Globally, the problem of doping or the use of illegal performance enhancing substances in sport has become a gigantic one. Recently, Russian athletes were banned as a group for systemic doping allegedly supported by the country’s sports bodies.

In Pakistan, the lack of awareness about dope and the use of inferior substance can sometimes have disastrous consequences. Many of these items, especially anabolic steroids including testosterone are sold in various gymnasiums. In 2016, no less than five bodybuilders based in the Punjab died one after the other, some say as a result of consuming these steroids others say due to dehydration contributed to by the use of diuretics, used to clear doping agents from the system or to drop weight. The Pakistan Bodybuilding Federation had announced soon after the tragic deaths that it would start registering gyms and clubs across the country and "increase awareness about supplements and drugs to reduce unauthorized usage". However, there is no indication that any such action has actually been taken. The Federation has however made it mandatory for clubs to issue an affidavit saying they would not be using any illegal substance to develop rapid muscle growth.

However, bodybuilders and also other athletes who use gyms regularly say such substances are quite easily available. "The trainers and coaches at the gym can quite easily obtain materials which build muscle rapidly and make you stronger. The price varies on the quality of the materials," said a cyclist who preferred not to be named.

The substances, while they enhance athletic performance, can be extremely dangerous for the health of an athlete. According to the United States Anti-Doping Agency, anabolic agents or steroids such as testosterone, perhaps the most widely used and available substance in Pakistan, can cause a variety of side effects ranging from acne to severe liver damage as well as increased aggression and severe depression when the substance is stopped. In males, it can also cause impotence. In females, deepening of the voice, growth of hair on the face and other effects are common.

While anabolic steroids are widely known as substances which will dramatically improve performance, too few athletes are educated about the risks they pose. "I did not know that the steroids could cause me to lose my hair or develop organ damage". However, the young athlete said that many of his peers were not concerned with these risks but simply at performing well at all costs in a competition to gain much sought after medals and sometimes money.

While many other types of performance enhancing substances are available and are used at international level, including peptide hormones, human growth factor substances and other drugs, these are expensive and are less common in Pakistan. Blood doping or EPO are also believed by coaches to have not yet become popular.

Dr. Rizwan Ahmed, a physician based in the US who has worked with athletes, says that blood doping or EPO can be extremely hard to detect as it builds up a higher count of red blood cells in the system, enabling the athlete to avoid fatigue and is especially useful for endurance sports. In 2013, the legendary American cyclist Lance Armstrong had admitted to long-term use of EPO by him and his entire team, resulting in a removal of all his international awards.

In Pakistan, the effort against doping is hampered by the fact that testing, most commonly of urine, at World Anti Doping Agency (WADA) approved laboratories is expensive. The test at the nearest WADA-approved lab in Doha costs at least $250 per test, making it difficult to test more than a few athletes. Testing does however occur occasionally, such as before events such as the Commonwealth Games. There are also disturbing stories heard about Pakistani athletes being discovered carrying syringes or other materials which indicate drug use. The rumours and insinuations about drug use are unfair to ‘clean’ athletes while of course it is extremely unfair when some do use them, aware there will be no testing at top national competitions even though technically it should be taking place as is now the case in many Asian nations.

Some federations have however made extremely bold efforts to clear their sport of drugs.  In 2010, the Pakistan Olympic Association upheld a ban on two sprinters, Sadaf Siddiqui and Jaweria Hassan, during two year suspensions after drug use was detected. Seven other male and female athletes from Pakistan were banned from all local and international competitions for two years because they failed to defend themselves against accusations of using banned substances before an inquiry committee set up by the Pakistan Sports Board. The dope tests were reportedly conducted in India.

However, generally even though coaches active in training national level athletes say that "drugs and banned substances are very widely used and the athletes obtain them through their peers and sometimes through their coaches."

They hold "Boys use them more often than girls, but girls are also susceptible to the idea of rapid improvement through these drugs."

One leading coach emphasized it was the duty of the sporting federations to conduct doping tests, especially at national competitions as at international events, fearing testing, athletes often stop using substances or deliberately avoided exceeding their usual times to evade being called up for a test. However, anti-doping action at national level championships is rare, even though there have been calls that these be made regular in athletics, swimming, cycling and even team sports to clear the name of athletes and to make the sport transparent.

A top coach suggested "WADA could be called upon to support the setting up of a local laboratory which would make the process much simpler. However, labs already exist in India, Singapore and Doha and can be used."

While costs, according to experts, of setting up a local lab are very high, it is possible that WADA and other international agencies may offer support.

The duty of the PSB after all lies in ensuring sports is fair, transparent and to the benefit of participants. Doping of course violates the Olympic spirit and international law, and is ultimately capable of causing grave harm to the athletes.

Incidents have been cited in Pakistan where even small children are given substances which are banned or borderline substances such as creatine which can cause kidney damage and is banned by the US National College Athletic Association. Energy drinks, inhalers and other items falling under the WADA banned substances are used, sometimes by parents who must be aware of the risks. Winning it seems comes ahead of all else.

It is clear that doping is a massive problem in the country, and affects many sports. Cricketers such as Ahmad Shehzad and others have been found guilty. In individual sports, it is still more likely that athletes will turn to these substances because of lack of awareness and the desire to win at all costs regardless of ethics, fair play and health. Sporting federations, the government, the PSB, the POA and all other stakeholders need to act quickly and stop the menace before it causes even more harm.