The International Olympic Committee and the US Olympic Committee are among almost 700 sports organizations worldwide as of Apr. 9, 2021 that have adopted the World Anti-Doping Agency’s (WADA) Code banning performance enhancing substances and methods.
Drugs can be added and removed from this list by WADA annually and not all of the banned substances are explicitly named. Caroline Hatton, a sports anti-doping science consultant, told ProCon: “A key concept in prohibited lists is that they avoid being finite. Instead of listing all banned drugs one by one, they list entire drug classes and name drugs merely as examples. This is to keep users who took designer drugs from claiming that they didn’t break the rules because the drugs they took weren’t listed.”
Each sports organization that adopts the code is also responsible for enforcing it through drug testing and non-compliance penalties.
Below are examples of banned substances and methods by category, with information about medical uses, performance effects on athletes, and side-effects. Some categories also include common pro and con arguments for banning the substances or doping methods.
For a complete list of banned substances, see the 2021 World Anti-Doping Code International Standard Prohibited List from the World Anti-Doping Agency (WADA). For the drug policies of other sporting organizations, see Sports Drug Policies.
For medical and/or legal advice, please consult the appropriate legal and medical professionals.
Drinks made from fermented sugars in fruits, berries, grains, and other ingredients.
Medical Uses
- none
Effects on Athletes
- anti-anxiety
- maximize effects of other drugs taken at the same time
- sedative
Side Effects
- addiction and withdrawal
- cirrhosis of the liver
- death
- depression
- double vision
- incontinence
- judgment impairment
- memory and comprehension loss
- reflex and muscular coordination impairment
- sleepiness
- speech slurring
- suicide
- vomiting
Examples
Ethanol: beer, distilled spirits, and wine
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Anabolic steroids mimic our bodies natural hormones, specifically male sex hormones, and have legitimate medical uses to treat anemia, asthma, bone pain from osteoporosis, muscle loss, and postmenopausal symptoms, among other ailments. Athletes use the drugs illicitly to achieve endurance increases, fat loss, muscle recovery increases, and muscular size and strength increases. However, the drugs carry serious side effects including but not limited to: abnormal menstrual cycles, aggressiveness, brain tissue damage, depression, hypertension, impotence, liver dysfunction, mania, and testicular shrinkage or atrophy.
PRO
Proponents of allowing athletes to use anabolic steroids argue that athletes are going to dope regardless of the rules so steroids should be allowed, that allowing steroids could reinvigorate boring or languishing sports, and that athletes using steroids doesn’t lessen, but may increase, the entertainment value.
CON
Opponents of allowing athletes to use anabolic steroids argue that anabolic steroid use is dangerous and can cause serious side effects (including addiction and death), that steroid use is not setting a good example for youth sports, and that sports should encourage clean play for the fairness and spirit of the game.
Medical Uses
- anemia
- asthma
- bone pain from osteoporosis
- gonadal function decrease or absence
- hereditary angiodema metastatic breast cancer
- muscle loss (i.e. burn injury, HIV-infection, muscular dystrophy)
- postmenopausal symptoms such as hot flashes and sweating
- puberty delay
Effects on Athletes
- endurance increase
- fat loss
- muscle recovery increase
- muscular size and strength increase in combination with exercise
Side Effects
- abnormal menstrual cycles
- acne
- aggressiveness
- anemia
- asthenia
- baldness
- brain tissue damage
- breast enlargement
- clitoris enlargement
- depression
- dizzy spells
- fever
- hair growth on the face and body
- HIV and other disease contraction due to contaminated needles used for injection of steroid
- hypertension
- impotence
- kidney tumors
- liver dysfunction
- mania
- masculinization
- muscle strains or ruptures
- myalgia
- nausea
- periorbital pain
- prostate gland enlargement
- psychiatric dysfunction
- sexual appetite increase
- sperm production reduction
- stunted growth in adolescents
- tearing of tendons
- testicular shrinkage or atrophy
- voice deepening
- vomiting
Examples
Endogenous Anabolic Androgenic Steroids (AAS): androstenediol, androstenedione, dihydrotestosterone, prasterone, and testosterone
Exogenous Anabolic Androgenic Steroids (AAS): 1-androstendiol, 1-androstendione, bolandiol, bolasterone, boldenone, boldione, calusterone, clostebol, danazol, dehydrochlormethyltestosterone, desoxymethyltestosterone, drostanolone, ethylestrenol, fluoxymesterone, formebolone, furazabol, gestrinone, 4-hydroxytestosterone, mestanolone, mesterolone, metenolone, methandienone, methandriol, methasterone, methyldienolone, methyl-1-testosterone, methylnortestosterone, methyltrienolone, methyltestosterone, mibolerone, nandrolone, 19-norandrostenedione, norboletone, norclostebol, norethandrolone, oxabolone, oxandrolone, oxymesterone, oxymetholone, prostanozol, quinbolone, stanozolol, stenbolone, 1-testosterone, tetrahydrogestrinone, and trenbolone
Other Anabolic Agents: clenbuterol, selective androgen receptor modulators (SARMs), tibolone, zeranol, and zilpaterol
Want to know more about anabolic steroids? Visit Britannica.com
Bronchodilators (drugs that widen the bronchial tubes to allow more air to move).
Medical Uses
- asthma
- chronic obstructive pulmonary disease
Effects on Athletes
- aerobic exercise improvement
- fat reduction
- muscle growth
Side Effects
- anxiety
- arrhythmias
- dizziness
- headache
- insomnia
- mood disorders
- muscle cramps
- nausea
- palpitations
- sweating
- tachycardia
- tremor, usually of the hands
Examples
Albuterol, metaproterenol, pirbuterol, terbutaline, isoetharine, Levalbuterol, and salmeterol xinafoate
Drugs that reduce excitation of the nervous system.
Medical Uses
- anxiety
- heart problems
- high blood pressure
- migraine
Effects on Athletes
- muscle tremor reduction
- sedative
Side Effects
- blood pressure lowering
- heart rate decrease
- performance capacity decrease in endurance sports
- sleep disturbance
- tiredness
Examples
Acebutolol, alprenolol, atenolol, betaxolol, bisoprolol, bunolol, carteolol, carvedilol, celiprolol, esmolol, labetalol, levobunolol, metipranolol, metoprolol, nadolol, oxprenolol, pindolol, propranolol, sotalol, and timolol
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Chemical compounds found in the cannabis plant.
Marijuana is frequently banned by sports organizations, yet the drug’s status as performance-enhancing is questioned. Further complicating the issue is that marijuana, as a medical or recreational drug is legal in most US states. Athletes take the drug illicitly to reduce anxiety, pain, and reliance on opioids. Side effects include appetite increase, balance and coordination impairment, concentration loss, drowsiness, motivation loss, panic attacks, and weight gain. If smoked (rather than consumed via edible), side effects can include bronchitis and cancer of the lung, throat, mouth, and tongue.
PRO
Proponents of allowing athletes to consume marijuana argue that the benefits for athletes are well-documented, that the drug is better than opioids, and that the ban is a continuation of an unjust drug war.
CON
Opponents of allowing athletes to consume marijuana argue that all athletes should not play under the influence of any drug, that marijuana is not legal everywhere the players play, and the benefits are questionable.
Side Effects
- addiction and withdrawal
- anxiety
- apathy
- appetite increase
- balance and coordination impairment
- bronchitis
- cancer of the lung, throat, mouth, and tongue
- concentration loss
- drowsiness
- hallucinations
- heart rate increase
- dry mouth
- learning ability impairment
- memory impairment
- mood swings
- motivation loss
- motor skill impairment
- panic attacks
- paranoid thinking
- reflex loss
- weight gain
Examples
Want to know more about cannabinoids? Visit Britannica.com
Diuretics & Other Masking Agents
Drugs that increase the flow of urine, or otherwise work to diminish the appearance of drugs in someone’s body.
Medical Uses
- heart failure from the kidneys
- high blood pressure
Effects on Athletes
- prevent detection of banned substances
- produce urine excretion to reduce concentration of banned substances
- weight loss
Side Effects
- blood pressure drop
- cramps
- death
- dehydration
- dizziness
- electrolyte imbalance
- headaches
- heart failure
- kidney failure
- muscle cramps
- nausea
- potassium depletion
- volume depletion
Examples
Diuretics: acetazolamide, amiloride, bumetanide, canrenone, chlorthalidone, etacrynic acid, furosemide, indapamide, metolazone, spironolactone, thiazides, and triamterene
Other masking agents: alpha-reductase inhibitors, epitestosterone, plasma expanders, and probenecid
Corticosteroids that prevent and reduce inflammation.
Medical Uses
- asthma
- chronic obstructive pulmonary disease (COPD)
- allergies
- rheumatoid arthritis
- osteoarthritis
- Crohn’s disease and other types of inflammatory bowel disease
- eczema and other skin conditions
- multiple sclerosis
- tendinitis
- lupus
Effects on Athletes
- anti-inflammatory
Side Effects
- acne
- blurred vision
- feeling nervous or restless
- feeling very hungry
- mood swings
- muscle weakness
- trouble sleeping
- stomach irritation
- water retention or swelling
- weight gain
Examples
Budesonide, cortisone, dexamethasone, prednisone, and triamcinolone
Hormone Antagonists & Modulators
Drugs that decrease the amount of estrogen in the body or block estrogen receptors.
Medical Uses
- breast cancer
- infertility
Effects on Athletes
- anabolic effects
- strength increase
- reduction of anabolic steroid use side effects (i.e. breast tissue growth)
Side Effects
- abdominal discomfort
- cancer
- hot flushes
- libido reduction
- verbal slurring
Examples
Aromatase inhibitors: aminoglutethimide, anastrozole, exemestane, formestane, letrozole, and testolactone
Myostatin inhibitors
Other anti-estrogenic substances: clomiphene, cyclofenil, and fulvestrant
Selective estrogen receptor modulators (SERMs): raloxifene, tamoxifen, and toremifene
An organic substance that regulates psychological activities and maintains the body’s homeostasis.
Human growth hormone (HGH) is naturally produced by humans to control how the body grows into adulthood. Medical uses for children include growth hormone deficiency, Prader-Willi syndrome, Turner syndrome, idiopathic short stature, and growth deficiency. Medical uses for adults include hormone deficiency, radiation therapy, or trauma. Off-label uses on HGH are illegal and can result in felony convictions in the United States, but athletes use the drug illicitly to improve muscle mass and performance. However, side effects of HGH include joint pain, muscle weakness, diabetes, carpal tunnel syndrome, enlarged heart, and hypertension.
PRO
Proponents of allowing athletes to use HGH argue that HGH can be used safely by athletes to repair injuries and that adult athletes should be able to make their own choices about their bodies.
CON
Opponents of allowing athletes to use HGH argue that any doping is cheating and doping allows a culture of coercion, bribery, unsafe medical practice, and unsportsmanlike conduct.
Medical Uses
- anemia due to kidney failure
- cosmetic symptoms of aging
- diabetes
- growth hormone deficiency in children
- growth retardation in children
- HIV
- infertility
- some cancers
- spasms in infants
- Turner’s syndrome
Effects on Athletes
- anti-inflammatory action aids recovery from injury
- body fat percentage decrease
- growth stimulation
- increases adrenal corticosteroid levels
- masking agent for anabolic steroids
- muscle definition when used in conjunction with other substances
- muscle size and growth growth when used in conjunction with other substances
- muscle tissue repair
- protein breakdown reduction
- protein synthesis increase
- testicular damage due to anabolic steroid use counteraction
- testosterone and epistestosterone production stimulation
Side Effects
- abnormal body changes
- acromegaly
- antibody formation
- arthritis
- brain damage
- brain swelling
- cardiomyopathy
- coma
- congestive heart failure
- coronary artery disease
- Cruetzfeldt-Jakob disease
- death
- deep vein thrombosis
- diabetes mellitus
- diabetic (hypoglycemic) coma
- drowsiness
- facial nerve paralysis
- forehead and jaw shape change
- gynaecomastia
- hand enlargement
- heart attack
- heart enlargement
- hypercholesterolemia
- hyperviscosity of the blood
- hypoglycemia
- hypothyroidism
- impotence
- menstrual irregularities
- metabolic dysfunction
- myocardial infarction
- myopathies
- nausea
- osteoporosis
- psychological effects such as irritability
- pulmonary embolism
- shaking
- shortness of breath
- similar effects as anabolic steroids
- softening of connective tissue
- stomach irritation and ulcers
- stroke
- thrombosis
- weakening of an injured area in muscles, bones, tendons or ligaments, osteoporosis and cataracts
- weakness
Examples
Erythropoietin (EPO), growth hormone (hGH), insulin-like growth factors (e.g. IGF-1), mechano growth factors (MGFs), gonadotrophins (e.g. LH, hCG), insulins, and corticotrophins (ACTH)
Drugs that produce pain relief, a state of stupor or relief, and addiction.
Medical Uses
- pain
Effects on Athletes
- feelings of invincibility
- pain killer
- pain threshold increase
- euphoria
Side Effects
- addiction and withdrawal
- balance and coordination loss
- cardiovascular collapse
- concentration ability decrease
- death
- injury risk
- nausea
- respiratory depression
- sleepiness
- vomiting
Examples
Buprenorphine, dextromoramide, diamorphine (diacetylmorphine/heroin), fentanyl, hydromorphone, methadone, morphine, oxycodone, oxymorphone, pentazocine, and pethidine
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Stimulants are drugs that speed up parts of the body and brain, directly affect the central nervous system, and increase heart rate, blood pressure, metabolism, and body temperature. Medical uses include the treatment of allergies, asthma, ADHD (attention deficit hyperactivity disorder), common colds, headaches, and nasal congestion. Athletes use the drugs illicitly to increase alertness, competitiveness, responsiveness, and weight loss. However, side-effects of the drugs include addiction, aggression, anxiety, hypertension, brain hemorrhage, coma, convulsions, dehydration, heart attacks, insomnia, stroke, tremors, and even death.
PRO
Proponents of allowing athletes to use stimulants argue that Air Force pilots, long haul truckers, and others use stimulants without stigma, and that their use does not lessen the integrity of the game.
CON
Opponents of allowing athletes to use stimulants argue stimulants are dangerous, can result in death, and do nothing to promote the health of the athlete, and that the cultural acceptance of stimulant use should change.
Medical Uses
- allergies
- asthma
- ADHD (attention deficit hyperactivity disorder)
- cold
- headache
- nasal congestion
Effects on Athletes
- aggressiveness
- alertness
- competitiveness
- responsiveness
- tiredness reduction
- weight loss
Side Effects
- addiction/withdrawal
- aggressiveness
- alertness
- anxiety
- blood pressure increase
- cardiac arrhythmia
- cerebral hemorrhage
- coma
- convulsions
- death
- dehydration
- hand tremors
- heart attack
- heart rate increase
- heat stroke
- inhibited judgment and decision-making
- insomnia
- stroke
- sweating
- tremor
- weight loss
Examples
Adrafinil, adrenaline, amfepramone, amiphenazole, amphetamine, amphetaminil, benzphetamine, benzylpiperazine, bromantan, cathine, clobenzorex, cocaine, cropropamide, crotetamide, cyclazodone, dimethylamphetamine, ephedrine, etamivan, etilamphetamine, etilefrine, famprofazone, fenbutrazate, fencamfamin, fencamine, fenetylline, fenfluramine, fenproporex, furfenorex, heptaminol, isometheptene, levmethamfetamine, meclofenoxate, mefenorex, mephentermine, mesocarb, methamphetamine (D-), methylenedioxyamphetamine, methylenedioxymethamphetamine, methylamphetamine, methylephedrine, methylphenidate, modafinil, nikethamide, norfenefrine, norfenfluramine, octopamine, ortetamine, oxilofrine, parahydroxyamphetamine, pemoline, pentetrazol, phendimetrazine, phenmetrazine, phenpromethamine, phentermine, 4-phenylpiracetam (carphedon), prolintane, propylhexedrine, selegiline, sibutramine, strychnine, and tuaminoheptane
Want to know more about stimulants? Visit Britannica.com
Blood Doping
Blood-doping refers to any method, including using the enhancement drug erythropoietin (EPO), to increase red blood cells. EPO can be used medically to treat anemia, among other applications. Athletes use blood-doping illicitly to increase endurance and reduce fatigue. However, blood-doping has been found to “thicken” blood, increasing the chances of hypertension, blood clots, stroke, and heart attacks.
PRO
Proponents of allowing athletes to blood-dope argue that blood-doping is already so prevalent that banning it now would lessen the sport, that the methods are safe for athletes, and that the same effects can be achieved by working out at high altitudes.
CON
Opponents of allowing athletes to blood-dope argue that blood doping is dangerous and can lead to athletes’ deaths, that normalizing blood-doping is asking athletes to risk their lives to play a sport, and sport doesn’t need more athletes that break the rules.
Effects on Athletes
- endurance performance improvement
- ability to perform better at higher altitudes
Side Effects
- allergic reaction
- blood poisoning
- cardiac output decrease
- contraction of infectious diseases such as viral hepatitis, malaria, cytomegalovirus, or HIV
- death
- heart failure
- hypertension
- immune system overload
- infection
- intravascular clotting
- iron overload
- kidney damage
- platelet count reduction
- sexual dysfunction
- thrombosis
- transient fever
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Chemical and Physical Manipulation of Samples
Can include tampering with samples, substitution and/or alteration of urine, catheterization, and intravenous infusion. Intravenous infusion is prohibited unless there is an acute medical situation (i.e. acute blood loss) for which the use of this method is necessary.
Effects on Athletes
- negative drug tests
Side Effects
- infection
- over-hydration
Gene Doping
Gene-doping is a still-experimental manipulation of cells or genes to improve athletic performance. Gene therapy came about in the 1990s and entered popular culture via “Schwarzenegger mice,” which had been treated for muscle wasting conditions and ended up with twice the normal amount of muscle after gene manipulation. While currently more science fiction than reality, WADA has already banned the practice in athletes. The benefits and drawbacks medically are still hypothetical.
PRO
Proponents of allowing athletes to gene-dope argue that the enhancements could breathe new life into boring sports, could allow more categories of participation, and could be finely tuned to help athletes with specific issues such as muscle twitches.
CON
Opponents of allowing athletes to gene-dope argue that doping is doping and all doping is unfair, and that gene-doping is basically science fiction that has numerous and serious ethical concerns such as parents altering fetuses in vitro to produce super athletes.
Effects on Athletes
- unknown
Side Effects
- unknown
Want to know more about gene doping? Visit Britannica.com
Techno Doping
Techno-doping as a technological augmentation that confers an advantage to the athlete, be it a specially designed shoe, a bike motor, or limb protheses that specifically offers an advantage over other athletes in the same competition. While the issue currently revolves around athletes who are otherwise impaired (including Oscar Pistorius who wears “cheetah” prosthetic legs, future iterations of the debate could involved able-bodied athletes who otherwise augment their bodies and athletes who improve their equipment, such as bicycles.
PRO
Proponents of allowing athletes to techo-dope argue that the advancements could push the sports and athletes in interesting ways, and that audiences not only don’t oppose new technology, but will be excited to see sports and athletes play a reinvigorated game.
CON
Opponents of allowing athletes to techno-dope argue that doping is doping and all doping is unfair, that the advancements disadvantage athletes who refuse to dope, and that tech moves sport too far away from the accomplishments of the human body.
Effects on Athletes
- unknown
Side Effects
- unknown
Sources:
Australian Academy of Science “Stimulants in Sport,” science.org.au (accessed on Apr. 19, 2021)
Australian Sports Anti-Doping Authority (ASADA), “2008 Anti-Doping Handbook,” ASADA website, 2008
Nick Busca, “Should Athletes Be Allowed to Enhance Their Genes?,” onezero.medium.com, Apr. 29, 2019
Daniel J. DeNoon, “Why Steroids Are Bad for You,” webmd.com, March 16, 2005
William D. Knopp, “Ergogenic Drugs in Sports,” Clinics in Sports Medicine, July 1997
Maryville University, “Understanding and Preventing Steroid Abuse in Sports,” online.maryville.edu, Apr. 14, 2021
Mayo Clinic, “Performance-Enhancing Drugs: Know the Risks,” mayoclinic.org, Dec. 4, 2020
David R. Mottram, Drugs in Sport, 2003
Elizabeth Quinn, “Erythropoietin (EPO) and Blood Doping in Sports,” verywellfit.com, Mar. 26, 2020
Jennifer Robinson “What Are Glucocorticoids?,” webmd.com, May 30, 2019
US Anti-Doping Agency (USADA), “Guide to Prohibited Substances and Prohibited Methods of Doping,” USADA website, Dec. 2007
USADA, “Growth Hormone in Sport: What Athletes Should Know,” usada.org, Feb. 13, 2019
WebMD, “Anabolic Steroids,” webmd.com (accessed Apr. 9, 2021)
