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Drug Control in Horse
Racing

1. Definitions

Definitions

Definitions

Definitions

Definitions

Definitions

Definitions

Definitions

Hay, Oats and Water

2. Testing/Screening
Methods

Post-race testing today…

Thin-Layer Chromatography

ELISA

Mass Spectral Methods

Laboratory screening
methods

Therapeutic
Medication

Drug X

Challenges posed by
increased testing sensitivity

3. U.S. Regulatory
Framework

U.S. Regulatory Framework

U.S. Regulatory Framework

U.S. Regulatory
Framework—What actually happens

U.S. Regulatory
Framework—What actually happens

U.S. Regulatory
Framework—Challenges

4. Therapeutic Drugs and
the Model Rules

RMTC/RCI Model Rules

RMTC/RCI Model Rules

RMTC/RCI Model Rules

Salix/NSAID Adoption
Progress

RMTC/RCI Model Rules

Anabolic steroids

Anabolic steroids

AAS Adoption Progress

Other Therapeutic Drugs

Slide 35

RMTC/RCI Model Rules

Challenges

Challenges

Challenges

INSIGHTS INTO
BACKSTRETCH  VETERINARY PRACTICES &
PROCEDURES

Practicing Veterinarians

Therapeutic medications

Normal
Therapeutics

Anesthetics/Tranquilizers

Normal
Therapeutics

Local Anesthetics

Normal
Therapeutics

Respiratory Agents

Normal
Therapeutics

Respiratory Agents

Normal
Therapeutics

Corticosteroids

Normal
Therapeutics

NSAIDS

Normal
Therapeutics

Muscle Relaxers

Normal
Therapeutics

Ulcer Medications

Normal
Therapeutics

Anabolic Steroids

Normal
Therapeutics

Joint Health

Normal
Therapeutics

Vitamins/ Minerals

Normal
Therapeutics

Antibiotics/Vaccines

Not Normal
OR

Non-Therapeutic

Not Normal
OR

Non-Therapeutic

Not Normal
OR

Non-Therapeutic

Not Normal
OR

Non-Therapeutic

Not Normal
OR

Non-Therapeutic

Not Normal
OR

Non-Therapeutic

Not Normal
OR

Non-Therapeutic

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Slide 66

Drug Control in Horse

Racing

Scot
Waterman, DVM

Executive Director

Racing
Medication & Testing Consortium

End of slide show, click to exit.

Drug Control in Horse
Racing

Scot Waterman, DVM

Executive Director

Racing Medication & Testing
Consortium

1. Definitions

Definitions

Screening test- rapid and
sensitive, specificity not crucial. A sample with a positive screening test
would be said to be “suspicious”

Confirmation test- sensitive
and specific, if the result is positive the presence of a forbidden substance
is said to be  confirmed.

Definitions

Concentration

The amount of a substance
dissolved in a specific amount of fluid. Concentrations of importance in US
racing chemistry generally expressed on a per milliliter basis

micrograms/ml, mcg/ml = part
per million

nanograms/ml, ng/ml = part per
billion

picograms/ml, pg/ml = part per
trillion

Definitions

Limit of Detection--the lowest
concentration of a drug that can be detected by a particular laboratory
method

Limit of Quantitation--the
lowest concentration of a drug that can be reliably quantified by a
particular laboratory method

Definitions

Regulatory Limit

When a drug and/or its
metabolites are found in the urine or blood at a concentration that is at or
below the regulatory limit, no administrative action is taken.

Also called a “threshold” or
“decision level”

Can be a LOD, LOQ, arbitrary,
based on research results

Definitions

Withdrawal Time – the time
period that must elapse from the time of administration of the last dose of a
drug formulation until the drug concentration decreases below some
concentration.

That concentration may be the
LOD, the LOQ, or some predetermined concentration.

Factors affecting withdrawal
time include dose, route of administration, formulation, number of doses
administered, accuracy and precision of the assay, and within-horse and
between-horse variability among other factors

Definitions

Zero Tolerance—somewhat of a
myth since no testing methodology can detect down to a concentration of zero.

Usually used to mean that the
laboratory calls positive any concentration of drug that is detected

Entirely dependent on the
method being used though

Definitions

Hay, oats and water—there is
really no definition since the phrase means different things to different
people.

No drug administration on
raceday?

No detectable concentrations of
drugs on raceday? Since we can’t detect down to zero whose definition of
“detectable” is used

No drugs ever?

Hay, Oats and Water

Keene Dangerfield, The
Blood-Horse, 1979:

“One things I will say is that
people who are talking about going back to racing on hay, oats and water
don’t know what they are talking about. We’ve never raced on hay, oats and
water…Today we simply are able to find out what they are medicating them
with.”

2. Testing/Screening
Methods

Post-race testing today…

Screen urine samples using  thin layer chromatography (TLC), enzyme
linked immunosorbent assays (ELISA) or mass spectral techniques (GC/MS,
LC/MS)

Blood samples- used to quantify
the amount of a permitted medication/substance.

NSAIDs- phenylbutazone,
flunixin, ketoprofen

Furosemide- (Lasix)

Confirm suspicious findings
with mass spectral techniques—GC/MS or LC/MS

Thin-Layer Chromatography

1970’s technology

Looks for a wide array of drugs
in a single run

Labor intensive

Limited sensitivity and
specificity

ELISA

1990’s technology

Highly specific and very
sensitive

Automatable

Relatively inexpensive

Mass Spectral Methods

2000’s technology

Creates a molecular fingerprint

Machinery alone in the mid six
figures

Extremely sensitive and
specific

Laboratory screening
methods

Thin Layer Chromatography

LOD…100 nanograms/ml

Are you missing drugs due to
the lack of sensitivity?

ELISA

LOD…1 nanogram/ml

Are you using enough of them?

Mass Spectral Methods

LOD…low picogram/ml

Can all laboratories afford?

Therapeutic
Medication

Drug X

Challenges posed by
increased testing sensitivity

Increases in sensitivity
creates a dilemma for therapeutic drugs…how long do we want or need to
detect?

At what point does the
increasing sensitivity adversely affect the veterinarian’s ability to care
for the animal?

How do we create a system that
does not “trap” honest horsemen but still preserves the integrity of the
race?

3. U.S. Regulatory
Framework

U.S. Regulatory Framework

State statute enables a state
agency to govern pari-mutuel wagering

Commission has power to write,
enforce and adjudicate rules…executive, quasi-judicial, quasi-legislative

Commissioners are usually
political appointees

Reason…the industry asked for
it to get rid of bookmaking operations, state wanted to control since
gambling is a vice

U.S. Regulatory Framework

Makeup of commission varies
state-by-state

Some states do not allow those
involved in the industry day-to-day to serve as commissioners

Number of commissioners (as low
as 1, as high as 13)

Funding for operations varies
state-by-state

Majority of states funded
through general funds but some based on revenue sources from handle

Rulemaking process varies
state-by-state

NJ, NY, CA from start to finish
process can take one year. Some states also have regulations encoded in
statute.

U.S. Regulatory
Framework—What actually happens

Early 1970’s—The Rise of
Permitted Medication (furosemide, phenylbutazone)

1980—The Corrupt Horse Racing
Practices Act introduced in Congress

24-hour prohibition on
medication

Pre-race testing

Racing regulation under the DEA

Harsh penalties including
prison

U.S. Regulatory
Framework—What actually happens

1981 NASRC bans Lasix and
Bute—only WV, KY and DE continue to allow

Mid 1980’s—Lasix begins to
reemerge due to horsemen/veterinarian pressure

1985—only 3 jurisdictions
continue to ban Lasix…AZ, AR, NY

1995—the last holdout (NY)
allows Lasix

U.S. Regulatory
Framework—Challenges

Commission only
quasi-legislative

Generally some state
legislature oversight which creates another potential hurdle for model rules

Commission only quasi-judicial

Violations appealed to state
court which historically have reduced significant penalties

Funding, funding, funding

Horsemen/practicing
veterinarians have too much influence

4. Therapeutic Drugs and
the Model Rules

RMTC/RCI Model Rules

Furosemide

Only raceday medication allowed
under model rules

Administration is voluntary,
horse does not need to be proven a bleeder

Only medication with scientific
support in ability to manage EIPH but has performance enhancing capabilities
beyond ability to control bleeding

90+% of horses suffer from some
degree of EIPH, estimated that industry cost of EIPH approaches $100 million
dollars

RMTC/RCI Model Rules

Lasix Perceptions

We are breeding generations of
bleeders

Lasix masks the presence of
other drugs

Lasix is somehow linked to
soundness issues

RMTC/RCI Model Rules

Non-Steroidal Anti-Inflammatory
Drugs

One of three (phenylbutazone,
flunixin, ketoprofen) can be administered 24 hours out

Must be administered with a
single IV injection

Threshold concentration used to
enforce

Studies indicate analgesic
effect is gone by 12 hours after IV injection

Salix/NSAID Adoption
Progress

RMTC/RCI Model Rules

Androgenic Anabolic Steroids

Model rule sets thresholds for
4 anabolic steroids and prohibits presence of any others

Adopted the international
thresholds for endogenous anabolic steroids

Thresholds for stanozolol and
nandrolone based on the LOD using GC/MS in urine

“Regulate” vs. “Ban” is a
political distinction and not a scientific or regulatory distinction

Anabolic steroids

Why now?

Several surveys showed
extremely high levels of use

Perception and level of public
consciousness of anabolic steroids

Federal scrutiny of major
league sports

“Shot across the bow” in the
federal jockey insurance bill

Harmonizes the US
internationally

Anabolic steroids

Significant interest at the
federal level on this issue

Reps from RMTC, RCI, NTRA met
with congressional staffers in Jan 08

Alex Waldrop testified in
February in front of House Energy and Commerce Sub-committee

Interstate Horseracing Act is
in play, state regulation of drug control also in jeopardy

AAS Adoption Progress

Other Therapeutic Drugs

Identified drugs with
legitimate uses

Prioritized drugs into five
groups

Collected previous science on
each drug

If science is insufficient then
perform administrations on a minimum of 20 horses

Research costs of
administration, collection and analysis are ~$50,000 depending on drug

Plasma is preferred but some
drugs will have both urine and plasma collected

Ultimate goal: uniform
withdrawal time with a corresponding threshold level of drug which regulates
the withdrawal time

Slide 35

RMTC/RCI Model Rules

Penalties

Reconfigured Drug
Classifications to consider “appropriateness”

Penalties apply to any culpable
licensee

Owner has horse “suspended” and
can be fined for multiple offenses

Steward education a key

Guidelines being used by 25
states

Challenges

Corticosteroids

RCI Class 4 Substances

Anti-inflammatory in action

Very diverse group of drugs,
wide number of uses

Some are difficult to test for
and process is complicated by multiple routes of administration

Many states choose to use
testing budget elsewhere mostly due to Class 4 status

Abuse, particularly
intra-articular is significant anecdotally especially in claiming horses

Challenges

How do we combat the “rocket
fuels?”

Need good
security/investigatory capabilities

Sample acquisition and analysis
is a key for true unknowns

Ongoing research program based
on good intelligence

Don’t discount rumors because
it doesn’t involve an “exotic” drug

Challenges

Funding for continued research

Funding from state for
commissions to increase spending on testing, investigatory capabilities,
adjudication

Dealing with issues that may be
strictly based on perception and misinformation

INSIGHTS INTO
BACKSTRETCH  VETERINARY PRACTICES &
PROCEDURES

Practicing Veterinarians

Most of the effort goes into to
diagnosing and treating two systems:

Respiratory

Musculoskeletal

Horse “mental health” also a
focus

Significant effort spent at
prevention

Vaccinations

Anti-ulcer

Therapeutic medications

General Categories:

Anesthetics

Tranquilizers

Local Anesthetics

Respiratory Agents

Corticosteroids

NSAIDs and other
anti-inflammatories

Antihistamines

Anti-ulcer medications

Anabolic Steroids

Joint Health

Antibiotics

Vitamins/Minerals

Normal
Therapeutics

Anesthetics/Tranquilizers

Acepromazine

Butorphanol

Detomidine

Xylazine

Diazepam

Guaifenesin

Fluphenazine

Reserpine

Normal
Therapeutics

Local Anesthetics

Lidocaine

Mepivacaine

Normal
Therapeutics

Respiratory Agents

Bronchodilators

Clenbuterol

Albuterol

Anticholinergics

Atropine

Glycopyrrolate

Ipratropium

Normal
Therapeutics

Respiratory Agents

Bleeder Treatments

Furosemide

Aminocaproic Acid

Tranexamic Acid

Carbazochrome

Ergonovine

N-butyl alcohol

Etc, etc, etc.

Normal
Therapeutics

Corticosteroids

Dexamethasone

Isoflupredone

Methylprednisolone

Prednisolone

Betamethasone

Beclomethasone

Triamcinolone

Normal
Therapeutics

NSAIDS

Flunixin

Ketoprofen

Phenylbutazone

Naproxen

Meclofenamic Acid

Normal
Therapeutics

Muscle Relaxers

Methocarbamol

Dantrolene

Phenytoin

Normal
Therapeutics

Ulcer Medications

Cimetidine

Omeprazole

Ranitidine

Normal
Therapeutics

Anabolic Steroids

Boldenone

Nandrolone

Stanozolol

Testosterone

Normal
Therapeutics

Joint Health

HYALURONATE PRODUCTS

Legend®, Hyvisc®

PSGAGS

Adequan®, etc.

GLUCOSAMINE, CHONDROITIN

Normal
Therapeutics

Vitamins/ Minerals

VITAMINS

B complex, C

Injectable and tablet

ELECTROLYTES

Injectable and powder
supplements

MINERALS

Magnesium sulfate

Calcium

Iron Dextran

Normal
Therapeutics

Antibiotics/Vaccines

ANTIBIOTICS

Gentocin

Sulfa/Trimethoprim

Cephalosporin

Penicillins

PARASITICS

Ivermectin, Eqvalan

Panacur

Pyrantel

Marquis®, Sulfadiazine

VACCINES

Tetanus

Upper Respiratory

Rabies

West Nile

ANTI-FUNGALS

Griseofulvin

Ketoconazole

Not Normal
OR

Non-Therapeutic

BLOOD DOPING AGENTS

Epogen®

Aranesp ®

Hemopure ®

Oxyglobin

Perflourocarbons

Hydroxyethyl Starch

Transfusion equipment

Not Normal
OR

Non-Therapeutic

VENOMS FOR LOCAL ANESTHESIA

Cone Snail Venom, Prialt®,
ziconotide, CSV

Cobra or other snake venoms

Not Normal
OR

Non-Therapeutic

DEA Schedule I and II Drugs

Morphines

Amphetamines

Etorphine

Barbiturates

EXCEPTION:

Euthanasia solutions

Not Normal
OR

Non-Therapeutic

ACID—BASE MANIPULATION

Bicarbonate injectables

Baking soda products

Weak Acids

Acetic Acids

Not Normal
OR

Non-Therapeutic

EQUIGEN®

Equine Growth Hormone

Only available in Australia

IGF-1

Insulin-like Growth Factor

Not Normal
OR

Non-Therapeutic

POTENT ANTI-INFLAMMATORIES AND
ANALGESICS:

Cyclophosphamide

Methotrexate

Tramadol

Ketorolac

Actiq®

Procaine

Not Normal
OR

Non-Therapeutic

Extracorporeal Shock Wave
Therapy

Machine creates shock waves
that can be directed into tissues

Creates strong analgesic effect
beginning shortly after treatment and lasting 3-5 days

Has some possible therapeutic
benefit but not consistent with backstretch use

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