Ethics of prescribing drugs to enhance sporting performance

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• 1.
• Banned drugs: If the athlete is competing at competition level it is essential that care be taken to avoid a drug on the banned list. Mistakes can be easily avoided by checking the drug details in publications such as MIMS or the Drugs in sport handbook² (published by the Australian Sports Drug Agency [ASDA], or by contacting the ASDA hotline on 1800 020 506).

• 2.
• Exposure conditions: Doctors should be aware that athletes will often expose themselves to extremes of endurance, so care is needed when using agents such as non-steroidal anti-inflammatory drugs, prochlorperazine and pseudoephedrine, which can affect heat regulation or cardiac rhythm. Patients should also be informed of the effects a drug may have on their sporting performance per se. For example, if -blockers are medically indicated, the trade-off will be a decrease in aerobic performance.

• 3.
• Professional competence: It is the responsibility of each prescriber to know the pharmacological facts about a drug and the medical facts about the patient. For example, AAS are not only widely abused, but also are a drug group about which there is much published information. A healthy athlete has no medical condition that will require prescribing of AAS, which will worsen, not improve, tendon and muscle injuries.¹³ There are no studies showing that AAS enhance skilled performance. There are data showing AAS increase muscle size and strength,¹⁴ although these data need to be interpreted conservatively.¹⁵ There are also a number of predictable adverse reactions that occur with their use, such as acne and gynaecomastia.¹⁰
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