Medication in Racing and Performance Horses
Medication issues in equine competitions might have reached their highest level of public focus in 2008 due to high-profile situations such as Kentucky Derby winner Big Brown's steroid regimen and the disqualification of several Olympic horses for prohibited medications. Despite a significant investment of time and money by various advisory and regulatory groups, medications clearly continue to be a thorny problem for many equine sports. During the 2008 American Association of Equine Practitioners (AAEP) convention, held Dec. 6-10 in San Diego, Calif., a two-hour panel discussion of medication in racing and performance horses sought to sort out some the issues for equine veterinarians.
The well-attended session began with presentations on the status of medication testing and regulation in the United States Thoroughbred racing industry and in U.S. Equestrian Federation (USEF)-sanctioned events, and it continued into a spirited discussion of medication regulations, enforcement, and ethics among the audience and the panel members, who included:
- Moderator Robert Lewis, DVM, AAEP's representative to the Racing Medication and Testing Consortium (RMTC);
- Scot Waterman, DVM, executive director of the RMTC;
- Rick Arthur, DVM, equine medical director of the California Horse Racing Board and secretary of the RMTC;
- Craig Dado, vice president of marketing at the Del Mar Thoroughbred Club (standing in for Alex Waldrop, president and CEO of the National Thoroughbred Racing Association);
- John Kimmel, VMD, a veterinarian and Thoroughbred trainer;
- Kevin Dunlavy, DVM, a veterinarian practicing on racetracks in Kentucky and Louisiana;
- Stephen Schumacher, DVM, chief administrator of the United States Equestrian Federation medication and testing program;
- Kent Allen, DVM, veterinary coordinator for the 2010 World Equestrian Games; and
- Rick Mitchell, DVM, team veterinarian for the U.S. Olympic team.
Racing Medication and Testing Consortium Work
Waterman kicked off the session by presenting a brief discussion of the history of the RMTC and its activities, along with its future goals. The RMTC had its beginnings in the AAEP's Racehorse Medication Summit in 2001, which intended to address whether uniform medication rules were achievable. "At that time there were some high-profile medication cases ongoing and groups putting forth national proposals for medication policies," he recalled. "AAEP recognized the potential damage to the sport from medication controversies and that their members would be in the crosshairs of such situations."
The nonprofit organization's mission is "to develop, promote, and coordinate, at the national level, policies, research, and educational programs that seek to ensure the fairness and integrity of racing and the health and welfare of racehorses and participants, and to protect the interests of the racing public."
The RMTC board of directors, composed of representatives of 24 organizations, "ensures that no single agenda can drive the adoption of a rule," noted Waterman. The organization's board has completed two phases of model medication rules and recommendations for uniform penalties for medication violations.
The original Model Rules were released in 2005; they prohibited some medication practices, included drug classifications and categories, and permitted some therapeutic medications (such as furosemide and phenylbutazone or Bute) with restrictions. "These rules have been adopted by 34 of the 38 (U.S.) racing jurisdictions to date, and it won't be long until all 38 do," said Waterman.
The Uniform Penalties recommendations, released in 2006, took nearly two years to complete. It resulted in a three-tiered system that significantly increased penalties for prohibited performance-enhancing drugs, reduced penalties for therapeutic medication mistakes, redefined trainer responsibilities for medications, and added penalties for other licensees (such as veterinarians, owners, and grooms). "The penalties have been adopted as rules or policy in 25 states," Waterman reported.
The second Model Rules (released in 2007) included regulation of anabolic steroids and blood doping agents (including testing outside competitions for the latter), and established threshold levels for FDA-permitted or endogenous anabolic steroids (those produced naturally by the horse). Currently, 35 of the 38 racing jurisdictions have adopted or are in the process of adopting this model rule.
The RMTC's current work includes identifying medications with legitimate therapeutic uses and researching the science on medication withdrawal times (how long it takes for a horse to reduce the levels of a drug in his body to legal levels), recommending research on those for which science doesn't provide solid answers, and helping fund research where possible. The group has also established an online withdrawal times database that currently includes regulations for 18 of the racing jurisdictions and withdrawal times for more than 70 medications. Practitioners can sign in to the database at www.rmtcnet.com.
Drug testing protocols and standardization are another key focus for the RMTC, which is pressing to standardize lab testing procedures according to World Anti-Doping Agency standards and establish programs to train laboratory managers. Currently, 18 different labs test racehorse samples in the United States, and they all do things differently, said Arthur.
"Uniformity in rules is useless if you don't have uniformity in labs," he added. "One lab is probably the most practical solution if we can fund it. Vets, trainers ... everyone benefits from a better lab system."
Lewis noted, "The phrase 'zero tolerance' crops up a lot, but zero tolerance will be one thing in one lab and another in another because labs have different detection abilities," said Lewis. "It sounds good, but it is technically nonsense."
"Over the last 20 years, I've seen an escalation of use/abuse of therapeutic drugs in racehorses," commented an attendee. "It's become a drug culture where many people think they can't race without drugs. If we don't address that issue--change the mindset of trainers and owners who think they have to have drugs to get a horse to the track, I don't know how much change we'll get no matter how much testing we do."
Racing Perceptions Survey
"This year's Triple Crown saw the perfect storm--a high-profile accident (Eight Belles) and Big Brown's steroid controversy resulting in outrage from humane societies and questions about the fragility of the Thoroughbred breed," began Dado. "Together all this led to unprecedented negative publicity for racing. We can't afford this, or the stereotypes of the racing audience as old men and sicko gamblers."
He presented some of the results from a large NTRA study on perceptions of racing among casual fans, core fans, and industry members. After conducting more than 1,800 interviews, the message was clear: All three groups were very, very upset with the current situation. "We're losing integrity by the day," Dado stated. "We have serious challenges on two fronts: Performance-enhancing drugs and the safety and welfare of the horses."
The interesting thing, he noted, is that the more people know about racing, the less they believe it to be a sport of integrity. When asked how serious the issue of performance-enhancing drugs is in horse racing, nearly one-quarter of casual fans rated it a 10 out of 10 (very serious). Nearly 42% of core fans rated it a 10, while more than half (52%) of industry stakeholders scored it a 10.
"For those of you in the audience who pride yourselves as being the first line of defense (for medications and racehorse welfare), this is a very serious wakeup call," he said. "People see you not as defenders of the horse, but as the status quo.
"We can't talk our way out of this," he continued. "We have zero credibility right now, and we have to change this. Unless meaningful, swift, decisive, transparent actions are implemented to bring in national uniform medication and safety standards, a significant portion of our 7.1 million core fans will abandon the sport, guaranteed. It's already happening. The industry must act to restore credibility. We must be bold, transparent, and authentic."
"I think it's important for us to recognize that casual fans don't differentiate between therapeutic and performance-enhancing drugs," commented Lewis. "It's a very real perception problem we have to deal with--we have to educate people on this."
Performance Horse Medications
The mission of the USEF drug/medication program is: "To ensure the welfare of equine athletes, maintain balance and fairness of competition, maintain the integrity of equestrian sport, educate members regarding responsible use of legitimate therapeutics, and provide deterrence for non-judicious use of medications," said Schumacher.
The USEF governs numerous equestrian breeds and disciplines, and its medication testing program includes testers showing up unannounced at competitions. One lab tests all USEF samples, unlike with racing; it's one of four Fèdèration Equestre Internationale (FEI) laboratories worldwide. Schumacher reported that out of 16,905 samples collected from 674 competitions in 2007, there were 133 positive test results (some medications were for emergency purposes; not all were violations).
Allen discussed the USEF Drugs and Medication rule, which classifies substances as permitted, restricted, or forbidden. Permitted substances (such as antimicrobials, ulcer medications, dewormers, etc.) are not regulated; restricted substances (such as non-steroidal anti-inflammatory drugs) can be used if specific dose and timing recommendations are followed; and forbidden substances are not allowed in horses that are competing.
"There are pretty lengthy withdrawal times for these," said Allen. These include many substances used daily in veterinary practices, such as tranquilizers and local anesthetics, as well as other substances such as stimulants, depressants, and psychotropic drugs.
Allen cautioned attendees about compounded medications, dosing strategies, and herbal products. "Compounded medications may or may not contain the exact amount of medication they say they do," he explained.
Regarding dosing strategies, he warned that adding medication to a horse's feed can play havoc with withdrawal times. "For example, if a horse is fed a medication with a meal, but doesn't clean up his feed until several hours later, that can certainly cause an issue. It's the owner's responsibility to be compliant. Or if a medication is given in a different manner than the withdrawal times specify (for example, if a medication listed with withdrawal times for intravenous use is given orally), you can see extremely prolonged detection times."
Herbal, natural, and holistic medications also should be handled with care, he advised. "You don't always know what's in there," he said. "The labels are often fascinating fiction. If it's supposed to calm the horse and it works, it's forbidden. That's against the spirit of the rule."
--Dr. Rick Mitchell
He also warned that the U.S. regulations on equine medications are much more permissive than those of other countries, so those competing abroad will need to be aware of the medication regulations in their country of destination in time to observe withdrawal times.
Ethics and Enforcement
"I feel there is a lot of pressure to win on practicing veterinarians, who are also supposed to act as gatekeepers for the welfare of the horse," said Mitchell. "We're faced with these situations every day. The only thing I can say to young vets is that having practiced in this world for 32 years, you have to take a stand on side of the horses' welfare."
One attendee said, "We can talk all day about testing, but who is accountable? If I don't (give a horse medication illegally), plenty of other vets will, and the clients will just go to the next guy. We need to police ourselves. What does it matter if I don't do it when many others will?"
"You have to make the stand," Allen answered. "And I make the stand, even if it costs us clients. Would we all love AAEP to stand up and regulate our morals and ethics? Sure, but they're an educational group, not a regulatory one."
Lewis noted that one way some vets are reducing medication usage is by visiting horses frequently and working hard to limit or prevent lameness very early so they don't have to keep treating it (nipping problems in the bud).
Enforcement of medication usage, aside from testing, is another issue. "We assume that in highly regulated environments, veterinarians have exclusive control of medications," said Lewis. "But there is lots of concern about trainers using medications and keeping it to themselves."
"Competitions are very similar to racing in that you can't control the stable area," added Allen. "People haul horses in and out, and there's no way to control what's done to them. What we can control is our lab and detection levels."
"There is certainly discussion about increasing backside security," said Lewis. "The problem comes in because it costs money to have security; like anything else, integrity costs money. Is it the racing commission's responsibility or the track's responsibility?"
One attendee noted that pharmaceutical companies know which veterinarians or clients might be ordering too many equine medications, just as they track abuse of human pharmaceutical prescriptions. "We can say we don't know who the abusers are, but really we do," she said amid applause.
Lastly, an Australian veterinarian had the following comments: "I'd like to say how far you've come in what you're recognizing as a problem. It is a problem for you (the U.S. equine competitive industry). It all runs around money. I think the changes you're making are very good thing, but regulations have to be severe and uniform. Most of our trainers train very well without medications; all they're asking for is a level playing field. They don't want people winning because they have the best vet, not the best horse."
"Racing and our profession are under a challenge right now," concluded Lewis. "For those of you who practice, particularly in racing, I hope you're aware this organization (AAEP) is actively trying to find solutions."
About the Author
Christy West has a BS in Equine Science from the University of Kentucky, and an MS in Agricultural Journalism from the University of Wisconsin-Madison.
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