It’s a stimulant. It’s a weight-loss product. It’s a cold and asthma medication.
It also might be a killer.
Ephedrine, the active ingredient in the herbal stimulant ephedra, is in the news again this week after the heatstroke death of 23-year-old Orioles pitcher Steve Bechler.
The drug is sold – often combined with caffeine – over the counter at health food and supplement stores under brands that promote its ability to burn off fat and give an athlete that extra boost of energy.
Bechler was said to have taken three capsules of a product called Xenadrine before a workout Sunday at the Orioles’ spring training facility. He collapsed in the 81-degree heat and died the next day. The Broward County medical examiner concluded that ephedrine was one of several contributing factors, although the toxicology tests won’t be available for about two weeks.
Cytodine Technologies, manufacturer of Xenadrine, said in a statement that the recommended dose is two capsules a day and that the product is safe when used as directed.
The tragedy is not a new story, though it is new to baseball. Professional football player Korey Stringer died at the Minnesota Vikings’ training camp in 2001 after a heatstroke episode believed to be ephedrine-related.
And there have been dozens of similar incidents at various levels of football and other sports.
The National Football League banned the use of products that contain ephedrine after Stringer’s death. The International Olympic Committee and many major sports federations have done the same. Major League Baseball does not restrict the use of ephedrine by major league players, but Bechler’s death may force the sport and its players union to a reassess a drug that was left off the restricted substance list when the sport hammered out its new drug-testing program last summer.
Baseball officials declined to comment on the subject yesterday, but a major-league source indicated their silence might be part of an attempt to address the issue with the players union in a nonconfrontational manner. The union has long opposed random drug testing on civil liberties grounds and resisted the inclusion of ephedrine in the industry’s recently revised drug policy because it is a legal substance.
Major League Baseball Players Association director Donald Fehr said he might have a comment this weekend. “It would be inappropriate to have any comment until after the funeral,” he said. “We need to show respect for the family and give the family a chance to grieve.”
In light of Bechler’s death, it may be more difficult for union officials to object to an ephedrine ban.
Orioles team doctor William Goldiner would like to take the idea even further. “From my point of view as physician, I see no reason to have it in the marketplace,” he said. “I think it should be off the shelves.”
The Food and Drug Administration may be moving in that direction. It has commissioned a RAND Corp. study on the potential dangers of ephedrine. Results, expected in April, are expected to confirm FDA suspicions that the drug has contributed to nearly 100 deaths over the past decade.
The FDA’s new chief, Mark McClellan, told the Associated Press yesterday that the agency’s investigators are looking into Bechler’s death. He said, “Sports use is one area where I have got some particular concerns.” Also yesterday, officials at the Department of Health and Human Services, which oversees the FDA, met to discuss how dangerous ephedra may be.
Based on market surveys, about 12 million Americans use products containing ephedrine either to lose weight or stay alert. It is popular among truck drivers who have to stay awake behind the wheel for long periods. Some refer to it as “legal speed.” Baseball players and other athletes acknowledge using it for both purposes.
Bechler felt pressure to drop weight quickly at the start of spring training, a teammate has said.
Several other Orioles said they have used ephedrine capsules to perk up before games.
Derivatives also are found in many cold medications but in concentrations that have been determined safe by the FDA.
“I have taken one [ephedrine capsule] before a game,” said Orioles second baseman Jerry Hairston. “I use it for energy, only when I feel tired. It’s more like coffee. You get that quick burst, but then you have a down time.”
Sometimes, players don’t even know they are using ephedrine. Some products list it as ma huang, the name of the Chinese herb that is refined to produce ephedra and its active ingredient, ephedrine.
The stimulant is a “thermogenic” drug, which means that it works by increasing the heart rate and raising body temperature. Because the body has to work harder to generate that heat, it burns more calories. That’s why the capsules are often advertised as “fat burners.”
It’s logical that the substance could aggravate heatstroke, which is an abnormal elevation of body temperature caused by exertion in hot and humid conditions. Bechler’s temperature rose to 108 degrees, even though the temperature was a relatively comfortable 81 degrees in Fort Lauderdale Sunday.
Still, the promise of quick weight reduction is a strong temptation in the big money world of professional sports, where players know that weight problems could prevent them from achieving their maximum earning potential.
“These guys are vulnerable,” Houston Astros general manager Gerry Hunsicker told the Houston Chronicle this week. “The sad part about it is that as much as you try to educate these guys, some put themselves in harm’s way because of what’s at stake.”
Though many professional sports federations including the Women’s Tennis Association and the Association of Tennis Professionals prohibit the use of ephedrine, Major League Baseball is not the only one that has been slow to recognize the danger of using the stimulant.
The National Hockey League “actively discourages players from using the substance,” according to Frank Brown, vice president for media relations, but the NHL does not have a drug-testing program. Ephedrine wasn’t an issue the last time the sport negotiated a collective bargaining agreement, but restrictions could be discussed when a new labor agreement is negotiated next year.
The National Basketball Association has not conducted a survey on the substance’s use but does send out updates on supplements to the players. A reminder to consult with doctors before using supplements is posted in each locker room.
NBA spokesman Tim Frank said, however, that because ephedrine is not an illegal drug, the NBA has not considered banning it, nor has the supplement been discussed in collective bargaining with the players. All of the NBA’s banned substances are illegal drugs.
The Ladies Professional Golf Association does not have a drug policy in place. “If we ever have evidence of performance-enhancing drugs, and anything compromising the integrity of the competition, we would consider a drug policy. So far we haven’t had the need,” said Connie Wilson, LPGA director of media relations.
The Professional Golfers Association does have a drug and alcohol program in place, but it does not cover ephedrine or any other over-the-counter medication or supplement.
Ephedrine apparently is not an issue in the world of horse racing, where jockeys are much more likely to use the diuretic Lasix to help them drop weight quickly.
The issue is not just about professional athletes, though. Ephedrine capsules are available to anyone where supplements are sold.
Severna Park baseball coach Jim McCandless, who played baseball at the College of William and Mary, said he believes there is more of a tendency among players at the college level to use supplements than on the high school level.
“I haven’t, from my exposure to high school kids, seen or known anyone who used it [ephedrine] or anything similar,” he said. “I think maybe when you get to the college level, you may see some of that.”
McCandless managed the Severna Park American Legion team that made it to the Legion World Series in 1997 in South Dakota. Bechler was the 18-year-old ace pitcher of the Medford, Ore., entry that was runner-up to Sanford, Fla.
“He [Bechler] was a good-sized kid, and you could tell he might have had a bit of a weight problem,” said McCandless. “He was pretty darned good.”
Arundel High School baseball coach and athletic director Bernie Walter, who also teaches health and has been a department chairman, said high school students do use ephedrine “as a food supplement.”
“I think there are some kids using supplements, not necessarily athletes,” Walter said. “They want to take shortcuts on their diet. They don’t want to take the time and effort to have a good nutritional diet.”
Walter said “responsible coaches” need to discuss diets and supplements with their athletes. There is no county policy to prohibit the use of supplements because they are legal.
The Associated Press and Sun staff writers Joe Christensen, Christian Ewell, Milton Kent, Tom Keyser, Roch Kubatko, Don Markus, Jon Morgan, Ken Murray, Pat O’Malley and Lem Satterfield contributed to this article.