The Hidden Risks of Performance Enhancement: Pharmacists Are Critical to Protecting Athletes in a “Quick-Fix” Era

At the 2026 Sports Pharmacy Summit in Fort Lauderdale, Travis Tygart, CEO of the United States Anti-Doping Agency (USADA), delivered a keynote that reframed the modern doping conversation—not as an isolated issue of elite misconduct, but as a growing public health concern shaped by accessibility, misinformation, and cultural pressure.¹

Titled “Beyond the Pill: Protecting Clean Sport in a Quick-Fix Society,” the presentation emphasized that performance enhancement is no longer limited to elite doping scandals. Instead, it reflects a broader societal trend toward rapid optimization—often at the expense of safety and fairness.¹

A “Quick-Fix” Culture Driving Risk

Tygart opened by highlighting the normalization of rule-bending across competitive environments, noting that even outside of sport, “if you ever thought that everybody’s just going to play by the rules… these examples ought to blow any notion of that.”¹

Within athletics, however, the stakes are significantly higher. “[The athletes] deserve the opportunity to compete on a level playing field,” he said, underscoring that doping undermines both fairness and athlete well-being.¹

This pressure to gain a competitive edge has contributed to widespread supplement use. Research indicates that up to 90% of elite athletes report using dietary supplements, often without full awareness of associated risks.²

Inadvertent Doping and the Reality of Contamination

A central theme of the keynote was the growing prevalence of “innocent source positives”—cases in which athletes test positive due to contaminated or mislabeled products rather than intentional doping.¹

“It is a real threat,” Tygart said, describing cases where “a medication that was totally fine to use but still led to a positive test” due to contamination in the manufacturing process.¹

This concern is well documented in multiple studies. A landmark analysis found that approximately 15% of dietary supplements may contain undeclared anabolic agents or other prohibited substances.³ More recent studies confirm that contamination and mislabeling remain persistent issues, particularly in products marketed for performance enhancement.⁴

Further evidence suggests that dietary supplements are a major contributor to inadvertent doping, with athletes often unaware of the variability in ingredient quality and regulatory oversight.⁴

Emerging Substances and Online Markets

Tygart also warned of a rapidly evolving risk landscape involving peptides, selective androgen receptor modulators (SARMs), and compounded or online-sourced substances.¹

“This is turning into a pretty scary environment,” he said, pointing to increased use among younger athletes influenced by social media and online marketing.¹

Unlike FDA-approved medications, many of these products are not subject to rigorous quality control. A study published in JAMA found that substances marketed as SARMs frequently contained incorrect dosages or entirely different compounds than listed on their labels.⁵

This lack of transparency creates significant safety concerns, including unpredictable pharmacologic effects and increased risk of anti-doping violations.

Pharmacists at the Center of Athlete Safety

Tygart directly called on health care professionals to address these challenges. “If you’re advising athletes, be aware of these risks and help minimize them,” he said.

Pharmacists are uniquely positioned to lead in this space. Their expertise in medication safety, pharmacology, and regulatory frameworks enables them to identify high-risk products and counsel athletes effectively.

Key responsibilities include:

• Evaluating supplements for potential contamination risks
• Screening medications against prohibited substance lists
• Educating athletes on third-party certification and regulatory limitations

Importantly, research highlights ongoing gaps in doping-related knowledge among athletes and support personnel, reinforcing the need for pharmacist-led education and intervention.⁶

Legal Implications and Expanding Accountability

Beyond clinical risks, Tygart emphasized the growing legal consequences associated with doping. Under the Rodchenkov Anti-Doping Act, individuals who knowingly facilitate doping in international sport may face criminal penalties.

“The bullseye is directly on those who are knowingly conspiring,” he said, noting that enforcement efforts increasingly target suppliers and support personnel.¹

For pharmacists, this evolving legal landscape shows the importance of evidence-based practice, documentation, and adherence to established guidelines.

Prevention Through Education

Despite the complexity of the issue, Tygart emphasized that prevention remains the ultimate goal. “Our goal is to champion athletes to achieve their dreams through fair and healthy competition,” he said.¹

Pharmacists play a critical role in achieving this goal by bridging the gap between clinical care and regulatory compliance. As performance-enhancing substances become more accessible, their role in safeguarding athlete health and preserving the integrity of sports has never been more important.

REFERENCES

1. Tygart T. Beyond the Pill: Protecting Clean Sport in a Quick-Fix Society. Sports Pharmacy Summit 2026. Fort Lauderdale, Florida. April 10, 2026.

2. Jagim AR, Harty PS, Erickson JL, Tinsley GM, Garner D and Galpin AJ (2023) Prevalence of adulteration in dietary supplements and recommendations for safe supplement practices in sport. Front. Sports Act. Living 5:1239121. doi:10.3389/fspor.2023.1239121

3. Geyer H, Parr MK, Koehler K, Mareck U, Schänzer W, Thevis M. Nutritional supplements cross-contaminated and faked with doping substances. J Mass Spectrom. 2008;43(7):892-902. doi:10.1002/jms.1452

4. Martínez-Sanz JM, Sospedra I, Ortiz CM, Baladía E, Gil-Izquierdo A, Ortiz-Moncada R. Intended or Unintended Doping? A Review of the Presence of Doping Substances in Dietary Supplements Used in Sports. Nutrients. 2017;9(10):1093. Published 2017 Oct 4. doi:10.3390/nu9101093

5. Van Wagoner RM, Eichner A, Bhasin S, Deuster PA, Eichner D. Chemical Composition and Labeling of Substances Marketed as Selective Androgen Receptor Modulators and Sold via the Internet. JAMA. 2017;318(20):2004-2010. doi:10.1001/jama.2017.17069

6. Davoren AK, Rulison K, Milroy J, et al. Doping Prevalence among U.S. Elite Athletes Subject to Drug Testing under the World Anti-Doping Code. Sports Med Open. 2024;10(1):57. Published 2024 May 20. doi:10.1186/s40798-024-00721-9