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Introduction
In the United States, anabolic-androgenic steroids (AAS) have always been considered drugs. Contrary to what today's young athletes may believe, these substances were never stocked on the shelves of the corner grocery store. However, only within the last decade have these drugs been classified as "controlled substances," thereby placing them in the same general category as more infamous drugs, including heroin, cocaine, LSD, and methamphetamine. The purpose of this article is to examine some of the social, medical and legal forces which have driven these changes and which continue to influence the use, abuse, and prohibition of anabolic-androgenic steroids.
What Led to the Classification of AAS as Controlled Substances?
Historically, AAS were classified as prescription drugs; they could be dispensed only upon the order of a licensed medical practitioner, who could then monitor their use and control individual dosages.1 Minors could not obtain prescriptions for AAS without the informed consent of their parents or guardian. Since medical practitioners knew that the administration of hormones could affect the body's natural development, particularly in adolescents, they rarely prescribed AAS for minors, except in cases of a genuine medical disorder. Thus, as we examine the history of AAS and the progression toward their prohibition, we should be mindful of the following:
Anabolic-androgenic steroids were subject to government regulation long before legislators decided to criminalize their use;
Prior to the criminalization of AAS, proper dosages could be prescribed and potential side effects could be monitored by trained medical practitioners;
Existing government regulation, a practitioner's medical judgment, and the required consent of legal guardians have always stood as natural barriers between adolescents and their use of AAS.
In June of 1889, Charles Édouard Brown-Séquard, a 72-year-old physiology professor, announced at the Société de Biologie that he had injected himself with extracts of dog and guinea pig testicles, resulting in an increase in his physical strength and health; further research into these purported effects led to the synthesis of testosterone in 1935.2 During World War II, German scientists began to synthesize other anabolic steroids, experimenting with human prisoners, as well as with German troops, whose aggressive tendencies they hoped to increase.3 Adolph Hitler's personal physician reported that Hitler was given injections of testosterone derivatives for various maladies.4 Ironically, one of the initial therapeutic uses of AAS was treatment of chronic wasting, such as was experienced by Nazi concentration camp prisoners.5
As early as the 1950s, bodybuilders and strength athletes began to experiment with AAS. Soviet weightlifters demonstrated impressive strength gains from the use of testosterone derivatives, and their secret was passed on to the Americans at the 1954 World Championship.6 By the 1960s, the medical community was conducting controlled scientific studies of the effects of AAS on strength and muscle mass.7 Early studies yielded promising results, but later research concluded that no palpable strength or muscle gains resulted from the use of AAS; recently, this trend has reversed, with scientists again finding that AAS promotes strength and muscle gains.8 This discrepancy in scientific findings leads one to wonder if some researchers intentionally misrepresented scientific findings in order to discourage the use of AAS for physical enhancement.
By the late 1960s, the use of AAS had become commonplace amongst bodybuilders and strength athletes, a trend which was quite noticeable in Olympic competition; the androgynous appearance of female athletes from former Communist bloc nations was a regular source of bawdy humor. In 1975, the Medical Commission of the International Olympic Committee (IOC) added anabolic steroids to its list of banned substances, and testing began at the 1976 Montreal Olympic Games.9 The most notorious violation of the IOC's drug policy came in 1988, when Olympic sprinter Ben Johnson was stripped of his gold medal in the 100-meter after testing positive for the use of AAS; another positive test in 1993 resulted in Johnson being subject to a lifetime ban.10
Acting upon the lead of the IOC, the National Collegiate Athletic Association (NCAA) followed suit. Although the NCAA had, in principle, banned the use of AAS in the college sports in 1973, it was not until 1986 that it initiated an active testing program.11 Likewise, the National Football League (NFL) began testing professional football players for AAS use during training camps in 1986, and by 1990, the NFL's testing program included random tests during the regular competitive season.12
The medical community was not blind to the fact that AAS were regularly distributed outside legal channels; in December of 1986, the American Medical Association (AMA) published a report that endorsed the efforts of law enforcement to curb illegal distribution of AAS and promoted educational efforts to increase public understanding of the issues surrounding the use of AAS.13 Nevertheless, the AMA opposed the criminalization of AAS because government regulation of prescription drugs already existed, and because AAS did not meet the traditional criteria for scheduling drugs as controlled substances.14 Despite this opposition, a few vocal practitioners published studies and lobbied strenuously for AAS to be classified as illicit drugs.15 As a result, the Anabolic Steroids Control Act was passed into law by the federal legislature, and AAS were classified as Schedule III controlled substances.16
Once AAS were classified as controlled substances under federal law, mere possession could result in penalties of imprisonment of up to one year for a first offense, with enhanced penalties for subsequent offenses.17 Manufacturing, distributing or dispensing AAS, or possessing AAS with purpose to do the same, could result in imprisonment up to five years.18 However, the most onerous burden under the new classification may have been the one placed on medical practitioners by the Code of Federal Regulations: if a practitioner prescribes AAS for any purpose other than a "legitimate medical purpose * * * in the usual course of his professional practice," or for "authorized research," he or she may be prosecuted as common drug dealer and subjected to the same penalties.19
Although the general public presumes that federal jurisdiction is without limit, it is not. Federal authorities cannot possibly investigate and prosecute all drug cases, nor do they have the universal jurisdiction to do so. Approximately 92% of all drug trafficking convictions are in state courts, as are nearly all convictions of simple drug possession.20 Therefore, nearly all states have adopted the federal classification of anabolic steroids as controlled substances.21 Perhaps more interesting are the specific limitations which some states have placed on medical practitioners regarding prescriptions for AAS. Ohio law specifically prohibits a licensed health professional from prescribing, administering, or personally furnishing "a schedule III anabolic steroid for the purpose of human muscle building or enhancing human athletic performance."22 A Texas statute prohibits a medical practitioner from dispensing, prescribing, delivering, or administering AAS for anything other than "a valid medical purpose," further stating that "bodybuilding, muscle enhancement, or increasing muscle bulk or strength through the use of an anabolic steroid or human growth hormone listed in Schedule III by a person who is in good health is not a valid medical purpose."23 Statutes such as these are clearly intended to intimidate medical practitioners and preclude any possibility that AAS will ever be legally prescribed for physical enhancement.
The attack on AAS did not end with their legal prohibition. Passionate statements before Congress continue to this day. On October 20, 1999, in a statement before the Senate Committee on Commerce, Science and Transportation, drug czar Barry McCaffrey asserted that "the international sale of steroids is becoming increasingly sophisticated and entrenched in criminal networks."24 Furthermore, McCaffrey has joined in the active movement to ban prohormones, stating, "The DEA is engaged in a scientific process to determine if Andro [androstenedione] actually produces muscle growth -- and, in turn, whether it should be classed as a steroid."25
As we stand at the turn of the millennium, AAS have been banned in sports, prohibited by law, and vilified before the general public. But what is it that makes anabolic-androgenic steroids so evil?
Why Should AAS Be Illicit Drugs?
Anabolic-androgenic steroids are clearly the "bastard child" of controlled substances. A review of federal and state drug schedules reveals that nearly all controlled substances are listed in sub-classifications which describe them in terms of their immediate psychoactive effects: stimulants, depressants, hallucinogens, and narcotics or opiates.26 Since AAS appear to have no immediate mood-altering effects, how did they come to be classified amongst this collection of unlike drugs?
Serious Side Effects
Numerous references have been made in popular literature to the "serious side effects" of anabolic steroids. But what substantial side effects are well established by scientific evidence?
We know that certain AAS, when taken in substantial amounts, are toxic to the liver; however, this applies largely to 17-alpha-alkylated steroids, such as methandrostenolone (Dianabol) and oxymethelone (Anadrol-50).27 There appears to be no strong evidence of such hepatotoxicity in orally-effective testosterone esters, such as methenolone acetate (Primobolan) and testosterone undecanoate, nor in the many injectable testosterone esters, including testosterone cypionate (Depo-Testosterone) and nandrolone decanoate (Deca-Durabolin).28 It has also been suggested that hepatocellular carcinoma (liver cancer) may result from the long-term use of 17-alpha-alkylated AAS, although a regression of tumors has been noted when AAS use is discontinued.29
Liver toxicity alone can hardly justify the classification of AAS as controlled substances. Paracetamol, also known as acetaminophen (Tylenol®), is touted as "the most trusted combination of strength and safety in pain relief today,"30 yet liver damage, even fatal hepatic necrosis, has been reported from repeated therapeutic usage of this over-the-counter drug, particularly from therapeutic usage amongst alcoholics.31 Nevertheless, even if the hepatotoxicity of 17-alpha-alkylated AAS is a matter of great concern, the banning of less toxic AAS contributes to the problem. A perfect example is stanozolol (Winstrol), a 17-alpha-alkylated steroid that is toxic to the liver in both its oral and injectable form, but which continues to be readily available on the U.S. black market because of its use as a veterinary drug (Winstrol®-V).32 One might logically speculate that the current use of more toxic AAS is less a matter of choice than one of accessibility, where the availability of safer choices has been limited by a legal prohibition that applies to all AAS, regardless of their toxicity.
In the United States, anabolic-androgenic steroids (AAS) have always been considered drugs. Contrary to what today's young athletes may believe, these substances were never stocked on the shelves of the corner grocery store. However, only within the last decade have these drugs been classified as "controlled substances," thereby placing them in the same general category as more infamous drugs, including heroin, cocaine, LSD, and methamphetamine. The purpose of this article is to examine some of the social, medical and legal forces which have driven these changes and which continue to influence the use, abuse, and prohibition of anabolic-androgenic steroids.
What Led to the Classification of AAS as Controlled Substances?
Historically, AAS were classified as prescription drugs; they could be dispensed only upon the order of a licensed medical practitioner, who could then monitor their use and control individual dosages.1 Minors could not obtain prescriptions for AAS without the informed consent of their parents or guardian. Since medical practitioners knew that the administration of hormones could affect the body's natural development, particularly in adolescents, they rarely prescribed AAS for minors, except in cases of a genuine medical disorder. Thus, as we examine the history of AAS and the progression toward their prohibition, we should be mindful of the following:
Anabolic-androgenic steroids were subject to government regulation long before legislators decided to criminalize their use;
Prior to the criminalization of AAS, proper dosages could be prescribed and potential side effects could be monitored by trained medical practitioners;
Existing government regulation, a practitioner's medical judgment, and the required consent of legal guardians have always stood as natural barriers between adolescents and their use of AAS.
In June of 1889, Charles Édouard Brown-Séquard, a 72-year-old physiology professor, announced at the Société de Biologie that he had injected himself with extracts of dog and guinea pig testicles, resulting in an increase in his physical strength and health; further research into these purported effects led to the synthesis of testosterone in 1935.2 During World War II, German scientists began to synthesize other anabolic steroids, experimenting with human prisoners, as well as with German troops, whose aggressive tendencies they hoped to increase.3 Adolph Hitler's personal physician reported that Hitler was given injections of testosterone derivatives for various maladies.4 Ironically, one of the initial therapeutic uses of AAS was treatment of chronic wasting, such as was experienced by Nazi concentration camp prisoners.5
As early as the 1950s, bodybuilders and strength athletes began to experiment with AAS. Soviet weightlifters demonstrated impressive strength gains from the use of testosterone derivatives, and their secret was passed on to the Americans at the 1954 World Championship.6 By the 1960s, the medical community was conducting controlled scientific studies of the effects of AAS on strength and muscle mass.7 Early studies yielded promising results, but later research concluded that no palpable strength or muscle gains resulted from the use of AAS; recently, this trend has reversed, with scientists again finding that AAS promotes strength and muscle gains.8 This discrepancy in scientific findings leads one to wonder if some researchers intentionally misrepresented scientific findings in order to discourage the use of AAS for physical enhancement.
By the late 1960s, the use of AAS had become commonplace amongst bodybuilders and strength athletes, a trend which was quite noticeable in Olympic competition; the androgynous appearance of female athletes from former Communist bloc nations was a regular source of bawdy humor. In 1975, the Medical Commission of the International Olympic Committee (IOC) added anabolic steroids to its list of banned substances, and testing began at the 1976 Montreal Olympic Games.9 The most notorious violation of the IOC's drug policy came in 1988, when Olympic sprinter Ben Johnson was stripped of his gold medal in the 100-meter after testing positive for the use of AAS; another positive test in 1993 resulted in Johnson being subject to a lifetime ban.10
Acting upon the lead of the IOC, the National Collegiate Athletic Association (NCAA) followed suit. Although the NCAA had, in principle, banned the use of AAS in the college sports in 1973, it was not until 1986 that it initiated an active testing program.11 Likewise, the National Football League (NFL) began testing professional football players for AAS use during training camps in 1986, and by 1990, the NFL's testing program included random tests during the regular competitive season.12
The medical community was not blind to the fact that AAS were regularly distributed outside legal channels; in December of 1986, the American Medical Association (AMA) published a report that endorsed the efforts of law enforcement to curb illegal distribution of AAS and promoted educational efforts to increase public understanding of the issues surrounding the use of AAS.13 Nevertheless, the AMA opposed the criminalization of AAS because government regulation of prescription drugs already existed, and because AAS did not meet the traditional criteria for scheduling drugs as controlled substances.14 Despite this opposition, a few vocal practitioners published studies and lobbied strenuously for AAS to be classified as illicit drugs.15 As a result, the Anabolic Steroids Control Act was passed into law by the federal legislature, and AAS were classified as Schedule III controlled substances.16
Once AAS were classified as controlled substances under federal law, mere possession could result in penalties of imprisonment of up to one year for a first offense, with enhanced penalties for subsequent offenses.17 Manufacturing, distributing or dispensing AAS, or possessing AAS with purpose to do the same, could result in imprisonment up to five years.18 However, the most onerous burden under the new classification may have been the one placed on medical practitioners by the Code of Federal Regulations: if a practitioner prescribes AAS for any purpose other than a "legitimate medical purpose * * * in the usual course of his professional practice," or for "authorized research," he or she may be prosecuted as common drug dealer and subjected to the same penalties.19
Although the general public presumes that federal jurisdiction is without limit, it is not. Federal authorities cannot possibly investigate and prosecute all drug cases, nor do they have the universal jurisdiction to do so. Approximately 92% of all drug trafficking convictions are in state courts, as are nearly all convictions of simple drug possession.20 Therefore, nearly all states have adopted the federal classification of anabolic steroids as controlled substances.21 Perhaps more interesting are the specific limitations which some states have placed on medical practitioners regarding prescriptions for AAS. Ohio law specifically prohibits a licensed health professional from prescribing, administering, or personally furnishing "a schedule III anabolic steroid for the purpose of human muscle building or enhancing human athletic performance."22 A Texas statute prohibits a medical practitioner from dispensing, prescribing, delivering, or administering AAS for anything other than "a valid medical purpose," further stating that "bodybuilding, muscle enhancement, or increasing muscle bulk or strength through the use of an anabolic steroid or human growth hormone listed in Schedule III by a person who is in good health is not a valid medical purpose."23 Statutes such as these are clearly intended to intimidate medical practitioners and preclude any possibility that AAS will ever be legally prescribed for physical enhancement.
The attack on AAS did not end with their legal prohibition. Passionate statements before Congress continue to this day. On October 20, 1999, in a statement before the Senate Committee on Commerce, Science and Transportation, drug czar Barry McCaffrey asserted that "the international sale of steroids is becoming increasingly sophisticated and entrenched in criminal networks."24 Furthermore, McCaffrey has joined in the active movement to ban prohormones, stating, "The DEA is engaged in a scientific process to determine if Andro [androstenedione] actually produces muscle growth -- and, in turn, whether it should be classed as a steroid."25
As we stand at the turn of the millennium, AAS have been banned in sports, prohibited by law, and vilified before the general public. But what is it that makes anabolic-androgenic steroids so evil?
Why Should AAS Be Illicit Drugs?
Anabolic-androgenic steroids are clearly the "bastard child" of controlled substances. A review of federal and state drug schedules reveals that nearly all controlled substances are listed in sub-classifications which describe them in terms of their immediate psychoactive effects: stimulants, depressants, hallucinogens, and narcotics or opiates.26 Since AAS appear to have no immediate mood-altering effects, how did they come to be classified amongst this collection of unlike drugs?
Serious Side Effects
Numerous references have been made in popular literature to the "serious side effects" of anabolic steroids. But what substantial side effects are well established by scientific evidence?
We know that certain AAS, when taken in substantial amounts, are toxic to the liver; however, this applies largely to 17-alpha-alkylated steroids, such as methandrostenolone (Dianabol) and oxymethelone (Anadrol-50).27 There appears to be no strong evidence of such hepatotoxicity in orally-effective testosterone esters, such as methenolone acetate (Primobolan) and testosterone undecanoate, nor in the many injectable testosterone esters, including testosterone cypionate (Depo-Testosterone) and nandrolone decanoate (Deca-Durabolin).28 It has also been suggested that hepatocellular carcinoma (liver cancer) may result from the long-term use of 17-alpha-alkylated AAS, although a regression of tumors has been noted when AAS use is discontinued.29
Liver toxicity alone can hardly justify the classification of AAS as controlled substances. Paracetamol, also known as acetaminophen (Tylenol®), is touted as "the most trusted combination of strength and safety in pain relief today,"30 yet liver damage, even fatal hepatic necrosis, has been reported from repeated therapeutic usage of this over-the-counter drug, particularly from therapeutic usage amongst alcoholics.31 Nevertheless, even if the hepatotoxicity of 17-alpha-alkylated AAS is a matter of great concern, the banning of less toxic AAS contributes to the problem. A perfect example is stanozolol (Winstrol), a 17-alpha-alkylated steroid that is toxic to the liver in both its oral and injectable form, but which continues to be readily available on the U.S. black market because of its use as a veterinary drug (Winstrol®-V).32 One might logically speculate that the current use of more toxic AAS is less a matter of choice than one of accessibility, where the availability of safer choices has been limited by a legal prohibition that applies to all AAS, regardless of their toxicity.