Transcript NCAA Drug Policies: What administers need to know

Examining Drugs, Alcohol and
Supplement Use in Sport:
What do we know?
AVCA 2008
Kathy Turpin
The National Center for Drug
Free Sport, Inc.
www.drugfreesport.com
Mary E. Wilfert
National Collegiate Athletic
Association
www.ncaa.org/health-safety
/
Who is The National Collegiate
Athletic Association?


Higher Education Association with services to
support athletics departments at over 1000 IHE
Membership-led association abiding by the NCAA
principles of student-athlete welfare: shared
responsibility to provide an environment that
protects the health safety of student-athletes.
NCAA Committee on
Competitive Safeguards and Medical
Aspects of Sports

University staff that work in sports medicine, law,
athletics administration, research.

Researches student-athlete health and safety issues.

Oversees NCAA drug-education and testing policy.

Develops sports medicine handbook guidelines.

Ensures fair and credible drug-testing and appeals
processes.
NCAA Study of Substance Use





Conducted every four years
Over 20,000 student-athletes complete
anonymously (out of 380,000 S-A)
Trends help determine policy and practice
Reported use is within last twelve months,
unless otherwise indicated
Following slides are from the 2005 study.
Ergogenic Drug Use - By NCAA Division
5
4.6
4.5
4
4
3.8
Percent
3.5
3
2.5
2.6
2.6
2.4
2
1.5
1.3
1.2
1
1
0.5
0
Division I
anabolic steroids
Division II
amphetamines
Division III
ephedrine
Ergogenic Drug Use - By Gender
5
4.4
4.5
4
3.6
Percent
3.5
3
3
2.5
2
1.7
1.7
1.5
1
0.5
0.2
0
Male
anabolic steroids
Female
amphetamines
ephedrine
Ergogenic Drug Use - By Ethnicity
5
4.5
4.5
4
3.4
Percent
3.5
3
2.5
2.7
2.4
2.5
2.2
2
1.7
1.7
1.5
1
1
0.5
0
White
anabolic steroids
Black
amphetamines
Other
ephedrine
Ergogenic Drug Use - Historic Trends
5
4.5
4
Percent
3.5
3
2.5
2
1.5
1
0.5
0
1989
1993
anabolic steroids
1997
2001
amphetamines
ephedrine
2005
Out of about 20,000 student-athletes,
214 males and 13 females reported hGH* use
Males:

106 FB

33 baseball

30 basketball

14 soccer

13 wrestling

12 outdoor

9 indoor

8 lacrosse

8 golf

7 Tennis

6 cross country

3 Ice Hockey

Smattering of other

0 VB / 85 surveyed
Females:
6 basketball
4 golf
3 soccer
3 indoor
2 outdoor
2 lacrosse
2 VB/ 871 surveyed
*reports of hGH use may not accurately reflect true use of growth hormone, as many “hGH” products
don’t actually contain growth hormone. . . . .
Social Drug Use - By NCAA Division
90
80
81.5
74.7
74.5
70
Percent
60
50
40
25.8
30
20
17.3 16.2
17.8 16.6
16.4 16.6
14.1
12.3
10
0
Division I
alcohol
Division II
marijuana
spit tobacco
Division III
cigarettes
Social Drug Use - By Gender
90
80
77.2
76.8
70
Percent
60
50
40
30
25.8
22.6
20
16.9
15.9
12.8
10
1.7
0
Male
alcohol
Female
marijuana
spit tobacco
cigarettes
Social Drug Use - By Ethnicity
90
82
80
70.1
70
Percent
60
52.8
50
40
30
20
21.3 18.6
19.7
15.3
14
10
12 15.1
6
5.3
0
White
alcohol
Black
marijuana
spit tobacco
Other
cigarettes
Social Drug Use - Historic Trends
90
80
70
Percent
60
50
40
30
20
10
0
1989
1993
alcohol
marijuana
1997
2001
spit tobacco
cigarettes
2005
Among Drinkers, Those Having 6 or More Drinks
per Sitting
70
60
61.9
56.5
55.5
Percent
50
40
26.9
30
20
22.6
20.7
10
0
1997
2001
Male
Female
2005
Among Drinkers, Those Having 10 or More Drinks
per Sitting
30
27.8
25
20.5
20.7
Percent
20
15
10
5
3.4
2.4
2.3
0
1997
2001
Male
Female
2005
Alcohol on Performance






Causes dehydration which slows healing
Requires increased conditioning to
manage weight
Slows muscle recovery
Inhibits absorption of nutrients
Interferes with ability to sharply focus
Hampers memory and retention
Ergogenic Drug Use in Women’s Sports
Women’s
Basketball
Women’s
Softball
Women’s
Swimming
Women’s
Tennis
Women’s
Track/Field
Drug
1993
Amphetamines
1997
2001
2005
1993
1997
2001
2005
1993
1997
2001
2005
1993
1997
2001
2005
1993
1997
2001
2005
1.5% 1.0% 2.0% 2.9% 4.0% 4.7% 3.9% 5.2% 2.2% 4.7% 3.3% 4.4% 0.0% 2.5% 2.7% 2.6% 1.4% 2.1% 1.7% 1.9%
Anabolic
1.5% 0.4% 0.7% 0.3% 1.7% 0.9% 0.8% 0.4% 0.6% 0.8% 1.3% 0.1% 2.7% 0.3% 0.0% 0.2% 2.7% 0.6% 0.6% 0.1%
steroids
Ephedrine
N/A
1.8% 1.3% 1.5%
N/A
1.1% 2.3% 2.9%
N/A
0.5% 2.2% 1.7%
N/A
1.9% 1.2% 1.2%
N/A
0.9% 1.3% 1.1%
Ergogenic Drug Use Patterns in Other Women’s Sports
Anabolic
Amphetamines
Ephedrine
steroids
Sport
1997
2001
2005
1997
2001
2005
1997
2001
2005
Fencing
0.0%
0.0%
**
0.0%
0.0%
**
3.0%
2.5%
**
Field Hockey
4.6%
4.1%
4.4%
1.5%
0.0%
0.0%
0.5%
1.9%
3.1%
Golf
5.1%
3.0%
4.6%
0.0%
0.5%
0.4%
1.5%
1.9%
3.0%
Gymnastics
3.3%
3.4%
2.1%
0.0%
0.0%
1.0%
1.1%
3.4%
1.1%
Ice Hockey
0.0%
2.4%
4.9%
0.0%
0.8%
2.4%
0.0%
3.2%
11.9%
Lacrosse
3.2%
2.9%
8.6%
0.0%
0.0%
0.0%
1.1%
0.3%
2.7%
Skiing
4.3%
**
**
0.0%
**
**
0.0%
**
**
Soccer
5.3%
4.6%
4.3%
0.5%
0.5%
0.1%
3.3%
1.6%
1.0%
Volleyball
3.0%
4.1%
2.9%
0.8%
0.1%
0.6%
2.1%
1.7%
1.7%
Social Drug Use in Women’s Sports
Women’s
Basketball
Women’s
Softball
Women’s
Swimming
Women’s
Tennis
Women’s
Track/Field
Drug
1993
Alcohol
1997
2001
2005
1993
1997
2001
2005
1993
1997
2001
2005
1993
1997
2001
2005
1993
1997
2001
2005
85.3% 78.5% 72.0% 67.4% 91.3% 81.4% 85.8% 80.9% 92.2% 84.3% 88.3% 83.3% 96.1% 78.4% 84.4% 73.1% 82.5% 72.9% 71.3% 64.6%
Cocaine/
0.7%
0.8%
0.8%
0.7%
1.2%
1.8%
1.3%
1.4%
1.7%
1.5%
1.6%
1.1%
0.0%
0.8%
1.5%
1.4%
0.0%
0.2%
0.6%
0.5%
crack
Marijuana/
hash
14.7% 22.4% 21.3% 12.1% 24.2% 26.5% 29.1% 18.2% 29.5% 29.0% 29.9% 19.6% 21.6% 21.4% 20.4% 14.0% 11.5% 17.5% 14.8% 10.4%
Spit
Tobacco
7.4%
5.3%
3.5%
1.6%
8.6%
8.5%
4.9%
2.9%
9.5%
5.4%
3.2%
1.4%
10.7%
1.4%
3.6%
1.6%
6.9%
4.1%
1.5%
0.9%
Psychedelics/
hallucinogens
N/A
1.9%
1.6%
0.7%
N/A
2.6%
4.0%
0.9%
N/A
5.6%
3.7%
2.2%
N/A
3.2%
2.1%
0.6%
N/A
2.8%
1.5%
0.5%
Cigarettes
N/A
N/A
18.9% 10.9%
N/A
N/A
35.3% 22.6%
N/A
N/A
31.3% 16.8%
N/A
N/A
30.1% 17.0%
N/A
N/A
11.6%
6.2%
Social Drug Use Patterns in Other Women’s Sports
Alcohol
Cocaine/crack
Marijuana
Spit tobacco
Psychedelics
Sport
1997
2001
2005
1997
2001
2005
1997
2001
2005
1997
2001
2005
1997
2001
2005
Fencing
78.8%
80.0%
**
0.0%
0.0%
**
12.1%
10.0%
**
3.0%
0.0%
**
3.0%
0.0%
**
Field Hockey
88.8%
88.4%
88.8%
1.0%
2.5%
0.9%
34.9%
38.2%
23.6%
6.6%
4.1%
0.9%
9.3%
5.6%
1.0%
Golf
89.8%
83.9%
75.1%
3.0%
1.4%
2.5%
28.6%
20.9%
14.5%
5.1%
2.9%
4.1%
2.9%
1.6%
0.4%
Gymnastics
75.3%
78.4%
87.5%
0.0%
1.1%
1.1%
21.4%
13.6%
13.5%
5.4%
1.1%
2.1%
1.1%
1.1%
0.0%
Ice Hockey
83.4%
87.9%
92.9%
0.0%
1.6%
0.0%
35.3%
28.5%
34.1%
22.3%
5.6%
19.5%
0.0%
5.8%
2.4%
Lacrosse
95.9%
93.7%
93.3%
1.1%
1.6%
3.6%
51.5%
42.8%
36.5%
12.4%
2.8%
4.6%
14.3%
3.8%
0.9%
Skiing
83.3%
**
**
0.0%
**
**
16.7%
**
**
12.5%
**
**
0.0%
**
**
Soccer
86.9%
87.4%
83.4%
1.1%
1.3%
2.3%
37.6%
29.5%
24.1%
6.0%
3.5%
3.3%
7.6%
4.9%
2.6%
Volleyball
81.9%
77.9%
79.1%
1.2%
1.2%
1.6%
24.6%
22.6%
15.9%
5.0%
2.1%
1.6%
3.4%
3.5%
1.7%
Initial Use of Ergogenic Drugs
Percentages Based on Those Who Continue to Use
*Nutritional Supplement related question was not included previous to the 2001 survey.
Amphetamines
Anabolic steroids
All nutritional
supplements*
Ephedrine
Response Choice
1997
(n=197)
2001
(n=345)
2005
(n=1223)
1997
(n=61)
2001
(n=100)
2005
(n=397)
1997
(n=254)
2001
(n=520)
2005
(n=1729)
2001
(n=6191)
2005
(n=8271)
Junior high or
before
10.1%
5.7%
14.3%
26.9%
15.4%
17.4%
3.4%
3.5%
6.4%
5.7%
9.2%
High school
53.7%
46.2%
51.4%
25.0%
41.8%
39.3%
37.4%
58.0%
66.4%
57.3%
66.1%
During
freshman year
of college
15.4%
26.0%
19.1%
19.2%
16.5%
16.4%
18.9%
17.3%
16.0%
20.0%
14.7%
After freshman
year of college
20.7%
22.1%
15.1%
28.8%
26.4%
27.0%
40.3%
21.2%
11.2%
15.9%
9.9%
Initial Use of Social Drugs
Percentages Based on Those Who Continue to Use
Alcohol
Cocaine/crack
Marijuana/hashish
Spit tobacco
Cigarettes*
Response Choice
1997
(n=9279)
2001
(n=14405)
2005
(n=15849)
1997
(n=78)
2001
(n=139)
2005
(n=647)
1997
(n=1865)
2001
(n=2899)
2005
(n=6865)
1997
(n=1941)
2001
(n=2393)
2005
(n=3982)
2001
(n=4606)
2005
(n=4019)
Junior high or
before
14.2%
13.1%
17.0%
10.7%
10.2%
9.9%
8.6%
14.8%
16.3%
17.8%
17.0%
15.5%
16.6%
25.9%
High school
63.2%
64.9%
60.7%
34.7%
32.8%
45.4%
62.7%
63.7%
65.7%
58.7%
57.0%
57.9%
59.0%
53.9%
During freshman
year of college
18.2%
17.1%
16.9%
10.7%
21.9%
21.2%
17.4%
12.9%
11.8%
15.0%
16.4%
17.3%
14.6%
12.1%
4.3%
4.9%
5.4%
44.0%
35.2%
23.5%
11.4%
8.6%
6.1%
8.4%
9.7%
9.3%
9.8%
8.1%
After freshman
year of college
Dietary Supplements
US Dietary Supplement Health and
Education Act of 1994:
Puts burden onto FDA to prove that a
nutritional supplement is harmful before
it can regulate its sale.
Dietary Supplements



Do not need to be
proven effective
Do not need to be
proven safe
Lack standards on
potency and
PURITY
Where do athletes get
supplement information?
What Athletes tell us about
supplement use





Can’t gain weight without it
Can’t meet nutrient needs
Want the extra edge
Can’t be all bad –
everyone is using
I only use legal supplements
without
What we know about supplements?



In 2001, the IOC conducted a study of 634
non-hormonal supplements from around the
world
Products included – vitamins, minerals, protein
powders, creatine, herbal extracts, etc.
Looked at 13 nations and 215 different
companies

Supplements were tested in IOC accredited lab

Only looked for anabolic steroids

Results:
What we know about supplements?
Country
No. of products No. of positives % of positives
Netherlands
31
8
25.8 %
Austria
22
5
22.7 %
UK
37
7
18.9 %
USA
240
45
18.8 %
Italy
35
5
14.3 %
Spain
29
4
13.8 %
Germany
129
15
11.6 %
Belgium
30
2
6.7 %
France
30
2
6.7 %
Norway
30
1
3.3 %
Switzerland
13
-
-
Sweden
6
-
-
Hungary
2
-
-
Total
634
94
14.8 %
Is your athlete willing to take a 14.8 % chance they will test positive?
What we know about supplements?





In 2007, HFL a British laboratory that does sport
drug surveillance, conducted a study of dietary
supplements sold in the USA
Study was overseen by Informed Choice
Of the 52 products analyzed, 25% contained
traces of anabolic steroids and 11.5% contained
banned stimulants
Report concluded: “It is clear that not all
supplement manufacturers follow good
manufacturing practices and the necessary
control are not always implemented to ensure
the safety of athletes and the general public who
use supplement products.”
Bottom line: Nothing has changed!
What we know about supplements?

Most dietary supplements are ineffective

For the few supplements that do work:

Not everyone benefits equally

They don’t help for all events

They can  performance in some events

Some have significant side effects
NCAA 2005 drug use survey

21,000 athletes surveyed
41% reported nutritional/dietary supplement use within
last year

Most commonly used:





Creatine
Protein products and amino acids
Thermogenics
Most cited reasons for use were



To improve athletic performance (38%)
For health reasons in general (24%)
For weight loss/weight gain (22%)
Creatine


Not a banned substance.
What does it claim?



promote muscle growth
reduce recovery time
Increase energy production
[No evidence of increasing muscle mass without
resistance exercise]

What does the research
say?



Short-term use appears safe,
but…cramping, heat illness
Long-term risks not known
and difficult to study.
Recommendations are not to
provide to youth!
“Weight-loss supplement linked to
at least 155 deaths”
The use of stimulants
- including ephedrine –
before, during or after
exercise, especially when
such use is accompanied by
hot and/or humid
environments is
dangerous.
Sports drinks vs. “Energy” drinks



Sports Drinks
Rehydrate
Help maintain
electrolyte balance
Do not contain
stimulants
Energy Drinks
o
o
o
May contain more
concentrated sugar
Contain one or more
sources of stimulants
(caffeine, guarana)
May contain amino acids
and herbals (unregulated)
Caffeine Comparison:
360 mg
Caffeine
4.5 lbs of milk chocolate
8 cans of
Classic Coke
Anabolic Steroid Control Act of
2004

Prohormones are now Anabolic Steroids
and classified as Schedule III Controlled
Substances

Illegal to possess without a prescription

Carved out an exception for DHEA
DHEA



Dehydroepiandrosterone is a prohormone, produced by the adrenal
gland and is found naturally in the
body.
Advocates claim that DHEA
supplements can improve mood,
increase energy and libido, counteract
the effects of stress, preserve muscle,
strengthen the immune system, and
prevent cancer and heart disease.
DHEA is an NCAA banned
substance.
What about Multi-Vitamins?



Subject to the same
lack of regulation
No guarantees
Added Herbs
Before deciding to use a supplement






Do I need this supplement?
Do I know that this supplement is
safe?
Does this supplement interact with
any drug or food I am consuming?
Do I know that this supplement
works?
Can I afford this supplement?
Do I know enough about this
supplement?
Performance Enhancers
Food
Hydration
Conditioning
Rest and Recovery
Stress Management
Stay Well!
The Message . . . .
Good Nutrition
Promotes Health
Enhances Performance!
Nutrition Survey
n = 9930
If you skip meals, which one are you most likely to
miss?
n
%
I do not skip meals
2248
22.9
Breakfast
4683
47.6
Lunch
2636
26.8
Dinner
268
2.7
What is your main reason for skipping meals?
n
%
Lack of time
4366
Food not around
629
Practice conflicts with meal time
718
Dining hall not open
199
Not hungry
1089
Weight managment
276
Financial concerns
278
57.8
8.3
9.5
2.6
14.4
3.7
3.7
Female Athlete Triad
NCAA Study:
Coaches Regarding Amenorrhea

1%: normal, not serious

36%: normal, assess after 6 months

15%: not normal, not harmful

48%: not normal, medical required
Female coaches were more likely to be aware of, talk to
athletes about, and refer for menstrual irregularity.
2003 NCAA Coaches Survey
Meals and Snacks

institutions must take
responsibility for
ensuring that the
nutritional needs of
their student-athletes
are met. . . .
“Peace sign” eating


2/3 of the plate as
carbohydrate foods:
 bread, bagels,
cereal, rice, pasta,
sweets, fruit,
vegetables,
crackers, pretzels,
beverages
1/3 protein:
 meat, poultry, fish,
dairy foods, nuts,
seeds, soy foods,
dried beans, eggs
TIMING






Breakfast is a must!
Something to eat/drink every 3-4 hours
Meal 3-4 hours BEFORE games
Snack 1 hour BEFORE games
Carbohydrate food/fluid DURING
practices/games
Carbohydrate food/fluid within 15 minutes
AFTER practices/games
Urine color—teach athletes to
check color for hydration
This shows an example
or normal, straw
colored urine. Anything
darker would suggest a
level of dehydration
SALT LOSERS

IF:



Your sweat stings your eyes
Your skin/uniform are coated with a white
residue after practices/games
THEN:



Use more salt on foods
Eat salty foods
Don’t overdo with water
CSSD: Certified Sports Dietitian




Registered dietitians with expertise in sports
dietetics
Board certified by the American Dietetic
Association as specialists in sport dietetics
Many CSSD’s also have exercise and/or
athletic training credentials
Most are SCAN- the Sports, Cardiovascular
and Wellness Nutritionists practice group of
the American Dietetic Association
Nutrition and Performance
Go to:
www.ncaa.org/nutritionandperformance
Click on “Resources” and then:
Performance: The Role of Nutrition and
Body Image (PowerPoint file courtesy of Leslie
Bonci)
IGNORANCE IS NO EXCUSE
Student-athletes are responsible for
reading a product’s label and
consulting with the appropriate
athletics department representative
to determine whether the product’s
ingredients include an NCAA
banned substance on the label.
Student-athletes assume the risk
that supplement products may be
mislabeled or contaminated with an
undisclosed banned substance.
Ultimately, student-athletes are
responsible for any substance
they put in their body.
NCAA Banned Drug Classes

Stimulants (e.g., amphetamine, ephedrine, Ritalin, ecstasy)

Anabolic agents (e.g., andro, testosterone)

Beta blockers and alcohol (rifle)

Street drugs (i.e., heroin and marijuana)

Peptide hormones (e.g., EPO, growth hormone)

Diuretics and urine manipulators (masking agents)

Anti-Estrogens (used to mitigate unwelcome steroid side effects)
NCAA Drug Testing
Why Test?
 To deter cheating
 To protect health and safety
 To maintain the integrity of the game
Testing is part of a comprehensive approach to
drug deterrence:



Written policy
Education
Testing
Testing protects individuals
and the integrity of the game
Headline: Former Vols guard Lofton
underwent cancer treatment
“Former Tennessee guard Chris Lofton underwent
treatment for testicular cancer after a failed drug test
revealed he potentially had a tumor.”
Testing positive for hCG - could be doping,
Or could be a marker for cancer . . .
NCAA Drug Test Penalties


365 days from date of test
Loss of one year of eligibility



Drug-Test Appeal outcomes:





Second positive for performance enhancer, loss of remaining eligibility
Second positive involving street drug, additional loss of year of eligibility
and out 365
appeal is denied and the full penalty is upheld;
appeal is denied and the penalty is reduced by 50%;
appeal is granted and the positive test is overturned and no penalty is
assessed.
No other NCAA recourse beyond appeal.
Reinstatement after negative “exit test” and request is
granted.
What if a Banned Substance is Prescribed?
Medical Exception review for all classes except street drugs

No pre-approval needed for





Stimulants
Beta blockers
Diuretics
Anti-Estrogens
Pre-approval needed for


Peptide hormones
Steroids
Must maintain records with sports medicine staff!
USE OF a BANNED Medication without a prescription can result in
loss of eligibility.
Medical Exceptions for
Banned Drug Use




Not for street drugs
Pre-approval for anabolic agents and peptide hormones
and analogues
Stimulants, diuretics, anti-estrogens are approved with
appropriate documentation after a positive drug test
report.
NCAA is providing its membership a new guideline with
‘templated’ reporting letters
NCAA Health and Safety
Resources
www.ncaa.org/health-safety