The Prevalence and Outlook of Doping in Electronic Sports (Esports): An Original Study and Review of the Overlooked Medical Challenges.

Background The first electronic sports (esports) tournament was recorded in 1972, and since then, gaming leagues and tournaments with prizes have been established. Nowadays, the commercialization of competitive gaming may drive players to cheat their way to success and neglect their physical and mental well-being. The issue is all the more vital, as it is often overlooked by classically educated doctors, including sports medicine specialists. The aim of this study was to investigate the current situation of doping in esports and the future of anti-doping actions in this field, as well as to present a more generalised approach and to point out and discuss other possible health risks associated with the rising popularity of esports. Methods A standardised online survey was published in a social media group for Polish fans and people associated with esports. Two hundred and forty-one responses were collected and subjected to a statistical analysis. Only filled-out forms containing answers to all of the questionnaire's questions from people considering themselves regular players of either League of Legends (LoL) and/or Counter-Strike: Global Offensive (CS:GO) were considered viable. The study group was divided into amateur and professional players. The calculation of test power was done post hoc to determine whether the data collected were of sufficient quality to be used further. The normal distribution was assessed using the Shapiro-Wilk test. Then, between-group differences comparing the data results from the questionnaire were analysed with Mann-Whitney U tests and Chi-square tests. The significance level was set at p <0.05. Then, the literature was screened for relevant articles. Results The majority of gamers (85.5%), despite most of them being amateurs, strive to achieve the best results when playing. Borderline legal substances are commonly used, including energy drinks (97.8%), coffee (81.6%), beer (29.7%), herbs (15.7%), and available medicines (15.1%), while more than half the participants have heard about situations during tournaments involving the use of substances forbidden by the World Anti-Doping Agency (WADA). In most answers, there were no significant differences between professionals and amateurs. Statistically significant differences were observed in the following areas: the usage of legal stimulants in the responders' environments; outlooks on implementing more strict anti-doping regulations; and the perceived usage of forbidden doping substances in a tournament setting. Conclusions E-competitors suffer from a plethora of both physical and mental health problems. These issues may be more prevalent than generally thought and include repetitive strain injuries, sleep disorders, anxiety, and depression. The largest esports organisations have started to implement measures to provide a holistic approach to esports healthcare; however, it remains a distant dream for most amateurs and aspiring e-athletes.