Doping, or the use of restricted performance-enhancing drugs in the United States occurs in different sports, most notably in the sports of baseball and football.

As of a 2024 study, 2.2% of U.S. athletes have self-reported to using anabolic steroids, peptide hormones, or blood manipulation. When beta-2 agonist inhalers and marijuana are included, 9.2% of athletes have self-reported themselves as having used in-competition prohibited substances.

Prevalence and frequency The United States has had ten Olympic medals stripped or returned for doping, specifically by Rick DeMont (1972 due to mishandling of medication declaration), Marion Jones (5 medals in 2000), Antonio Pettigrew and Jerome Young (2000), Lance Armstrong (2000), Tyler Hamilton (2004), and Tyson Gay (2012).

According to a 2024 peer-reviewed study published in the journal of Sports Medicine, between 6.5 and 9.2% of US athletes self-reported using one or more prohibited methods in a survey. A 2024 study from the University of Chicago reported a 2.2% doping prevalence rate for use of anabolic steroids, peptide hormones, and blood manipulation. When beta-2 agonist inhalers, marijuana or other in-competition prohibited substances were included, 9.2% of athletes reported themselves as having doped.

History Restrictions regarding drug use like synthetic hormones by athletes for enhanced performance in competition did not come around until the 20th century. The International Olympic Committee (IOC) established its initial list of prohibited substances in 1967 and introduced the first drug tests at the France and Mexico Olympic Games in 1968. Thirty years later, the World Anti-Doping Agency (WADA) was founded. WADA was founded at a time when individual governments, sport federations, and the IOC all had differing definitions, policies, and sanctions for doping. WADA bridged these differences by setting unified anti-doping standards and coordinating the efforts of sports organizations and public authorities worldwide.

The United States, a WADA Foundation board member, followed suit by establishing the United States Anti-Doping Agency (USADA) in 2000. USADA is recognized by the United States Congress as the official anti-doping agency for Olympic, Pan American and Paralympic sport in the United States. The agency has adjudication powers and abides by WADA's World Anti-Doping Code ("Code"), which provides the global framework for anti-doping policies, rules, and regulations. Doping in sports is generally defined as using a prohibited / banned substance; however, WADA expanded the definition to include breaking one or more of eight anti-doping rules within the Code, which range from presence of a prohibited substance in an athlete's test sample to administering or attempting to administer a prohibited substance or method to an athlete. As of December 19, 2008, the Code banned 192 performance-enhancing drugs, substances, and methods.

Similar to the definitional disputes the international community faced in the 1990s, national professional sports leagues in the U.S. approach anti-doping policy differently and independently of U.S. government regulation, WADA guidelines, and one another. This is not a big issue for WADA because the athletes participating in these leagues do not compete internationally, i.e. at the Olympics or World Championships. The leagues do not have the same list of banned substances or tests they require players to abide by, may not provide tests or sanctions for use of some prohibited substances, and negotiate their anti-doping policies with their respective players associations through collective bargaining.

In 2005, the United States House Committee on Oversight and Government Reform took an active interest on anti-drug policies in professional sports by opening an investigation into the matter following heightened media activity on steroid use in Major League Baseball (MLB). The use, possession, distribution, dispensing, or selling of steroids is a punishable federal offense under the Controlled Substances Act which, in addition to steroids, lists other performance-enhancing drugs and substances as Schedule III drugs. A series of Schedule III drugs were held, most notably with MLB, the National Football League (NFL), and the National Basketball Association (NBA). Each league's anti-drug policy was compared to that of the IOC, and each fell short of the IOC requirements. Response to the congressional investigation by sports league representatives resulted largely with push back and a "we can police our own" mentality, but the Committee felt differently and introduced the Clean Sports Act, one of six bills introduced that year in both chambers —addressing the need to adopt uniform national anti-drug policy standards among professional sports leagues that are consistent with, and as stringent as, those enforced by the USADA. While most of the bills were voted out of committee, none were enacted. As of 2013, professional sports leagues continue to negotiate their anti-doping policies privately through collective bargaining.

The advent of anabolic steroid use in the United States The father of anabolic steroids in the United States was John Ziegler (1917–1983), a physician for the U.S. weightlifting team in the mid-20th century. In 1954, on his tour to Vienna with his team for the world championship, Ziegler learned from his Russian colleague that the Soviet weightlifting team's success was due to their use of testosterone as a performance-enhancing drug. Deciding that U.S. athletes needed chemical assistance to remain competitive, Ziegler worked with the CIBA Pharmaceutical Company to develop an oral anabolic steroid. This resulted in the creation of methandrostenolone, which appeared on the market in 1960 under the brand name Dianabol.

The American specialist in doping, Max M. Novich, wrote: "Trainers of the old school who supplied treatments which had cocaine as their base declared with assurance that a rider tired by a six-day race would get his second breath after absorbing these mixtures."Novich, ibid. Cited De Mondenard, Dr Jean-Pierre: Dopage, l'imposture des performances, Chiron, France, 2000 John Hoberman, a professor at the University of Texas in Austin, Texas, said six-day races were "de facto experiments investigating the physiology of stress as well as the substances that might alleviate exhaustion."Hoberman, John; Dopers on Wheels: The Tour's sorry history, MSNBC/id/19462071/ retrieved December 2007

Olympic medals stripped United States has had eight Olympic medals stripped for doping violations. In the case of swimmer Rick DeMont, the USOC has recognized his gold medal performance in the 1972 Summer Olympics in 2001, but only the IOC has the power to restore his medal, and it has as of 2017 refused to do so. DeMont originally won the gold medal in 4:00.26. Following the race, the IOC stripped him of his gold medalNeil Amdur, "Of Gold and Drugs ", The New York Times (September 4, 1972). Retrieved March 16, 2015. after his post-race urinalysis tested positive for traces of the banned substance ephedrine contained in his prescription asthma medication, Marax. The positive test following the 400-meter freestyle final also deprived him of a chance at multiple medals, as he was not permitted to swim in any other events at the 1972 Olympics, including the 1,500-meter freestyle for which he was the then-current world record-holder. Before the Olympics, DeMont had properly declared his asthma medications on his medical disclosure forms, but the USOC had not cleared them with the IOC's medical committee. Rick DeMont. Sports-Reference.com

Revelations by the United States Olympic Committee's director Wade Exum In 2003, Wade Exum, the United States Olympic Committee's director of drug control administration from 1991 to 2000, gave copies of documents to Sports Illustrated that revealed that some 100 American athletes failed drug tests from 1988 to 2000, arguing that they should have been prevented from competing in the Olympics but were nevertheless cleared to compete; among those athletes were Carl Lewis, Joe DeLoach and Floyd Heard. Before showing the documents to Sports Illustrated, Exum tried to use them in a lawsuit against USOC, accusing the organization of racial discrimination and wrongful termination against him and cover-up over the failed tests. His case was summarily dismissed by the Denver federal Court for lack of evidence. The USOC claimed his case "baseless" as he himself was the one in charge of screening the anti-doping test program of the organization and clarifying that the athletes were cleared according to the rules.

Exum's documents revealed that Carl Lewis had tested positive three times at the 1988 Olympics trials for minimum amounts of pseudoephedrine, ephedrine, and phenylpropanolamine, which were banned stimulants. Bronchodilators are also found in cold medication. Due to the rules, his case could have led to disqualification from the Seoul Olympics and suspension from competition for six months. The levels of the combined stimulants registered in the separate tests were 2 ppm, 4 ppm and 6 ppm. Lewis defended himself, claiming that he had accidentally consumed the banned substances. After the supplements that he had taken were analyzed to prove his claims, the USOC accepted his claim of inadvertent use, since a dietary supplement he ingested was found to contain "Ma huang", the Chinese name for Ephedra (ephedrine is known to help weight loss). Fellow Santa Monica Track Club teammates Joe DeLoach and Floyd Heard were also found to have the same banned stimulants in their systems, and were cleared to compete for the same reason. The highest level of the stimulants Lewis recorded was 6 ppm, which was regarded as a positive test in 1988 but is now regarded as negative test. The acceptable level has been raised to ten parts per million for ephedrine and twenty-five parts per million for other substances.Wallechinsky and Loucky, The Complete Book of the Olympics (2012 edition), page 61. According to the IOC rules at the time, positive tests with levels lower than 10 ppm were cause of further investigation but not immediate ban. Neal Benowitz, a professor of medicine at UC San Francisco who is an expert on ephedrine and other stimulants, agreed that "These [levels] are what you'd see from someone taking cold or allergy medicines and are unlikely to have any effect on performance." Following Exum's revelations the IAAF acknowledged that at the 1988 Olympic Trials the USOC indeed followed the correct procedures in dealing with eight positive findings for ephedrine and ephedrine-related compounds in low concentration. Additionally, in 1988 the federation reviewed the relevant documents with the athletes' names undisclosed and stated that "the medical committee felt satisfied, however, on the basis of the information received that the cases had been properly concluded by the USOC as 'negative cases' in accordance with the rules and regulations in place at the time and no further action was taken".

Doping by sport SubstanceAthlete populationPercentage of athletes using substance (2014)Any substance banned by WADAElite athletes across sports (positive drug tests)2% over past yearAnabolic steroidsProfessional football players (self report)9% used at some point in careerOpiatesProfessional football players (self report)52% used at some point in career (71% of those misused at some point in career)Smokeless tobaccoProfessional basketball players (self report)35%–40% over past yearProfessional football players (self report)20%–30% over past year

National Collegiate Athletic Association NCAA banned substances

Major League Baseball

The Mitchell Report