Doping in Sport: Health Risks, Psychosocial Drivers, and the Evolving Anti-Doping Response

Doping in sport is often discussed as a problem of prohibited drugs, positive tests, and sanctions. That framing is incomplete. Contemporary anti-doping governance also addresses prohibited methods and conduct that undermines testing and investigation, while effective prevention must account for health risks, athlete decision-making, team cultures, medical practice, and the commercial pressures surrounding sport. This narrative review synthesizes selected peer-reviewed literature and official anti-doping instruments to examine four connected questions: how doping is defined and regulated; what is known about health consequences; why athletes may consider prohibited performance enhancement; and how detection and prevention can be combined more effectively. The evidence indicates that health risks vary by substance, dose, duration, route, combinations, and the population studied, so findings from non-athlete users should not be generalized uncritically to elite athletes. Research on athlete attitudes identifies perceived performance benefits, social influence, recovery concerns, and financial or career pressures as relevant factors, although attitudes do not directly establish actual use. The World Anti-Doping Code and the annually updated Prohibited List provide a harmonized framework, but testing alone cannot address every source of risk. A more credible response combines risk-based testing and investigation with values-based education, competent medical advice, supplement-risk management, confidential reporting, and proportionate, procedurally fair results management. The review concludes with priorities for prevention and research, including better evaluation of education, improved evidence on long-term health outcomes in athletic populations, and clearer coordination between international standards and national implementation.