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Official websites use. Share sensitive information only on official, secure websites. This is an open access article distributed under the terms of the Creative Commons Attribution 4. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. People perform sports for better health and wellbeing. However, the use of doping agents is emerging among young adults. This study investigated aspects related to doping agents. Among pharmacists, However, The majority of responders Enhancing physical performance was perceived as a leading driver The perceived best tool for awareness was social media and TV sites, as suggested by pharmacists A total of 6. Almost half of the users utilized a diet or medication to counteract the side effects of doping agents. Within pharmacists, males received more requests to provide doping agents It is crucial to enhance professional and legal knowledge and public awareness about doping agents, not only for non-HCP but also for HCPs. Applying more restrictions on doping agents is strongly recommended. Exercise is vital for human health and wellbeing. It is associated with better health outcomes and enhanced muscle profile \[ 1 \]. Introducing externally abnormal materials as a supposed performance-enhancing substance PES will lead to abnormal adaptation in the body as well as long-term negative consequences. Such methods and practices are mostly illegal and unethical practices \[ 2 , 3 \]. Risks are magnified if such PES are used with inadequate medical supervision. It is a self-governed international association aimed toward bringing consistency to anti-doping policies and regulations within sports organizations and governments across the world \[ 5 \]. Despite being perceived as beneficial in the short-term response, doping causes serious health adverse events, including liver, heart, vascular diseases, severely impacts sexual functions, and leads to behaviour changes and mood disturbances. Moreover, practicing irresponsible doping and using medical substances without medical supervision was associated with sudden death \[ 2 , 3 \]. Doping is a widespread practice in the young population. There is a belief that doping is a useful way for better achievement in sports, either for competitive or non-competitive exercise training. It is more common in bodybuilding and weight lifting sports \[ 2 , 3 , 7 \]. Yet, several studies disagreed with the safe and effective use of anabolic-androgenic steroids AAS in improving muscle mass and strength performance \[ 8 - 11 \]. For example, Andrews and colleagues in their systematic review, assessed muscular strength, body composition, cardiovascular endurance, and power. They found a small absolute increase in strength attributed to AAS and a moderate increase in lean mass. Nevertheless, they confirmed that the adverse effects of AAS were not rigorously assessed nor reliably reported \[ 8 \]. D Van Gammeren et al. Another very recent review has listed an excellent summary of studies between — that documented adverse effects of anabolic steroid use on the brain and behaviour, as well as body systems, including the cardiovascular, urinary, musculoskeletal, and reproductive systems, the liver, and the blood \[ 12 \]. Unfortunately, using doping agents has not always been considered cheating \[ 13 \]. In all cases, it is challenging to prevent young adults and even older athletes from using doping medications to boost their performance, even if medical and scientific evidence exists \[ 17 \], as dopers were considered potential addicts that need addiction treatment \[ 18 \]. Multiple studies and systematic reviews were carried out to explore broad aspects of sports medicine, doping agents, and anti-doping techniques \[ 19 \]. Researchers consistently investigated clinical, humanistic, pedagogic, behavioural, and legal aspects related to doping and subsequent substances \[ 17 , 18 , 20 - 25 \]. In particular, a number of studies have investigated knowledge, attitude, and beliefs about doping in sports \[ 13 - 16 , 18 , 26 \]. The focus of most researchers was related to anabolic hormones. However, there is a common agreement that knowledge, correct classification of substances, and awareness about doping are still insufficient and poorly evaluated, even among pharmacists \[ 27 \]. Doping-related science is poorly addressed in Jordanian curricula, and the qualification competency requirements for health care providers HCPs , such as physicians, pharmacists, and nurses, are inadequate \[ 2 , 4 , 28 , 29 \]. Unfortunately, a lack of professional and proper knowledge leads to misleading rumours and myths. For example, illegal promotion and the circulated rumours minimise the awareness about doping adverse events, which results in more consumption of such agents. Accordingly, this study aimed to carry out a comprehensive investigation about doping agents among Jordanian pharmacists as HCP versus a population of non-healthcare providers non-HCP. A validated and reliable questionnaire was used to assess details related to knowledge, attitudes, and practicalities. The second part assessed the following attitudes: personal attitude toward doping 2 questions , attitudes toward users 2 questions , penalties 3 questions , attitude toward social awareness 4 questions , perceptions about benefits 3 questions , and drivers for doping 5 questions. The third part investigated practicalities among users of doping agents such as prevalence, regimen to counteract side effects, and source of providing the agents. Additional practicalities among pharmacists were related to quantifying requests for providing doping agents and readiness to report issues related to doping agent users. The basic questionnaire was designed to assess knowledge, attitude, awareness approaches, and other aspects related to doping agents. The authors created a panel of specialist pharmacists and non-healthcare providers who practice work related to sports and coaching. This panel enhanced the process of questionnaire validation face and criterion validity. The panel members were as follows: assistant professors in the following disciplines: pharmacotherapy, pharmaceutics, pharmacologists, clinical pharmacists; a pharmacist who is a board member in the Jordanian Pharmacist Association, a pharmacy director of the hospital pharmacy department, and a physician. Non-HCPs associated with sport-related issues were as follows: a director of accounting, an accountant and part-time coach, an engineer, an administrative director, a personnel trainer, and a sports consultant. All panel members agreed on the final form of the questionnaire with its suggested criterion scoring. A pilot sample of 40 responders was contacted twice within a 15 days time difference. The coefficient alpha results reflect reliable acceptable internal consistency. The results of the stability coefficient indicated stronger test-retest reliability. Jordanians aged between years were 6,, i. This study used a cross-sectional design using Google form templates to distribute the survey, which was active for receiving answers between 1 st Dec till 30 th April Eligible responders were those pharmacists and non-healthcare providers who would like to voluntarily respond to the survey. The survey link was distributed using social media platforms Facebook and WhatsApp applications through the study panel members. Responders were informed that their responses would be treated confidentially and anonymously. There was no personal identifier in the survey. Responders were also informed that they had the choice to withdraw from the survey, as their participation is voluntary. Accordingly, participants who submitted the survey with their answers were considered to have given informed consent for their participation. A chi-square test of association was conducted between answers to the questions within the survey and speciality of responders, according to the following hypothesis:. The null hypothesis: H0: no association relationship between answers and the speciality pharmacists vs. The alternative hypothesis: HA: an association relationship exists between answers and the speciality pharmacists vs. Total responses were The number of pharmacists who participated in the questionnaire was While male pharmacists dominated in non-HCP , While It was notable that almost half of the females, Males within both pharmacists and non-HCP generally reported higher-income categories than females. However, no association was reported between income and the usage of doping agents. A higher proportion of pharmacists A higher proportion of pharmacists compared with non-HCP Poor knowledge about doping agents classification has been illustrated in the results of the present study. The proportions pharmacists vs. It was expected that smokers' vs. Nevertheless, the analysis showed no significant difference, as On another front, a significantly higher proportion of females Pharmacists demonstrated significantly better knowledge about the side effects profile of the doping agents. A higher proportion of the pharmacists were able to identify the side effects of the doping agents compared with non-HCP; impotence The answers related to questions about formal education were almost similar in both study groups. Compared to pharmacists According to the findings of this study, This shows a reliable construct with Unfortunately, the majority , Moreover, less than half , A similar proportion , More details are shown in Table 2. No differences were reported between both study groups in their attitude toward perceived benefits of doping agents for physical As seen in Table 3 , the most common perceived reason for the use of doping agents was to enhance physical performance The weakest perceived driver was improving mental performance The distribution of answers between pharmacists and non-HCP was almost similar. No significant differences were reported between both groups in their perception toward the consumption of doping agents for muscular enhancement, weight management, enhancing physical or mental performance, and copying with others. The only exception was at the sub-analysis with non-HCP females and males in the question about bodyweight management. A different trend was noticed in the pharmacists' group, where almost Pharmacists more than non-HCP supported the elimination of the doping agents user from sports competition Similarly, pharmacists more than non-HCP supported the application of deterrent penalties for doping agents users Moreover, Most The majority The second-ranked awareness tool recommended by responders Finally, the study participants As seen in Table 4 , a total of 6. However, non-HCP had a significantly higher proportion of doping agent use compared with pharmacists 9. A total of 31 out of 56 responders Out of the 56 responders, nine responders did not specify any regimen, while 47 A dominant positive attitude toward such regimens was noticed across both groups. However, less proportion More than half Almost one-third of the doping agents users obtained doping agents through their sports friends or sports coaches. Almost one-third of pharmacists received a request to obtain the doping agents for customers. Both males However, less proportion of both males However, male pharmacists reported in higher percentage 6. Results are shown in Table 5. In the present study, a gap between knowledge, perceptions, and practicalities was identified. Pharmacists, in the present study, claimed their knowledge about the doping agents; however, the in-depth assessment showed a gap in their knowledge. In a Japanese study, In the present study, the best sub knowledge domain was the knowledge of side effects of the doping agents, where almost two-thirds of the participants reported that the doping agents can cause sexual weakness leading to sterility, and three-quarters of pharmacists reported that the doping agents cause cardiovascular and kidney diseases. These percentages were higher than those reported among German adolescents, where only In Saudi Arabia, the participants in a cross-sectional study agreed that the doping agents are considered dangerous for health Remarkably, Such answers indicate a perception of good general knowledge in the Jordanian medical staff; however, it remains questionable, as in-depth knowledge of the doping agents and their classification showed a gap between self-assessed and actual knowledge. As the sample included pharmacists and non-pharmacists, the most common and local names, in addition to well-known scientific names, were used to identify the doping agents. Unfortunately, poor knowledge among pharmacists was demonstrated. A comparable level of knowledge with non-HCP was noticed, as well. In almost all questions, less than half of the pharmacists identified correct answers. The only exception was testosterone, where This is not unexpected, as testosterone is mentioned abundantly in medical books, especially those related to pharmacy, as it increases masculinity and shows a male appearance. Moreover, it was agreed previously that the main reason for using the doping agents is bodybuilding. This corresponds to a study of Slovenian pharmacists \[ 4 \], where No statistically significant differences were found when comparing the answers of pharmacists with non-HCPs. This result came against that reported by Slovenian researchers \[ 4 \], where Despite the strong evidence on both the short- and long-term side effects of AAS, there is very little evidence based on the users' perception of the negative consequences of its usage \[ 12 \], especially among young adults and adolescents \[ 37 \]. Pharmacists reported good awareness of side effects in both Qatar \[ 28 \] and Japan \[ 36 \]. In the present study, it was found that the first reason to use the doping agents was to enhance physical performance, followed by building body mass. This is in line with many studies, which reported that users aim to improve athletic performance and physical attractiveness, increase body weight, fat-free mass, muscle size, strength, and social recognition \[ 2 , 23 , 26 , 29 , 38 , 39 \]. Andrews et al. The most commonly assessed adverse effects were negative impact on lipids, mood, and liver-associated enzymes \[ 8 \]. Albano et al. Despite its prevalence and negative consequences, most of the responders did not study doping in schools and universities. Moreover, most responders neither read a scientific text nor attended an awareness lecture about doping. This is in line with results reported by Japanese pharmacists, where Despite the attitude of prohibiting the doping agents, a high percentage of responders had poor knowledge about JADO. More than half of the participants believed there is no doping law in Jordan. The justification for this is straightforward: increased awareness of JADO and the doping-related laws is crucial. The legal knowledge about doping in Saudi Arabia seemed to be better than in Jordan, as The phenomenon of awareness about doping agents is a global problem. It is not a unique case in Jordan. In Slovenia, only In the present study, most participants believed that the most common reasons for using the doping agents are to enhance physical performance, followed by building muscle mass. The results were somehow similar to those from Saudi Arabia, where Nevertheless, such results are contrary to the Syrian study's findings, where In the present research, the overall prevalence of use of the doping agents was 6. Nevertheless, the real-life prevalence would be expected to be higher. This was a self-reported result; the academic endorsement of the questionnaire and ethical approval was announced. Thus, individuals may be reluctant to share information about the use of the doping agents to avoid liability and personal discomfort. It could be argued that respondents who took the doping agents 6. It is expected that they participate in sports competitions, where 7. A similar trend was also noticed in another study carried out in Syria \[ 2 \], where the proportion of responders who used the doping agents was almost equal to those considering their use as a moral act. However, the prevalence of the doping agent users in the present study is more than that reported in Syria 4. The number of those who consider doping to be a moral act in the Syrian study was more than the number reported in the current study. This percentage reached In the present study, almost one-third of the doping agent users obtained them through their sports friends. The second-largest providers were sports coaches. Such results confirm the previous findings from Syria \[ 2 \], Germany \[ 37 \], and France \[ 40 \]. Almost half of the doping agent users The serious risk is that some regimens will increase long-term negative consequences. Such medicines increase female hormone levels where the rationale of such usage is to create balance with the exogenous anabolic masculine hormones. The unseen risk here is having very high levels of such hormones, more than the standard levels in the human body. On the other hand, using a healthy diet rich in vitamins and natural products would not be a scientifically validated method to protect against the harmful effects of the doping agents. Our assessment led us to say that such myths of using regimens to counteract side effects are circulated without scientific evidence. Our assessment showed that the most common source to sell such agents were sports coaches and sports friends. Accordingly, the scientific background of sports coaches and conflict of financial interest should be crucially considered by both individuals and authorities when dealing with such regimens. A positive attitude toward supporting community awareness was not unexpected. Similar results were reported from Slovenia \[ 4 \]. In the present study, most of the responders supported applying deterrent penalties against the doping agents' abuse. Most responders did not want the doping agents to become legal. With consistent reliability, the vast majority Although they felt less responsibility toward reporting claims against doping dealers, both males About one-third of Jordanian medical staff had been exposed to a prescription containing a doping agent. A similar percentage received a request for providing an illegal doping agent. The present study makes several noteworthy contributions to the understanding of the aspects related to the doping agents among the population and the pharmacists as health care providers. To our knowledge, this is the first study that sheds light on such an important topic in Jordan. The study illustrated that the Jordanian population claimed reasonable knowledge about the doping agents. However, proper knowledge related to the classification and legal issues of the doping agents was poor. Athletes reported the usage of the doping agents despite their knowledge of their harmful consequences. There is a general perception that the doping agents enhance physical performance and build muscle mass. Although these facts are true, the misuse may lead to tragic scenarios. Many people reported using doping agents although they are not sports professionals and they do not aim to participate in sports competitions. This illustrates the general probability of using the doping agents despite their possible side effects. Unfortunately, myths about the negative sequences of the doping agents are circulated. It is worthy to emphasize that the resources for the doping agents need to be restricted and more regulated. Such action is expected to prevent doping malpractice. The evidence from this study reported that pharmacists did not receive proper knowledge regarding the doping agents. Therefore, doping-related issues should be included in the curricula of pharmacy programs. Regardless of the reasons, we strongly recommend investing more efforts to enhance public awareness and professional knowledge. Future studies are recommended to investigate in more depth the aspects of the doping agents in order to come out with stronger and more evidence-based conclusions. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Clin Pract Epidemiol Ment Health. Find articles by Mohanad Odeh. Find articles by Haneen M Tailakh. Find articles by Nour A Elsahoryi. Find articles by Karem H Alzoubi. Open in a new tab. Yes 83 56 0. Yes 86 56 0. Yes 2. Yes 5. Yes 20 36 56 Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Male sex hormones Testosterone. Erectile dysfunction agents Viagra, Cialis. There is a Jordanian organization to combat prohibit doping. Do you know what JADO abbreviation is? Using or trading doping is a crime punishable by law in Jordan. There is a law related to doping in Jordan. Bodybuilding building muscle mass. I support doping to be a legal substance in Jordan. I support the presence of an anti-doping authority in Jordan to reduce its consumption. Have you ever taken a doping agent even if it was once? Did you take a diet or medication after taking a doping agent to protect your body from its side effects? I received information that these diets or drugs are good for the body. The reason for taking these diets is to hide the presence of doping in the blood when performing a laboratory examination. I was directly exposed to request a doping prescription or request help to get a doping agent. I was exposed to someone who asked me for an illegal doping agent. I feel responsible for educating people about doping prevention. I feel responsible for reporting doping dealers.

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