NEW YORK -- A booklet published nearly two years ago by Major League Baseball and the players' association warned about the dangers of using ephedra, the nutritional supplement that contributed to the heatstroke death of Baltimore Orioles pitcher Steve Bechler.

The 15-page booklet called "Steroids and Nutritional Supplements'' was published in June 2001 and compiled by Dr. Robert Millman and Dr. Joel Solomon. It summarized the effects and side effects of 10 substances.

Regarding ephedrine, the booklet says, "Increased doses generally do not lead to enhanced performance. There have been a number of severe side effects reported related to the drug, including high blood pressure, rapid heart rate, seizures, strokes, heart attacks and death.

"Ephedrine also is associated with psychological side effects such as increased irritability, anxiety, tremors, paranoia, and in rare instances, a complete break with reality.''

The only other substance to list death as a side effect in the booklet was human growth hormone, which has been associated with mad cow disease.

The booklet, printed in English and Spanish, appeared to have had limited circulation. Only one of 10 players and medical personnel asked about the booklet had seen it, according to the newspaper.

On Thursday, Broward County medical examiner Dr. Joshua Perper said toxicology tests confirmed that "significant amounts'' of an over-the-counter supplement containing ephedra led to Bechler's heatstroke.

Bechler was taking the supplement to lose weight at the start of spring training when he collapsed Feb. 16. The 23-year-old pitcher died the next day after his temperature rose to 108 degrees.

Ephedra, which has been linked to heatstroke and heart trouble before, is already banned by the NCAA, NFL and International Olympic Committee.

After Bechler died, commissioner Bud Selig banned players with minor league contracts from taking ephedra, and the players' association urged major leaguers not to use the substance.

The Food and Drug Administration says at least 100 deaths have been linked to ephedra, but it remains available without a prescription in diet supplements.