The anabolic steroid control act requires that anabolic steroids are in what drug schedule?

Anabolic Steroids

Anabolic steroids promote the growth of skeletal muscle and the development of male sexual characteristics. They are ingested (oxandrolone, oxymetholone, stanozolol) or injected (nandrolone, testosterone, boldenone) intramuscularly by bodybuilders to increase muscle mass and by athletes to boost physical performance. Physical and psychological dependence can develop after habitual use. Cardiovascular disease, hepatic disorders (e.g. peliosis hepatis, hepatic adenomas), infectious diseases (due to needle sharing), and perhaps mood disorders are among the long-term complications of anabolic steroid misuse. The cutaneous side effects of these and other drugs are outlined inTable 89.2.

Control of Anabolic Steroids

Anabolic steroids are controlled substances in several countries, including Australia, Argentina, Brazil, Canada, the United Kingdom, and the United States. The US congress passed the Anabolic Steroid Enforcement Act in 1990, which declared anabolic steroids a controlled substance (Schedule III, Controlled Substance Act). In 2003, the Controlled Substance Act was amended to include prohormones (steroid precursors) since they may potentially act as steroid hormones. The Anabolic Steroid Control Act of 2004 was introduced, which took effect in January 2005, and it reclassified prohormones as controlled substances by amending sections of the Controlled Substance Act and the Anabolic Steroid Enforcement Act of 1990.

The International Olympic Committee (IOC) Medical Commission introduced anabolic steroids as a banned class in 1974 in order to control doping in human sport. In 1999, various governments, intergovernmental organizations, and other public and private bodies fighting against doping in human sport in concert with IOC started the World Anti-Doping Agency (WADA). All the rules and detailed technical documents concerning anabolic steroids (and other drugs) are constantly evolving under WADA and up-to-date information can be found at the WADA web site (http://www.wada-ama.org/en/).

Anabolic Steroids

At high doses, anabolic steroids often produce reversible bland cholestasis, usually within 1 to 6 months after treatment is started. Recovery usually follows drug withdrawal, but protracted cholestasis with biliary ductopenia can occur. Rarely, anabolic steroids may cause acute hepatocellular injury.308

Both OCS and the 17-alkylated anabolic steroids are associated with cholestasis, vascular lesions, and hepatic neoplasms (see later). The strength of these associations with individual lesions varies. Hepatic adenomas are clearly associated with use of OCS, whereas the association of OCS with HCC is controversial.309 By contrast, HCC is well documented in anabolic steroid users. Likewise, hepatic and portal vein thrombosis is an established adverse effect of OCS but not of anabolic steroids, whereas peliosis hepatis is seen more often with the latter than with OCS.

Targets-Pharmacodynamics

Anabolic steroids act at the androgen receptor. As there is only one androgen receptor, differences in effects in different tissues remain unexplained. Animal studies show anabolic:androgenic ratios of ∼ 3:1–6:1 (Goldfien, 1998), but there is no clear evidence supporting these data in the human. Reduced androgenicity of nandrolone is explained by the reduction in its activity by 5-alpha-reductase. Thus, it has reduced activity in tissues expressing high levels of this enzyme and full activity in tissues that express low levels or no 5-alpha-reductase (Bergink et al., 1985; Sundaram et al., 1995. There is also evidence that they act as antiglucocorticoids by competing for binding at the glucocorticoid receptor (Roy et al., 1997). Their effects on the liver are unlikely to be mediated by androgen receptors, because they are not mimicked by testosterone. They bind to a low-affinity glucocorticoid binding site, which binds neither natural estrogens nor androgens (Luzardo et al., 2000).

Anabolic Steroids

Anabolic steroids (Ch. 36) include a large group of compounds with testosterone-like effects, including about 50 named compounds on the prohibited list. New chemical derivatives (‘designer steroids’), such astetrahydrogestrinone (THG), are regularly developed and offered illicitly to athletes, posing a continuing problem to the authorities charged with detecting and identifying them. A further problem is that some of these drugs are endogenous compounds or their metabolites and their concentration can vary dramatically for physiological reasons. This makes it difficult to prove that the substance had been administered illegally. Isotope ratio techniques, based on the fact that endogenous and exogenous steroids have slightly different12C:13C ratios, may enable the two to be distinguished analytically. Since anabolic steroids produce long-term effects and are normally used throughout training, rather than during the event itself, out-of-competition testing is essential.

When given in combination with training and high protein intake, anabolic steroids undoubtedly increase muscle mass and strength but probably not other parameters of sporting performance. However, they have serious long-term effects, including male infertility, female masculinisation, liver and kidney tumours, hypertension and increased cardiovascular risk, and (in adolescents) premature skeletal maturation causing irreversible cessation of growth. Anabolic steroids produce a feeling of physical well-being, increased competitiveness and aggressiveness, sometimes progressing to actual psychosis. Depression is common when the drugs are stopped, sometimes leading to long-term psychiatric problems. In attempt to circumvent the rules, other drugs that release androgens, for example,human chorionic gonadotrophin (hCG,Ch. 36) or modify their action, such as androgen receptor modulators (Ch. 4), are increasingly used.

Clenbuterol, is a β-adrenoceptor agonist (seeCh. 15). Through an unknown mechanism of action, it produces anabolic effects similar to those of androgenic steroids, with apparently fewer adverse effects. It can be detected in urine and its use in sport is banned.

Indications

Anabolic Steroids (eSlide 39.8)

Anabolic steroids (ASs) have three general effects that enhance athletic performance. By binding androgen receptors, ASs stimulate messenger RNA synthesis, thereby increasing structural and contractile protein synthesis and producing an anabolic state. ASs also exert anticatabolic effects via competitive inhibition of the glucocorticoid receptor, leading to inhibition of the catabolic effects of cortisol and preservation of muscle mass. Finally, ASs have emotional effects, pushing athletes to train more intensely and more often. Premature deaths have resulted from AS use, most commonly as a result of suicide and acute myocardial infarction. ASs are banned by all major sporting leagues.

Anabolic steroid abusers suffer from low self-esteem, sometimes to the point of delusion and even mental illness. However, this can manifest itself in a variety of ways, and may even result in overcompensation in one form or another. Anabolic steroid abusers in law enforcement are prone to a number of related motivations and rationalizations, including performance enhancement, image enhancement, and the desire to frighten and intimidate others. Additionally, public safety leadership often participates in these rationalizations and fails to act, for their own reasons.

None of these rationalizations make anabolic steroid abuse less of an addiction or a crime. None of them can protect the public safety officer from the adverse side effects of long-term abuse. And none of them can protect the agency from the liabilities that can result from anabolic steroid abuse.

Anabolic Steroids

Anabolic steroids may first have been used by German troops in World War II to increase strength and aggressiveness. By the 1950s, competitive athletes were receiving such drugs, and other individuals as well. Use among amateur athletes, and nonathletes, is common. Estimates of the prevalence among exercisers and athletes range from 6% to 38%. Cardiovascular complications represent only a portion of the detrimental effects of anabolic steroids that also have adverse effects on the reproductive organs, liver, blood, endocrine, renal, immunologic, and musculoskeletal systems [14]. There are many different preparations available [15].

Anabolic steroids cause hypertension that likely contributes to the most commonly associated cardiac morphologic abnormality, namely, hypertrophy. These steroids also adversely affect serum lipids and increase coagulability of blood. Accordingly, myocardial infarction has been reported with use of anabolic steroids. Coronary spasm, coronary thrombus, and coronary atherosclerosis have all been implicated as the cause of the ischemic event. It is not clear whether sudden deaths that occur are related to an ischemic event and/or cardiac hypertrophy (Figure 18.3b). Systolic and diastolic dysfunction may persist for years after misuse of anabolic steroids [16].

Anabolic steroids, which are Schedule III controlled substances, can be prescribed for a narrow field of legitimate medical conditions. Typically, they are prescribed one at a time, and by a single physician that is closely monitoring both dosage and side effects. These prescriptions do not result in dramatically elevated anabolic steroid levels, and they are generally not long term because of the potential for addiction and other harmful side effects.

Because of the growing performance and image enhancement market, roid mills have sprung up all over the United States and the illegal importation of anabolic steroids from foreign countries is at an all-time high. This means that what appears to be a legitimate prescription for anabolic steroids may be obtained illegally by falsifying information, by visiting a “clinic” that is operating in an unlawful fashion, or by getting what may be an unlawful prescription from an online source.

It is not difficult to determine when anabolic steroids are being prescribed or used unlawfully. It does, however, require thoughtful observation and basic inquiry by public safety personnel. To that end, they must be aware of, and respond to, red flags associated with illegal steroid procurement, prescriptions, and abuse.