-reporting. The latter study proved that their assumption may have been correct.
In 1985, 32 Vanderbilt football players were indicted in a case involving the sale and distribution of steroids. In 1986, after years of rumors of widespread drug abuse, the NCAA voted to institute drug testing at major football bowl games and championships in other men’s and women’s sports to detect AAS as well as illegal street drugs and amphetamines. Prior to this, athletes could get steroids from a coach, team physician, or athletic trainer. If you talk with athletes from that time period (1970’s to early 1980’s), many can tell you how they got their AAS from their trainers. When the statistical data is looked at however, the results from several surveys indicate that most athletes obtained AAS from outside physician sources. I think this discrepancy is due to the fact that athletes don’t want to implicate themselves or their sources. It also points out the possible flaws that can be associated with survey-type studies. When you ask a group of athletes if they are taking something, or if they think someone else in their sport is taking something, it is difficult to get unbiased answers. With all the negative press around steroid use, the fact that it is illegal without a doctor’s prescription, and not to mention banned in the NCAA, athletes are conditioned to say they don’t take anything. They also realize that if they report their teammates, then they also become guilty by association.
Prior to 1990, a typical scenario was that an athlete was told he would get drug tested on a given date. This meant he knew in advance when to come off whatever he was taking so he could beat the test. If he didn’t think he was going to beat the test, he could simply go to the team physician, and say he didn’t feel well. The doctor would send him home to get some rest and sleep and get the athlete excused from testing. These tests were done very infrequently so it could be a month or longer before the athlete was called back for a test. Plenty of time for the athlete’s system to clear out anything he was on. In addition, most of the testing was done out of season. So if an athlete was taking something early in the season, he could just go off before the bowl game or out of season testing and then pass every time.
In 1990, the NCAA knew that their drug testing program was not working. The fear tactic had worn off and educated athletes now knew that several agents could be taken up to days before the drug test date to allow their urine sample to test negative. So to discourage AAS use further, the NCAA implemented year round spot-checking in Division I-A and I-AA football. But by the time the NCAA had implemented this testing practice, athletes were already using probenecid (a renal tubular transport blocking agent), epitestosterone (E), diuretics, growth hormone (GH), and other masking agents. The chemical actions of these substances will be covered in part three. For now I will just point out that probenecid prevents the kidneys from excreting steroids and other drugs, E administration lowers the T:E ratio so that the athlete’s drug test shows up negative, diuretics dilute the urine sample, and GH was undetectable by the lab test protocols at that time.
Presently, drug testing for the NCAA is divided between the IOC-accredited laboratories at UCLA and Indiana University. In recent years, 78% to 83% of all NCAA tests (9000-12 000 per year) were short-notice tests (notification of the test was in 48 hours or less). The remaining tests (announced) are divided between male athletes competing in football and other sports and female athletes, who account for approximately 14% of those tested. More than 90% of football and track and field athletes are tested using the short-notice program.

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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.
Introduction
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.
Anecdotal Stories
NCAA
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.
Weightlifting
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
Previous Methods
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.
Future Trends
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 **** 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.
Final Words
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.

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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.
Introduction
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.
Anecdotal Stories
NCAA
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.
Weightlifting
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
Previous Methods
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.
Future Trends
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 **** 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.
Final Words
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.