United States Sports Academy - "America's Sports University"

Abstract

Incidence of anabolic steroid use among college athletes is about 1%, with another 12% considered at-risk in that they would use such drugs under the right circumstances. This study aimed to determine if volunteer drug testing, without fear of penalty, would result in positive identification of drug use, or if the testing alone is a deterrent. A group of 197 college athletes, all of who denied drug use, voluntarily and anonymously supplied urine samples. Average T/E ratio was 1.33 ± 0.86, with two cases (1.1%) above the accepted ratio. We conclude that T/E ratio testing is effective in detecting use of performance-enhancing drugs and that testing itself, although an effective deterrent to drug use, may not eliminate drug use among college athletes.

Introduction

Athletes have used performance-enhancing drugs for decades. In 1968 the International Olympic Committee (IOC) banned the use of performance-enhancing substances to promote fair play in competition. At that time the banned substances were primarily anabolic steroids and amphetamines. Other athletic associations and sport governing bodies soon followed suit by adopting similar bans, including the National Collegiate Athletic Association (NCAA) which adopted a drug-testing program to promote fair and equitable competition and to safeguard the health and safety of student-athletes. Since then the specified number of banned substances has risen dramatically as athletes are driven to finding new ways to obtain a competitive edge and/or to avoid detection. Currently the NCAA promotes drug education and mandates that each athletic department conduct a drug and alcohol education program once a semester, presumably to increase the athletes' understanding of the drug-testing program and to promote the avoidance of drug use.

Despite these regulations, the incidence of anabolic steroid use among athletes has not decreased, and, in some instances, has increased (Catlin & Murray, 1996). In general, the decision to not use drugs is felt to be related more to the fear of reprisal than to health issues, and users continue to look for ways to avoid detection rather than decide not to use these banned substances. Tricker and Connolly (1997) reported an 8% rate of anabolic steroid use in college athletes over a lifetime and a 1% use within the past six months. In addition they identified about 12% at-risk athletes, i.e., they would use steroids under the right circumstances. Those circumstances were largely defined as the ability to achieve their athletic potential without testing positive for use.

The purpose of this study was to examine T/E ratios in a group of college athletes who volunteered for testing under the conditions of anonymity and therefore had no fear of reprisal. The T/E ratio was chosen because of its low false-positive rate (0.1%). We aimed to determine if the anticipated results of no positive test results would occur, or if there might be any positive test results with the threat of reprisal removed.

Method

Subjects

A group of 206 male varsity or junior varsity NCAA Division I college athletes identified themselves as not currently taking nutritional supplements or performance-enhancing drugs and volunteered to provide a urine sample for testing. Because the testing was done anonymously, there was no fear of reprisal from submitting to the testing. Nine samples were contaminated during processing and were eliminated, leaving a study group of 197 college athletes, all of whom would presumably have negative test results.

Testing Procedure

Urinary specimens were examined for the ratio of testosterone (T) to epitestosterone (E). The accepted standard for identifying anabolic steroid use was used with a T/E ratio above 6:1 as a positive indication of doping (Catlin et al.,1996; International Olympic Committee, 1982). All urine specimens were run on HP 599SC gas chromatography - mass spectrometry (Hewlett Packard Company, Avondale, Pennsylvania) using standard testing procedures (Borts & Bowers, 2000; Dehennin, 1994; Ismail & Harkness, 1966; van de Kerkhof, De Boer, Thijssen, & Maes, 2000). Because there is a small incidence of false positive results, it is recommended that additional testing be done on those whose T/E ratios exceed 6:1 before legal action is considered (Dehennin & Scholler, 1990). However, in this study, no additional testing was done as the athlete could not be identified and there would be no punitive action. It is also known that there are athletes who use exogenous testosterone, yet their T/E ratio never exceeds 6:1 (Garle, Ocka, Palonek, & Bjorkhem, 1996).

Results

The average testosterone/epitestosterone (T/E) ratio was 1.33:1 ± 0.86 (mean ± standard deviation). Two of the 197 (1.1%) athletes tested had T/E ratios greater than the accepted international standard (12:1 and 9:1) and, thus, had positive test results. Thus, the specificity of the T/E testing in this study group was 195/197 (98%) as all subjects were presumably drug-free.

Discussion

Our data confirms that the T/E ratio testing is at least 98% accurate, depending upon the true drug status of the two individuals who had abnormal T/E ratios in this study. The two specimens with ratios higher than the accepted norm were not verified with further testing, and, therefore, it is not know whether these two cases represented true or false positives. If we assume that those two athletes were, in fact, taking performance enhancing drugs, the accuracy, sensitivity, specificity, of the T/E ratio testing becomes 100%.

The fact that two athletes tested positive under the study conditions is interesting. Although only those who professed that they did not use any performance-enhancing drugs were recruited for the study, perhaps those two athletes thought they might draw attention by their lack of participation and possibly be singled out for sanctioned testing in the future if they chose not to participate. Since there was no fear of personal identification or of reprisal for positive test results, they may have felt participation was risk-free regardless, or they simply may have felt that they could beat the system or wanted to test the system to see if they might go undetected.

Confirmation or refutation in the two positive cases was not pursued. However it is felt that most likely these were true positives. The reasons for this assumption are based on known percentages of drug use among college athletes and previous reports of the incidence of false positive results on initial testing. Tricker and Connolly (1997) reported a 1% use of anabolic steroids within the past six months in their survey of 563 college athletes. Catlin and Murray (1996) reported a similar percentage in Olympic athletes over a nine-year period and, over a three-year period in NCAA football players, the average was also approximately 1%. On the other hand, Dehennin and Scholler (1990) reported the incidence of false positives at 15 per 10,000 (0.15%). The two positive results in this group of 197 college athletes represented 1.1% of the study group, and this percentage would be consistent with the anticipated number of positive results in a random sample of male college athletes.

The more important issue is that the use of anabolic steroids among athletes, although not increasing, has not diminished under the current testing programs. Even in this study, where volunteer athletes were recruited to participate only if they were non-users, positive test results occurred. This is not to say that the testing programs are ineffective, but they are not entirely effective in acting as a deterrent to drug use. The fear of testing positive and risking disqualification or sanction clearly deters a certain percentage of athletes considered at risk for drug use, but others continue to use drugs and either hope to or try to beat the system. Testing programs vary among sports governing agencies. At the 1996 Olympics Games in Atlanta, approximately 18% of athletes were tested after their events including all medallists and one or two others at random (Catlin and Murray, 1996). Random testing leaves a chance for an athlete to avoid detection, yet testing of all athletes one or more times during a season is cost-prohibitive. In addition, those motivated to gain a competitive edge, legal or otherwise, will seek novel ways to avoid detection, including taking masking substances.

Drug use is a serious concern, not only for the concepts of integrity and fair play in competitive sports, but because of the health threats to the athletes. Certainly drug testing programs should continue with increasing numbers of athletes being tested and increasing penalties for detection, since these are most likely means of deterrence. Drug education programs must also continue in a further attempt to curtail the use of illegal performance-enhancing drugs by empowering the young athlete with the information and skills to make responsible and healthy decisions.

Conclusion

Drug testing programs are designed to promote fair play and deter drug use among athletes. Under conditions of anonymity a group of professed non-user athletes volunteered for drug testing. Two positive results were identified indicating the importance of continued testing and need for further testing and education, as testing alone is not a sufficient deterrent to eliminate drug use among college athletes.

Acknowledgement

This study was supported by a student institutional grant by and performed at Brigham Young University in Provo, Utah. References

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Russell Meldrum, MD, and
Judy R. Feinberg, PhD
Indiana University
School of Medicine
Department of Orthopedic Surgery
541 Clinical Drive
Suite 600
Indianapolis, IN 46202-5111
Phone: 317-274-8318
Fax: 317-274-3702
Email: rmeldrum@iupui.edu