Placebos for Performance Enhancement

Athletic regulatory bodies have a new headache. This time, the pain is being caused by placebos (an unexpected side effect!)

As reported in New Scientist, athletes have found that they can exert themselves to a greater extent, while under the influence of opioid pain killers. That is not permitted in competition, of course, but there is a wrinkle. If they train while under the influence, then get a placebo prior to competition, their brains react to the placebo as if it were the real thing. Thus, they are less limited by pain during the competition.

The regulatory agencies are aware of this, but do not know what to do. They can't ban placebos, and there is no urine test to detect them, anyway...

If there were such a test, you can bet an entire cottage industry would spring up to find a way to fool the test. And people would pay for it.

The thing is, what the athletes are doing is not really making use of the placebo effect. Rather, they are undergoing a conditioned response. A minor point, perhaps, but a purist would not call this a placebo effect.

Regardless of the terminology, it is a bit of a problem. In the USA, it is unethical for a physician to prescribe an opioid in the absence of an appropriate medical condition. And of course it is illegal for someone to use an opioid without a prescription. Clearly, that makes it wrong.

It also is reckless. Pain does serve a function, after all. As we've seen from some tragedies involving marathon runners recently, excessive exertion can be fatal.

In my opinion, it is foolish and senseless to do this. But then, there are no Olympic medals for common sense.

There is no easy way to detect a short-acting opioid more than a few days after administration. So unless you are going to screen the athletes every few days, there is no good way to tell if someone is doing it.

Hair samples can be used to detect heroin use up to 90 days out, but there are a lot of opioids, and it would get to be very expensive to do screening that way. To complicate matters, there are legitimate uses for opioids, so even a positive test would not tell you for sure that there had been an infraction. I have to think that if someone can get such drugs in the first place, then getting a fake doctor's note to explain it would be no problem.

I guess the question is, does it make sense to impose a ban that cannot be enforced?

-Scienceblogs.com

Well it's really just conditioning, so they're not technically doing anything wrong other than illegally using opioids during training. If they aren't under the influence of them during actual competition, I don't see how much can be done about it.

So wait, do the athletes know they're only consuming placebos? Or are their trainers fooling them? Cause I don't think it would work if they knew it was fake. I'm just confused on how this got started.

I was also wondering that. For it to be a placebo effect, the people would have to actually think it's drugs, not a sugar pill.

When I compete in Iron Man Marathons I just pump myself full of my own blood I have stored previous to the race. More blood = more oxygen.