The history of drug use, or doping, or PED use (performance-enhancing drugs), in sports is almost as old as the history of sport itself. Doping is the European term for drug use but the term is less often used in the United States. Even the name itself has a history, as it comes from the 19^th century, when the term “dop” was used to describe a South African drink which was an extract of cola nuts to which was added xanthines (found in caffeine) and alcohol. The drink was intended to improve endurance and the term “doping” was derived from it.

In the Ancient Olympics, trainers gave athletes various concoctions that they felt would improve their performance. The first physician to be considered a specialist in sports medicine was Galen, who prescribed as follows, “The rear hooves of an Abyssinian ass, ground up, boiled in oil, and flavored with rose hips and rose petals, was the prescription favored to improve performance.”

In the late 1800s, trainers often gave European cyclists strychnine mixed with caffeine and alcohol. Most of the cyclists simply considered them a necessity. A similar potion, strychnine with brandy and egg white, was given to American marathoner, Thomas Hicks, when he was near collapse at the end of the 1904 Olympic marathon in St. Louis, which he went on to win.

Early documentation of sport doping focuses on cycling. The first punishment for doping in cycling goes back to the 19th century, when trainer Choppy Warburton was banned from the sport for suspicions of drugging his riders. Warburton coached Arthur Linton, who won Bordeaux-Paris in 1896, but was suspected of being doped by Warburton during that race.

All of these techniques were used to improve performance and little concern was given to them. It is safe to assume that over the next few decades drug use only increased, but it rarely made the news and there were few problems with its use. But eyebrows were raised at the 1952 Olympic Winter Games when syringes and empty drug vials were found in the speed skater’s locker rooms (speed skaters often train by cycling in the warmer months). Similar detritus was found in the cyclist’s locker rooms at the 1956 Melbourne Olympics.

It was known that the professional cyclists used drugs freely, mainly stimulants such as amphetamines. In 1924 Henri Pélissier and his brother, Charles, admitted to various doping methods, describing in an interview their use of strychnine, cocaine, chloroform, aspirin, and horse ointments, although they later stated that the writer had exaggerated their claims. By the 1940s Italian campionissimo Fausto Coppi freely admitted to doping, calling it “la bomba,” and said there was no alternative if one hoped to stay competitive.

In 1955 French rider Jean Malléjac collapsed in the Tour de France near the top of Mont Ventoux, and it was attributed to doping. He had been riding wildly and sporadically and fell off his bike with one foot still in his toe clip. He later stated he had been drugged against his will and proclaimed his innocence to his death in 2000.

Roger Rivière, a star of the late 1950s, who was paralyzed after a crash in the 1960 Tour, later admitted to doping during his career, and even said his career-ending accident was possibly due to the use of painkilling drugs which had affected his reflexes and judgment. Ironically, Rivière once commented about the marathon legend of Pheidippides, “Had the soldier from Marathon had access to some kind of restorative product, he would most likely not have died.”

At the 1960 Rome Olympics, Danish cyclist Knut Enemark Jensen collapsed and died during the cycling road race. He was later found to have been given amphetamines (Ronital) and nicotinyl tartrate (a nicotine-type of stimulant). Jensen’s death, however, caused no great call to enforce rules against drug use in sports.

In 1965 Tour superstar Jacques Anquetil admitted during a television interview that he used drugs, stating that it was common at the time, and that a man could not ride Bordeaux-Paris or the grand tours while riding only on water. On 1 June 1965, performance-enhancing drugs were made illegal in France and in July 1966 the Tour authorities began testing the riders for drugs, with Raymond Poulidor the first rider to be tested on 29 July.

The most famous drug-related sports death then occurred at the 1967 Tour de France, when the great British cyclist, Tommy Simpson, collapsed and died while ascending Mont Ventoux. An autopsy revealed he had been heavily dosed with stimulants.

Sports administrators could not continue to avoid the problem. The deaths of Jensen and Simpson alerted the sporting authorities, among them the IOC and the IAAF, to the dangers inherent in drug use in sports. At the 1968 Olympic Winter Games, the IOC tested for drugs for the first time. The first athlete to be disqualified in the Olympics for drug use was Sweden’s Hans-Gunnar Liljenwall. Liljenwall was a modern pentathlete who had helped his team win a bronze medal. Prior to the shooting event he drank a few beers to help steady his nerves. This was commonplace among modern pentathletes in those days, but it cost him and his teammates a bronze medal.

The IOC did not start testing for anabolic steroids until 1972 at the Olympics. Seven athletes were disqualified for doping offenses at the 1972 München Games, with three athletes losing medals – Rick DeMont (USA) in the controversial 400 metre freestyle, after he was found to have a stimulant (ephedrine) in his Marex inhaler that he used for his asthma; Aad van den Hoek (NED), who was found to have taken coramine, a stimulant, which eliminated the Dutch team from the team time trial, after they had placed third; and Bakhaavaa Buidaa, a Mongolian judoka who lost his silver medal when he became the first Olympian to test positive for an anabolic steroid, Dianabol.

Since the advent of drug testing, the major scandals have involved the use of anabolic steroids, blood doping, and erythropoietin (EPO). None of these just came about in the 1980s or 1990s.

Anabolic steroids had been invented in the early 1950s by the American physician, John Ziegler, who developed them to help patients with serious illnesses, including soldiers, although concurrent development by Soviet and German doctors was later revealed. Many of these patients were unable to maintain their body weight, and they essentially wasted away. The anabolic steroids were capable of keeping the patients in what is known as “positive nitrogen balance.” In that state, protein is being added, rather than taken away, from the body’s muscles. It was not long before athletes discovered their usefulness, with weightlifters and weight throwers in track & field known to have started using them in the early 1960s.

Blood doping, also termed blood boosting, blood packing, and induced erythrocythemia, involves the infusion of red blood cells to increase a person’s aerobic capacity. Rumors of blood doping first became rampant when the great Finnish distance runner, Lasse Virén, won both the 5,000 and 10,000 at the 1972 München and 1976 Montréal Olympics. Between Olympics, Virén’s performances were relatively poor – he never won any other major event. While Virén claimed he was simply a master at peaking, his rivals whispered that he was being helped by blood doping. The rumors were never substantiated.

It goes much farther back than that, however, as blood doping was first investigated in 1947 by the American physiologist Pace. He infused 2,000 cc. of whole blood into subjects and noted increases in endurance capacity of as great as 35%. Multiple other studies have also shown increases in aerobic and endurance capacity, although no study used such a massive quantity as Pace’s study. (The normal adult male has a volume of blood of about 6 liters, so Pace was injecting 1/3rd of the patient’s blood volume.)

Most studies now confirm that blood doping increases both aerobic and endurance capacity, if properly administered, but blood doping was originally not considered terribly helpful to athletes, because it was thought adding extra red blood cells to the body increased the viscosity of the blood to a point that the heart could not generate enough output to increase aerobic capacity. This has been shown not to be true in the quantities of normal blood doping.

The first known documented blood doping scandal concerned the 1984 United States Olympic cycling team that admitted to blood doping prior to the Los Angeles Olympics, which was a systematic scheme also involving their coaches. Coincidentally the American cyclists did very well, winning multiple medals and titles, albeit in the absence of the Eastern European riders. Later, at the 2002 Olympic Winter Games, after the athletes had left Salt Lake City, discarded blood bags were found at the residence of the Austrian skiers and two Austrian cross-country skiers were disqualified, as well as the team doctor.

Blood doping was somewhat supplanted by the use of erythropoietin (EPO) and its analogues. Erythropoietin is a natural hormone synthesized by the kidneys and which stimulates red blood cell formation. Erythropoietin was first synthesized as a drug in the late 1980s, after the development of recombinant bacterial production, primarily as a method of treating patients with anemia. It has been especially helpful in treating patients with renal failure and on dialysis as a result. Since the kidney produces erythropoietin, kidney failure invariably causes a deficiency of the hormone, and virtually all of these patients are anemic. It is also used in cancer patients receiving chemotherapy, which often causes the body to stop producing red blood cells naturally.

Because it will naturally boost an athlete’s red blood cell mass without the risks of either autologous or heterologous blood doping, which can transmit viral diseases, or cause transfusion reactions, athletes have often used EPO to increase their aerobic capacity. This may also create long-term problems for the athlete as use of the drug may interfere with the body’s natural production of erythropoietin. Early studies also showed that supplements of erythropoietin may increase the risks of blood clots, diabetes and hypertension (high blood pressure).

In the late 1980s and early 1990s the European cycling press investigated a series of startling deaths. At least 10 and perhaps as many as 20 professional cyclists died very suddenly. Most of these athletes were from the Netherlands or Belgium, and most were young, and in extremely good condition as a result of the demands of their sport. While never proven, the rumor was that many of these athletes died as a result of using EPO. EPO increases the amount of red blood cells in the body, but extremely fit aerobic athletes, such as professional cyclists, already have a very high percentage of red blood cells, which is measured by checking a lab value termed the hematocrit. Normal hematocrit values for adult males are in the 38-43 range, while women have a slightly lower value.

Aerobic athletes usually have very high hematocrits naturally, as they have developed their aerobic capacity by training. Their hematocrits are often in the 45-50 range. But by taking EPO, these athletes can artificially raise their hematocrit even higher, often above 50. At hematocrit levels much above 50, the blood becomes very viscous, and may sludge. It is unable to circulate easily and can lead to strokes or heart attacks. This was considered to be the etiology of many of the deaths of the professional cyclists.

And it did not stop with anabolic steroids, blood doping or EPO. After them came designer steroids, the use of pure testosterone, and testosterone/epi-testosterone combinations to avoid detection, human growth hormone or somatotropin (hGH), and on virtually ad nauseum.

And this led to …

• the state-supported GDR doping system of the 1970s-80s, later revealed by released Stasi documents;
• the 1983 Pan American Games in Caracas, Venezuela when tight drug testing protocols caught 15 weightlifters;
• the Chinese system of the late 1980s in which their female distance runners set world records still never approached;
• Ben Johnson at Seoul in 1988;
• Marion Jones at Sydney in 2000, though not formally admitted for several years;
• the Festina Scandal of 1998;
• Lance Armstrong from 1999-2005 at the Tour de France;
• the BALCO Scandal in American professional sports around 2000-02;
• Operación Puerto in professional cycling circa 2006;
• the Floyd Landis fiasco at the 2006 Tour de France and thereafter;
• the admissions by Tyler Hamilton, and later Armstrong, about their drug use in cycling,
• the Russian scandal most fully revealed on Monday, 9 November, by the release of the Pound Report, … and so it goes

The athletes continue to use performance-enhancing drugs, and the scientists, and now governments and legal agencies, continue to pursue them. Plus ça change, plus c’est la même chose.