Just weeks before the Olympic flame ignites in Milan, the International Testing Agency (ITA) announced the results of the latest round of re-analysis of samples from the 2016 Summer Games in Rio de Janeiro. Seven athletes have tested positive for doping – nearly a decade after the samples were initially collected and cleared.
The Rio re-testing program has now revealed a total of ten cases. The ITA specifically stated that “the majority of these results are made possible by technical progress” – today’s laboratories can detect metabolites of steroids that were undetectable a decade ago.
This isn’t an isolated incident. it’s a systematic component of the Olympic anti-doping program. Samples from each Games are preserved for up to ten years and re-tested using newer methods. The re-testing program from Beijing 2008 and London 2012 led to the disqualification of over 130 athletes, including at least 50 medalists. The same fate now awaits samples from Milan 2026: the ITA will store them in a centralized warehouse and make them available for repeated analysis until 2036.
It’s statistically almost certain that some medals from the recently concluded Milan Olympics will ultimately be stripped and potentially awarded to athletes who originally finished off the podium. The question isn’t “if,” but “how many?” And to even begin to answer that, we need to look at what we know – and, crucially, what we *don’t* know – about the true extent of doping in elite sports.
Official Numbers and Their Shadow
Since the founding of the World Anti-Doping Agency (WADA) in 1999, the percentage of positive tests has remained consistently in the 1-2% range of all tests. In 2012, it was 1.76% – 4,723 positive results from 267,645 samples. According to the latest available data from 2023, accredited laboratories in Olympic sports collected 238,827 samples and recorded 0.73% with positive or atypical findings.
This seemingly low number has remained remarkably stable. Even a significant expansion of testing – from around 117,000 controls in 2000 to over 275,000 in 2008 – didn’t significantly shift the percentage of positive findings. Two explanations present themselves: either doping is a rare phenomenon, or those who cheat are adept at evading tests. Available data suggests the latter is more likely.
A study commissioned by WADA in 2011 attempted to answer the question of “how widespread is doping” through an anonymous questionnaire distributed among participants in the World Athletics Championships in Daegu, South Korea. The research team surveyed 2,167 athletes. The method guaranteed complete anonymity for respondents – researchers didn’t see individual answers, only the statistical result of the entire sample.
The result was, to position it mildly, startling: 43.6% of athletes admitted to using prohibited substances in the past 12 months. At the Pan Arab Games in Doha, the figure was 57.1%. Yet, positive doping tests at both of these championships were only 0.5–3.6%.
The study was published in the journal *Sports Medicine* in 2018 – more than six years later. *The Guardian* called the delay “scandalous” and quoted the authors, who suggested that sports organizations were reluctant to release uncomfortable findings.
However, it’s vital to note that the 43% estimate isn’t definitive. A later re-analysis of the data using a different statistical method, Single Sample Count, published in *Frontiers in Sports and Active Living* in 2022, reached substantially lower numbers, and its authors pointed out that “most other studies estimate the prevalence of doping between 0 and 25%.” An independent American study from 2024, which directly surveyed 1,398 elite athletes, estimated the prevalence of doping at 6.5–9.2%. A statistical model based on data from athletes at the 2011 World Championships estimated the prevalence of blood doping alone at 18%.
The real number likely lies somewhere between the official 1-2% and the upper limit of 44%: roughly in the lower tens of percent. Even with a conservative estimate of around 10%, that’s five to ten times more than what tests detect.
Incidentally, winter sports historically have lower doping rates than summer sports – 0.28% positive tests compared to 0.44% from 1968-2014. The reasons are likely due to differences in who is tested, as well as the fact that there’s less truly well-compensated sport in the Winter Games.
That doesn’t mean winter sports are clean. Cross-country skiing is historically the “most doped” Olympic sport after weightlifting and athletics. At the 2001 World Championships in Lahti, six Finnish skiers tested positive for blood doping, and the revelation of systematic doping among Russian athletes in Sochi in 2014 ultimately uncovered over a hundred offenders.
Tradition Above All Else: What They’re Using
Despite the wide array of prohibited substances listed on “anti-doping” lists, the core of the doping repertoire hasn’t changed much in two decades. And anabolic steroids still reign supreme.
A twenty-year analysis of data from WADA-accredited laboratories confirmed that anabolic agents consistently account for around 40–50% of all positive findings. In 2023, that number was 1,660 cases out of a total of 3,724 detections. The reason is simple: steroids work. They stimulate protein synthesis in muscle cells, allowing for harder training and faster recovery – a crucial advantage for any sport where strength and explosiveness are key.
The most frequently detected substance is testosterone, for good reason: the body naturally produces it, so distinguishing synthetic from natural requires expensive isotope analysis, which laboratories don’t perform on every sample.
The second largest category involves methods to increase oxygen transport in the blood – primarily the hormone EPO (erythropoietin) and blood transfusions. They represent around 15% of elite doping cases but dominate endurance sports. EPO, originally a drug for anemia, dramatically changed professional cycling in the 1990s.
Detection of EPO in urine didn’t reach until the Sydney 2000 Olympics – more than a decade after it was freely used. And even today, athletes apply micro-doses that flush from the body within hours, making classic testing difficult. That’s why the biological athlete passport was introduced in 2009, tracking long-term trends in blood values and signaling suspicious fluctuations, even if no specific substance is detected at the time of sampling.
The third significant category consists of stimulants and “masking” agents, particularly those that dilute urine, reducing the concentration of other prohibited substances.
Doping pharmacology changes more slowly than a layperson might expect. But occasionally, there’s a sharp break: an example is meldonium, a heart medication widely used in Eastern Europe. WADA banned it from January 1, 2016, and that year saw a noticeable increase in positive findings – from 1.26% to 1.60% – as dozens of athletes either failed to stop using the drug or chose not to. In 2017, the percentage dropped again as athletes adjusted to the new rules and oversight.
This episode demonstrates the dynamics of the doping “market”: each ban on a new substance triggers a temporary increase in detections, after which the curve falls again – not due to the fact that doping disappears, but because cheaters adapt to the new reality.
It’s Almost Too Easy
Doping in elite sports isn’t primarily a story of individual moral failings. It’s a systemic problem that can be described in terms of game theory – as a variation of the so-called Prisoner’s Dilemma.
The situation looks like this: rules prohibit doping, and all athletes would ideally prefer a clean competition. But once some competitors decide to break the rules and remain undetected, clean athletes face an unpleasant choice – to dope as well, or accept likely defeat. The result is a cascade: doping by some triggers doping by others. Professional cycling in the 1990s demonstrated this mechanism in a crystal-clear form. Once EPO became widespread in the peloton, “clean” riders “burned out trying to keep up” with doped competitors – and most eventually succumbed.
The cascade is driven by economic incentives. The Summer Olympic Games generate sponsorship deals and career opportunities unmatched in sport. Doping historian John Hoberman summed it up in an interview with *The Guardian*: “The entire system of elite sport has built into it incentives to dope that are essentially irresistible.” As we’ve said, the financial pressure is lower in winter sports – a smaller media market, fewer sponsors – which partially explains the aforementioned difference in detection rates.
That doesn’t mean winter sports are clean. Skiing has historically been the “most doped” Olympic sport after weightlifting and athletics. At the 2001 World Championships in Lahti, six Finnish skiers tested positive for blood doping, and the revelation of systematic doping among Russian athletes in Sochi in 2014 ultimately uncovered over a hundred offenders.
To this economic logic, psychology adds another layer. Athletes rationalize doping with the belief that “everyone else is doing it” – and often, unfortunately, they’re right. Legend (originally a cyclist, later a doping figure) Lance Armstrong justified his systematic doping program for years as leveling the playing field in an environment where most of the peloton was doping.
Fans and sponsors, conversely, succumb to the opposite bias: they seek to believe their hero is clean and ignore warning signs. This double deception – of athletes and the public – helps keep the whole system running.
Detection and the Future
The anti-doping system for Milan 2026 represents the most comprehensive pre-Games program in the history of the Winter Olympics. The ITA tested 92% of athletes beforehand – more than 7,100 tests on 2,900 athletes over six months. And, as with previous Games, all samples collected during the Games will be stored for repeated analysis until 2036.
Long-term sample storage is now the most effective deterrent. Improvements in steroid metabolite detection have enabled retroactive findings from Rio that were unthinkable a decade ago. Isotope ratio mass spectrometry (GC/C/IRMS), which has the highest detection rate of all methods, continues to improve. And the aforementioned athlete biological passport adds another layer of security.
An interesting and still somewhat open question for the future is that of so-called gene doping – targeted modification of an athlete’s DNA using tools like CRISPR. WADA banned it as early as 2003, long before anyone could realistically try it.
How could gene doping work? In laboratories, scientists have created mice with the myostatin gene knocked out – resulting in animals with double the
