4. The use and misuse of performance-enhancing substances in sport

John W Orchard, Deborah J Healey, Peter A Fricker, Louise M Burke and Susan L White
Med J Aust 2006; 184 (3): 132-136.


  • Antidoping laws generally exist in order to provide a safe and fair environment for participation in sport.

  • These laws should prevent and protect athletes from subjecting themselves to health risks through the use of unsafe, but performance-enhancing drugs.

  • Because of difficulties in proving intent to cheat, the World Anti-Doping Agency enforces a principle of strict liability for positive test results for banned substances.

  • An area of major controversy with respect to liability is the “sports supplement” industry, which is poorly regulated when compared with prescription drugs yet is a potential source of doping violations.

  • Medical practitioners can be found guilty of anti-doping violations if they traffic banned drugs, prescribe these to athletes or otherwise assist athletes in taking banned substances.

  • Medical practitioners are also now required to complete paperwork (therapeutic use exemption forms) to enable athletes to take banned substances which are required on medical grounds for specific illnesses.

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  • John W Orchard1
  • Deborah J Healey2
  • Peter A Fricker3
  • Louise M Burke4
  • Susan L White5

  • 2 Sports Medicine at Sydney University, University of Sydney, Sydney, NSW.
  • 3 University of New South Wales, Sydney, NSW.
  • 4 Australian Institute of Sport, Canberra, ACT.
  • 5 Olympic Park Sports Medicine Centre, Melbourne, VIC.


Competing interests:

Susan White is a member of the Australian Sports Drug Medical Advisory Committee (ASDMAC). Peter Fricker was a member of ASDMAC while writing this article, but has since resigned after accepting the position of Director of the Australian Institute of Sport.

  • 1. Yesalis C, Bahrke M. Anabolic-androgenic steroids and related substances. Curr Sports Med Rep 2002; 1: 246-252.
  • 2. Videman T, Lereim I, Hemmingsson P. Changes in hemoglobin values in elite cross-country skiers from 1987–1999. Scand J Med Sci Sports 2000; 10: 98-102.
  • 3. Stray-Gundersen J, Videman T, Penttila I, Lereim I. Abnormal hematologic profiles in elite cross-country skiers: blood doping or? Clin J Sport Med 2003; 13: 132-137.
  • 4. Savulescu J, Foddy B, Clayton M. Why we should allow performance enhancing drugs in sport. Br J Sports Med 2004; 38: 666-670.
  • 5. World Anti-Doping Agency. Comment on para 10.5. WADA Anti-doping code, 2005. Available at: (accessed Jan 2006).
  • 6. National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines. Canberra: NHMRC, 1999. Available at: (accessed Jan 2006).
  • 7. van Baak M, de Hon O, Hartgens F, Kuipers H. Inhaled salbutamol and endurance cycling performance in non-asthmatic athletes. Int J Sports Med 2004; 25: 533-538.
  • 8. Kaufman K. Modafinil in sports: ethical considerations. Br J Sports Med 2005; 39: 241-244.
  • 9. Hodges A, Lynn B, Bula J, Donaldson M, et al. Effects of pseudoephedrine on maximal cycling power and submaximal cycling efficiency. Med Sci Sports Exerc 2003; 35: 1316-1319.
  • 10. Magkos F, Kavouras S. Caffeine and ephedrine: physiological, metabolic and performance-enhancing effects. Sports Med 2004; 34: 871-889.
  • 11. Orchard J. Is it safe to use local anaesthetic painkilling injections in professional football? Sports Med 2004; 34: 209-219.
  • 12. Conway A, Handelsman D, Lording D. Use, misuse and abuse of androgens. Med J Aust 2000; 172: 220-224.
  • 13. Corrigan B. Attention deficit hyperactivity disorder in sport: a review. Int J Sports Med 2003; 24: 535-540.
  • 14. Burke L. Sports supplements and sports foods. In: Hargreaves M, Hawley J, editors. Physiological bases of sports performance. Sydney: McGraw Hill, 2003.
  • 15. van Loon L, Oosterlaar A, Hartgens F, et al. Effects of creatine loading and prolonged creatine supplementation on body composition, fuel selection, sprint and endurance performance in humans. Clin Sci (Lond) 2003; 104: 153-162.
  • 16. Requena B, Zabala M, Padial P, Feriche B. Sodium bicarbonate and sodium citrate: ergogenic aids? J Strength Cond Res 2005; 19: 213-224.
  • 17. Blue JG, Lombardo JA. Steroids and steroid-like compounds. Clin Sports Med 1999; 18: 667-689.
  • 18. Geyer H, Parr MK, Mareck U, et al. Analysis of non-hormonal nutritional supplements for anabolic androgenic steroids — results of the international IOC study. Int J Sports Med 2004; 25: 124-129.
  • 19. Bosy T, Moore K, Polkis A. The effect of oral dehydroepiandrosterone (DHEA) on the urine testosterone/epitestosterone (T/E) ratio in human male volunteers. J Anal Toxicol 1998; 22: 455-459.
  • 20. Uralets VP, Gillette PA. Over-the-counter anabolic steroids 4-androsten-3,17-dione; 4-androsten-3beta,17beta-diol; and 19-nor-4-androsten-3,17-dione: excretion studies in men. J Analyt Toxicol 1999; 23: 357-366.
  • 21. Geyer H, Bredehoft M, Mareck U, et al. High doses of the anabolic steroid metandienone found in dietary supplements. Eur J Sport Sci 2003; 3: 1-5.
  • 22. Yesalis C. Medical, legal, and societal implications of androstenedione. JAMA 1999; 281: 2043-2044.


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