What does the evidence show?
A new study explores attitudes toward performance-enhancing drugs in the ultrarunning world
Let’s do a quick word-association test. I say “drugs” and “marathon,” and you say... “EPO,” right? But when I say “drugs” and “ultramarathon,” you say... “marijuana?” There’s a massive cultural shift that takes place somewhere around 26.3 miles—or at least, that’s the perception. But as ultrarunning has slowly evolved from an insular hippie niche to a corporate-backed mass-participation sport, the boundaries have started to blur. There’s money in the sport now—and where there’s money, it’s reasonable to wonder if hardcore performance-enhancing drugs can be far behind.
A new study from researchers at the University of Utah, published in Wilderness & Environmental Medicine, takes a tentative first stab at figuring out how common performance-enhancing drug (PED) use is among ultrarunners. There have been some previous informal attempts to gauge PED use in the ultra world: a 2015 survey of 705 ultrarunners by Ian Torrence for iRunFar, for example, found that 9 percent of respondents admitted to using PEDs in training or competition. But that didn’t differentiate between injecting EPO and eating a pot brownie. The new study digs a little deeper, in an attempt to figure out just what’s going on out in the mountains and on the trails.
The study consisted of a fairly simple anonymous online survey, distributed via the Facebook pages of Ultrasignup and the Western States Endurance Run, which received 609 responses. The questions collected a bunch of demographic data plus details on exactly what PEDs the runners had tried or heard of their friends trying, and assessed their attitudes toward the use of performance-enhancing drugs.
The main result was remarkably consistent with Torrence’s findings: 8.4 percent of the respondents admitted using PEDs during training or competition. But there were some additional wrinkles. Another 18.5 percent said they personally knew of someone else, not including themselves, who used PEDs during ultrarunning. (That presents an interesting mathematical dilemma. Either everyone who uses drugs tells several different people about it, or the respondents aren’t being entirely forthcoming about their “friend’s” PED use.) In addition, 18.7 percent reported using PEDs for social reasons and 19.8 percent reported using them for medical reasons. It’s probably safe to assume those two groups aren’t talking about EPO.
When you combine medical, social, and running-related use, the most popular PED choice was—sure enough—cannabinoids, used by a total of 13.3 percent of respondents, followed by narcotics (6.4 percent), and stimulants (3.0 percent). Rounding out the list were glucocorticoids, anabolic agents, and (with just one person each) peptide hormones and diuretics. Interestingly, none of the demographic data—things like sex, age, weekly mileage, longest race completed, race frequency, and years of participation—seemed to have any particular impact on the likelihood of drug use.
There are all sorts of problems with data from anonymous online surveys, which I won’t bother belaboring. Still, there are a few interesting points to make about this data. First: yes, lots of ultrarunners smoke (or eat) pot. That story has been making headlines for a few years now, with lots of debate about whether it’s actually a performance-enhancer for ultrarunners or whether it just feels that way. Personally, I liked Jenn Shelton’s quote from a Wall Street Journal article back in 2015: “The person who is going to win an ultra is someone who can manage their pain, not puke and stay calm. Pot does all three of those things.” I’m far from convinced that it’s really helpful—at best, I suspect it’s highly individual and dependent on temperament. But these results bolster the anecdotal case that a non-negligible number of ultrarunners are toking.
One surprise to me was that less than 2 percent of respondents reported using anabolic steroids. Along with “ultrarunners smoke pot,” one of the familiar narratives that circulates in athletic circles is “male masters athletes abuse testosterone.” Testosterone patches are aggressively marketed as an anti-aging panacea, and pretty much all it takes to get a prescription is to head to a friendly doctor and say you don’t feel quite as virile as you used to. Given the demographics of the survey (three-quarters male and almost half over 40), I expected to see a lot more “medical” use of testosterone, but perhaps that narrative is overstated, at least among ultrarunners.
As for the near-total absence of peptide hormones like EPO, that’s encouraging... but really not surprising. While few details about performance level are given, the survey respondents appear to be mostly recreational ultrarunners: only a quarter report finishing in the top 20 percent of their races, and there’s no indication of whether any of them would be classified as elite or professional. If you finished in the top 20 percent at Western States this year, your race time could still be more than 50 percent slower than the winner. Aside from a few bizarre anomalies, the only people likely to invest in a PED like EPO are those competing for prize money and sponsorships. There has been an increasing push to make drug testing more widespread in ultrarunning, and races like Comrades and Ultra-Trail du Mont-Blanc have had some high-profile busts. But this survey doesn’t tell us anything about that world.
The final element of the survey was the Performance Enhancement Attitude Scale, a battery of 17 questions assessing people’s feelings about the use of PEDs in sports. Those who reported using PEDs also had significantly more positive attitudes about doping. While this may seem obvious, it conflicts with the idea that doping in ultras is just an accidental byproduct of the clash between ultrarunning’s countercultural roots and the new rules imposed by the encroaching forces of commercialization. Instead, it suggests that at least some of the people in the survey are choosing to deliberately take drugs to enhance their performance.
While that attitude appears to be limited to a tiny minority, it’s worth calling it out for what it is: cheating. Shelton, in the Wall Street Journal article, said she sometimes trained with marijuana, but never raced with it because she believed it would be unfair. That’s consistent with revised anti-doping rules that ban marijuana in competition but not in training. For many runners, ultras are voyages of personal discovery, where the only opponents are themselves and the distance. These runners are unlikely to encounter any doping tests. But if you’re competing against other runners, vying for places and prizes, then playing by the same rules as your competition seems like the only fair way to go.
My new book, Endure: Mind, Body, and the Curiously Elastic Limits of Human Performance, with a foreword by Malcolm Gladwell, is now available. For more, join me on Twitter and Facebook, and sign up for the Sweat Science email newsletter.