Steroids

As athletes gathered at the 2000 Olympic Games in Sydney, Australia, the issue of performance enhancing drugs, especially anabolic steroids, once again gained international attention. These drugs are used by high school, college, professional, and elite amateur athletes in a variety of sports (e.g. weight lifting, track and field, swimming, cycling, and others) to obtain a competitive advantage. Body builders and fitness buffs take anabolic steroids to improve their physical appearance, and individuals in occupations requiring enhanced physical strength (e.g. body guards, night club bouncers, construction workers) are also known to use these drugs.

Concerns over a growing illicit market, abuse by teenagers, and the uncertainty of possible harmful long-term effects of steroid use, led Congress in 1991 to place anabolic steroids as a class of drugs into Schedule III of the Controlled Substances Act (CSA). The CSA defines anabolic steroids as any drug or hormonal substance chemically and pharmacologically related to testosterone (other than estrogens, progestins, and corticosteroids) that promotes muscle growth.

Once viewed as a problem associated only with professional and elite amateur athletes, various reports indicate that anabolic steroid abuse has increased significantly among adolescents. For example, the National Institute on Drug Abuse 1999 Monitoring the Future survey reveals that more than a half million 8th and 10th grade students were using anabolic steroids. Abuse is higher among males than females, but is growing most rapidly among young women.

Most illicit anabolic steroids are sold at gyms, competitions, and through mail operations. For the most part, these substances are smuggled into the United States from many countries. The illicit market includes various preparations intended for human and veterinary use as well as bogus and counterfeit products. The most commonly encountered anabolic steroids on the illicit market include testosterone, nandrolone, methenolone, stanozolol, and methandrostenolone. Other steroids seen in the illicit market include boldenone, fluxoymesterone, methandriol, methyltestosterone, oxandrolone, oxymetholone, and trenbolone.

A limited number of anabolic steroids have been approved for medical and veterinary use. The primary legitimate use of these drugs in humans is for the replacement of inadequate levels of testosterone resulting from a reduction or absence of functioning testes. Other indications include anemia and breast cancer. Experimentally, anabolic steroids have been used to treat a number of disorders including AIDS wasting, erectile dysfunction, and osteoporosis. In veterinary practice, anabolic steroids are used to promote feed efficiency and to improve weight gain, vigor, and hair coat. They are also used in veterinary practice to treat anemia and counteract tissue breakdown during illness and trauma.

When used in combination with exercise training and high protein diet, anabolic steroids can promote increased size and strength of muscles, improve endurance, and decrease recovery time between workouts. They are taken orally or by intramuscular injection. Users concerned about drug tolerance often take steroids on a schedule called a cycle. A cycle is a period of between 6 and 14 weeks of steroid use, followed by a period of abstinence or reduction in use. Additionally, users tend to "stack" the drugs, using multiple drugs concurrently. Although the benefits of these practices are unsubstantiated, most users feel that cycling and stacking enhance the efficiency of the drugs and limit their side effects.

Another mode of steroid use is called "pyramiding." With this method users slowly escalate steroid use (increasing the number of drugs used at one time and/or the dose and frequency of one or more steroids), reach a peak amount at mid-cycle and gradually taper the dose toward the end of the cycle. The escalation of steroid use can vary with different types of training. Body builders and weight lifters tend to escalate their dose to a much higher level than do long distance runners or swimmers.

The long-term adverse health effects of anabolic steroid use are not definitely known. There is, however, increasing concern of possible serious health problems associated with the abuse of these agents, including cardiovascular damage, cerebrovascular toxicity, and liver damage.

Physical side effects include elevated blood pressure and cholesterol levels, severe acne, premature balding, reduced sexual function, and testicular atrophy. In males, abnormal breast development (gynecomastia) can occur. In females, anabolic steroids have a masculinizing effect, resulting in more body hair, a deeper voice, smaller breasts, and fewer menstrual cycles. Several of these effects are irreversible. In adolescents, abuse of these agents may prematurely stop the lengthening of bones, resulting in stunted growth.

With some individuals the use of anabolic steroids may be associated with psychotic reactions, manic episodes, feelings of anger or hostility, aggression, and violent behavior.

A variety of non-steroid drugs are commonly found within the illicit anabolic steroid market. These substances are primarily used for one or more of the following reasons: 1) to serve as an alternative to anabolic steroids; 2) to alleviate short-term adverse effects associated with anabolic steroid use; or 3) to mask anabolic steroid use. Examples of drugs serving as alternatives to anabolic steroids include clenbuterol, human growth hormone, insulin, insulin-like growth factor, and GHB. Drugs used to prevent or treat adverse effects of anabolic steroid use include tamoxifen, diuretics, and human chorionic gonadotropin. Diuretics, probenocid, and epitestosterone may be used to mask anabolic steroid use.

Over the last few years, a number of precursors to either testosterone or nandrolone have been marketed as dietary supplements in the United States. Some of these substances include androstenedione, androstenediol, norandrostenedione, norandrostenediol, and dehydroepiandrosterone (DHEA).

TRAFFICKING

The Anabolic Steroid Control Act was passed by Congress in the fall of 1990 and became effective on February 21, 1991. The Steroid Act classified 27 steroids as Schedule III substances under the CSA. Street prices of anabolic steroids have increased substantially as a result.

Fitness clubs have been, and continue to be, the primary distribution centers of steroids, since bodybuilders and weightlifters comprise a predominant portion of the user population. Once viewed as a problem strictly associated with professional athletes, a recent survey of students indicates increased steroid use among boys in the 8th and 10th grades. The percentage of 8th grade boys reporting past-year use of steroids increased from 1.6 percent in 1998 to 2.5 percent in 1999, and from 1.9 percent to 2.8 percent among 10th grade boys.

Anabolic steroids are illicitly smuggled from Mexico and European countries to the United States. Recent DEA reporting indicates that Russian, Romanian, and Greek nationals are significant traffickers of steroids and are responsible for substantial shipments of steroids entering the United States. The lack of international control over foreign sources of supply, however, makes it impossible to attack the trafficking at its source.