football players admitted to current or former aas use. at the collegiate level, surveys show that aas use among athletes range from 5 percent to 20 percent and continues to rise. the study found that skin changes were an early marker of steroid use in young athletes, and underscored the important role that dermatologists could play in the early detection and intervention in these athletes. 1988 seoul olympics a famous case of aas use in a competition was canadian ben johnson's victory in the 100 m at the 1988 summer olympics. he subsequently failed the drug test when stanozolol was found in his urine. he later admitted to using the steroid as well as dianabol, testosterone, furazabol, and human growth hormone amongst other things. johnson was stripped of his gold medal as well as his world-record performance. carl lewis was then promoted one place to take the olympic gold title. lewis had also run under the current world record time and was therefore recognized as the new record holder. johnson was not the only participant whose success was questioned: lewis had tested positive at the olympic trials for pseudoephedrine, ephedrine and phenylpropanolamine. 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. 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 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. linford christie of great britain was found to have metabolites of pseudoephedrine in his urine after a 200m heat at the same olympics, but was later cleared of any wrongdoing. of the top five competitors in the race, only former world record holder and eventual bronze medalist calvin smith of the us never failed a drug test during his career. smith later said: "i should have been the gold medalist." the cbc radio documentary, rewind, "ben johnson: a hero disgraced" broadcast on 19 september 2013, for the 25th anniversary of the race, stated 20 athletes tested positive for drugs but were cleared by the ioc at this 1988 seoul olympics. an ioc official stated that endocrine profiles done at those games indicated that 80 percent of the track and field athletes tested showed evidence of long-term steroid use, although not all were banned. stimulants stimulants are drugs that usually act on the central nervous system to modulate mental function and behavior, increasing an individual's sense of excitement and decreasing the sensation of fatigue. in the world anti-doping agency list of prohibited substances, stimulants are the second largest class after the anabolic steroids. benzedrine is a trade name for amphetamine. the council of europe says it first appeared in sport at the berlin olympics in 1936. it was produced in 1887 and the derivative, benzedrine, was isolated in the u.s. in 1934 by gordon alles. its perceived effects gave it the street name "speed". british troops used 72 million amphetamine tablets in the second world war and the raf got through so many that "methedrine won the battle of britain" according to one report. the problem was that amphetamine leads to a lack of judgement and a willingness to take risks, which in sport could lead to better performances but in fighters and bombers led to more crash landings than the raf could tolerate. the drug was withdrawn but large stocks remained on the black market. amphetamine was also used legally as an aid to slimming and also as a thymoleptic before being phased out by the appearance of newer agents in the 1950s. everton, one of the top clubs in the english football league, were champions of the 1962–63 season, and it was done, according to a national newspaper investigation, with the help of benzedrine. word spread after everton's win that the drug had been involved. the newspaper investigated, cited where the reporter believed it had come from, and quoted the goalkeeper, albert dunlop, as saying: i cannot remember how they first came to be offered to us. but they were distributed in the dressing rooms. we didn't have to take them but most of the players did. the tablets were mostly white but once or twice they were yellow. they were used through the 1961–62 season and the championship season which followed it. drug-taking had previously been virtually unnamed in the club. but once it had started we could have as many tablets as we liked. on match days they were handed out to most players as a matter of course. soon some of the players could not do without the drugs. the club agreed that drugs had been used but that they "could not possibly have had any harmful effect." dunlop, however, said he had become an addict. in november 1942, the italian cyclist fausto coppi took "seven packets of amphetamine" to beat the world hour record on the track. in 1960, the danish rider knud enemark jensen collapsed during the 100 km team time trial at the olympic games in rome and died later in hospital. the autopsy showed he had taken amphetamine and another drug, ronicol, which dilates the blood vessels. the chairman of the dutch cycling federation, piet van dijk, said of rome that "dope – whole cartloads – used in such royal quantities." the 1950s british cycling professional jock andrews would joke: "you need never go off-course chasing the peloton in a big race – just follow the trail of empty syringes and dope wrappers." the dutch cycling team manager kees pellenaars told of a rider in his care: i took him along to a training camp in spain. the boy changed then into a sort of lion. he raced around as though he was powered by rockets. i went to talk to him. he was really happy he was riding well and he told me to look out for him. i asked if he wasn't perhaps "using something" and he jumped straight up, climbed on a chair and from deep inside a cupboard he pulled out a plastic bag full of pills. i felt my heart skip a beat. i had never seen so many fireworks together. with a soigneur we counted the pills: there were 5,000 of them, excluding hormone preparations and sleeping pills. i took them away, to his own relief. i let him keep the hormones and the sleeping pills. later he seemed to have taken too many at once and he slept for a couple of days on end. we couldn't wake him up. we took him to hospital and they pumped out his stomach. they tied him to his bed to prevent anything going wrong again. but one way or another he had some stimulant and fancied taking a walk. a nurse came across him in the corridor, walking along with the bed strapped to his back. currently modafinil is being used throughout the sporting world, with many high-profile cases attracting press coverage as prominent united states athletes have failed tests for this substance. some athletes who were found to have used modafinil protested as the drug was not on the prohibited list at the time of their offence, however, the world anti-doping agency (wada) maintains it is a substance related to those already banned, so the decisions stand. modafinil was added to the list of prohibited substances on 3 august 2004, ten days before the start of the 2004 summer olympics. one approach of athletes to get around regulations on stimulants is to use new designer stimulants, which have not previously been officially prohibited, but have similar chemical structures or biological effects. designer stimulants that attracted media attention in 2010 included mephedrone, ephedrone, and fluoroamphetamines, which have chemical structures and effects similar to ephedrine and amphetamine. strychnine hicks and supporters at the 1904 summer olympics these "de facto experiments investigating the physiology of stress as well as the substances that might alleviate exhaustion" were not unknown outside cycling. thomas hicks, an american born in england on 7 january 1875, won the olympic marathon in 1904. he crossed the line behind a fellow american fred lorz, who had been transported for 11 miles of the course by his trainer, leading to his disqualification. however, hicks's trainer charles lucas, pulled out a syringe and came to his aid as his runner began to struggle. i therefore decided to inject him with a milligram of sulphate of strychnine and to make him drink a large glass brimming with brandy. he set off again as best he could he needed another injection four miles from the end to give him a semblance of speed and to get him to the finish. the use of strychnine, at the time, was thought necessary to survive demanding races, according to sports historians alain lunzenfichter and historian of sports doping, dr jean-pierre de mondenard, who said: it has to be appreciated that at the time the menace of doping for the health of athletes or of the purity of competition had yet to enter the morals because, after this marathon, the official race report said: the marathon has shown from a medical point of view how drugs can be very useful to athletes in long-distance races. hicks was, in the phrase of the time, "between life and death" but recovered, collected his gold medal a few days later, and lived until 1952. nonetheless, he never again took part in athletics. countries east germany (the gdr) in 1977 one of east germany's best sprinters, renate neufeld, fled to the west with the bulgarian she later married. a year later she said that she had been told to take drugs supplied by coaches while training to represent east germany at the 1980 summer olympics. at 17, i joined the east berlin sports institute. my speciality was the 80m hurdles. we swore that we would never speak to anyone about our training methods, including our parents. the training was very hard. we were all watched. we signed a register each time we left for dormitory and we had to say where we were going and what time we would return. one day, my trainer, günter clam, advised me to take pills to improve my performance: i was running 200m in 24 seconds. my trainer told me the pills were vitamins, but i soon had cramp in my legs, my voice became gruff and sometimes i couldn't talk any more. then i started to grow a moustache and my periods stopped. i then refused to take these pills. one morning in october 1977, the secret police took me at 7am and questioned me about my refusal to take pills prescribed by the trainer. i then decided to flee, with my fiancé. she brought with her to the west grey tablets and green powder she said had been given to her, to members of her club, and to other athletes. the west german doping analyst manfred donike reportedly identified them as anabolic steroids. she said she stayed quiet for a year for the sake of her family. but when her father then lost his job and her sister was expelled from her handball club, she decided to tell her