The use of performance enhancing drugs is so deeply entrenched in all levels of sport that one in three GPs is likely to encounter a patient who uses anabolic steroids, claims a report published this week by the BMA.
The report states that drugs are commonly used not only by elite athletes but also at recreational level throughout British gyms. For some athletes the motivation to take drugs is media pressure to win or huge financial rewards. For others it is simply to improve their body image. Some athletes have said they would take a drug to enhance their performance, even if there was a risk it might kill them.
The report raises concern at the easy availability of steroids through the internet or on the black market. Poor quality black market products have been linked to a number of cases of poisoning, infection, and mental illness, it states.
"What is really worrying is that people who use drugs in sport are taking potentially life threatening drugs and think it's worth it," said the BMA's head of ethics and science, Dr Vivienne Nathanson. "Surely no accolade is worth your health or indeed life?"
As well as anabolic steroids, the report lists amphetamines, cocaine, human growth hormone, and narcotics as drugs commonly used by sportsmen and women.
The report recommends that all doctors receive training at undergraduate and postgraduate levels on the recognition and treatment of problems relating to drugs used in sport. Education is also urged for all elite and non-elite athletes on the effects of doping.
"Sportsmen and women should be encouraged to have long-term medical monitoring after giving up competition work whether or not they were using drugs at certain times in their career, since intensive sport may lead to health problems," states the report.
It urges the pharmaceutical industry to exert tighter control on the supply of drugs such as human growth hormone and to include warnings in patient information leaflets on the dangers of using anabolic steroids for non-medical purposes.
It suggests a scheme whereby elite athletes would be required to keep a "drugs passport" that would be regularly updated with their testing history. Their participation in competitions would depend on this.
Athletes banned from competition would be required to undergo rehabilitation before being allowed back into the sport. "Doctors should be involved in advising on the development and content of the rehabilitation programmes," the report says.
Dr Nathanson acknowledged that an effective anti-doping strategy would be difficult to achieve and would have to be robust enough to withstand legal challenges from athletes. "More research and improved testing are required. But there is a lot that policy makers could and should be doing."
Drugs in Sport: The Pressure to Perform is available from BMJ Books, BMA House, Tavistock Square, London, WC1H 9JP