Steroids, painkillers and food supplements: overview of doping in sport

According to the World Anti-Doping Agency’s annual report for the year 2024, 91 French athletes tested positive in 2024. For the second year in a row, France is the second nation with the highest number of positive cases recorded by the World Anti-Doping Agency. This Friday, April 24, Inserm unveils the results of a collective expertise establishing an inventory of doping and doping practices in sporting environments (professional and amateur).

The report was commissioned by the Ministry of Sports and is based on the critical analysis of the international scientific literature of the last ten years (more than 3,800 references examined) by a multidisciplinary group of experts covering the fields of epidemiology, sociology, political philosophy, psychosociology, psychology, prevention science, cardiology, psychiatry, exercise physiology and sports medicine.

The analysis of the different methods used to estimate the prevalence of doping and doping practices highlights the heterogeneity of the populations concerned. Over the past 10 years, the overall prevalence of doping in high-level competitions is estimated at less than 5%. Depending on the methodology used (excluding biological tests), the prevalence could however reach up to 30% in certain sports. “In the results of biological tests that may constitute a violation of the World Anti-Doping Code, anabolic steroids constitute the most commonly detected category of doping substances (43 to 45%), followed by stimulants and diuretics and masking agents3 (12 to 16%),” confirms Inserm.

Athletes with disabilities are not spared from doping either. “Between 2013 and 2022, the violation rate was below 1% ; the sports most concerned being para-athletics and disabled weightlifting. Disabled sport is faced with specific forms of doping,” report the experts. Indeed, athletes with disabilities have distinct prescribed medication consumption profiles. “The studies analyzed – most of which were conducted among Paralympic athletes – reported increased use of analgesics and non-steroidal anti-inflammatories, with prevalence rates around 20%.”

Concerning the propensity for doping in amateur sport, studies on European countries estimate the consumption of substances aimed at improving performance among amateurs of 2 to 39% depending on the disciplines.

Painkillers, dietary supplements, anabolic-androgenic steroids ; what are the most common doping products? Concerning anabolic-androgenic steroids, studies in Western countries estimate their consumption among 12-30 year olds in the general population at 1.6% with consumption increasing since 2022 and more than half of users reporting symptoms of dependence. “Among athletes who attend gyms, the prevalence of SAA consumption is on average higher than in the general population, varying between 10 and 35%,” explains Inserm.

Regarding painkillers, their use is widespread among professional and amateur athletes. The use of painkillers is widespread in particular in endurance sports (trail, football, etc.) and contact sports. The consumption of the most common painkillers – paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or ketoprofen does not constitute doping as defined by WADA. On the other hand, “certain opioid analgesics (morphine, tramadol, oxycodone, etc.) appear on its list of prohibited substances”.

Studies document concomitant intake of several classes of different anti-inflammatory molecules and dosages higher than recommendations. “Among young athletes and in professional football, rates sometimes exceed 50%. In endurance sports, consumption tends to increase with the duration or length of the events: from 3% for half-marathons to more than 60% during races of more than 100 km, making it one of the first legal substances declared (more than one in five participants in the Ultra-Trail du Mont-Blanc),” explains Inserm.

According to the experts in this vast analysis, studying doping involves dealing with questions relating to individual choices as well as geopolitical issues. “In the case of France, the expertise highlights the need to improve coordination between the different actors and to control illegal distribution markets in a more structured way,” concludes Inserm.