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Drug use among athletes has become a recognised problem in sports. Athletes may use drugs for therapeutic indications, for recreational or social reasons, as ergogenic aids or to mask the presence of other drugs during drug testing. Stimulants were some of the first drugs used and studied as ergogenic aids. Amphetamines may increase time to exhaustion by masking the physiological response to fatigue. Caffeine may improve utilisation of fatty acids as a fuel source thereby sparing muscle glycogen. Cocaine and other sympathomimetic drugs have little or no effect on athletic performance. Anabolic steroids appear to have the potential to increase lean muscle mass and strength under certain conditions. Human growth hormone may also be used for an anabolic effect, but data on this effect are lacking. Erythropoietin may represent a pharmacological alternative to blood doping by increasing red blood cell mass. The use of narcotic analgesics is not necessarily ergogenic but can be harmful if used to allow participation of an athlete with a severe injury. According to the American College of Sports Medicine alcohol does not possess an ergogenic effect. However, it may be used to reduce anxiety or tremor prior to competition. Marijuana does not increase strength. Tobacco products may produce psychomotor effects or control appetite which may be beneficial to some athletes. Other drugs used by athletes include beta-blocking agents, diuretics, and a variety of nutritional supplements. In addition, diuretics and probenecid may be taken to mask drug contents in the urine. Whether the ergogenic effects are real or perceived, the potential for adverse effects exists for all of these drugs. Potential health complications represent a serious risk to an otherwise healthy population. Further research on the long term health risks in athletes taking ergogenic drugs is needed.

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Anabolic steroids have been used by athletes since the 1950s to increase size and strength in order to improve their performance. The abuse of these substances has since expanded to include junior high and high school male and female athletes and non-athletes. The anabolic and androgenic effects of these agents, when taken in the doses needed to produce increases in size and strength, result in significant serious adverse effects involving the skin, liver, cardiovascular, musculoskeletal, endocrine and reproductive systems. Some of these effects are irreversible. It is essential that clinical toxicologists, emergency room physicians and psychiatrists are familiar with the physical and psychological effects, as well as the changes in laboratory parameters, that typically occur from chronic use of anabolic steroids. The toxicities and representative clinical profiles of steroid users are presented, and the methods available for diagnostic screening using psychological testing and urine analysis are also reviewed.