Bringing Awareness of Performance Enhancing Drug Use to the Family Medicine Practitioner

Bringing Awareness of Performance Enhancing Drug Use to the Family Medicine Practitioner
Athena Cannon, PharmD, Broadway Family Medicine

Performance enhancing drugs (PEDs) are drugs commonly found in prescription medications or dietary supplements used to enhance mental or physical performance.  According to the World Anti-Doping Agency, sports organizations test for PEDs in elite athletes to preserve the integrity of sport by creating a level playing field, to inspire true sport by celebrating and encouraging hard work and dedication, and to protect the rights of athletes. A recent editorial published by Smith and Colleagues in American Family Physician brings awareness to PED use outside of the elite athletic population and inside the family medicine practice setting. As sports organizations broaden their anti-doping initiatives to detect the use of PEDs in recreational and masters level (>30 years old) athletes, there have been a growing number of positive doping tests. Of the many PEDs used, selective androgen receptor modulators (SARMs), growth hormone and metabolic modulators, and designer stimulants should be on any practitioner’s radar as these are easily accessible on the internet and found in dietary supplements. Examples of these include ostarine, meldonium and higenamine, respectively. Knowing if a patient is using these products is particularly important to determine drug interactions or the likelihood of exacerbating underlying conditions. Additionally, the short- and long-term consequences of using these novel drugs are unknown. Because PED use is prohibited in sport, patients who use them and compete as recreational or masters level athletes can experience negative consequences on their athletic careers. Smith and Colleagues emphasize the importance of family medicine practitioners being alert to the signs of PED use, integrating screening into their workflow, and having open dialogue about the safety and efficacy of using such products. They stress the importance for practitioners to be aware of the competition status of patients and the need for therapeutic use exemptions, which allows patients to use these drugs for legitimate medical conditions. Additionally, pharmacists can play an important role in evaluating the indication, efficacy, and safety of medications and dietary supplements consumed by individual athletes. Resources to check if a medication is permitted in a certain sport can be found at Global Drug Reference Online (



  1. World Anti-doping Agency. The World Anti-doping code international standard: prohibited list. World Anti-doping Agency website. January 1, 2020. Accessed May 6, 2021. https://www.wada

  2. Smith T, Fedoruk M, Eichner A. Performance-enhancing drug use in recreational athletes. American Family Physician. 2021;103(4)