A Novel Method for Doping in Sporting Competitions

At a time when even our greatest athletic champions are being exposed as cheats for using performance-enhancing drugs, the science behind the doping methods that enhance athletic performance is both important and pertinent to anyone who identifies as a sports fan.  The use of performance-enhancing drugs, furthermore, is not limited by sport, gender, or creativity; and it involves not merely mediocre talents and fringe contributors, but household names and marquee athletes as well.  Out of the laundry list of athletes that have been convicted of using performance enhancing drugs in recent years, we need only look at a few – baseball’s home run king (Barry Bonds) and best player (Alex Rodriguez), Tour de France champion Floyd Landis, and Olympic gold medalist Marion Jones – to see just how profound of an impact that performance-enhancing drugs have had on the sporting world.

With the societal implications of performance-enhancing drugs in mind, a recent study, published in the Journal of Neuroscience and blogged about by Wired magazine, examined a novel method of doping in sport competitions.  The study found that injecting athletes with morphine allowed them to exercise longer and harder during training, and that these performance increases could be replicated by a placebo injection on the day of competition.  If athletes are able to experience the same performance-enhancing benefits by taking a placebo on race day that they receive from taking morphine on training days, then this new method of doping presents a novel method for enhancing athletic performance.  Moreover, the authors of the study are presenting the findings as an undetectable doping technique because the World Anti-Doping Agency only bans competitors from taking opiates on the day of competition.

The study, in devising a method to test the benefits of placebo-induced gains in pain tolerance, drew on previous studies that have shown that administration of a placebo after pharmacological conditioning with opioids (e.g., morphine) can produce powerful “morphine-like” responses.  In fact, administration of a placebo after pharmacological preconditioning has been shown to activate the same neurotransmitters in the brain that are activated by actual endogenous opioids.  Thus, in other words, in some ways a placebo behaves no differently – physiologically speaking – than the actual drug in patients who have been pharmacologically preconditioned.

To examine the effects of morphine injection on athletic endurance, the researchers divided the study participants into four categories:  Teams A and B underwent training without morphine; Teams C and D received morphine injections one hour before the training session.  The training sessions consisted of a test of pain tolerance while exercising, and the procedure was run once a week for two weeks before competition.

On the day of competition, of the two teams that received no pharmacological preconditioning (Teams A and B), only Team B was given a placebo (Team A was not given anything).  Interestingly, the participants who received a placebo without preconditioning (i.e., Team B), experienced a small but significant increase in pain endurance.  The participants on Team C, which had underwent preconditioning, were also given a placebo on competition day, and were found to have the highest mean pain tolerance on the day of competition (Fig. 1).

Figure 1: Main pain tolerance after injection

While Team D also underwent preconditioning, they received injections of morphine plus naloxone – a substance known to block opioid receptors (via competitive inhibition) – on competition day.  As such, Team D had a mean pain tolerance similar to the two teams that did not undergo preconditioning.

The crux of the studies’ discovery lies in the finding that Team C – the team that underwent pre-competition training with morphine, but received only a placebo injection on competition day – had the highest mean pain tolerance on race day.  It reinforces the idea that a placebo can produce physiological “morphine-like” responses in people who have undergone pharmacological preconditioning with morphine.  By examining the pain tolerance results among the individual participants in

Team C, the researchers also found that larger performance increases after morphine administration also translated to larger performance increases after placebo administration.

In terms of the study’s relevance to the sporting world, perhaps the most significant piece of data is that the placebo effect was observed one week after the participants last underwent morphine preconditioning.  This means that cyclists or runners training for a competition could feasibly use morphine to increase pain tolerance and pharmacologically precondition their opioid

receptors, and then reap the benefits on race day without actually injecting a banned substance.  This, of course, raises serious ethical consequences that cannot be ignored.  While this novel method of doping is legal in theory (because narcotics are not banned outside of competition), it is potentially very dangerous:  it is no secret that opiates are highly addictive (throughout history, people as brilliant as Charles Dickens, and as, um, not-brilliant as Rush Limbaugh, have become addicted to them).  And it should also be emphasized that this novel form of performance enhancement is only legal in principle; as the authors of the study were swift to ask:  do opioid-mediated placebo effects during competitions have to be considered a doping procedure?  If the placebo effect is as robust as the results of the study suggest, then I think that this form of pharmacological preconditioning has to be considered nothing less than cheating.

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~ by darrinhinkel on November 27, 2009.

7 Responses to “A Novel Method for Doping in Sporting Competitions”

  1. I want to agree with your conclusion that opioid-mediated placebo responses are a form of illegal doping, in the hopes that fewer athletes would choose to take a risky and addictive substance. However I feel that the most interesting result of this study is that of Team B, the subjects that had no pharmacological preconditioning and experienced an increase in pain endurance from receiving a placebo on the day of competition. Is this increase (albeit minor) also illegal? Clearly the placebo effect was a positive contribution to Team B’s performance, so should it be treated the same as a placebo effect stemming from preconditioning? It seems we have reached a fuzzy area of athletic performance enhancement, just like Oscar Pistorius the double amputee that has won the right to compete at the Olympic games despite controversy over the benefits of his carbon-fiber prosthetics.

    http://edition.cnn.com/2008/SPORT/05/16/athletics.pistorius/index.html

    http://www.wired.com/wired/archive/15.03/blade.html?pg=1&topic=blade&topic_set=

  2. When I first began reading this post, I was not surprised by the fact that placebos enhance performance on raceday after treatment with morphine during training. I have been a competitive long distance runner for 10 years now, and I know the value of keeping practice and race strategies consistent, even for silly things. For example, if I have an awesome hard workout, I’ll take note of what I had for lunch that day and make sure that I eat that food before my competitions. I think this gives me (and other athletes) a mental boost more than anything.
    Team D, however, suggests that the effects of the placebo on race day are not due to a mental boost, provided that Team D did not know that they were recieving opium + an opium inhibitor such that they would not get the affects of opium. If all of the athletic performance were due to the mental boost of the placebo, Team D should have done just as well as Team C. What, then, are the molecular mechanisms responsible for the placebo being able to activate the same neurotransmiters as the opium? This study suggests that some of the mechanisms are biological, but does psychology play a role as well?

  3. Amanda,

    What the study suggests is that there are BOTH psychological and biological mechanisms to the placebo-induced gains that were seen in this study. The point of the preconditioning was to verify that biological mechanisms are at work. Remember that Team D received naloxolone — which is an INHIBITOR of morphine — with their morphine injections. Therefore, Team D participants did not experience the same neurological preconditioning as Team C participants. This explains why they did not experience the same benefits on race day.

  4. I would certainly say that this should be considered an illegal form of doping. Although this is a clever way of bypassing the rules that opiates are only prohibited on the day of an event, it is quite clear that the effects brought about on that day are a direct result of opiates, even though none are being injected on that day. In many ways people define everything around us in terms of its function, or purpose. For instance, a chair is defined in terms of its function as an object on which we sit. It becomes nearly impossible to define it in terms of the physical characteristics of the chair, since so many can exist. (3 legged, 4 legged, even a box could be considered a chair by some). The ties into opiates and athletic doping in the following manner. Opiates are banned because of the function they have on an athlete on event day. Even though no opiates are being injected on that day, the same effect is being produced. In terms of the utility of this ban on opiates, I feel as though I am justified in saying that opiates are banned because of the effect they produce. Since the same effect is still occurring here, and also the effect is occurring as a result of previous induced opiate conditioning, I believe it is clear that this type of doping should also become banned in athletics.

  5. I agree with Brad’s line of logic. If the effect elicited by opiates is duplicated by a placebo injection after training with the substance, then the substance’s use in training should be disallowed. This is akin to endurance athletes using their own blood as a method of doping. In some sports athletes withdraw blood a few weeks or a month prior to competition then receive an infusion of their own blood before competition. While there are no substances injected or abnormal compounds taken into the body the effects are similar – higher aerobic capacity with increased pain threshold. While the blood is outside of the body, the body attempts to compensate for lost blood with increased erythrocyte production. Upon reintroduction of the old blood the athlete has higher levels of erythrocytes and can therefore carry more oxygen needed for aerobic activity.

    While I believe that the method described by Darrin should be banned the athletes who are willing to take advantage of the effects (while there is no penalty) should do so. If the end goal of athletic competition is solely to win (something that can be argued in other forums), then all mechanisms to enhance the possibility of winning should be undertaken.

  6. Darrin,

    I realize this study is in early stages, and athletes have probably not been “doping” in this manner very long (if at all), but I am wondering how addiction would play a role in pain desensitization.

    Opioid receptors are very interesting receptors in humans, and as they are overstimulated, the begin to develop characteristics of addiction. Here, I briefly summarize the cellular principles behind biological addiction: Over time, fewer receptors are expressed in an opioid-receptor expressing neuron after negative feedback mechanisms tell the neuron to alter transcription of these genes. Additionally, transcription of other genes involved in the cascades caused by opioid binding is also suppressed. As a result, it takes a higher concentration of opioid binding to the receptor to have the same effect on the neuron.

    My main question, then, is, how will addiction responses affect the placebo response? Will it take more morphine over time to produce this effect? The placebo response is surely psychological, but I wonder if taking the same dose of morphine each day would actually cause this placebo response to decrease, since the actual drug effect would be decreasing over time? Or would the pure psychological component be enough to keep up the placebo effect? I guess I foresee some problems in the future for athletes trying to “dope” in this manner. Not only is it not fair to the competition, these athletes will probably do themselves harm by developing morphine addiction, especially if they have to increase their doses to maintain a placebo effect.

  7. I certainly think that there would be significant health risks if athletes were to adopt this procedure as a habitual doping practice. And yes, it seems as if the athletes would have to increase the dosages of morphine over time if they wish to see the same pyschological + physiological benefit of opiod receptor conditioning on race day.

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