A fair few riders have probably spent the holidays reading FEI human anti-doping rules, following news that US eventers Hannah Sue Burnett, Jennifer Brannigan and Alyssa Phillips tested positive to prohibited substances at the CIC3*Ocala-Reddick horse trials, Florida in November. This breaches the World Anti-Doping Agency Code for human athletes, to which the FEI adheres.
All three tested positive to the stimulant amphetamine. Alyssa also tested positive for canrenone and Jennifer to methylphenidate and its metabolite ritalinic acid.
One medical use of amphetamine is for narcolepsy and attention deficit hyperactivity disorder (ADHD), sold as Adderall. Methylphenidate also treats those conditions. Canrenone is a diuretic.
Of course, all meds have multiple uses other than the one primarily marketed. That is why, presumably, in a recent endurance horse doping case no one seemed surprised a corticosteroid was injected inarticulately (i.e. into a joint) even though the Flumetasone at issue was initially explained as a treatment for skin disorders.
The Ocala backlash is shocking on several levels. First, how did three experienced riders from a sophisticated equestrian nation get into this mess in the first place? It poses questions about all governing bodies’ awareness of rider health management, even if the Ocala cases do come down to misunderstandings about TUEs (Theraputic Use Exemptions) for legitimately prescribed meds, as is claimed by Jennifer and Alyssa. The chances of obtaining a retroactive TUE are zero, though, looking at past FEI Tribunal cases (see below). TUEs aren’t necessarily granted “on the nod” even to people who do apply on time.
USEF circulates anti-doping information annually when riders renew registrations. But how do USEF – or any other national federation – know that everyone reads it? USEF don’t give the impression of having their finger on the pulse in this case. In the face of mounting speculation, two weeks ago USEF announced that no one at Ocala tested positive to cocaine (so that’s alright, then…). At that point did USEF really have no inkling three riders were positive to a bunch of other stuff?
Second is the apparent naivety of fans and active competitors. Social media seems surprised that riders are dope-tested at all. Others didn’t realise competitors can’t take an over-the-counter flu remedy without triple-checking its ingredients and declaring to doping control at the competition (which isn’t the same as a TUE). There’s an incorrect presumption that if a drug is “legal” for a medical condition, de facto it can’t be on the FEI-WADA prohibited list.
Some of those rushing to the girls’ defence insist that “canrenone is only a diuretic.” Given the frequent headlines about doping in other sports, it is surprising so many still haven’t twigged why masking agents and diuretics are banned alongside the potions they flush from the system.
Some argue the other substances are routinely used for ADHD, so yes-that-must-be-the-explanation. It is quite a coincidence, though, that three riders randomly sampled at Ocala suffer from ADHD, when published research estimates ADHD affects only 2-5% of the adult population. Having said that, many (mostly using a pseudonym) horse people have now stated on social media that they have ADHD too.
Some armchair medics think eventers are more likely to succumb to ADHD in adulthood, given the adrenalin spikes of riding across country. Not unlike the notion that road pollution triggers asthma in cyclists and why, controversially, so many cyclists now have TUEs for triamcinolone, the fast-acting injectable steroid.
And third, the news is shocking for launching a breathtakingly candid alternative conversation: widespread use of Adderall as a party drug, crash-diet pill and study aid. Experts concur. Among others, last year Dr Marc J Romano, assistant medical director at Ocean Breeze Recovery in Pompano Beach, Florida told the media: “Adderall has become one of the mainstay drugs at many party events both on campus and off because it is cheap and easy to access. Adderall’s appeal is the surge in energy that results when taking this drug, along with a more subdued euphoric effect.”
We don’t, of course, yet know facts of the Ocala cases.
But in general terms, many equestrians must have lived a sheltered life if they think horse sport is uniquely free of recreational drugs. Five of the 13 human anti-doping cases heard by FEI Tribunal since 2007 involved cannabis or cocaine. (In two cases – see below – riders testified that the week before sampling was the first time they had ever smoked a joint – a very unfortunate coincidence…) And while the FEI hasn’t shouted this from the rooftops, last spring it mandated the FEI medical committee to examine recreational drug use by riders. FEI medical chief Dr Peter Whitehead flagged it as a health and safety concern during the General Assembly in Uruguay in November.
The eight other FEI cases since 2007 mostly involve riders who hadn’t thought about TUEs and hadn’t told their doctors they were sportsmen liable to dope-testing. Most had ridden at major championships and/or the Olympics; how do you progress to those heights without team management drilling you about meds?
Thirty thousand people are currently registered to compete in FEI. Only 78 riders worldwide were sampled in 2016 compared with 5,218 horses. Seven positives since 2007 were sampled at just three venues – in Canada, Brazil and Portugal. It must make folk complacent about the odds of being tested, and no wonder people entitled to TUEs don’t bother to apply. Only 36 TUEs were granted in 2015, 29 in 2016.
Read also Article 2.10 of the WADA code which since January 2015 prohibits “professional association” of active athletes with suspended “athlete support personnel.” That is open to interpretation but could well kibosh any rider who assumes he can still train and produce while grounded.
In every archived horse and human doping case, FEI Tribunal emphasises – to the point of sounding like a broken record – the “strict liability” of the athlete. You can’t blame your doctor, vet, a misleading label, Google, your first-grade teacher etc. ad infinitum, but many still try to pass the buck. I don’t think many riders preparing for a Tribunal hearing read-up about past cases, given the gauche defences so often proffered. In one case summarised below, the rider argued he could not be accused of failing to read the label, as the pill container didn’t have one. You couldn’t make it up.
The three American girls have a tough time ahead, but if good thing from this sad situation is a massive wake-up call to everyone else.
How other riders have fared at Tribunal
Exactly 10 years ago WADA adopted a more “proportionate” approach to punishments for doping violations.
The starting point for first offenders is two years suspension. Considerable reductions are offered, including waiving a suspension completely, if the rider admits the offence promptly; can show exactly how the substance entered their system; passes the no-fault/no negligence test (not easy); and/or convinces Tribunal it was not intended to be performance-enhancing. Here is a summary of all human athlete cases heard by FEI Tribunal since the end of 2007. Details here.
Mark Armstrong, GB. Positive to: Salbutamol – a Beta-2 Agonist, a specified/threshold substance. Penalty: Warning and reprimand, 1,000 (Swiss franc) CHF costs, disqualification of all results from the show. Sampled at: Braintree CSI-2*, November 2007. The former British jumping team member had asthma since childhood. A week before he got a chest infection and was prescribed antibiotics and salbutamol to stop it developing into pneumonia. No TUE was requested until January 2008. Dr Craig Ferrell, chair of the FEI Medical Committee, said a TUE would probably have been granted, if applied for on time, as the prescription was “appropriate, medically indicated and necessary.” Armstrong was disappointed that the British Equestrian Federation had not directed him “proactively” to apply for a TUE because BEF knew he used a Ventolin inhaler when he joined the GB high performance squad.
Daniel Pinto, Portugal. Positive to: Marijuana. Penalty: three months suspension, 1000 CHF fine, 1000 CHF costs, disqualification. Sampled at: Olympia CDI-W, December 2007. Pinto, an Olympian with a previously unblemished record, admitted smoking a joint at a social occasion in Seville, Spain 10 days earlier. He said it was an “isolated act” and swiftly admitted fault to set a “pedagogical” example to his students. Tribunal accepted his explanation for the positive test and that marijuana would not have enhanced performance. However, he was “grossly negligent” for competing after “knowingly consuming the prohibited substance for no therapeutic reason.”
Jose Henrique Fernandes Pereira, Portugal. Positive to: Cannabinoids. Penalty: three months suspension, 2000 CHF fine, 1500 CHF costs, disqualification. Sampled at: CDI Arruda dos Vinhos, Portugal, December 2009. The rider admitted smoking cannabis “in a friendship environment” at a birthday party 12 days earlier, not realising it was a FEI banned substance. It was “simple negligence” and cannabis is not performance-enhancing. It was the first and only time he had smoked cannabis. Friends testified their “surprise” at witnessing him doing so. Tribunal accepted he had not intended to enhance performance, but he was “grossly negligent” for competing after consuming cannabis “for no therapeutic reason.”
Josep Massana, Spain. Positive to: Cocaine and cannabinoids. Penalty: two years suspension, 1500 CHF fine, 2500 CHF costs, disqualification. Sampled at: CDI Arruda dos Vinhos, Portugal, December 2009. Throughout, Massana denied any consumption, and instead alleges that numerous procedural flaws in sampling and testing caused the adverse findings. However, Tribunal was satisfied all tests were valid. As the athlete “had not made any attempt” to establish how the substances entered his body and were not intended to be performance-enhancing, reduction in suspension was non-negotiable.
Daryl Billing, Canada. Positive to: Hydrochlorothiazide. Penalty: Reprimand, CHF 1500 fine, 1000 costs, disqualification. Sampled at: CAI-A Bromont, June 2010. The driver had taken prescribed med Novo-Hydrazide for hypertension for some years. He did not realise a TUE was required for hydrochlorothiazide as a prohibited diuretic. He applied retroactively in September 2010 and was denied, but a TUE was granted for future use along with two other medications. Tribunal accepted he was “new” to the driving world and had not intended to influence performance, but said he should have educated himself and consulted his doctor about the “risks.”
Angela Covert, Canada. Positive to: Methlhexaneamine. Penalty: Two years retrospective suspension imposed in 2013 by CAS who over-turned the FEI Tribunal’s original reprimand and 500 CHF fine. Sampled at: Spruce Meadows CSI-W, June 2011. The jumper broke her nose in a fall mid-June. The emergency doctor provided Euvanol spray to stop the bleeding. She was dope-tested 11 days later. Methlhexaneamine, a stimulant, was not listed on the spray but is a component of geranium oil, which was listed. Covert’s expert Dr Edward Sellers said Euvanol accounted for the positive test, and could not have enhanced performance because of the small amount used. FEI Tribunal accepted that explanation but found Covert negligent for failing to research Euvanol or read WADA’s explanatory notes. WADA appealed to the CAS demanding a suspension of two to four years, asserting the substance was of synthetic origin, i.e. not geranium oil. Covert’s sample had been erroneously destroyed by the time the CAS process was underway in spring 2013, which Covert argued prejudiced her right to a fair hearing. Lengthy debate and tests ensued about geranium oil. Covert later said a multi-vitamin might be the source, while further experts offered pharmacokinetic explanations. CAS partially upheld WADA’s appeal and in June 2013 imposed a two-year suspension, backdated to June 2011, annulling all her competition results in that time-frame.
Jonathon Millar, Canada. Positive to: Prasterone (Dehydroepiandrosterone – DHEA). Penalty: two years suspension, 2000 CHF fine, 4000 CHF costs, disqualification, all amended on appeal to CAS. Sampled at: Spruce Meadows CSI-W, June 2011. DHEA is an anabolic androgenic steroid, prohibited in and out of competition. After a spell of exhaustion and depression resulting from his mother’s terminal cancer, in October 2008 the jumping rider was diagnosed with DHEA deficiency and prescribed DHEA drops. He applied for a TUE, though in May 2009 it was denied. He temporarily stopped taking DHEA while re-submitting the application. In December 2009 TUE was again denied, but Millar claimed he never received that notification from Equine Canada, nor a reminder to re-submit sent August 2010. He took DHEA “on and off” and tested negative in July 2010. Protracted Tribunal proceedings included multiple physician assessments. The FEI blamed Millar for procedural delays by repeatedly requesting a stay. Millar later admitted acquiring non-prescription DHEA in the US, and calling it “multi-vitamin” on the FEI doping control form. Tribunal admonished him for taking DHEA with the TUE denied. He was suspended for two years, through August 23, 2013. Millar admitted the offence promptly and so felt eligible for a reduction. He appealed to CAS, though by the time CAS partially upheld his appeal and backdated the suspension, it had just a short time to run. CAS also halved the FEI fine and waived contribution to costs.
Aleksandr Kovshov, Ukraine. Positive to: 11-nor-delta-9-tetrahydrolcannabinol -9- carboxllcacid (Carboxy-THC). Penalty: two years suspension, 1000 CHF fine, 500 CHF costs, disqualification. Sampled at: Zhashkiv CDI-W (UKR), February 2012. Kovshov said he visited a billiard hall the night before and tried a hookah made of a “fruit mixture.” As he failed to show how the hookah was to blame for the cannabinoid or not intended to enhance performance, Tribunal refused any reduction in suspension. Kovshov was “highly negligent” when he “cannot possibly have known what was in it.”
Ali Nilforushan, US. Positive to: Phentermine, Hydrochlorothiazide, Carboxy-THC. Penalty: 12 months suspension, 1000 CHF fine, 2000 CHF costs, disqualification. Sampled at: CSI2*-W, Thermal, California, March 2012. Phentermine is a stimulant, hydrochlorothiazide is in the diuretics/masking list. The Iranian jumper moved to the US aged seven. He competed at the Sydney 2000 Olympics. He gained a lot of weight due to business worries and so his doctor at the Viva Wellness Center, San Diego prescribed two prescriptions as a diet aid, in unmarked containers. Nilforushan argued he could not be accused of not reading the contents label if no label existed. He had never received any education about doping control from his very small Iranian federation, and thought only horses were tested. Cannabis is legal in California for medical purposes and also prescribed by his physician, so he shouldn’t have needed a TUE. He declared no meds to doping control. Dr Peter Whitehead, representing the FEI medical committee, said that while phentermine and hydrochlorothiazide were common in diet pills, weight reduction could be described as performance-enhancing. The rider was admonished for not telling his doctor he was an Olympic sportsman subject to dope-testing, and for failing to undertake detailed research. However, although multiple substances were involved, he was credited for promptly admitting the offence.
Fabricio Caldas Albuquerque, Brazil. Positive to: Isometheptene and metabolites. Sampled at: CIC3* Colina SP, Brazil, April 2012. Penalty: three months suspension, 1000 CHF fine, disqualification. Albuquerque was one of three event riders testing positive to the same substances at Colina; the cases were heard together. Isometheptene, a stimulant, is an ingredient of Neosaldina, a popular over-the-counter analgesic in Brazil. Albuquerque suffered from chronic sinusitis and rhinitis since childhood. He felt ill and his doctor prescribed vitamin C and Neosaldina. He declared it to FEI doping control. The FEI’s Dr Whitehead accepted this was plausible, but said stimulants could combat fatigue, giving an advantage, or a false sense of wellbeing that might diminish the rider’s reflexes. A TUE would likely be rejected as other permissible migraine treatments are available. Albuquerque, a soldier, said that in 13 years as an amateur international rider he received no anti-doping advice. He never told his army doctor he was liable for dope-testing.
Eder Gustavo Baldin Pagoto, Brazil. Positive to: Isometheptene and metabolites. Sampled at: CIC2* Colina SP, Brazil, April 2012. Penalty: six months suspension, 1500 CHF fine, disqualification. The rider took prescribed Neosaldina to relieve migraines the day before. He declared it to doping control. He only had a copy of the 2002 prohibited list and did not know Neosaldina was added in 2006. He did a “simple internet search” only after being notified of the positive, which Tribunal regarded as “serious” negligence. He never told his doctor he was a sportsman. Dr Whitehead made the same clinical observations as above. Tribunal felt that as Pagoto had competed at Sydney 2000 Olympics and was a named substitute for London 2012, he should know the rules. Tribunal did, though, reject the FEI’s contention that if Pagoto couldn’t ride with a migraine, in relieving migraine Neosaldina was performance-enhancing.
Elson Marcelo Baldin Pagoto, Brazil. Positive to: Isometheptene and metabolites. Sampled at: CIC3* Colina SP, Brazil, April 2012. Penalty: nine months suspension, 2000 CHF fine, disqualification. Elson Pagoto initially said he accepted a single Neosaldina migraine tablet from his brother Eder (see above). It was not intended to enhance performance as he had already qualified for London 2012 and was competing just to “maintain a good rhythm for his horse.” Any stimulant-induced behavioural change by the rider could be fatal, Pagoto said. He declared Neosaldina to doping control and thought it was the trade name for dypirone, which isn’t prohibited. Dr Whitehead repeated his clinical observations. Elson Pagoto later admitted he was not a migraine sufferer and had only a “light headache.” Tribunal said he was “highly negligent” for “blindly” taking something prescribed to someone else.
Pablo Barrios, Venezuela. Positive to: Hydrochlorothiazide. Penalty: Reprimand, 1500 CHF fine, disqualification; plus one and a half month suspension from Central American and Caribbean Sports Organization (ODECABE). Sampled at: Central American and Caribbean Games, Veracruz, November 2014. Hydrochlorothiazide is a diuretic/masking agent. Barrios, a veteran jumper, declared Advil and Clonazepah only to doping control. But he was also prescribed Lisinprol for hypertension and had no TUE; it contains hydrochlorothiazide. Initially ODECABE handled the disciplinaries and disqualified and suspended Barrios, dropping the Venezuelan team from first place to third. In February 2015, Barrios’s request for a retroactive TUE was denied, though granted for future use. Barrios had consulted anti-doping databanks and did not realised the “HCTZ” mentioned in Lisinoprol’s ingredients was an acronym for hydrochlorothiazide. Tribunal said he was wrong to blame his doctor, who was not a sports specialist. Barrios was negligent in relying on website GlobalDro for information instead of consulting the FEI or WADA direct.