Public Health Feature - February 2008
By Crystal Conde
Did that 300-pound lineman who crushed your quarterback son like a soda can in last year's big game get that way naturally, or did he have some help? State athletic officials want to find out, and they're about to invade high school locker rooms as they embark on the largest random anabolic steroid testing program of its kind in the world.
Fourteen companies are vying to run the testing program, but the winner hadn't been selected by the end of 2007. The University Interscholastic League (UIL) Banned Substance Testing Program didn't get off the ground in time for football season. But the legislature has ordered the UIL to conduct tests in 30 percent of the state's public high schools in the 2007-08 and 2008-09 school years.
Testing will begin before the end of the spring semester this school year, but officials say that despite receiving authority to move forward with the program last Sept. 1, they're taking time to make sure they get it right the first time. UIL, in conjunction with the Texas Education Agency (TEA), has developed a comprehensive protocol governing banned substance testing, granting a medical exception, and penalties.
The 14-page protocol is posted on the UIL Web site, www.uil.utexas.edu . Click on Athletics. The UIL's Web site also features a list of banned substances (see " UIL Banned Substances ").
The legislation that gave birth to the testing program, Senate Bill 8, authored by Sen. Kyle Janek, MD (R-Houston), grants rule-making authority to the UIL and appropriates funds to the TEA. The TEA will transfer $3 million per biennium - $6 million total - to the UIL and require it to study potential future funding mechanisms and make recommendations to the legislature by Dec. 1, 2008.
The UIL estimates it will test 20,000 to 25,000 students (roughly 3 percent of Texas' more than 700,000 student athletes) in the first year - a large undertaking. Florida and New Jersey conduct testing, but each state's program affects only 500 high school student athletes annually.
Jeff Kloster, TEA's associate commissioner of health and safety, says thorough setup and careful planning are essential to success when dealing with a program of this scope.
"The UIL has a tremendous job in front of them. Once they do this, it will be the single largest testing program in the nation," he said. "I would caution folks that the approach is to do it right; they're going about this methodically."
Stephen Brotherton, MD, a Fort Worth orthopedic surgeon and team doctor for Texas Christian University athletics and several ballet troupes, understands the reasoning for meticulous planning.
"You've got to spend the money and spend the time to make sure your testing is accurate and you're not accusing kids of doing something they really haven't done," he said.
Before testing begins, physicians who treat high school students in athletics should become familiar with the banned substances officials will be testing for and should counsel their patients on the dangers and negative long-term effects of anabolic steroid use.
Student athletes will be chosen at random for testing, and the vendor will test for the presence of a banned substance in an athlete's urine. Students who test positive or refuse to participate will be suspended for 30 school days of competition in all UIL athletic activities. A second positive specimen will lead to suspension from all UIL athletic contests for one year. To have their eligibility restored, athletes must test negative on a follow-up exam. A third strike bans the student from competition for the remainder of his or her high school career.
Before the start of each school year, student athletes, their parents, and physicians will have an opportunity to request an exception allowing the athlete to use a banned substance. A physician appointed by the vendor will review the request and approve or reject it.
Do You Know What's in There?
While the UIL won't test student athletes for nutritional and dietary supplements, it cautions that such products may contain banned substances that could cause a positive test result for steroids.
Albert Hergenroeder, MD, a Houston sports medicine physician, adds that the U.S. Food and Drug Administration doesn't regulate supplements, thus there are risks associated with taking them. Consumers don't know what they're buying, making the products' contents even more questionable.
"Kids are playing Russian roulette with these supplements. If they want to bulk up, they can do it with good, sound nutrition and proper training. That's what physicians should keep emphasizing. The use of dietary supplements is fraught with danger," he said.
USAToday reported in December that a study by Informed-Choice, a nonprofit coalition of dietary supplement manufacturers, showed that 13 of 52 supplements purchased at various U.S. retailers contained small amounts of steroids, and six contained banned stimulants.
Dr. Hergenroeder highlights the article's inclusion of an International Olympic Committee study from 2000-02 that says steroids were found in 18.8 percent of 240 supplements purchased in the United States.
In addition, the UIL won't test students for use of illegal and recreational drugs or alcohol. Dr. Hergenroeder says he's concerned about the use of illicit substances that may be associated with steroid use. He says he's unsure whether steroid testing is a deterrent for drug use.
"The keys are prevention, proper education, and the emphasis on the situations that kids get themselves into, which might be associated with higher risk for drug use. We need to help them develop behavioral strategies so they don't want to use drugs," Dr. Hergenroeder said.
The American Academy of Pediatrics (AAP) offers a brochure on the topic of steroid use that physicians can use to open a dialogue with patients and their parents. "Steroids: Play Safe, Play Fair" is for sale on the AAP's Web site, www.aap.org , in packs of 50. The publication will help physicians review with their patients the facts about steroids, including what they are, how they're used, and their potential side effects.
Some Still Skeptical
Testing students isn't without its opponents. Critics of the Texas program cite a two-year randomized, controlled study of 11 Oregon high schools that examined the effects of testing student athletes for drug and alcohol use. The study showed athletes in schools with a testing policy didn't differ in past-month drug use from those attending schools without a testing policy. The report concluded that additional research is necessary to determine if random drug testing is a deterrent.
The Texas School Survey of Substance Abuse Among Students shows that the use of alcohol and tobacco was a bigger concern than steroid use from 1990 to 2006. In 2006, 65.9 percent of students in grades 7 through 12 said they'd had alcohol. The same year, 35.4 percent reported using a tobacco product.
The survey indicates steroid use has declined among students in grades 7 through 12 since 1988. In 2000 and 2002, the highest incidence of students - 2.3 percent - reported having ever used steroids. In 2006, that dropped to 1.5 percent. The survey is conducted every two years to collect self-reported data on tobacco, alcohol, inhalant, and licit and illicit substance use among elementary and/or secondary students in individual districts throughout the state.
Mr. Kloster says schools, parents, and health officials will find out just how significant a problem steroid use is among high school athletes once the program ramps up. He hopes educating students about the negative impact of banned substances will help prevent them from using in the future.
Dr. Brotherton says random steroid testing could be a deterrent for student athletes.
"I think you want a realistic way to catch kids who are cheating, for their health if for no other reason," Dr. Brotherton said. "If they know there's a chance they'll get caught, it will reduce their use of steroids."
He also suspects that steroid use is higher than reported. The worst ancillary effect of steroids, he says, is coercion of others, not a potential associated use of illegal drugs.
"If a kid uses a nonperformance-enhancing drug, from an athletic point of view, it's to his detriment. It doesn't encourage others quite as much. When you have poor control over kids taking steroids, it amps up the competition," he said.
Mr. Kloster says the program isn't about busting student athletes, but is instead focused on making sure education on the dangers of steroid use is a priority.
To that end, the TEA and the UIL developed an educational DVD and a question-and-answer PDF, both available on the UIL's Web site. SB 8 also mandates that athletic coaches in grades 7 through 12 complete an educational program regarding the health effects of steroid use, which range from liver tumors and cancer to high blood pressure and mood swings.
Dr. Brotherton encourages his colleagues to educate themselves on the signs of steroid use and to counsel their young patients.
"The best thing you can do is to be available to the students and athletic trainers and know the kids the best you can. When a kid bulks up quickly, you can ask how he or she transformed so quickly," he said. "You need to be credible to them and tell them steroids can kill them and can have permanent damage. Your best effect will be on the kids you're closest to."
Crystal Conde can be reached at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by e-mail at Crystal Conde .
UIL Banned Substances
Other anabolic agents: clenbuterol
*For testosterone, the definition of positive depends on an adverse analytical finding (positive result) based on any reliable analytical method (e.g., IRMS, GCMS, and CIR) that shows that the testosterone is of exogenous origin, or if the ratio of the total concentration of testosterone to that of epitestosterone in the urine is greater than 6:1, unless there is evidence that this ratio is due to a physiological or pathological condition.
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