The release of the NCAA's first drug survey in four years on Friday confirms some experts' deepest fears in this summer of tragedy.

The unregulated use of over-the-counter nutritional supplements are at least a contributing factor in positive drug tests.

At worst, supplements could play a part in deaths and are likely a contributing factor in the debilitation of athletes. The survey reported "widespread acceptance" of nutritional supplements commonly found at well-known chain body-building stores.

The NCAA reported that 58 percent surveyed had used some sort of nutritional supplement in the past year. Of that group, 27.3 percent used it to enhance physical appearance.

Creatine used to be dispensed to players by colleges.(AP)

"There may not be a common denominator. We always see heat-related deaths this time of year," said Cindy Thomas of the National Center for Drug Free Sports, an independent company that conducts drug tests for the NCAA. "But it seems we had several right in a certain time period. To be honest, our feelers go up immediately because of what we know about supplements."

In July, Florida freshman Eraste Autin died of heatstroke following a voluntary summer conditioning drill. Florida State linebacker Devaughn Darling died while performing "mat drills" in February. Minnesota Vikings lineman Korey Stringer died of heatstroke complications last week.

Since 1995, 18 high school and college players have died due to heatstroke, according to figures tracked for the NCAA by Dr. Fred Mueller of North Carolina's sports medicine department. Mueller said it's a concern that figures have begun to "creep back up."

In light of the recent deaths, the NCAA on Friday reminded members in a separate press release of the risk factors associated with heat illness cited in its sports medicine handbook. No. 1 on the list is nutritional supplements.

The concern by Thomas and others is that nutritional supplements, while available over the counter, might contain banned substances in their ingredients. To that end, Thomas' group established an 800-number athletes could dial to get expert evaluations of banned substances.

Based on anecdotal evidence from those calls, the stimulant ephedrine is one of the most inquired-about substances. Ephedrine is commonly found in nasal decongestant used to treat colds. It was formerly widely used to treat asthma but has been replaced by drugs that have fewer side effects.

The overall use of ephedrine among those surveyed increased 11 percent from 1997 (3.5 percent in '97, 3.9 percent in 2001). There was a massive increase in use of the substance in women's gymnastics. Only 1.1 percent admitted to using it four years ago compared to 8.3 percent in the latest survey.

The use among wrestlers, though, dropped from 10.4 percent to 4.3 percent.

"Ephedrine is rampant in the supplements," Thomas said. "They're not buying it in drug stores, they're buying it in (supplement stores)."

Deceased Northwestern player Rashidi Wheeler died of asthma complications a week ago but it is not known if ephedrine was involved.

"But it's a stimulant," Thomas said. "It speeds up the heart and then along with the heat, you get the dehydration effect. I think it will really accelerate heat illness. It's been a big hit with the athletes. We are getting a lot of information. We see trends before you ever know about them because of the number of calls."

The NCAA bans approximately 90 substances. It has been tracking the use of those substances through surveys and drug testing since 1989. This is the fourth such survey and first in the quadrennial series since 1997.

The latest results are based on responses from 21,000 NCAA athletes.

Boston College staff physician Dr. Arnold Mazur called it the "largest and most comprehensive" such survey in NCAA history.

"This is very important for colleges to know because most NCAA positive drug tests results from substances found in nutritional supplements," said Mazur, a member of the NCAA's competitive safeguards committee. "You need to educate student-athletes from the time you start recruiting them. We have several freshmen test positive in the early weeks for their first semester from the use of supplements."

Steroids, the poster child of NCAA drug testing, seem to have lost their starring role. Their use has fallen from an initial figure of 4.9 percent admitting use in 1989 to 1.4 percent in 2001. Use of cocaine and marijuana has leveled off. But supplements have recently become a concern because their long-term effects have yet to be determined.

"Who knows what it will mean 20 years down the line?" said Miami center Brett Romberg. "There's not much drug testing in the summer. A lot of kids go home and get on this andro and 'Ripped Fuel' that absolutely destroys their body.

"It's good to look in the mirror and good to be strong for two months but when it comes to pushing your body on the field, I don't know if your body can handle that, especially in 95-100-degree weather."

In its report, the NCAA stated there was "cause for concern" that approximately 60 percent of athletes have been buying their supplements from stores. Only 15 percent said they got them from a trainer or physician. Sixty-three percent said they began taking supplements in high school.

"Athletes are always going to try to find an edge," said Wake Forest head trainer Greg Collins. "Most of our student-athletes are very intelligent ... but if one guy says, 'Try this Brand X, it's really going to make a difference,' they're going to take it (instead of) investigating it first."

The NCAA and national center are in the early stages of studying supplements. Creatine, for example, is not a banned substance in and of itself, but the NCAA says schools are not allowed to provide it to athletes.

"The NCAA has done a good of monitoring what's legal and what's not," said Arizona State football coach Dirk Koetter, "but it was less than five years ago that every college was giving their guys Creatine. Now you can't do that. They're still walking in health stores and buying Creatine."

Makers of Creatine purport it increases short bursts of energy needed in jumping and sprinting. It also is said to aid in speeding up the body's recovery time after exercise. But at what price?

Four years ago, football players at Missouri began cramping up in practice and in games. The cause was eventually traced back to the use of Creatine. At least that's what then-coach Larry Smith thought when he banned the supplement from use by his players.

As two-a-days began this week at Miami, Romberg suggested the use of supplements is getting out of hand everywhere.

"I know a kicker that dehydrated and was cramping during a game because he was taking 'Ripped Fuel,'" Romberg said. "What does a kicker need to take 'Ripped Fuel' for? Please. He kicks five times a game."