Performance and Image Enhancing Drugs and Substances

Issues, Influences and Impacts

Aaron Smith, Bob Stewart, Kate Westberg, Constantino Stavros

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351029322
• Edition: 1
• Topic: Medicine
• Subtopic: Sports Medicine

In the pursuit of more muscle, enhanced strength, sustained endurance and idealised physiques, an increasing number of elite athletes, recreational sport enthusiasts and body-conscious gym-users are turning to performance and image enhancing drugs and substances (PIEDS). In many instances, such use occurs with little regard for the health, social and economic consequences.

This book presents a nuanced, evidence-based examination of PIEDS. It provides a classification of PIEDS types, physical impacts, rates of use, user profiles, legal and sporting status, and remedial program interventions, covering both elite and recreational use.

It offers the perfect guide to assist students, government policy makers and sport managers in understanding the complex issues surrounding PIEDS consumption.

1
APPLY, INGEST, INJECT AND REGRET

Introduction to performance and image enhancing substances

Introduction: Overview of the book

More than a billion people apply, ingest or inject performance and image enhancing drugs and substances (PIEDS) daily to swell muscle mass, shed fat, sustain endurance, resist fatigue, stimulate energy, improve mood, tolerate pain, deflate inflammation, enhance relaxation, promote concentration, sharpen reactions, maintain alertness, reduce fluid, control steadiness, augment body shape, induce euphoria and strengthen confidence.¹ PIEDS are used to make us look and feel better. The dilemma is, however, that better-looking and -feeling bodies now can come with regret later.

Our aim in this book is to present an easy-to-understand summary and review of the implications associated with the use of PIEDS. We therefore view this book as a ‘primer’—a concentrated guide to understanding PIEDS. It is not a ‘user’s guide’. Rather, this primer focuses on educating and informing anyone interested in PIEDS by identifying the risks associated with their use, from the likelihood of wasting money on ineffective supplements, to the potential for serious harm. However, the forthcoming content should not be seen as a medical guide, or a definitive assessment of each PIEDS type. Many of the PIEDS reviewed here remain under-researched, the full implications of their long-term use unknown. As a result, a comprehensive evaluation cannot be undertaken, so readers should approach the content aware that in many cases the best we can provide is an introductory overview. We advise every reader to consult a medical professional prior to using any PIEDS.

While elite and professional sports have become inexorably linked with performance enhancing drugs, the full extent of their use across the sporting and general community remains unknown. As this book notes, however, the use of substances for image enhancing purposes has escalated to the extent that the volume and scope of use overshadows that within sport’s elite ranks. The unregulated use of PIEDS presently constitutes a serious health and social concern. This book observes the rise of PIEDS alongside their more ready accessibility, a combination that has enticed almost everyone physically active to test out one form of PIEDS or another, from legal, health-bolstering supplements to illicit, health-risky pharmaceuticals. PIEDS are no longer just the purview of elite athletes.

This book contains seven chapters. Chapter 1, here, continues with a summary of the primer’s 10 key conclusions. These are: 1) The abuse of some PIEDS can have serious, deleterious implications for the long-term health of users, both during active use and well after use has discontinued. 2) The use of PIEDS exclusively for image enhancing purposes now exceeds PIEDS use for sporting performance or for medical interventions. 3) Most PIEDS usage is moderate, but the pathological and supra-therapeutic use of substances, dosages and combinations has become normalised in some communities. 4) PIEDS users obtain a significant amount of their knowledge and advice about substances, effects, dosages and distribution through unreliable online sources. 5) The authenticity, quality and potential contamination of PIEDS products have become worrisome. 6) The majority of pharmaceutical-grade PIEDS are acquired without medical guidance or a prescription. 7) Driving forces behind PIEDS use include gender associations, dysfunctional body images and a powerful desire to meet the cultural ideals of health and image. 8) More effective programmes for changing attitudes, behaviours or intentions relating to PIEDS deliver over longer periods, comprise numerous teaching sessions, address a range of topics including drug- and alcohol-related issues and alternatives to drug use and media/peer pressure resistance, and increase participant involvement and ownership through peer-led teaching. 9) Emerging evidence links PIEDS abuse with gateway behaviours, beginning with dietary and nutritional supplements (DNS) and moving into performance enhancing drugs (PEDS). 10) There remains a great deal of confusion about the effects, veracity, risks and legality of different PIEDS.

The remainder of this chapter introduces the problems and issues associated with PIEDS use. It outlines some foundational influences related to PIEDS use, such as their relationship to a user’s life course and the possibility that certain substances serve as gateways to others. Our review demonstrates the need for more research examining the decision-making driving use, as well as the contextual, experiential and behavioural pathways that shape these decisions. Not only must we better understand what influences decisions to employ PIEDS, but we also need to provide policy makers with solid data about how decisions may be influenced in order to produce more responsible practices in the future. Sport and health policy makers need avenues to help users mark out substance-use boundaries that protect their personal health and well-being, without constraining them from improving their physical performances and general health. We suggest that the conclusions noted in this book are important because the decision to use PIEDS can lead to health risks.

Chapter 2 examines the nature, types and use of dietary and nutritional supplements (DNS) as PIEDS. DNS are not inherently unhealthy products in the same way that alcohol, sugary drinks and fast foods may be considered unhealthy. However, concerns have been raised with respect to their efficacy, health risks and the potential for accidental doping. While the efficacy of supplements remains difficult to ascertain, meta-analyses of commonly sold supplements have generally come to the conclusion that while some are demonstrably efficacious, a large percentage of the market consists of products with little or no scientific backing. This is significant because not only do supplement companies promote specifically sports-associated supplements (such as creatine, energy bars, etc.), but they also promote various sport- or health-related products (vitamins, daily health-boosting products, etc.). Evidently some products do have benefits, but the current evidence is not of sufficient quality from which informed decisions can be made. While elite athletes and coaches might be highly knowledgeable about which products to use and when, the general public is unlikely to have access to detailed scientific data on product efficacy or applicability to their exercise and/or health requirements.

With respect to the health risks of DNS use, while acute adverse effects are uncommon there are some indications that the use of some supplements may result in unwelcome health outcomes. Nevertheless, this is rare and usually associated with substances now prohibited in sport, or with excessive dosages. Perhaps more worrying is the skewed perception that all DNS products are safe to take in any amount. Another concern with respect to DNS is that they may contain prohibited, unlabelled substances. While not a concern for the majority of people taking DNS, it may be relevant for elite-amateur or semi-professional athletes.

Chapter 3 explores the scale and scope of PIEDS use. The scope, magnitude and diversity of substance use in sport and recreation make its study complex. For example, some substance use is common, benign and even advantageous to health. Such usage includes the infrequent use of painkillers, the moderate consumption of coffee and the liberal use of most vitamins and recovery supplements such as protein powders. At the same time, both serious recreational athletes and elite athletes use a range of additional substances, the health implications of which range from the uncertain to the severely dangerous. Examples of the latter include the use of significant quantities of analgesics, stimulants, anabolic agents or hormones, sometimes combined in experimental cocktails and dosages. In some cases, athletes employ pharmaceutical products designed for use with animals, while in other cases they test out the latest—probably ineffectual—designer nutritional supplements.

In short, a huge variety of PIEDS are available for athletes to ingest or inject. Adding to the uncertainty is the combination of widespread availability—often through Internet-order mail—and limited (or no) regulation ensuring security around the quality, efficacy and legality of the PIEDS. Since most athletes, both recreational and elite, self-prescribe PIEDS, they tend to engage in potentially dangerous practices such as the ingestion of high dosages, failure to cycle off or in lower dosages, the use of experimental substances, the use of untried combinations and the unknowing use of tainted, contaminated, mislabelled and inauthentic substances, all the while receiving advice on use from a variety of different-quality sources such as coaches, peers, supplement marketers or web forums.

Chapter 4 considers the impact of culture, values and ethnicity on PIEDS use. The evidence indicates that PIEDS use has permeated throughout all cultures and contexts. Alarmingly, it begins in school sport, although most of the available data come from American high schools where inter-school sport is highly valued, and where it contributes significantly to a school’s reputation and financial viability. PIEDS use also seems prevalent in community gyms and fitness centres, with Europe and the United States (US) featuring prominently. Substances of all kinds appear liberally in US colleges and universities as well, where both licit and illici...