Editorial on the special focus: Drug policy in sport: critical perspectives

Sport is a global economic, social and cultural phenomenon. An indication of its social value was detailed in an English report in April 2016. The authors demonstrated that over £23bn was spend by participants and consumers, which returned £44.75bn of social benefits to the country. These included improved health and educational attainment, reduction in crime and enhanced life satisfaction (Davies, Taylor, Ramchandani, & Christy, 2016).

Sport is a form of entertainment, consumed through media platforms by billions of people. Sport is also a social good: a form of physical activity in which people of all ages can develop skills and fitness, enjoy competition and develop communities. It promotes volunteering, social engagement and employment. Active sports for the sake of health are promoted by Governments in the interest of having a productive and happy population. However, these competing strands of sport’s role in society serve to frame the ways in which sports organisations have tried to regulate drug use. The promotion of health aspects seems to mitigate against drug use, but the demand for exceptional performances remains a powerful cultural force underpinning the continuity of doping behaviours and cultures.

The use of drugs to support competitive performance at the highest level has been a major concern for over 60 years. Drugs can be used for many purposes: to build muscle more quickly, to boost oxygen carrying red blood cells, to relieve fatigue and pain. The creation and development of policies to prevent this, known as anti-doping, sought to also protect the value of sport as the traditional amateur ethos gradually gave way in the late twentieth century to modernising influences of professionalism, commercialism and the use of new technologies to enhance athletes’ performance and training capacities. Thus, anti-doping principles and ideas were interwoven with social constructions of sporting ethics, emphasising fair play, with the aim to prevent “artificial” enhancements and cheating.

The testing of athletes using urine and blood samples has itself become an industry: there are now around 280,000 tests conducted every year at a total cost of over $228 m (Maennig, 2014). In fact, this figure may be an under-estimation as each country or region has to fund an independent anti-doping organisation. Moreover, the cost of a test varies according to country and the scope of the test. For example, the Australian Anti-Doping Agency “price” their tests at up to AUS$1580 (ASADA, 2017). The list of prohibited substances continues to grow; now over 300, but the authorities can store and re-test samples for up to 10 years in order to detect newly available substances for which there was no previous test (or existing products for which more sensitive testing will become available).

However, there are ways in which athletes’ health is undermined by anti-doping: disproportionate sanctions (the standard penalty is a 4-year ban from all sport), excessive surveillance, limited access to some over-the-counter medicines and to some medically prescribed drugs, the risk of accidental positive tests due to contaminated nutritional supplements or flawed laboratory processes, and the emotional toil of dealing with a sanction. Any sanction leads to a ban which can impact severely on careers and leads to long-term social stigma from which athletes struggle to recover their reputation and role in sport.

Despite the many challenges faced by anti-doping in elite sport, there are increasing calls for the same systems to be imposed on non-elite competitive sports. We have seen the rise in some countries, especially the USA, of testing at regional events in cycling and road running. Some of the risks inherent in anti-doping for elite sport are magnified by the lack of medical support and drug education among those for whom sport is a leisure-time hobby. The full range of banned drugs include some such as marijuana, ephedrine, Ritalin, methylhexanamine and others including products to cure baldness or lose weight, which may not justify a ban of 2–4 years from sport and the reputational damage of being labelled a doper. The medical use of testosterone has caused controversy in cases of prescribed deficiencies in athletes who want to compete in cycling or athletics.

Yet, if anti-doping authorities aimed to use their resources to improve health, they would find a much larger population of users in fitness gyms. The use of steroids in bodybuilding and weightlifting environments has been identified since the 1950s. Surveys from the 1980s and 1990s showed significant prevalence rates. There is a huge black market industry linked to criminal sub-cultures that increase health risks to users (Fincoeur, van de Ven, & Mulrooney, 2015). Elsewhere, the Danish Government have attempted to monitor and minimise this culture by accreditation of fitness centres that have undertaken drug testing of their members.

Against this backdrop of daily, almost hidden usage is the increasing salience of global scandals relating to elite sport. In summer 2016, the International Olympic Committee and the International Paralympic Committee took the unparalleled step of precluding some athletes from Russia on the basis of evidence produced from investigative journalists and so-called “Independent Commissions” (that were closely linked to WADA and IOC personnel). However, there was some confusion between these two organisations and WADA about the scope of the ban, with the IOC allowing sports federations to decide and the IPC taking a blanket approach (BBC, 2016). Re-testing of samples from the 2008 and 2012 Olympics have led to around 100 new sanctions and many events have had medals and lower positions re-allocated. Failure and confusion characterise this period of anti-doping’s struggles. More recently, the British Government has had a series of hearings relating to drug use in Olympic sports and cycling, bringing high-profile leaders to account for their (in)actions (including Lord Sebastian Coe, President of the International Association of Athletics Federations and Sir David Brailsford, formerly of British Cycling, now Performance Director of Team Sky).

It would seem that health has taken a back seat to the ethical discourses of cheating and corruption and the concerns focussing on policy failings and inertia. Yet, as many academics have recently argued, if anti-doping is going to benefit athletes and have a clearer philosophical meaning that they might relate to, the protection of health should be the main focus. With that in mind, I organised a workshop that was kindly funded by Wellcome Trust and hosted by the University of Stirling in November 2015. The articles in this Special Issue are a selection of the presentations from that workshop which take contrasting perspectives.

The use of anabolic steroids in wide range of societal contexts is explored by McVeigh and Begley. They show that users in north-west England have been accessing needle exchange services to a much higher extent over the past 20 years. They found that there were 5336 steroid users in 2015, who had used a Needle and Syringe Programme (NSP). In spite of a wide of potential health risks, they identify a lack of evidence-based interventions and thus the public health issues are not being fully addressed.

Christiansen, Vinther and Liokaftos offer a detailed consideration of the nature of steroid use. Using the results of interviews with users, they define four types: the Expert, the Well-being type, the YOLO (“you only live once”) and the Athlete. This model potentially improves both sociological understanding and the design of educational interventions. It highlights contrasting motivations and perspectives to use steroid which potentially shifts the paradigm of understanding away from one-dimensional demonisation towards a more nuanced and complex model.

Henning takes a critical perspective on the prospects of applying anti-doping policy to non-elite amateur competitive athletes. There is an issue with amateur athletes using banned substances, but the one-size-fits-all punitive approach developed for elite athletes is not considered to be appropriate. The discussion of these critical factors leads to range of constructive solutions for a rational, health-based strategy.

Martensen and Møller criticise the lack of evidence that investment in anti-doping organisations leads to more effective and successful anti-doping outcomes. They chart the increasing levels of investment in anti-doping organisations in a wide range of countries, and set that against testing statistics. They conclude there to be little or no evidence to support the assumption that more financial resources leads directly to improved outcomes of fair play and clean sport.

In his Commentary article, Lopez develops and explores the idea that the fear of needles has underpinned much of the anxiety upon which anti-doping ideology has been built. This innovative study aims to address cultural foundations, the societal meanings given to aspects of medicalisation, and how policy might not be a rational or consistent outcome of anxiety based demands for regulation.

I would like to thank all the participants in the workshop. The discussions varied over the two days, but we never quite nailed down the answer to whether anti-doping protects the health of athletes. This is an on-going debate, these articles make a meaningful contribution. If the global “war on drugs” in sport continues to lurch from one crisis to the next, perhaps the next stage of evolution should be an open debate on what drugs and methods should be banned and why. This collection might pre-empt that debate; the authors aptly demonstrate the need for further discussion, research and conceptualisation.