Gordon Adds Another Dee to PED Discussion – The Steroid Dilemma Continues for MLB

Baseball Stadium - 2000 Sydney Olympic Games, Photo by Oliver Catlin

Baseball Stadium – 2000 Sydney Olympic Games, Photo by Oliver Catlin

While most people were waking up to a wonderful Friday morning, baseball fans were discovering some more depressing news in the announcement that Dee Gordon, infielder for the Miami Marlins, has been suspended 80 games due to test results revealing two performance-enhancing drugs (PED) in his system. Gordon had originally appealed the decision, but decided against appealing Friday morning.

Thursday night, Gordon revealed to his teammates, after a 4-game sweep of his former team in Los Angeles, that he tested positive earlier this year for synthetic testosterone and Clostebol, an anabolic steroid. He released a statement this morning through the MLB Players Association saying the following:  “Though I did not do so knowingly, I have been informed that test results showed I ingested something that contained prohibited substances. The hardest part about this is feeling that I have let down my teammates, the organization and the fans. I have been careful to avoid products that could contain something banned by MLB and the 20+ tests that I have taken and passed throughout my career prove this. I made a mistake, and I accept the consequences.”

Responses to the statement have been coming faster than Dee Gordon stealing second. Players, from all teams, are showing concern and making comments on the news about Gordon’s suspension.

Figure 1 Tweets by MLB players in response to Dee Gordon's PED suspension

Figure 1 Tweets by MLB players in response to Dee Gordon’s PED suspension

Justin Verlander’s Twitter response adds powerful perspective to the issue and shows how personal it is to the players, the majority of whom love and respect our national pastime.

Figure 2 - Twitter post made by Justin Verlander from the Detroit Tigers

Figure 2 Twitter post made by Justin Verlander from the Detroit Tigers. 

Why was Gordon Allowed to continue playing when these test results came in?

Gordon won the National League batting title in 2015 and was an All-Star player while with the Dodgers and the Marlins. Having him on the field obviously makes him a valuable asset to a team. You can ask anyone who was at Dodger Stadium Thursday night when Gordon “delivered the game-tying RBI single for the Marlins in the seventh inning,” which more or less solidified the series sweep.

Gordon had originally appealed the test results, meaning that nothing was going to be released publicly until the situation had been decided, which is in accordance with MLB policy. He was allowed to continue to take the field while the case was going through the appeal process. The news became public Friday morning, because Gordon decided to no longer appeal the results. But his answer just leads to more questions.

Should the punishment be more severe for players who cheat?

The topic of performance-enhancing drugs in the league has been trending lately due to the recent announcement of the Chris Colabello doping violation a week ago, Taylor Teagarden’s suspension earlier this month, as well as allegations of Chicago Cubs’ pitcher, Jake Arrieta, cheating after his recent successes on the field drew attention. Gordon’s suspension has further catalyzed conversations already in motion about what to do with his test results as well as the punishments associated with them.

The USA Today summarized the MLB penalties as of March 28, 2014 as follows: “Players and owners announce penalties will increase to 80 games for a first testing violation and to 162 for a second, and a season-long suspension will result in a complete loss of that year’s salary, rather than 162-183rds. A player who serves a PED suspension during the season will be ineligible for that year’s postseason.”

Even with these changes made, is it enough to incentivize players to not cheat? Many aren’t so sure. In an article released on April 21, by Fox Sports, the opinions players have about the MLB drug-testing program were discussed. Ever opinionated on the topic, Verlander discussed a potential way to clean up the league. “Maybe more severe punishments,” he said. He also mentioned that “It’s too easy for guys to serve a suspension and come back and still get paid,” which is what will happen with Gordon.

Another player, Matt Holliday from the St. Louis Cardinals, gave his take on punishments for cheating players in the article. “If you’re caught taking something where they prove that you’re trying to cheat,” he said, “that it’s a legitimate steroid or testosterone. I’m all for a year, two years, to keep guys from trying to cheat…for as harsh a penalty as possible. I’m all for second chances. But if you make the penalty super, super stiff, guys will think twice. They’ll look at 80 games and think, ‘That’s not that big a deal.’ But if you start taking away two years, that’s a lot of money. That might be different.”

We can all speculate that harsher punishments would make it a more difficult decision for players to take banned substances. They would also make it even more of a priority to be aware of what is in dietary supplement products or other medications athletes use. Lack of knowledge in this area can lead to problems, just ask Maria Sharapova, who tested positive at the Australian Open for the banned substance Meldonium. Thankfully, in the case of supplements, third-party certification programs like the BSCG Certified Drug Free® program are available that evaluate and test supplements to ensure they are free of banned substances to help mitigate the risks for athletes.

Is there incentive for players to cheat, regardless of the current punishments?

Gordon was traded to the Miami Marlins at the end of his best season with the Los Angeles Dodgers in 2014. Flash Gordon looked great in Dodger blue. Many fans in Chavez Ravine were sad to see him leave, especially having seen his stats soar after leaving. Of course, now that Gordon added another Dee to the PED discussion opinions have changed as we don’t need another superstar turned PED poster boy in L.A.

Last season, Gordon won the National League batting title with a .333 average. That was a big deal, due to the fact that he was neck-and-neck with Washington Nationals outfielder, Bryce Harper. He also led the league in stolen bases, with 58, a number not seen since JACKIE ROBINSON (yes, that guy) did it in 1949. Dee Gordon ended 2015 with the label “Big Deal” associated with his name and, as a result, was given a five-year, $50 million contract extension with the Miami Marlins.

Interviews were conducted before the 4-game series against the Dodgers on April 25th, prior to Gordon’s announcement. It was there, when Don Mattingly, who you might know as Donnie Baseball or the manager of the Los Angeles Dodgers from 2011 to 2015, discussed being the new manager of the Marlins and his thoughts of Gordon as a player, “What I always liked about him was his swing. You have to remember he was 140-something pounds when he started and now he’s brought it up to about 170. This is a kid that’s put on a lot of mature strength and his speed tools aren’t going away. That’s something that makes you feel really good about what he can do.”

As his manager ironically noted, Gordon was getting bigger, stronger, and better. The pressures that come with playing at this level include maintaining his skills in order to prove he is deserving of that label “Big Deal”. It isn’t unfathomable for a player to resort to taking performance-enhancing drugs in order to keep oneself at that professional level. It has been done before!

Gordon’s current punishment, aside from the 80-game suspension, includes a fine of $1.65 million. One might think that is a lot of money, until you realize it doesn’t even touch the $48.35 million he is still guaranteed on his contract. This being said, one could conclude that Gordon fought hard to earn this big paycheck, at any means possible, because cheating was worth close to fifty million dollars for him.   

Did Gordon use performance-enhancing drugs with mal intent? Did he cheat to gain weight and strength throughout his career? Was he trying to keep that “Big Deal” label while in Miami, or make it even bigger? Could this be something that happened unknowingly as his public statement claims?

While those questions linger, a single theme seems to resonate in professional baseball; even though a player’s failed test leads to a tarnished reputation, or demotion to the minor leagues, or retirement, or 80 game sanctions, he still makes millions of dollars. This is perhaps one reason why the issue of abusing banned substances in professional sports can be rationalized by players. Buster Olney’s statement about Gordon’s suspension puts it well, “the incentive to cheat will far outweigh the risks involved in being caught. Whatever the intent, whatever the justification, PED crime in baseball pays well.

If we can learn anything from the past two days, it is that the PED discussion is far from over in MLB. Those who thought the steroid era was over may need to reconsider. We also need to reconsider how the system can be improved and made stronger for the sake of the players and the fans who love our nation’s pastime. For now, Gordon is just another name added to the list of MLB players that have tested positive for PEDs. He isn’t the first, sadly–he won’t be the last.

Maria Sharapova and Meldonium – Consideration of a Therapeutic Use Exemption After a Positive Drug Test

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Maria Sharapova – London 2012 – Photo by Oliver Catlin, http://www.bscg.org

The coverage of Maria Sharapova’s announcement of her positive drug test for meldonium, or mildronate, has been astounding. Her case is yet another amazing example of a great champion falling victim to performance-enhancing drugs in one way or another. We wrote an immediate blog post about it an attempt to consider the two potential sides to a doping issue. That post still provides an interesting view of the perspective we were aiming to provide and we stand behind the bulk of the content.

In our haste to give Ms. Sharapova the benefit of the doubt in the situation, however, as we did in our conclusion and in the suggestion that perhaps her therapeutic use would be considered retrospectively, we did not fully consider the realities behind Ms. Sharapova’s claim of therapeutic use. Thankfully our friends in the anti-doping doping community have elegantly expounded on this element of the case.

The expert analysis below on therapeutic use and application in World Anti-Doping Agency (WADA) doping control is important to consider. It corrects the notion that a TUE could be granted retroactively and impact a pending sanction, which would be extremely rare if not completely unique in the field of anti-doping.

The information below was written by Dr. Ken Fitch and distributed by Jim Ferstle, both valued friends and colleagues who care deeply about clean sport and anti-doping and have spent their careers fighting for the cause as we have. The points of primary interest: retroactive TUEs would be unlikely to be considered from a standpoint of sanction relief, and the defined timeframe and clinical guidelines for use of a drug should always be scrutinized when evaluating potential therapeutic use. Thank you, Ken, for providing an insightful explanation of the criteria involved in the consideration of therapeutic use exemptions and the potential application to meldonium.

Dr. Ken Fitch is an Australian doctor and Professor, School of Sports Science, Exercise and Health, Faculty of Life Science University of Western Australia. Dr. Fitch wrote the original rules for TUEs in 1991 for the IOC, chaired the IOC’s TUE Committee for 20 years, chaired WADA’s interim committee (2001-2003) that established the initial International Standard for TUE (2004) and chaired Australia’s national TUE Committee for 22 years.

Maria Sharapova’s lawyer exploring a possible TUE to exempt a sanction
by Ken Fitch, M.D.

The ludicrous suggestion by Sharapova’s lawyer that she might seek a retroactive Therapeutic Use Exemption (TUE) to avoid a sanction for testing positive to meldonium demands a response. Ignoring whether the 2016 World Anti-Doping Code and the 2015 International Standard for TUEs does or does not make a retroactive TUE a possibility in her circumstances, if anybody examines the criteria that must be met to grant a TUE, he/she would understand that no respectable TUE Committee could approve any such application.

WADA states that there are four criteria, all of which must be met to grant a TUE.

  1. The drug is necessary to treat an acute or chronic medical condition and the athlete would experience a significant impairment to health if it were to be withheld.
  2. The therapeutic use of the prohibited drug is highly unlikely to produce any additional enhancement of performance beyond what might be anticipated by a return to the athlete’s normal state of health following the treatment.
  3. There is no reasonable therapeutic alternative to the use of the prohibited drug.
  4. The necessity to use of the prohibited drug is not a consequence of prior use of a prohibited drug or method.

Would Sharapova’s health be significantly impaired if she was denied a TUE? The Latvian makers of meldonium advise that it should be taken in intermittent courses of 4-6 weeks and for what period of time Sharapova administered meldonium during the past ten years, has yet to be disclosed. As the only acceptable medical indications are for ischemic cardiac and ischemic cerebral conditions, it is unthinkable that Sharapova has either. Hence any claim that should she be denied the right to take meldonium would impair her health is simply fanciful. Any TUE application must fail criterion 1.

The second criterion was introduced because some athletes had an essential need to take a prohibited drug. For example, an insulin dependent diabetic would die if denied insulin which has been prohibited in sport since 1998 and their daily insulin injections that are permitted with a TUE do not enhance performance. Whether meldonium actually enhances performance in humans has yet to be demonstrated. That WADA has advised that in less than two months since it was added to the Prohibited List, 99 athletes have tested positive for meldonium would appear to indicate that many athletes and their advisors believe that it does. No athlete could claim that meldonium was essential to restore their health back to normal levels. To claim that without it, a person’s health would be less than normal is surely fictitious. Fails criterion 2.

There are many drugs that have been demonstrated in scientific trials to be valuable in cardiac ischemia and the vast majority would be far superior to meldonium. The few meldonium studies performed in humans have been on persons who recently had experienced a myocardial infarction or an acute coronary syndrome. That the makers of meldonium recommend that it be administered only in intermittent courses in contrast to most of the widely acceptable, prescribed alternatives that are to be taken daily, is further evidence of the non-essential status of meldonium to treat cardiac ischemia. As the drug is marketed in only ten countries globally and Sharapova has lived in the USA for much of her life where meldonium is not approved for human use, this poses further questions for the tennis player.

Drug therapy for cerebral ischemia is generally ineffective and less frequently used than for cardiac ischemia but those patients on whom meldonium was trialled had had either a recent stroke or evidence of deteriorating brain function. As Sharapova could not possibly demonstrate that she has either of these or indeed significant cardiac or cerebral ischemia, and if she could, alternative permitted drugs are at least as effective if not more so, she fails criterion 3.

Hence Sharapova fails 3/3 and the fourth criterion has no relevance. Finally, should an unscrupulous or ignorant TUE Committee happen to grant Sharapova a retroactive or even a prospective TUE for meldonium, WADA would be certain to appeal to CAS and the decision would be or should be overturned.

Maria Sharapova and Meldonium – Consideration of a Positive Drug Test

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Maria Sharapova – 2012 London Olympic Games – Photo by Oliver Catlin, www.bscg.org

Before jumping to conclusions and lambasting Maria Sharapova as a deliberate doper over recent revelations, we should attempt to educate ourselves and arrive at an informed decision based on the circumstances at hand. There is much to consider when reviewing Ms. Sharapova’s recent positive drug test at the Australian Open for the drug Meldonium.

First, we start with the drug, Meldonium, also known as Mildronate. You can review the pubchem listing for mildronate if you are interested. Other synonyms for the drug include “Quaterin; 76144-81-5; Kvaterin.” The long IUPAC chemical name is 3-[(trimethylazaniumyl)amino]propanoate.

In medicine, Meldonium is used to treat cardiac conditions like angina and vascular disease. It was developed by a Latvian company Grindeks and is approved in the Russian Federation and other countries but not in the Unites States. The description on Drugs.com describes it in two therapeutic categories; “treatment of cardiac disorders” and “inhibitor of carnitine synthesis.” Drugs.com includes 11 brand names across the Russian Federation, Latvia, Georgia and Lithuania: “Cardionate, Meldonium Olainfarm, Meldonium-MIK, Mildronat, Mildronat Grindeks, Mildronats, Mildroxyn, Vazomag, Midromax, Mildronate, Milkor.” There are 189 publications to explore via PubMed if you want to want to spend the time perusing them.

It appears Ms. Sharapova tested positive for the drug in an ITF (International Tennis Federation) drug test on Jan. 26 at the Australian Open. This information comes from her own accounts and the various media summaries of her case, including one from the New York Times that includes a video of her press conference in which she disclosed the positive test results. She explains the details saying, “I was legally taking the drug for the last ten years. I was getting sick very often, I had a deficiency in magnesium. I had irregular EKG results, and I had a family history of diabetes.” She added she had used the drug since 2006 based on treatment advice from her doctor.

Meldonium was added to the World Anti-Doping Agency (WADA) Prohibited List for 2016 under the category ‘S4. Hormone and Metabolic Modulators’. Prior to 2016, Meldonium was on WADA’s monitoring program list, meaning they were watching to see if it was being abused by athletes. The notes from WADA’s 2016 Prohibited List – Summary of Major Modifications and Explanatory Notes that came out on September 16, 2015, says that “Meldonium (Mildronate) was added because of evidence of its use by athletes with the intention of enhancing performance.”

More specifically, an abstract from a publication on Meldonium in Drug Testing and Analysis from December 2015 mentions, “the anti-ischemic drug Mildronate demonstrates an increase in endurance performance of athletes, improved rehabilitation after exercise, protection against stress, and enhanced activations of central nervous system (CNS) functions.” A good explanation on the logic and research leading WADA to prohibit of Meldonium is included in a blog from March 3, 2016, noting the positive drug tests of runners Abebe Aregawi and Endeshaw Negesse, who also recently tested positive for Meldonium.

According to a Roidadvisor.com article, “Performance-enhancing Drugs Used by Athletes That Are Surprisingly Common,” (Oct. 17, 2015),“Meldonium has generally been used by athletes in various sports for its mild stimulant-like properties.” The piece goes on to say, “Of interest to athletes is the finding that it consistently and significantly improves exercise tolerance. Some pharmaceutical companies have recently marketed it explicitly as a performance-enhancing drug. It’s also used as a ‘smart drug’ by non-athletes. Athletes have been using it for over 5 years.” Of additional concern, the article mentions other similar drugs “telmisartan (Micardis) and T3 liothyronine (Cytomel) – are currently being used by numerous elite athletes particularly in endurance sports.”

So, on the one hand there appears to be a plausible and legitimate medical reason for Ms. Sharapova to have used Meldonium. It could have simply been a mistake that she continued to use it in 2016 without realizing it had become prohibited or seeking a therapeutic-use exemption for the drug, which presumably she could have and still might receive if her account holds true. It’s possible that will be evaluated retrospectively. It would appear there was enough time to consider the potential concern as Meldonium was on the WADA monitoring program list since January 1, 2015 and notification of it being added to the Prohibited List came out more than three months before the start of the year. It is not known if the ITF provided any notification to its players in addition to the information WADA provided.

Now, the cynics will probably look at the message board information and say it appears clear that athletes have known about the doping potential of drugs like Meldonium for years now. They may conclude that Ms. Sharapova has come up with a convenient explanation of what happened after the fact. Sadly, that explanation is also plausible.

This issue is the perfect example of a primary challenge we face when confronting the need to conduct anti-doping testing to keep sport clean. All we have is the test results that indicate a positive or negative finding in a urine sample. The results do not speak to the motivations or intentions of the athlete. In situations like this one, or in cases that involve dietary supplement use, it is hard to know whether the athlete is being truthful in their explanation or if they have developed a convenient explanation for their use of the substance involved.

We will see how things conclude in this case. Given what we know about the character of Ms. Sharapova, we have to think this is accidental doping. Of course one can never be certain and the rules of strict liability still apply as they always do in the anti-doping realm, and as she herself notes in her statement. Sadly, she is now subject to a possible two years of sanctions and has had a pall pulled over the culmination of a fabulous career. Tennis will miss her and her the game. This case is the perfect illustration of the need for drug tested athletes to take it upon themselves at the end of each year to be vigilant and review changes in the WADA Prohibited List to ensure their medications and dietary supplements are compliant with the drug testing rules for the next year.

By Oliver Catlin, President, Banned Substances Control Group, www.bscg.org

BSCG CERTIFIED DRUG FREE® CERTIFICATION PROGRAM ADDRESSES UNMET SUPPLEMENT ADULTERATION CONCERNS, AN ANALYSIS OF FDA STATISTICS CONFIRMS

BSCG Header imageFOR IMMEDIATE RELEASE

April 16, 2015

BSCG CERTIFIED DRUG FREE® PROGRAM ADDRESSES UNMET SUPPLEMENT ADULTERATION CONCERNS, AN ANALYSIS OF FDA STATISTICS CONFIRMS 

BSCG is the first to offer protection against drugs not banned in sport

(Los Angeles) – In broadening its services to include a range of new protections against supplement adulteration, including an expanded drug-testing menu for the protection of general consumers, BSCG (Banned Substances Control Group), a highly regarded independent dietary supplement certification provider, is filling important unmet needs in the realm of supplement quality control.  An analysis of the FDA’s Tainted Supplements List reveals that 76% of the hidden drugs found in supplements are not banned in sport—substances that only BSCG’s pioneering program covers.

The FDA’s testing has shown that products may contain harmful compounds falling outside the scope of those banned by the World Anti-Doping Agency (WADA) and elite and professional sports leagues including antihistamines, muscle relaxers, pain killers, weight loss drugs, PDE-5 inhibitors like sildenafil, and more dangerous agents. As the FDA warns, “this list only includes a small fraction of the potentially hazardous products with hidden ingredients.” BSCG is the only certification provider to focus on this concern.

“We knew that the FDA was finding a lot of prescription and over-the-counter drugs not banned in sport in the course of their testing,” said Oliver Catlin, BSCG President. “Recognizing the associated risks, we added those drugs and related compounds to our menu. We’re proud to take the lead in offering additional protection against these substances that are important for the protection of the general consumer.”

BSCG’s industry-leading drug testing menu includes more than 392 compounds, of which 185 are prescription or over-the-counter drugs and 207 are drugs banned in sport. BSCG not only has become the first certification program to safeguard against drugs not banned in sport but also offers the broadest and most finely tuned protection available in the supplement certification industry against substances prohibited by WADA, NFL, MLB, PGA, LPGA, NHL, MLS, ATP, WTA, NCAA, NASCAR and other sporting groups.

BSCG_FNLFounded in 2004 in Los Angeles by renowned sports anti-doping pioneer Don Catlin, M.D., his son, industry leader Oliver Catlin and respected attorney Ryan Connolly, BSCG grew out of the desire to protect elite athletes and professionals from ingesting hidden substances in supplement products that could lead to health concerns and positive drug tests. No product BSCG has certified has ever led to a positive drug test. In late 2014, the third-party company released its new BSCG Certified Drug Free® program.

In addition to security against drug contamination, the BSCG program includes annual testing for label claims and toxic contaminants and a Good Manufacturing Practices (GMP) audit. With fervent recent regulatory actions in New York and other states and added scrutiny on compliance with FDA’s 21 C.F.R. 111 – GMP quality control guidelines has come a renewed focus on ensuring that supplement products meet ingredient and finished product specifications for identity, purity, strength and composition and have been appropriately tested for potential contamination.

“Supplement consumers deserve assurance that products are not only drug free but that they meet label claim and contamination specifications and standards,” said Catlin. “BSCG recognizes the importance of these quality control elements and is pleased to include them as part our supplement certification services.”

The BSCG Certified Drug Free® program represents the gold standard in dietary supplement certification and can be applied to finished products, raw materials or manufacturing facilities. The Athlete Assurance Program offers protection directly to teams, leagues or individuals. BSCG’s certification allows clients to establish products and brands as reputable and drug free and offers assurance on product integrity to consumers and athletes. Look for the BSCG Certified Drug Free® seal.

For more about BSCG and the BSCG Certified Drug Free® program, call 1-800-920-6605 or e-mail info@bscg.org, visit its website at www.bscg.org and download its free brochure. Join Banned Substances Control Group on Facebook and @BSCGCertified on Twitter.

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For press inquiries, contact info@bscg.org or 800-920-6605, or Joseph Taylor, BSCG Public Relations Consultant, at joseph.taylor.pr@gmail.com.

DRUG TESTING RULES FOR NARCOTIC PAINKILLERS IN THE NFL, MLB, NCAA AND OLYMPIC SPORT

The world is focused once again on the NFL, after a DEA investigation into the possible illegal use of prescription painkillers in the sport, as first reported Sunday by Sally Jenkins and Rick Maese of the Washington Post.

The issue centers on how such drugs are used and dispensed within pro football. According to DEA regulations, controlled substances like narcotic painkillers, known as analgesics in the medical field, can only be monitored and prescribed by licensed medical personnel and only within states where the license applies.

Controlling the use and abuse of analgesics is not an isolated issue faced by the NFL. The problem is prevalent across sport and society. Alarmingly, the CDC reported deaths from prescription drug overdose had risen steadily through 2008 reaching the same level as deaths from vehicle accidents. Thankfully, the CDC reports this trend has slowed in recent years, but the issue remains present and acute.

To understand the issue better one needs to know what drugs we are talking about. Most of the concern is centered on narcotic opioid analgesics, substances that can be dangerous and addictive. These include morphine, heroin, codeine and their synthetic derivatives and analogs. Fentanyl, tramadol, meperidine (demerol), hydrocodone (vicodin), oxycodone are common examples of drugs in this category. Narcotic analgesics are to be distinguished from other drugs used to treat pain like muscle relaxers or non-steroidal anti-inflammatory drugs.

While controlled substance laws dictate how narcotic analgesics are managed in society, drug-testing programs in sport dictate how these drugs are treated within the sport in question.  We look deeper into the drug-testing policies and banned substance lists in sport to see how these drugs are governed and managed.

The World Anti-Doping Agency (WADA) Prohibited List governs international Olympic sport and is often used as a model by other sporting groups when considering what to ban. Some narcotic analgesics are on the WADA Prohibited List in the S7. Narcotics category, but not all the common ones mentioned above would be included.  The language for narcotics is shown below.

S7. NARCOTICS

The following are prohibited: Buprenorphine, dextromoramide, diamorphine (heroin), fentanyl and its derivatives, hydromorphone, methadone, morphine, oxycodone, oxymorphone, pentazocine, pethidine.

The language does not include the ‘similar chemical structure or similar biological effect’ language or the ‘including but not limited to’ language used in other categories to cover additional substances not listed. In the case of narcotics, the only substances not listed that are covered are fentanyl and its derivates. Codeine and derivatives like hydrocodone and tramadol are not covered by the WADA language. WADA prohibits the use of narcotics in-competition, but these agents are not tested for out of competition.

Interestingly, the language included on the WADA Prohibited List is different than that used by Olympic sport prior to WADA. In 2000, Olympic sport was still governed by the International Olympic Committee (IOC) and the rules in the Olympic Movement Anti-Doping Code. At the time, the narcotics section included ‘and related substances’ but a specific list of narcotic analgesics was permitted, as shown below.

  1. NARCOTICS

Prohibited Substances in class (B) include the following examples: buprenorphine, dextromoramide, diamorphine (heroin), methadone, morphine, pentazocine, pethidine, … and related substances

NOTE: codeine, dextromethorphan, dextropropoxyphene, dihydrocodeine, diphenoxylate, ethylmorphine, pholcodine, propoxyphene and tramadol are permitted.

The issue is different when one evaluates how narcotic analgesics are treated in professional sport leagues and college. We review the NFL, MLB and NCAA policies here. A review of how other sport groups might deal with these drugs is more difficult as drug-testing policy language is not always publicly available.

The NFL covers narcotic analgesics under its Policy and Program on Substances of Abuse. The policy says that, “Players shall be tested only for the following substances.” Narcotic analgesics are covered as follows: “Opiates (total morphine and codeine) ≥ 300 ng/mL, Opioids (e.g., hydrocodone, oxycodone) ≥ 300 ng/mL.” The language is somewhat vague but it should broadly cover narcotic analgesics depending a bit on how the testing provider interprets the listing of opioids (are only hydrocodone and oxycodone included or all opioids?). Looking at how the testing policy is applied in the NFL, one discovers that testing for drugs of abuse only occurs Pre Season, Pre-Employment, during an Intervention Program or by Agreement. During the season, when narcotic analgesics would be expected to be used, the drugs are not typically included in the drug-testing parameters.

In the MLB, narcotic analgesics are covered under Drugs of Abuse in Major League Baseball’s Joint Drug Prevention and Treatment Program. The MLB language describing the compounds covered is broader and more inclusive than WADA’s or the NFL’s and includes: “Opiates (e.g., Oxycodone, Heroin, Codeine, and Morphine),” “…and their analogs,” and “any and all drugs or substances included on Schedules I and II of the Code of Federal Regulations’ Schedule of Controlled Substances.” However, the application of the testing in the MLB is more restrictive as testing is only done for drugs of abuse in the case of reasonable cause or if a player is in a treatment program. No other testing for drugs of abuse is allowed.

In college sport narcotic analgesics are covered still differently in the NCAA Drug Testing Program. The 2014-2015 NCAA Banned Drugs list includes one opiate, heroin, under Street Drugs. The entire list is governed by language stating, “any substance that is chemically related to the class, even if it is not listed as an example, is also banned!” In the case of narcotic analgesics it is unclear if this would be interpreted narrowly to include only drugs chemically related to heroin or whether it would be interpreted more broadly to include opiates or opioids. This language leaves it vague as to the analgesics that are or are not approved. Use of banned substances can be allowed by medical exception, but “no medical exception review is available for substances in the class street drugs.” As for application, testing for street drugs, and any narcotic analgesics interpreted to be included, can occur year round for selected athletes.

It is fascinating to review the treatment of narcotic analgesics and see the lack of consistency between sport drug-testing programs as to the substances that are banned and the application of the testing. This is an example of the challenges faced when considering what to ban and how.

Perhaps the realization that significant differences exist in the treatment of narcotics will prompt a larger review of other categories of banned substances and the differences that exist across sport in the management of performance-enhancing drugs in general. After more than three decades of modern drug testing, we should be able to achieve greater consistency and clarity in drug-testing policy and the protections afforded therein to the sports and the athletes represented.