1. 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 /

2. 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.

3. NCAA Committee on Competitive Safeguards and Medical Aspects of Sports University staff that work in sports medicine, law, athletics administration, research. University staff that work in sports medicine, law, athletics administration, research. Researches student-athlete health and safety issues. Researches student-athlete health and safety issues. Oversees NCAA drug-education and testing policy. Oversees NCAA drug-education and testing policy. Develops sports medicine handbook guidelines. Develops sports medicine handbook guidelines. Ensures fair and credible drug-testing and appeals processes. Ensures fair and credible drug-testing and appeals processes.

4. NCAA Study of Substance Use Conducted every four years Conducted every four years Over 20,000 student-athletes complete anonymously (out of 380,000 S-A) Over 20,000 student-athletes complete anonymously (out of 380,000 S-A) Trends help determine policy and practice Trends help determine policy and practice Reported use is within last twelve months, unless otherwise indicated Reported use is within last twelve months, unless otherwise indicated Following slides are from the 2005 study. Following slides are from the 2005 study.

9. Out of about 20,000 student-athletes, 214 males and 13 females reported hGH* use Males: Females: 106 FB 6 basketball 106 FB 6 basketball 33 baseball 4 golf 33 baseball 4 golf 30 basketball 3 soccer 30 basketball 3 soccer 14 soccer 3 indoor 14 soccer 3 indoor 13 wrestling 2 outdoor 13 wrestling 2 outdoor 12 outdoor 2 lacrosse 12 outdoor 2 lacrosse 9 indoor 2 VB/ 871 surveyed 9 indoor 2 VB/ 871 surveyed 8 lacrosse 8 lacrosse 8 golf 8 golf 7 Tennis 7 Tennis 6 cross country 6 cross country 3 Ice Hockey 3 Ice Hockey Smattering of other Smattering of other 0 VB / 85 surveyed 0 VB / 85 surveyed *reports of hGH use may not accurately reflect true use of growth hormone, as many “hGH” products don’t actually contain growth hormone.....

16. Alcohol on Performance Causes dehydration which slows healing Causes dehydration which slows healing Requires increased conditioning to Requires increased conditioning to manage weight Slows muscle recovery Slows muscle recovery Inhibits absorption of nutrients Inhibits absorption of nutrients Interferes with ability to sharply focus Interferes with ability to sharply focus Hampers memory and retention Hampers memory and retention

17. Drug Women’s Basketball Women’s Softball Women’s Swimming Women’s Tennis Women’s Track/Field 19931997200120051993199720012005199319972001200519931997200120051993199720012005 Amphetamines 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 steroids 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% 0.1% EphedrineN/A1.8%1.3%1.5%N/A1.1%2.3%2.9%N/A0.5%2.2%1.7%N/A1.9%1.2% N/A0.9%1.3%1.1% Ergogenic Drug Use in Women’s Sports

18. Sport Amphetamines Anabolic steroids Ephedrine 199720012005199720012005199720012005 Fencing0.0% **0.0% **3.0%2.5%** Field Hockey4.6%4.1%4.4%1.5%0.0% 0.5%1.9%3.1% Golf5.1%3.0%4.6%0.0%0.5%0.4%1.5%1.9%3.0% Gymnastics3.3%3.4%2.1%0.0% 1.0%1.1%3.4%1.1% Ice Hockey0.0%2.4%4.9%0.0%0.8%2.4%0.0%3.2%11.9% Lacrosse3.2%2.9%8.6%0.0% 1.1%0.3%2.7% Skiing4.3%** 0.0%** 0.0%** Soccer5.3%4.6%4.3%0.5% 0.1%3.3%1.6%1.0% Volleyball3.0%4.1%2.9%0.8%0.1%0.6%2.1%1.7% Ergogenic Drug Use Patterns in Other Women’s Sports

19. Drug Women’s Basketball Women’s Softball Women’s Swimming Women’s Tennis Women’s Track/Field 19931997200120051993199720012005199319972001200519931997200120051993199720012005 Alcohol 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/ crack 0.7%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% 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/A1.9%1.6%0.7%N/A2.6%4.0%0.9%N/A5.6%3.7%2.2%N/A3.2%2.1%0.6%N/A2.8%1.5%0.5% CigarettesN/A 18.9%10.9%N/A 35.3%22.6%N/A 31.3%16.8%N/A 30.1%17.0%N/A 11.6%6.2% Social Drug Use in Women’s Sports

20. Sport AlcoholCocaine/crackMarijuanaSpit tobaccoPsychedelics 199720012005199720012005199720012005199720012005199720012005 Fencing 78.8%80.0%**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% 21.4%13.6%13.5%5.4%1.1%2.1%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% 1.6%24.6%22.6%15.9%5.0%2.1%1.6%3.4%3.5%1.7% Social Drug Use Patterns in Other Women’s Sports

21. Response Choice AmphetaminesAnabolic steroids Ephedrine All nutritional supplements* 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 Ergogenic Drugs Percentages Based on Those Who Continue to Use *Nutritional Supplement related question was not included previous to the 2001 survey.

22. Response Choice AlcoholCocaine/crack Marijuana/hashishSpit tobaccoCigarettes* 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% After freshman year of college 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% Initial Use of Social Drugs Percentages Based on Those Who Continue to Use

23. 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.

24. Dietary Supplements Do not need to be proven effective Do not need to be proven safe PURITY Lack standards on potency and PURITY

25. Where do athletes get supplement information?

26. What Athletes tell us about supplement use Can’t gain weight without it Can’t meet nutrient needs without Want the extra edge Can’t be all bad – everyone is using I only use legal supplements

27. 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:

28. What we know about supplements? CountryNo. of productsNo. of positives% of positives Netherlands31825.8 % Austria22522.7 % UK37718.9 % USA2404518.8 % Italy35514.3 % Spain29413.8 % Germany1291511.6 % Belgium3026.7 % France3026.7 % Norway3013.3 % Switzerland13-- Sweden6-- Hungary2-- Total6349414.8 % Is your athlete willing to take a 14.8 % chance they will test positive?

29. 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!

30. 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

31. NCAA 2005 drug use survey 21,000 athletes surveyed 21,000 athletes surveyed 41% reported nutritional/dietary supplement use within last year 41% reported nutritional/dietary supplement use within last year Most commonly used: Most commonly used: Creatine Creatine Protein products and amino acids Protein products and amino acids Thermogenics Thermogenics Most cited reasons for use were Most cited reasons for use were To improve athletic performance (38%) To improve athletic performance (38%) For health reasons in general (24%) For health reasons in general (24%) For weight loss/weight gain (22%) For weight loss/weight gain (22%)

32. Creatine Not a banned substance. Not a banned substance. What does it claim? What does it claim? promote muscle growth promote muscle growth reduce recovery time reduce recovery time Increase energy production Increase energy production [No evidence of increasing muscle mass without resistance exercise] What does the research say? What does the research say? Short-term use appears safe, but…cramping, heat illness Short-term use appears safe, but…cramping, heat illness Long-term risks not known and difficult to study. Long-term risks not known and difficult to study. Recommendations are not to provide to youth! Recommendations are not to provide to youth!

33. “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.

34. Sports drinks vs. “Energy” drinks Sports Drinks Rehydrate Rehydrate Help maintain electrolyte balance Help maintain electrolyte balance Do not contain stimulants Do not contain stimulants Energy Drinks o May contain more concentrated sugar o Contain one or more sources of stimulants (caffeine, guarana) o May contain amino acids and herbals (unregulated)

35. Caffeine Comparison: 4.5 lbs of milk chocolate 360 mg Caffeine 8 cans of Classic Coke

36. Anabolic Steroid Control Act of 2004 Prohormones are now Anabolic Steroids and classified as Schedule III Controlled Substances Prohormones are now Anabolic Steroids and classified as Schedule III Controlled Substances Illegal to possess without a prescription Illegal to possess without a prescription Carved out an exception for DHEA Carved out an exception for DHEA

37. DHEA Dehydroepiandrosterone is a pro- hormone, produced by the adrenal gland and is found naturally in the body. Dehydroepiandrosterone is a pro- hormone, 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. 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. DHEA is an NCAA banned substance.

38. What about Multi-Vitamins? Subject to the same lack of regulation Subject to the same lack of regulation No guarantees No guarantees Added Herbs Added Herbs

39. Before deciding to use a supplement Do I need this supplement? Do I need this supplement? Do I know that this supplement is safe? Do I know that this supplement is safe? Does this supplement interact with any drug or food I am consuming? Does this supplement interact with any drug or food I am consuming? Do I know that this supplement works? Do I know that this supplement works? Can I afford this supplement? Can I afford this supplement? Do I know enough about this supplement? Do I know enough about this supplement?

40. Performance Enhancers Food Hydration Conditioning Rest and Recovery Stress Management Stay Well !

41. The Message.... Good Nutrition Promotes Health Enhances Performance! Enhances Performance!

42. Nutrition Survey n = 9930

43. Female Athlete Triad

44. NCAA Study: Coaches Regarding Amenorrhea 1%: normal, not serious 1%: normal, not serious 36%: normal, assess after 6 months 36%: normal, assess after 6 months 15%: not normal, not harmful 15%: not normal, not harmful 48%: not normal, medical required 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

45. Meals and Snacks Meals and Snacks institutions must take responsibility for ensuring that the nutritional needs of their student-athletes are met.... institutions must take responsibility for ensuring that the nutritional needs of their student-athletes are met....

46. “Peace sign” eating “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

47. TIMING Breakfast is a must! Breakfast is a must! Something to eat/drink every 3-4 hours Something to eat/drink every 3-4 hours Meal 3-4 hours BEFORE games Meal 3-4 hours BEFORE games Snack 1 hour BEFORE games Snack 1 hour BEFORE games Carbohydrate food/fluid DURING practices/games Carbohydrate food/fluid DURING practices/games Carbohydrate food/fluid within 15 minutes AFTER practices/games Carbohydrate food/fluid within 15 minutes AFTER practices/games

48. 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

49. SALT LOSERS IF: IF: Your sweat stings your eyes Your sweat stings your eyes Your skin/uniform are coated with a white residue after practices/games Your skin/uniform are coated with a white residue after practices/games THEN: THEN: Use more salt on foods Use more salt on foods Eat salty foods Eat salty foods Don’t overdo with water Don’t overdo with water

50. CSSD: Certified Sports Dietitian Registered dietitians with expertise in sports dietetics Registered dietitians with expertise in sports dietetics Board certified by the American Dietetic Association as specialists in sport dietetics Board certified by the American Dietetic Association as specialists in sport dietetics Many CSSD’s also have exercise and/or athletic training credentials 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 Most are SCAN- the Sports, Cardiovascular and Wellness Nutritionists practice group of the American Dietetic Association

51. Nutrition and Performance Go to: www.ncaa.org/nutritionandperformance Click on “Resources” and then: Performance: The Role of Nutrition and Body ImagePerformance: The Role of Nutrition and Body Image (PowerPoint file courtesy of Leslie Bonci) Performance: The Role of Nutrition and Body Image

52. 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.

53. NCAA Banned Drug Classes Stimulants (e.g., amphetamine, ephedrine, Ritalin, ecstasy) Stimulants (e.g., amphetamine, ephedrine, Ritalin, ecstasy) Anabolic agents (e.g., andro, testosterone) Anabolic agents (e.g., andro, testosterone) Beta blockers and alcohol (rifle) Beta blockers and alcohol (rifle) Street drugs (i.e., heroin and marijuana) Street drugs (i.e., heroin and marijuana) Peptide hormones (e.g., EPO, growth hormone) Peptide hormones (e.g., EPO, growth hormone) Diuretics and urine manipulators (masking agents) Diuretics and urine manipulators (masking agents) Anti-Estrogens (used to mitigate unwelcome steroid side effects) Anti-Estrogens (used to mitigate unwelcome steroid side effects)

54. NCAA Drug Testing Why Test? To deter cheating To deter cheating To protect health and safety To protect health and safety To maintain the integrity of the game To maintain the integrity of the game Testing is part of a comprehensive approach to drug deterrence: Written policy Written policy Education Education Testing Testing

55. Testing protects individuals and the integrity of the game Headline: Former Vols guard Lofton underwent cancer treatment 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...

56. NCAA Drug Test Penalties 365 days from date of test 365 days from date of test Loss of one year of eligibility Loss of one year of eligibility Second positive for performance enhancer, loss of remaining eligibility Second positive for performance enhancer, loss of remaining eligibility Second positive involving street drug, additional loss of year of eligibility and out 365 Second positive involving street drug, additional loss of year of eligibility and out 365 Drug-Test Appeal outcomes: Drug-Test Appeal outcomes: appeal is denied and the full penalty is upheld; appeal is denied and the full penalty is upheld; appeal is denied and the penalty is reduced by 50%; appeal is denied and the penalty is reduced by 50%; appeal is granted and the positive test is overturned and no penalty is assessed. appeal is granted and the positive test is overturned and no penalty is assessed. No other NCAA recourse beyond appeal. No other NCAA recourse beyond appeal. Reinstatement after negative “exit test” and request is granted. Reinstatement after negative “exit test” and request is granted.

57. What if a Banned Substance is Prescribed? Medical Exception review for all classes except street drugs No pre-approval needed for No pre-approval needed for Stimulants Stimulants Beta blockers Beta blockers Diuretics Diuretics Anti-Estrogens Anti-Estrogens Pre-approval needed for Pre-approval needed for Peptide hormones Peptide hormones Steroids Steroids Must maintain records with sports medicine staff! USE OF a BANNED Medication without a prescription can result in loss of eligibility.

58. Medical Exceptions for Banned Drug Use Not for street drugs Not for street drugs Pre-approval for anabolic agents and peptide hormones and analogues 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. 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 is providing its membership a new guideline with ‘templated’ reporting letters

59. NCAA Health and Safety Resources www.ncaa.org/health-safety