Doping in Sports: From Strychnine Cocktails to Gene Doping

Strychnine Was Once a Legal Supplement

At the 1904 St. Louis Olympics, American marathon runner Thomas Hicks collapsed near the finish line and had to be supported by his trainers, who administered doses of strychnine sulfate mixed with brandy — a common practice of the era based on the stimulant properties of small strychnine doses at sub-lethal levels. Hicks crossed the finish line first but was initially disqualified when the original winner was found to have hitched a ride in a car for part of the course. Hicks was reinstated as the gold medalist. No one questioned the strychnine.

The pharmacological enhancement of athletic performance is as old as organized sport. Ancient Greek athletes ate specific foods and herbs believed to improve performance. Thomas Hicks's trainers were not cheating by the standards of 1904; they were optimizing. The transformation of performance enhancement from standard practice to prohibited cheating is a regulatory and ethical construction that has evolved continuously over 120 years — and it is far from settled.

Cycling's EPO Era: Undetectable and Deadly

Erythropoietin (EPO) is a hormone produced naturally by the kidneys that stimulates red blood cell production. Synthetic recombinant EPO, developed in 1989 as a treatment for anemia in kidney disease patients, was immediately recognized by endurance sport athletes as an extraordinary performance enhancer. By artificially elevating red blood cell counts (hematocrit levels), EPO increases the blood's oxygen-carrying capacity, dramatically improving aerobic endurance. A cyclist using EPO could expect performance gains of 5–10% — an enormous margin in a sport decided by seconds.

Through the late 1980s and most of the 1990s, EPO was undetectable in urine tests. It was so widely used in professional cycling that riders referred to it simply as "the product." The human cost was real: EPO-induced blood thickening, particularly at night when heart rate drops during sleep, was linked to the deaths of at least 18 professional Dutch and Belgian cyclists between 1987 and 1990 from cardiovascular events. Riders reportedly set alarms to wake themselves up to exercise during the night and prevent their blood from thickening fatally. The numbers are stark.

The 1988 Seoul Revelation

Ben Johnson's 9.79-second 100-meter world record at the 1988 Seoul Olympics — subsequently annulled — was not the beginning of elite track and field's doping problem but its most public exposure. Johnson tested positive for stanozolol, an injectable anabolic steroid that improves lean muscle mass and recovery. His gold medal and world record were stripped two days after his race.

The Seoul 100-meter final has become a shorthand for elite sport's doping problem because of what subsequent investigation revealed about the other finalists. Of the eight runners in that race, six were subsequently linked to doping violations or suspicions at some point in their careers. Carl Lewis, who was elevated to the gold medal, had tested positive for stimulants — pseudoephedrine, ephedrine, and phenylpropanolamine — at the 1988 US Olympic Trials. The USOC accepted his explanation that the substances were inadvertently consumed through a herbal supplement. His positive was not disclosed publicly for twelve years.

WADA and the Anti-Doping Architecture

The World Anti-Doping Agency was established on November 10, 1999, in Lausanne, Switzerland, following a scandal that threatened to destroy professional cycling. The 1998 Tour de France had been convulsed when customs officers discovered 400 doses of EPO and human growth hormone in the car of Festina team soigneur Willy Voet. Police raids on team vehicles and hotels produced evidence of systematic, team-organized doping across multiple cycling squads. Several riders and team officials were arrested; multiple teams withdrew from the race.

WADA's creation was a direct response to this crisis. Funded equally by the international sports movement (IOC and sports federations) and by governments, WADA maintains the Prohibited List, sets standards for anti-doping laboratories, and oversees the World Anti-Doping Code, to which all Olympic sports and most professional leagues have acceded. The Code covers prohibited substances, testing procedures, whereabouts requirements, and sanctions.

Lance Armstrong: The Sophisticated System

Lance Armstrong's seven consecutive Tour de France victories from 1999 to 2005 were annulled by the US Anti-Doping Agency (USADA) in August 2012 following an investigation that revealed what USADA called "the most sophisticated, professionalized, and successful doping program that sport has ever seen." Armstrong's program included EPO, testosterone, blood transfusions, and human growth hormone, coordinated by team physician Michele Ferrari and administered to multiple teammates as a systematic requirement of employment.

Armstrong had passed over 500 drug tests. His ability to evade detection — through microdosing EPO to minimize detection windows, timing blood transfusions around test schedules, and the use of a masking agent — demonstrated that the most sophisticated athletes and their support networks were consistently ahead of testing technology. The Armstrong case accelerated investment in athlete intelligence gathering, informant programs, and non-analytical violations as complements to testing.

Russia's State-Sponsored Program

The McLaren Report, commissioned by WADA and delivered in two volumes in 2016, documented what its author, Canadian lawyer Richard McLaren, described as a state-directed system involving over 1,000 Russian athletes across more than 30 sports at three Olympic Games (2012, 2014, and 2016). The program operated through the Russian Federal Security Service (FSB) and included the overnight swapping of athlete urine samples through a hole in the wall of the Sochi anti-doping laboratory during the 2014 Winter Games — samples that had been contaminated were replaced with clean samples collected months earlier.

Russia was not banned from the 2016 Rio Olympics as a consequence — a decision by the IOC that drew fierce criticism from clean athletes and anti-doping advocates. Instead, individual sports federations determined eligibility on a sport-by-sport basis. Russia competed at subsequent Olympics under neutral flags and names (Olympic Athletes from Russia, then ROC) following a formal ban on the Russian Olympic Committee. As of 2024, consequences for the individuals responsible for designing and implementing the state program remain largely absent.

Gene Doping and the Next Frontier

Gene therapy — the modification of gene expression to treat disease — creates the possibility of gene doping: the use of gene therapy techniques to enhance athletic performance. The most discussed candidate is the gene encoding IGF-1 (insulin-like growth factor 1), which promotes muscle growth. In animal studies, IGF-1 gene therapy has produced extraordinary muscle hypertrophy. The same effect in humans would be performance-enhancing on a scale that exceeds any chemical substance.

No confirmed case of human gene doping in sport has been documented. Detection is theoretically possible through biopsy analysis but not through the blood and urine testing that constitutes practical anti-doping surveillance. The Therapeutic Use Exemption (TUE) system — which allows athletes to use otherwise prohibited substances for legitimate medical conditions under physician authorization — has been consistently criticized as a pathway for sophisticated athletes to obtain pharmaceutical enhancements under medical cover. Approximately 1% of elite athletes hold TUEs at any time, but TUE data for specific athletes have leaked and generated controversy that the system has not fully resolved. The arms race between enhancement and detection has no foreseeable endpoint.