**5. Doping**

Doping urges for an institutional and collective attention as an underground phenomenon in rapid growth in the sporting world and social reality. Changing and refinement of substances and doping methods, their growing pharmacodynamic effectiveness, lacking or problematic detectability of substances with ergogenic purposes (so called food supplements), widespread and clandestine commercialization of drugs, and the volume of annual trade, all signify a state of emergency.

In this context, death caused by doping is an event routinely reported by high level sporting competitions [19]. The scarcity of data deduced from international literature and the lack of institutional systems of epidemiological monitoring does not permit reliable estimates of the size of the phenomenon, even and above all with reference to amateur sporting activity. The intrinsic dangerousness of all doping practices, as well as the remarkable heterogeneity of protocols investigating an athlete's sudden death, contribute to the problem. The risk of death related to use of doping substances and practices is mainly associated to anabolics and stimulants, followed by erythropoietic stimulating drugs, growth hormones and diuretics [20].

However, paucity of epidemiological data relative to doping consumption and correlating cases of deaths, cannot define the real size of the phenomenon, which is certainly underesti‐ mated. The use of doping seems to be accepted by the sporting community, also because of the underestimation of the related dangers.

The inability to define the real danger is reflected in the failure to alert institutions, entrusted with the implementation of preventative, informative and repressive educational interven‐ tions.

To dam difficulties associated with the growing abundance of doping substances, laboratories must exchange their experiences and rational adjustment of procedures is needed in a process of constant renewal, in technology and analytical procedures. The renewal must involve use of systems of greater sensitivity and analytical accuracy, as well as larger systematic screenings to incorporate new banned substances in real time.
