Maria Sharapova and Meldonium – Consideration of a Positive Drug Test

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

Amazon.com: An unfettered marketplace for banned and illegal drugs masquerading as dietary supplements

Banned and illegal drugs, by definition, should be hard to get, shouldn’t they? Unfortunately, the reality is quite the opposite; just explore Amazon.com, one of the largest marketplaces for banned or illegal drugs masquerading as dietary supplements.

Need steroids?  There are plenty of options.  New stimulant compounds that the FDA and other international authorities consider illegal and have proven harmful; no problem those are in stock.  What about new drugs that have yet to be approved for human consumption?  Sure you can get those too.  We explore a few startling examples of the illegal and potentially dangerous compounds available today at Amazon.com.

Steroids have been a concern for consumers and athletes for decades.  Pharmaceutical steroid development reached a pinnacle in the 1960’s with a handful of steroids like stanozolol and nandrolone approved for human use, after being evaluated for safety and toxicity. 

Since then a proliferation of prohormones, designer steroids or steroids in disguise, appeared in the dietary supplement marketplace and in positive drug test results in sport.  Unlike approved steroids, the safety, toxicity and approved dose of such compounds are unknown, and some, particularly 17-alpha-methylated steroids like Superdrol, have proven to be toxic and dangerous.  The drug caused liver failure and a positive drug test for an NCAA athlete Jareem Gunter in 2005.

With the BALCO scandal in 2003, that unearthed the doping escapades of Marion Jones, Tim Montgomery and Barry Bonds, came attention.  Steroids like ‘THG’ and ‘Madol’ were at its heart.  President George W. Bush focused on steroids in his 2004 State of the Union Address.  Later that year, Bush signed the Anabolic Steroid Control Act of 2004, which was enhanced with the passing of the Anabolic Steroid Control Act of 2012.

The FDA took prominent action in a highly publicized raid of Bodybuilding.com in November 2009.  In one of the largest regulatory actions to date, the FDA found 65 illegal steroid products for sale that contained five steroid compounds, “Superdrol,” “Madol,” “Tren,” “Androstenedione,” and/or “Turinabol.”  In 2012, as a result of this case, a fine of $7 million dollars was levied against Bodybuilding.com.

Unfortunately, Amazon did not heed the president’s 2004 State-of-the-Union message, nor the legal regulations in the Anabolic Steroid Control Acts, nor the prominent FDA enforcement action against Bodybuilding.com.

Amazingly, in January 2011 we noted in a blog post that products the FDA had raided Bodybuilding.com for in 2009 were still available at Amazon.com, namely CEL M-Drol, which contained ‘Superdrol’ (Superdrol, also known as methasterone, has the scientific name 2α, 17α-dimethyl-5α-androstane-3-one-17β-ol).  The Washington Post reported the story on January 19, 2011, numerous other news outlets followed with their own coverage.  We at The Catlin Consortium had hoped that by publicizing the issue Amazon would be put on notice allowing the company to address the issue responsibly.

That has not happened.  Instead, CEL M-Drol remained available at Amazon.com on September 10, 2013.  It has since mysteriously disappeared from the site after we
included the link in a supplement industry presentation in late September.  ‘Superdrol’, however, continues to appear in another product called M-Stane, which lists the compound on the label under the name 2a-17a-dimethyl-5a-androst-3-one-17b-ol.

M-Stane is only the tip of the iceberg.  As of October 20, Amazon.com still had two products available that were named on the FDA raid list in 2009; Kilo Sports Trenadrol and Purus Labs Nasty Mass.   A search for ‘prohormones’ on Amazon.com returned 125 products on October 20.  Many likely contain steroids or related substances. 

But the concern doesn’t stop with steroids.  Dangerous new stimulants like methlyhexaneamine and methamphetamine analogs, appearing as pre-workout supplements, remain available at Amazon.com.  Of particular concern is the original version of Jack3D from USP Labs and Craze from Driven Sports.

Jack3D grew to be one of the most popular pre-workout supplements on the market over the last several years.  The original version contained the now infamous stimulant methylhexaneamine, otherwise known in the industry as DMAA, geranamine, geranium oil extract and other names.  Patrick Arnold, the BALCO chemist, filed a patent for the compound under the name geranamine and included it in his own pre-workout product.

The drug has become a huge concern for athletes.  Astonishingly, more than 758 positive drug tests for methylhexaneamine have been reported by World-Anti-Doping Agency (WADA) labs since 2008, when the first positive was called.  The drug was not banned in 2008.  It was added to the WADA Prohibited List in 2009.  In 2012 alone there were 320 positive test results representing 7.1% of the 4,500 total WADA findings that year, placing behind only testosterone (T/E, 1,202 findings) and marijuana (398 findings). 

Some manufacturers defended methylhexaneamine, claiming it was geranium oil extract and thus of natural origin and present in the food supply prior to 1994, which would make it legal according to the definition of an ingredient in the Dietary Supplement Health and Education Act of 1994.  However, the natural origin of the DMAA used in supplements proved unfounded and the FDA has challenged its legality and safety for several years and considers the synthetic compound to be an illegal ingredient. 

Of primary concern is the potential for the compound to cause serious harm, and even death.  Sadly, Jack3D was implicated in the death of Claire Squires, a runner in the 2012 London marathon.

USP Labs has since reformulated the product and removed DMAA  as have other manufacturers.  Despite the significant attention and health risks, the original version of Jack3D continues to be available at Amazon.com.  The reformulated Advanced Formula Jack3D is also available, marketed differently, suggesting that the distinction between the two products is known.  Neither includes ingredient information on the site.

Craze is one of the second generation pre-workout products that began to proliferate when methylhexaneamine was addressed by authorities.  It was Bodybuilding.com’s New Supplement of the Year in 2012.  The Craze label says it contains Dendrobex™, a trademarked extract of dendrobium, an orchid.  The label suggests that several suspicious compounds are components of Dendrobex™: N,N-Diethyl-B-Phenylethylamine and N,N-Dimethyl-B-Phenylethylamine, a CAS registered compound that is .004 mass units away from methamphetamine.  Eventually, the compound present in Craze was shown to be a methamphetamine analog, N,α-diethylphenylethylamine, with no known natural presence.

USA Today, in its exhaustive reporting on Craze and its manufacturer Driven Sports, elicited a significant response from retailers in the dietary supplement industry.  Giants like Wal-Mart, eBay, and Bodybuilding.com have recently pulled the product, but not Amazon.com. As of October 20, Craze remained available from 8 Amazon sellers.

We conclude with perhaps the most amazing example of all, involving a new category of developing drugs called Selective Androgen Receptor Modulators, or SARMs for short.  SARMs are drugs that act like steroids by activating androgen receptors in the body.  SARMs are a relatively new category of drugs and thus many compounds are still in development and clinical trials where toxicity and safety are being evaluated.  One such drug is Ostarine, being developed for muscle wasting disease associated with cancer by a company called GT-X, under the name Enobosarm, GTx-024 and MK-2866. 

No need to wait for approval, it appears Ostarine is already for sale in dietary supplements at Amazon.com, IronMagLabs OstaRx and Cutting Edge Labs OstaMax are names that suggest the new SARM is an ingredient.  The label for OstaMax, included on Amazon.com, is astounding, stating, “FOR RESEARCH PURPOSES ONLY, NOT FOR HUMAN CONSUMPTION”, and yet there is a serving suggestion of one capsule daily!  The scientific name of Ostarine is on the label as is the MK-2866 naming convention used by GT-X.  Positive drug tests have already been seen with a female cyclist testing positive for Ostarine in June, and WADA reporting five SARMs as a whole in 2012.

The Amazon mission statement is “to be Earth’s most customer-centric company, where customers can find and discover anything they might want to buy online.”  Steroids, stimulants, drugs not approved for human consumption, and other potentially dangerous drugs, we hope, were not the intended aim of that mission.  Providing a marketplace for illegal compounds masquerading as dietary supplements in the face of international attention, consumer health concerns, and serious adverse events seems contrary to the customer-centric focus.  At the very least it is dangerous and irresponsible.

Global marketplaces like Amazon.com help set preferences across a variety of products, including dietary supplements.  We hope that Amazon becomes a real part of the solution by making the choice to eliminate these dangerous products instead of continuing to perpetuate their distribution.

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Amazon sellers trafficking steroids, some classified as Schedule III Controlled Substances

With the attention paid to anabolic steroids and the threat they pose to sport and public health, it is amazing to discover that such products are for sale today at Amazon.com.  We focus here on Amazon.com and on methasterone and madol, two drugs that appear in two products for sale there, but it is important to realize this marketplace is only the tip of the iceberg.  Although some suggest that we should continue to allow free access to these products, our contention is that products like these that can cause liver failure and other significant harm should not be a mouseclick away from unsuspecting consumers, especially our youth where the harm can be greatly magnified.

The first drug is methasterone, otherwise known as methyldrostanolone, which became known under the name Superdrol in late 2005. Don helped expose it as a new designer steroid in an article by Amy Shipley published by the Washington Post Nov. 2005. Methasterone has been connected to cases of liver failure in several publications.  The chat rooms on the topic provide the user accounts and hammer home the issue; check out this graphic example, if you want.  The FDA issued a warning and took action against marketers of the product in March 2006.  The World Anti-Doping Agency added the compound to the Prohibited List for 2006.

Despite inclusion on the FDA and WADA lists, the DEA does not yet have methasterone on its list of Controlled Substances as of Sept. 15. M-Drol caught the eye of the FDA in late 2009 when the product was included on a list of 65 steroid products that Bodybuilding.com was distributing.  The FDA took action against some of the products and against Bodybuilding.com resulting in voluntary recall of the products from the site.  Nonetheless, methasterone appears to be widely available in the marketplace today in many forms including Competitive Edge Labs M-Drol.

This dangerous non-FDA approved drug can still be purchased from many mainstream retailers including through 7 Amazon Sellers at Amazon.com, as of Jan. 17.  Included in the marketing heading for the product is, “M-Drol-Anabolic Muscle Building Formula, 90ct (Compare To Superdrol).”  We decided to go ahead and do the comparison.

Competitive Edge Labs M-Drol was purchased through Amazon.com on Nov. 15 in an order fulfilled by Amazon Seller Surplus-Supplements.  We analyzed it in our ISO 17025-accredited lab and compared it to a reference standard of methasterone, or Superdrol, and in fact M-Drol does still contain methasterone.  The sale of methasterone or a drug like it would likely qualify as sale of an unapproved new drug, according to the FDA’s recent letter to industry from Dec. 15: “These products are illegal because they are unapproved new drugs under 21 U.S.C. §§ 321(p) and 355(a) and/or adulterated dietary supplements under 21 U.S.C. § 342.”

There is more clarity in the case of the second product, Competitive Edge Labs P-Plex, which contains the anabolic steroid Madol.   Madol is classified as a schedule III controlled substance by the DEA under the name desoxymethyltestosterone (no other names listed).

Madol was the second of two designer steroids discovered during the BALCO doping scandal in 2003. During the federal BALCO investigation, vials of the seized drugs were analyzed and characterized by Don and his team, then at the UCLA Olympic Analytical Laboratory.  The drug that received the most notoriety was THG, short for tetrahydrogestrinone, a modified version of the already prohibited anabolic steroid gestrinone.  Madol was characterized later in 2004 and received much less publicity.  Madol was added to the Controlled Substance list Jan. 4. 2010 after a nearly two year process.

Madol has a proper scientific name of 17α-methyl-5α-androst-2-en-17β-ol.  The compound can be found under the following names; Madol, DMT, desoxymethyltestosterone, 17a-methyl-5a-androst-2-ene-17b-ol, 17a-methyl-etioallocholan-2-ene-17b-ol and other variations.

Despite its involvement in a high-profile case such as the BALCO investigation and inclusion on the controlled substance list, Madol appears in the dietary supplement marketplace in many forms.  It became popular under the name Phera-Plex and continues to be marketed in many products today.  Numerous options can be easily purchased on the Internet, including through Amazon.com.

Today at Amazon.com you will find Competitive Edge Labs P-Plex.  P-Plex was also included in the FDA action against Bodybuilding.com, yet it remains in stock and available through two Amazon Sellers as of Jan. 17. The marketing headline for P-Plex on Amazon.com reads, “P-Plex-Anabolic Muscle Building Formula 10mg, 90ct (Compare To Phera-Plex).”  We purchased the product on Jan. 6 through Amazon.com in an order fulfilled by Amazon Seller MMMPower and have identified Madol in the product.

The FDA considers this a serious matter and in a powerful letter to industry on December 15, 2010 wrote, “Responsible individuals and companies should be aware that the government may initiate criminal investigations to hold accountable those who violate the Federal Food, Drug, and Cosmetic Act (the Act) and endanger the public health. Responsible individuals, even if the individual did not participate in, encourage, or have personal knowledge of the violation, can be criminally prosecuted under the Act, pursuant to 21 U.S.C. § 331. See United States v. Park, 421 U.S. 658 (1975). When the evidence warrants, felony charges may be appropriate.”

Knowingly or not, Amazon does appear to be providing a marketplace for selling steroids, some classified as controlled substances.  Amazon was willing to withdraw the pedophile’s guide in three weeks, as we pointed out in our blog post Nov. 12.  Hopefully, Amazon will hear the FDA on this matter and also voluntarily withdraw these steroid products from their website, sooner rather than later.  We stand ready to help Amazon or other retailers in maintaining a safe marketplace for dietary supplements in the future.  ##

More methylhexaneamine positives. Why was the compound’s presence not addressed earlier?

Methlyhexaneamine

Sadly, the rash of positive drug tests related to methylhexaneamine continues.  Yesterday, it was reported by Velonation.com that the cyclist brothers Rui and Mario Costa both tested positive for methylhexaneamine in the past year.  This is merely the latest example of a string of high-profile positive drug tests related to methylhexaneamine that have surfaced in the last two years.

Our previous blog post (of Sept. 10) explains how the many synonyms and brand names that surround methylhexaneamine create confusion and can result in inadvertent use of the drug.  We also briefly looked into the interesting history of the compound.  We posed the question, ‘why is this drug banned in sport yet legal in dietary supplements’, and that question remains.

What we did not examine is why it took so long to address this compound, as it was exposed as a potential problem in the Washington Post on May 8, 2006.   Patrick Arnold, the chemist mastermind behind the infamous BALCO steroid scandal, was awaiting his sentencing at the time.  Meanwhile, his company was marketing methylhexaneamine under the trademarked name Geranamine.  The father of designer steroids, as many consider Arnold to be, had shifted his focus to methylhexaneamine.  The writing was on the walls, or at least in the Washington Post, that this substance would become a problem in sport.

Methlyhexaneamine was added to the World-Anti-Doping Agency Prohibited List for 2010.  In the U.S. supplement industry, the argument continues as to whether or not the compound should be allowed as an ingredient.  For now, it continues to be legal to make supplements that contain the compound.

Methylhexaneamine, the recent positives, and the larger issues

Methlyhexaneamine is back in the news again, this time after 14 Indian athletes tested positive for it. This is not the first time this substance has caused a problem with positive drug tests.

Methylhexaneamine is a weak stimulant that was added to the WADA list of banned substances in 2010. It is very similar to the banned substance tuaminoheptane, which was added to the WADA list of banned substances in 2008. In 2009, five Jamaican athletes returned positive drug test results after using methyhexaneamine. Although methylhexaneamine was not banned at the time, sanctions were pursued based on the rarely invoked “and related substances” clause in the WADA rules. Methylhexaneamine is chemically similar to tuaminoheptane. It was added to the WADA banned list largely in response to this situation.

Methylhexaneamine has an interesting history. It was first trademarked under the name “Forthane’ by Eli Lilly in 1971 as a nasal decongestant. That trademark has since expired. Patrick Arnold of BALCO fame and the creator of THG and other designer steroids, was part owner of Proviant Technologies until recently. Proviant Technologies currently holds a patent on Geranamine, a synonym for methylhexaneamine. You can also find it under the synonyms Forthan, Forthane, Floradrene jack3d, DMAA, shizandol A, 1-3 dimethylamine and Geranamine. It is often used as a “party pill” in New Zealand. It is included in many dietary supplements around the world using synonyms that may not be recognizable as banned substances. Methylhexaneamine has been shown to be naturally present in geranium oil at amounts less than 1%. This natural presence is why it is argued that the drug should be allowed to be used in dietary supplements. Given all the confusion it is certainly plausible that the Indian athletes were unaware that they were taking a banned substance.

The larger issues here are why is methylhexaneamine banned in sport and still legal in dietary supplements. If it is a stimulant then it should be banned in sport but should it not also be considered a controlled substance and thus not be allowed as an ingredient in dietary supplements? If the reason it is allowed to be in dietary supplement is that the drug is present naturally in geranium oil in small amounts, then why is androstenedione not legal? Androstenedione too can be derived from plants. Anyone who takes dietary supplements, vitamins, minerals or anything in this category should be vitally interested in the question, what is actually in my dietary supplements?