But more than a third of wheelchair athletes at the Beijing Paralympics said they were unaware of the condition, according to a 2010 study by Bhambhani published in the journal Disability and Rehabilitation. One in six athletes – all males – said they had boosted at least once to enhance their performance, the study found.
But of the 37 Paralympic athletes screened for boosting in Beijing, none tested positive, according to Spence.
"Boosting is very rare," he said, adding that the "gruesome nature" of the practice makes it a hot topic.
For Kirkland, who is the first Paralympic athlete to be inducted into the Alabama Sports Hall of Fame, the thought of voluntarily inducing a medical emergency is baffling.
"I thought I was going to die when I had my accident," he said. "Why would I want to kill myself now for some boost?"