New Trends
A new, alarming trend, is the use of other drugs to achieve the "performance-enhancing" effects of steroids. These steroid "alternatives" are sought in order to avoid the stiff penalties now in effect against those who possess anabolic steroids without a valid prescription. The two most common are gamma hydroxybutyrate (GHB) and clenbuterol.

GHB is a deadly, illegal drug that is a primary ingredient in many of these "performance-enhancing" formulas. The GHB that caused the prom night tragedy was marketed under the name "Somatomax PM." Rumors among teens that it caused a "high" increased the public health problems with GHB. In fact, the drug does not produce a high. It does, however, cause headaches, nausea, vomiting, diarrhea, seizures, and other central nervous system disorders, and, possibly, death.

Clenbuterol, another steroid "alternative," has become an extremely popular item on the black market. The drug is used in some countries for certain veterinary treatments, but is not approved for any use--in animals or humans--in the United States. In Spain, 135 people became ill with muscle tremors, fast heart rates, headaches, dizziness, nausea, fever, and chills after eating beef liver that contained residues of the drug. "The lack of information about clenbuterol is its greatest hazard. Most of the research we do have is from humans who ingested the drug by eating meat from animals who had been administered it, but as far as ingestion straight into humans, much work needs to be done," says Donald Legget, a compliance officer with FDA's Center for Drug Evaluation and Research who deals with enforcement of laws against steroid distribution (see "Show Animals Tested for Illegal Drug," in the Investigators' Reports section of this issue).

Why Does Anyone Use Them?
With so many harmful effects from steroids and similar illegal drugs, why do so many young people continue to use them? One answer is social pressures. Many young men feel they need to look "masculine," that is, strong and muscular. Bodybuilding stresses such muscularity, and some men--and women--abuse anabolic steroids to increase muscle mass and definition.

And then there's the "winning isn't everything, it's the only thing" philosophy common in so many school athletic programs. Some student athletes feel so pressured to succeed in their respective sports that they resort to steroids for help. Another reason, say many experts, lies in the basic nature of young people not to concern themselves with long-term effects. The desire to make the football team or to impress peers is much more immediate than the future prospect of possible damage to the liver, heart, and other vital organs.

In its effort to alert teenagers to the dangers of steroid abuse, FDA has developed a series of pamphlets, posters, and public service announcements. Recently, anabolic steroids were placed in the same regulatory category as cocaine, heroin, LSD, and other habit-forming drugs. This means that, in addition to FDA, the Drug Enforcement Agency helps to enforce laws relating to their abuse.

Celebrities like bodybuilding champs Arnold Schwarzenegger and Lee Haney and professional wrestler Jesse Ventura have spoken out against steroid use. Major magazines, ranging from Newsweek to Muscle and Fitness, have published articles warning of the dangers of steroid abuse.