Owing to a widespread diffusion, the consumption of banned and potentially harmful substances in sports has become a problem for the public health. Current estimations of the prevalence of doping in sports are rather uncertain, as most investigative tools do not reflect an absolute statistical power. However, the emerging scenario reflects a concerning underestimation by Structures and Institutions that should establish definitive rules and set reliable controls. Owing to restricted resources, prevention and fight against doping must be supported by meditated and rational strategies, with the aim to identify suitable contests and accurate procedures, considering carefully ethical issues that may arise from the positivity of the athletes to antidoping controls.