Table 2 illustrates some ways organized doping groups may seek to change environmental factors to enable doping. For the first factor, athletes’ physical safety is looked after by doctors or other lay experts to ensure optimum use for getting desired enhancing effects without negatively impacting health or performance. Their social risks are managed by providing social support among the doping group who all share the same (secretive) use. Policy risks are reduced by anticipating anti-doping testing in order to circumvent a positive test. Similarly, economic risks, including loss of one’s livelihood, are managed by avoiding positive tests and ensuring no disqualification, loss of prize money, or loss of sponsorships. Similar systems have also been reported in competitive bodybuilding where coaches support competitors doping practices through advising on what to take, how to acquire substances, proper dosing, and managing risks (Andreasson & Johansson, 2020; Monaghan, 2001).

The difference is that today’s doping substances are safer than they were years ago, when some athletes died because of them. In fact, many steroids are of medical use today and are administered to patients who have undergone difficult operations and need faster recovery. Coaches have an important role in athlets’ doping, most of the time, they are responsible negative effects of drugs in sport for the illegal actions of athletes by offering them the forbidden substances or by acquainting them with people who are involved in doping. There are also athletes who do not know the utility of a substance or if it is on the forbidden list and with their doctor’s recommendation they use the substance which may be on the forbidden list.

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PED users are increasingly encountered in needle-exchange programs, where they may sometimes represent most of the clientele (79, 80). In the largest Internet study, only 1 of 1955 male AAS users (0.05%) reported starting AAS use before age 15, and only 6% started before age 18 (39). In 5 other studies, collectively evaluating 801 AAS users, only 12 (1.5%) started before age 16, and 199 (24.8%) started before age 20. Notably, the median age of onset across all studies consistently fell into the narrow range of 22 to 24 years. However, the actual median age of onset is probably higher, because at the time of recruitment, many study candidates had not completed the age range of risk for starting AAS use.

The number of doping substances is very high, and their individual cataloging is not the purpose of this article. Instead, we can make a general classification according to how they act. A classification from S0 to S9 (Table 1) for prohibited substances and from M1 to M3 (Table 2) for prohibited methods has been developed. Programs that seek to remove doping as a viable activity for athletes want to preserve what is valuable about competition in the first place. Athletic competitions and games should be fun, build character, and offer a foundation of honesty. You must have a respect for oneself before there is an embrace of the true competitive nature that occurs during these events.

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Decades of draconian punishments have failed to eliminate, or even consistently lower levels of recreational drug use within the general population; there were more than a half million deaths related to illicit drug use in 2017 alone (United Nations Office on Drugs & Crime, 2019). Much like the complex individual and structural strains that shape problematic drug use outside of sport contexts, the disproportionate material and symbolic rewards that drive some athletes’ interest in doping are likely to persist, and in turn inspire systematic doping schemes. Policy changes that seek to reduce harm among some athlete groups, such as recreational, youth, or elder sport participants, could provide a similar concession within the sport context. Harm reduction proposals for addressing doping have attempted to do so by advancing suggestions such as medically supervised doping, health checks, and threshold testing (Kayser et al., 2007; Kayser & Tollneer, 2017; Smith & Stewart, 2015). Utilising such strategies in a policy context may begin to help foster sport enabling environments that are so far available only through illicit doping systems.

In fact, studies have reported steroid binding sites on both GABA and the N-methyl-d-aspartate neurons (256). The function of these receptors remains poorly understood, although there is some overlap with the opioid system (257, 258). These sites are recognized by neurosteroids produced endogenously in the brain. AASs also may interact with enzymes involved in neurosteroid metabolism, thereby modulating the action of these neurosteroids, which are known to produce effects on various behaviors (256, 259). Testosterone remains popular, both among elite athletes and nonathlete weightlifters, because of its low price, relatively ready access, and the challenges in distinguishing exogenous from endogenous sources of testosterone.

D. Erythropoiesis-stimulating agents

In 2004, I was in the middle of the Tour de France, I did a transfusion, I’d given blood weeks before and it was getting reinfused back into me, and I think the red blood cells had gone bad. And I had a bad reaction, my urine was like, black with dead red blood cells, I had a fever. I didn’t know if I could die from that, and sure enough, from the research that I’ve found out, that, yeah, it could have been really bad. In small doses narcotics have medical uses that include relieving severe pain and inducing sleep.

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