PERFORMANCE ENHANCING DRUGS 1 Athletic or PerformanceRelated Fitness

ﺍﻟﻤﻨﺸﻄﺎﺕ ﻭ ﺃﻀﺮﺍﺭﻫﺎ PERFORMANCE ENHANCING DRUGS 1

Athletic or Performance-Related Fitness Agility Balance or equilibrium Coordination Power Reaction time Speed or velocity 2

PERFORMANCE ENHANCING DRUGS 3

Performance-Enhancing Drugs Anabolic Steroids Description Drugs derived from testosterone and approved for medical use, but often used by athletes to increase musculature and weight. 4

Performance-Enhancing Drugs Anabolic Steroids Claims May enhance performance and improves physical appearance. Reported to increase lean muscle mass, strength, and the ability to train longer and harder. 5

Performance-Enhancing Drugs Anabolic Steroids Risks Liver tumors, jaundice, fluid retention, high blood pressure, severe acne, aggression and other psychiatric side effects. Men: Shrinking testicles, reduced sperm count, infertility, baldness, and development of breasts. Women: growth of facial hair, changes in or cessation of the menstrual cycle, enlargement of the clitoris, and deepened voice. 6

7 Table 5 -3, p. 126

Androstenedione produced by: 1 - the ovary, testes, and the adrenal cortex, 2 -is a prohormone for both estrogen and testosterone. . 3 - Androstenedione supplementation has become popular with male athletes because they believe they will be more powerful. 4 -Research shows no measureable effect on free or total testosterone, 5 -but HDL levels dropped and plasma estrogens rose. 6 - No measurable effect has been noted on athletic performance. 8

GYNECOMASTIA These pictures are the “BEFORE” (left) and “AFTER” (right) pictures of a man that had surgery to correct his case of gynecomastia. I’m sure he thought “It won’t happen to me. ” as well! Think about it before you choose to take P. E. D. ! 9

Performance-Enhancing Drugs Androstenodione Claims Improves testosterone concentration, increases muscular strength and mass, helps reduce body fat, enhances mood, and improves sexual performance. 10

Performance-Enhancing Drugs Androstenodione Risks Breast enlargement, increased risk of cardiovascular disease and pancreatic cancer in men, acne, male pattern baldness, and a decrease in “good” (HDL) cholesterol. In women, high testosterone levels can cause increased body hair, deepening of the voice, and other male characteristics. 11

RISKS OF P. E. D. Steroid induced acne Anti-hypertensive behaviors Hypertension or fatigue Chronic gonadotrophin Increased level of female hormones in a man’s body Testicular atrophy Induced gynecomastia Presence of abnormally large breasts in men Increased use of other drugs to mask symptoms 12

SYMPTOMS OF P. E. D. USE Rapid weight gain with larger muscle mass Aggressiveness Jaundice/Skin color change Purple or red spots on body Swelling of feet and legs Shaking and/or trembling Persistent body odors Severe acne breakouts with abnormally oily skin 13

DOES THIS LOOK APPEALING TO YOU? 14

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CNS Stimulants COCAINE CRACK METHAMPHETAMINE 16

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Stimulants Description: A group of synthetic or plant-derived drugs that increase alertness and arousal by stimulating the central nervous system. Medical Uses: Short-term treatment of obesity, narcolepsy, and hyperactivity in children No medical use for methamphetamine Method of Use: Intravenous, intranasal, oral, smoking

Types of Stimulant Drugs 1 - Cocaine Products Cocaine Powder (Generally sniffed, injected, smoked on foil) “Crack” (smoked) 19

Types of Stimulant Drugs 2 - Amphetamine Type Stimulants (ATS) Amphetamine Dexamphetamine Methylphenidate Methamphetamine “Speed” “Ice” “Crank” “Go Fast” 20

Methamphetamine vs. Cocaine half-life: 1 -2 hours Methamphetamine half-life: 8 -12 hours Cocaine and the amphetamines have very similar effects on mood, patterns of abuse, the type of dependence produced, and their toxic effects. Cocaine paranoia: 4 -8 hours following drug cessation Methamphetamine paranoia: 7 -14 days Methamphetamine psychosis - May require medication/hospitalization and may not be reversible Neurotoxicity: Appears to be more profound with amphetamine-like substances, rapid formation of lesions

Acute Stimulant Effects Psychological Increased energy Increased clarity Increased competence Feelings of sexuality Increased sociability Improved mood Powerful rush of euphoria intravenous only freebase and

Acute Stimulant Effects Physical Increased heart rate Increased pupil size Increased body temperature Increased respiration Constriction of small blood vessels Decreased appetite Decreased need for sleep Numbness of nasal mucosa - intranasal only

Chronic Stimulant Effects Physical Weight loss/anorexia Sleep deprivation Respiratory system disease Cardiovascular disease Headaches Severe Dental disease Needle marks and abscesses - intravenous only Seizure Agitation and violence

Cocaine Hydrochloride Crystalline white powder Snorted in “lines” of 10 -35 mg each Adulterated w cheap local anesthetics, stimulants, and inert white powders Yields moderate to high blood levels Gradual onset of effects at 15 -20 min with peak at 30 -60 min 26

Cocaine Hydrochloride: Intravenous Administration Soluble in water Peak blood levels achieved instantaneously Rapid onset, brief duration, intense “crash” Rapid development of compulsive use pattern “Speedball” when mixed with heroin to cushion the “crash” 27

Cocaine: Mechanism of CNS Action Increases the synaptic concentration of dopamine and Norepinephrine by preventing its reuptake Dopamine agonists/replacements have not proved therapeutically useful in addicts 28

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Because… Their Brains have been Re-Wired by Drug Use 31

Partial Recovery of Brain Dopamine Transporters in Methamphetamine (METH) Abuser After Protracted Abstinence 3 0 ml/gm Normal Control Hint: Ask about free radicals! METH Abuser (1 month deter) METH Abuser (24 months detox) Source: Volkow, ND et al. , Journal of Neuroscience 21, 9414 -9418, 2001. 32

Cocaine: Acute Effects Euphoric mood Increased energy, alertness Increased sexuality Paranoia Increased heart rate, blood pressure 33

Cocaine: Chronic Effects Lethargy, fatigue Reduced attention span Sexual dysfunction Depression, irritability, anhedonia Paranoid psychosis 34

Cocaine: Toxic Reactions Cardiac arrhythmias, fibrillation Hyperthermia- > 106º F Convulsions, loss of consciousness Respiratory & cardiac arrest Abruptio placentae (miscarriage) Fatal reactions rare, but unpredictable 35

Cocaine “Crash” Rebound dysphoria Agitation, restlessness Intensifies with dosage & chronicity of use Cravings & drug-seeking behavior Abuse of alcohol & other drugs Suicidal ideation, behavior Often followed by prolonged sleep 36

Cocaine/Amphetamines “The Runs” DRUG TAKING CRAVING DRUG TAKING The Blues FATIGUE DEPRESSION HYPERPHAGIA sleep CRASH CRAVING DRUG TAKING 37

Speed Methamphetamine powder ranging in color from white, yellow, orange, pink, or brown Color variations are due to differences in chemicals used to produce it and the expertise of the cooker Other names: Crystal, Crystal Meth, Crank, Go Fast, Zoom 38

Ice High purity methamphetamine crystals or coarse powder ranging from translucent to white, sometimes with a green, blue, or pink tinge color Depends on additives and filtering 39

Cardiac Disorders and Methamphetamine Coronary Syndromes Arrhythmia Cardiomyopathy Hypertension Valvular Disease 40

Neurologic Disorders and Methamphetamine Use Headache Seizure Cerebrovascular Ischemic stroke Cerebral hemorrhage Cerebral vasculitis Cerebral edema 41

Respiratory Disorders and Methamphetamine Use Pulmonary edema Bronchitis Pulmonary hypertension COPD 42

Formication 43

Formication 44

METH Use Leads to Severe Tooth Decay! “METH Mouth” Source: The New York Times, June 11, 2005. 45

Methamphetamine Psychiatric Consequences Paranoid reactions Permanent memory loss Depressive reactions Hallucinations Psychotic reactions Panic disorders Rapid addiction 46

Methamphetamine Psychosis Inpatients No. of patients having symptoms (%) Psychotic symptom Lifetime Current Persecutory delusion Auditory hallucinations Strange or unusual beliefs Thought reading Visual hallucinations Delusion of reference Thought insertion or made act Negative psychotic symptoms Disorganized speech Disorganized or catatonic behavior 130 (77. 4) 122 (72. 6) 98 (58. 3) 89 (53. 0) 64 (38. 1) 56 (33. 3) 35 (20. 8) 75 (44. 6) 39 (23. 2) 27 (16. 1) 38 (22. 6) 20 (11. 9) 18 (10. 7) 36 (21. 4) 19 (11. 3) 14 (8. 3) Srisurapanont et al. , 2003 47

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THERAPEUTIC DRUGS Diuretics Rapid weight loss Boxing, wrestling, judo Excretion or dilution of illegal substances Overall negative impact on performance Dehydration, hypotension, muscle cramps, electrolyte imbalance 51

THERAPEUTIC DRUGS Opioids Prescription pain killers most common Allow performance while injured 75% used after injury only Increased risk of further injury, dependence, drowsiness, mental clouding; in high doses: respiratory depression, hypotension 52

THERAPEUTIC DRUGS Beta-Blockers Anti-tremor, anxiolytic effect Shooters, ski jumpers, archery Negative effect on endurance Depression, bronchospasm, fatigue 53

PERFORMANCE ENHANCING DRUGS Peptide hormones: HCG Increases testosterone Maintains testicular volume with anabolic steroid use Ovarian cysts 54

PERFORMANCE ENHANCING DRUGS Pituitary and synthetic gonadotropins Increases testosterone, anti- estrogenic Ovarian cysts Corticotropins Increase testosterone Rare and related to excess corticosteroids- pituitary suppression, immunity, osteoporosis, hyperglycemia 55

PERFORMANCE ENHANCING DRUGS Growth hormone Increase muscle mass & decrease fat mass Gigantism, acromegaly, hypothyroidism, cardiac disease, myopathies, arthritis, diabetes mellitus, impotence, osteoporosis 56

PERFORMANCE ENHANCING DRUGS Erythropoietin (EPO) Stimulates RBC production Increases oxygen carrying capacity CVAs Blood doping RBC transfusion, artificial oxygen carriers Increases oxygen carrying capacity Allergic reactions, sludging of blood 57

FOOD SUPPLEMENTS 76 -100% of athletes use vs. 50% general population May or may not contribute to enhanced performance 58

WHAT DO WE HAVE IN COMMON? 59

Questions? 60