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Sexual enhancement supplements – like those reportedly taken by Lamar Odom before he collapsed at a Nevada brothel – are often spiked with powerful and hidden pharmaceuticals, despite labels claiming they only contain herbs and other natural ingredients, experts and regulators have warned for years.

Odom took cocaine and as many as 10 sexual–performance supplement pills leading up to his hospitalization in Las Vegas, according to a 911 call released Wednesday by the Nye County Sheriff’s Department. The product he took was “Reload; 72-hour strong; sexual performance enhancer for men,” two employees of the Love Ranch said on the 911 call.

In 2013, the FDA issued a public warning that consumers should not purchase or use a supplement called Reload because tests found it contains sildenafil, the active ingredient in the prescription erectile dysfunction drug Viagra. The undeclared ingredient may dangerously interact with other drugs, especially nitrates often taken by men with diabetes, high blood pressure or heart disease, the FDA warned.

A photo of the product that the FDA posted with its safety alert included no information about what company made the product. Despite the product's label claiming it was made in the USA, the website listed on it appears to be a Japanese dating site that provides little clue as to who is the maker of the product.

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USA TODAY's "Supplement Shell Game" investigation in 2013 found it difficult or impossible to determine who the people or companies are behind many of the drug-spiked supplements detected through a limited testing program run by the U.S. Food and Drug Administration. When companies could be identified, USA TODAY found that many of those caught selling spiked supplements are run by people with criminal backgrounds and regulatory run-ins. Consumers buying products from these firms were in some cases entrusting their safety to people with rap sheets involving  barbiturates, crack cocaine, Ecstacy and other narcotics, as well as arrests for selling or possessing steroids and human growth hormone. Other supplement company executives had records of fraud, theft, assault, weapons offenses, money laundering or other offenses, the investigation found.

It’s rare for supplements taken by consumers to undergo testing by the FDA. Out of an estimated 85,000 supplement products on the market, the FDA told USA TODAY in 2013 that it was budgeted to run just 1,000 tests per year.

"The current laws combined with lack of regulatory action by the FDA have left dangerous products on store shelves," said Pieter Cohen, an assistant professor at Harvard Medical School, who has published numerous studies about dangerous supplement products. "The FDA is simply not doing their job."

Products marketed as sexual enhancement supplements are a "very high risk sector" for consumers, Cohen said, because they often contain prescription erectile dysfunction drugs delivered in unpredictable doses. Some contain multiple different types of these drugs. Others contain chemical cousins of these drugs that have never been tested on humans and could have significant safety risks, he said.

Under the Dietary Supplement Health and Education Act of 1994, known by its acronym DSHEA, the FDA must show a product is unsafe before it can take any action to restrict its use or seek its removal from the market.

Products marketed as nutritional supplements – which range from vitamins and minerals to protein powders to herbal blends – are treated like foods and presumed to be all-natural and safe, unless proven otherwise. Although supplements are often sold and used as remedies to treat various conditions, they aren’t required to prove their safety or effectiveness before being sold, as is required for medications.

The FDA has found that products marketed as all-natural supplements for sexual enhancement, weight loss and bodybuilding are among the types most commonly found to be spiked with undisclosed pharmaceuticals.

The FDA said in a statement Thursday that the regulation of dietary supplements is "extremely challenging" and that the industry is huge and growing — currently about $35 billion in sales, up from about $5.8 billion just after DSHEA was enacted. Under the existing law, the FDA said it has "limited authority and faces significant hurdles and resource limitations" in regulating supplement products.

Supplement industry groups have said the FDA needs to do a better job of enforcing the law using authorities it already has.

“We don’t view the problem as a function of the law, because companies that choose to spike products with illegal drugs will find a way to do so regardless of the law — they’re simply law breakers,” said Judy Blatman, a senior vice president at the Council for Responsible Nutrition, an industry group. “It is illegal to sell Viagra, herbal or otherwise, as a dietary supplement.”

The supplement industry for many years has opposed efforts to require that supplements be registered with the FDA so the agency will know what’s on the market and what’s supposed to be in the products.

Legislation called the Dietary Supplement Labeling Act, introduced in 2013 by Sen. Dick Durbin, D-Ill., and Sen. Richard Blumenthal, D-Conn., has gained little traction. The bill seeks to give the FDA the authority to require manufacturers to register products and ingredients with the agency, and also to provide proof of any health benefit claims. It also includes provisions to require more information on product labels. A key goal, the sponsors have said, is to reduce the number of drug-spiked products masquerading as all-natural supplements.

“This bill, which we plan to reintroduce, is desperately needed to improve the currently inadequate oversight,” Durbin and Blumenthal said in a joint statement Thursday.

Durbin and Blumenthal noted that a study published in The New England Journal of Medicine this week found that dietary supplements send at least 23,000 Americans a year to the emergency room and cause at least 2,000 to be hospitalized.

“This study confirms that not enough is being done to protect consumers — especially young adults — from dangerous dietary supplements,” they said.

Read USA TODAY's Supplement Shell Game series at

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