While the Olympics often garner attention as a series of events showcasing determination, hard work, and perseverance, there is a dark side associated with the Games: the abuse of performance enhancing drugs (PEDs).

PEDs have long been connected to the Olympics. As far back as the first games in ancient Greece, athletes attempted to boost testosterone by eating sheep testicles and extracts of mushrooms and plant seeds. Today, their use is still widely prevalent, although the World Anti-Doping Agency (WADA) tries its best to maintain fair play in competition.

“It would be naïve to think that all athletes […] are clean,” said David Howman, the WADA director general.

While there is pressure on athletes to bring home gold medals, PED use brings with it potential side-effects, the disgrace if caught, and the risk of dependency.

Amphetamines: 

Often nicknamed “black beauties”, these drugs are stimulants which release excitatory neurotransmitters such as dopamine that stimulate the central nervous system.   Their purpose is to boost individuals’ energy levels while inducing feelings of power and reducing fatigue. However, their use often distorts the users’ sense of reality, and in athletes’ cases, it may cause them to compete even when injured. Worse, these drugs are related to many adverse effects including convulsions, insomnia, hallucinations, paranoia, nerve damage, and potentially death due to blood vessel ruptures.

The production of amphetamines began in the 1930s and their use spread shortly after. Tragically, Danish athlete Knut Jensen collapsed at the Rome Olympics in 1960 after using amphetamines. He died soon after, causing the International Olympic Committee to form a medical committee and establish drug testing for  future Games.

Diuretics: 

Diuretics are often prescribed to induce urination and are used to treat several disorders such as kidney diseases, high blood pressure, and heart failure. However, they are also commonly used by people suffering from eating disorders as it provokes weight loss, and by athletes right before being tested for drugs.

Taken orally or injected, the drugs’ sole purpose for athletes is to act as a masking agent. In other words, they remove or dilute enhancing drugs such as steroids out of the body by increasing urine volume. Some adverse effects include hypovolemia—decreased blood volume—and metabolic acidosis—high blood acidity leading to potential risks of cardiac arrhythmias, coma, or death.

Gymnast Luiza Galiulina of Uzbekistan tested positive for a diuretic substance (furosemide) in the 2012 London Olympics, and was banned from competing for two years. Runner Mariem Alaoui Selsoui of Morocco also tested positive for the same substance in the 2012 Games, after already having gone through a two-year suspension between 2009 and 2011 for using erythropoietin.

Erythropoietin (EPO):

EPO first emerged in 1987 as a way of boosting blood thickness. The drug is a peptide hormone that stimulates red blood cell production from the bone marrow, and is prescribed to treat anemia (due to kidney disease).

Athletes’ interest in it, however, comes from the fact that EPO improves endurance by enhancing oxygen delivery to muscles. Abnormally high red cell count leads to reduced blood flow—due to the increased thickness—which is linked to risks of stroke, heart disease, and thrombosis (blood clot).

A test to identify EPO was introduced in the 2000 Games. Past users in the Olympics include 2012 race walker Alex Schwazer of Italy,  who was subsequently disqualified after having tested positive.

Various other enhancers derived from anabolic steroids, such as nandrolone to ephedrine, have also been used by athletes despite dire consequences. To date, advances in technology have resulted in the creation of new drugs, including gene doping—when specific mutations are created to improve athletic performance. Therefore, anti-doping agencies have to be consistently updating their testing methods and banned substances list. Even before the Olympic opening ceremony in Sochi, Russian biathlete Irina Starykh, along with two other biathletes, tested positive for doping violation; Starykh has since then withdrawn from the Sochi Olympics. The next two weeks will be revealing as to the pressure of the Games and whether athletes succumb to drug abuse.