The Medication Conundrum

Current drug regulation challenges race and sport horse industries face

Ernest Hemingway traveled with his new bride to Paris for the Christmas holiday in 1921 and wound up staying there for five years. It was the best place to be during the early 1920s and hosted a rich community of prominent writers. Hemingway filled one blue notebook after another with his writing, and when he had spare time he went to the races. An astute handicapper could make decent money betting, he wrote in A Moveable Feast, especially if a person paid close attention to the “boosted horses.”

There was widespread use of performance-altering drugs, Hemingway explained, but identifying the doped horses in the paddock before a race was difficult. Some—the ones that reacted badly to the drugs—were easy to pick out, but the writer often had to rely on tips from insiders. A rudimentary saliva test to detect a few prohibited drugs already was in use in France by the early 1920s, but hardly ever at the tracks Hemingway frequented. It would be another decade before a modified saliva test made its way across the Atlantic to Hialeah Park race track, in Florida.

By the early decades of the 20th century, horse racing’s drug problem had become the sport’s most poorly kept secret. The Jockey Club, the breed registry for Thoroughbred horses in the U.S., Canada, and Puerto Rico, had approved a rule against doping in 1897 but, without a reliable test for illegal drugs, enforcement was problematic and relied on either a witness or a confession. Newspapers railed against the practice, but public indignation was rare. It took the work of a displaced G-man to change things.

The war on illegal drugs in U.S. racing began in earnest during the early 1930s. Leading the campaign was Harry J. Anslinger, who had moved from the soon-to-be-obsolete Commission of Prohibition to head the Treasury Department’s new Bureau of Narcotics. The Bureau was established to stem the tide of illegal drugs sweeping into the U.S., but Anslinger also was concerned about what he saw as the proliferation of drug use among backstretch workers and the doping of horses at the country’s racetracks.

By 1933 Anslinger’s investigators reportedly had gathered evidence—through witness statements or ­confessions—of more than 200 horse doping incidents, some at major tracks involving prominent horsemen. Acting on that evidence, federal narcotics agents conducted a series of well-publicized raids at tracks up and down the Atlantic Coast and in the Midwest that resulted in indictments and arrests of owners, trainers, jockeys, and stable workers. The charges generally were based on possession of illegal drugs, however, rather than attempts to influence race outcomes. Without a test for illegal drugs, there still was no way to prove a horse actually had raced with prohibited substances in its system.

An editorial in Blood-Horse magazine following the raids called out everyone in racing—starting with owners, trainers, and jockeys and moving on to regulatory ­officials—to stop the rampant doping. The next year Hialeah president Joseph E. Widener took up the challenge, imported the French saliva test, and began using it at the Miami track. The result was a horsemen’s ­rebellion.

Amid growing concerns about the new drug testing procedures and enforcement of the “absolute insurer rule,” holding trainers responsible for the condition of horses in their care, the trainers threatened a strike for Florida Derby Day. Widener vowed to stage the closing-day card, and when several strike leaders were barred from the track, the races filled.

Tests for prohibited medications today are more reliable and sensitive, and the absolute insurer rule remains the principal enforcement tool for assigning responsibility after a positive test result. Doping has become more sophisticated as well, however, both at racetracks and at sport horse competitions, and despite an almost perfect record in court, legal challenges to the absolute insurer rule continue.

The disqualification of Kentucky Derby winner Dancer’s Image in 1968 after testing positive for the anti-inflammatory phenylbutazone led to years of legal challenges and sweeping changes in track security, testing procedures, and enforcement. In 2018 a Kentucky court ruled that the state’s absolute insurer rule was unconstitutional. An appeal of that decision was pending as of this writing.

The Scope of the Drug Problem

Taken at face value, horse racing’s doping numbers are fine—better than fine, really. In 2014 the Association of Racing Commissioners International (RCI) released one of the most comprehensive reports on testing for prohibited substances in the U.S. The RCI reported that 340,932 “biological samples” were sent to testing laboratories around the country in 2013.

The results were impressive: From those tests there were only 1,140 medication violations, a “clear rate” of 99.67%. Compared with testing for prohibited substances in human sports, racing’s labs tested more samples and still fared slightly better than the United States Anti-­Doping Agency (clear rate of 99.55%) and the World Anti-Doping Association (clear rate of 98.97%). Horse racing’s clear rate was almost as good two years later, 99.63%, according to 2015 Racing Medication & Testing Consortium (RMTC) statistics.

Supporters of racing’s current regulatory scheme could point to the numbers and reasonably ask, “what drug problem?” Skeptics might point to the same numbers and reasonably caution, “not so fast.” To make sense of the statistics, we must put them in context. Not every horse in every race is tested. That would be impractical and prohibitively expensive, with the cost of drug tests running as high as $200 or more per horse in some jurisdictions.

The Jockey Club reported that 43,139 races were run on the flat and over jumps in the U.S. in 2013. Winners of those races account for at least the same number of tests, and perhaps as many as twice that number because RCI reference to tests on “biological samples” could include blood and urine samples from the same horse in a single race. Also included are tests done on “out-of-competition” samples, rather than on those taken post-race.

Every state tests every winner, plus some nonwinners chosen because of suspicious performance. Other horses are chosen for testing at random. A result of this selective testing is that racing’s impressive clear rate is representative of the population of horses racing or in training, but necessarily incomplete. A comprehensive clear rate, a number that truly represents how many horses are running with prohibited medications in any given race, might be better or worse than the published numbers. Until racing authorities come up with unlimited funds for testing, though, we can’t know for sure.

This potential discrepancy is not necessarily a serious problem, though, says RMTC executive director Dionne Benson, DVM, JD. “The challenge is money,” she says—not enough money to cover the laboratory fees and labor costs associated with testing every horse in every race. “Given the inherent restrictions, the goal of drug testing is not to catch every cheater. The goal is to discourage people from cheating in the first place.”

Testing every winner, plus some nonwinners picked at random, along with out-of-competition testing, is a “tactical solution” that keeps the cheaters guessing, never knowing whether a horse will wind up in the testing barn after a race.

Also encouraging, Benson adds, is the nature of the relatively few violations. Most are for therapeutic medications being used to treat a medical condition, rather than an attempt to cheat.

Clear rates in the sport horse world are comparable to racing’s numbers, ranging annually from 0.5 to 1.5%, says Stephen Schumacher, DVM, chief administrator for US Equestrian’s Equine Drugs and Medication Program. Facing the same financial constraints as racing’s ­regulators—not enough money for all the testing they’d like to do—US Equestrian follows a similar “tactical” approach, but with a few important differences.

The Medication Conundrum

“We’re all trying to do the same thing—to identify drug abusers,” Schumacher says. “In racing, they’re always looking for ways to make horses run faster and farther, but in our sports it’s different. They’re usually looking for ways to make horses jump better or perform better in an under-saddle class.”

In racing, the horse that runs fastest crosses the finish first. At a horse show, measuring success is more complicated, with blue ribbons in untimed events based on a judge’s subjective opinion. Sport horse regulators also enjoy more discretion in selecting horses for testing than their colleagues in racing, where rules dictate testing all winners. Without that requirement, drug testing at shows can be directed toward perceived problem areas in a class, division, or event, with targets changing as conditions dictate.

“An inherent challenge for us is that our competition venues often change on a weekly basis,” Schumacher says. “We use independent contractors who select horses for testing and collect samples, and there always is the possibility for unintentional sampling bias. We don’t have the resources to test every horse in a class, and we don’t always test the winner of a class. This means that at times we might select a horse for testing that does not have prohibited drugs on board and not select a horse that does. But we’re always trying to use our resources in a more focused way, and we do our best to maintain the random nature of the testing to deter the violators.”

One Step Forward, Two Steps Back

Benson and Schumacher agree that one of the most frustrating aspects of their work is the inability to see into the future and to know which new drugs to test for before they get used in competition. Regulators are constantly playing catch-up.

“We can only look for what we already know to look for,” Benson says. “Identifying a new drug in the laboratory often isn’t difficult, but you may never see that drug when you start actual testing. You may only see the metabolites of that drug, and deciding which metabolites to look for complicates the process. Running a drug sample through a machine is not the same as running that drug through a horse.”

New challenges also include developing effective ways to detect selective androgen receptor modulators, a group of drugs developed during the past few years to increase muscle mass in human athletes, and “blood doping” with erythropoietin (EPO), says Benson. The emergence of new therapeutic medications that have legitimate uses in veterinary medicine compound the problem for regulators when the same drugs are misapplied as performance enhancers in horses.

“You’ll get frustrated if you look at progress in short increments,” she says.

Schumacher and his cadre of scientists, testing veterinarians, and technicians face the same problem.

“People often ask me how it feels to be two steps behind,” he says. “Sometimes, I’d love to be only two steps behind.”

A Federal Solution?

Anslinger’s interest in racing and backstretch raids was short-lived. Already in the process of shifting the Narcotics Bureau’s full attention toward illegal drug trafficking for human consumption, his promised federal interventions into positive drug tests in racing never ­materialized.

Medication regulation in racing started at the state level with Widener at Hialeah and stayed there. Rule-making for drug testing and enforcement in the English sport horse world, on the other hand, always has been the responsibility of private organizations, such as US Equestrian in this country and the Fédération Equestre Internationale internationally.

Legislation to shift responsibility for drug testing and enforcement from individual states to a single federal agency was introduced in Congress for the first time in 2015, but it never gained traction. Now, with prominent horsemen’s groups on both sides of the issue and millions spent in lobbying, that legislative indifference might be about to change.

On May 25, 2017, the Horseracing Integrity Act of 2017 was introduced in the House of Representatives. Like earlier legislative efforts, the new version offered a federally mandated solution to racing’s drug problems through the formation of an oversight agency and the institution of uniform medication rules across all racing jurisdictions. A Congressional Subcommittee hearing, a preliminary step in the legislative process, was held on June 22, 2018, but no consensus has emerged.

The most divisive question, and the issue most likely to stall the bill before it reaches a vote, involves race-day administration of Lasix, a popular medication used to prevent or reduce the effects of exercise-induced pulmonary hemorrhage (EIPH, or “bleeding”). The current version of the Act would eliminate Lasix administration on race day, and finding an acceptable middle ground is proving difficult.

A much touted benefit of centralized regulation is rules uniformity across the country. Whether this will be successful in solving the problem depends on how you feel about drug testing thresholds. A threshold is the maximum level of a prohibited medication that is assumed to have no effect on a horse’s performance, and the current jigsaw puzzle of regulations might have different thresholds for the same drug from state to state. A concentration below the threshold is not considered a drug “positive.” The most restrictive type of regulation is zero tolerance, with no thresholds and a positive result for the smallest trace of any prohibited medication in a horse’s system. Proponents of a total ban on race-day medication include the Water, Hay, Oats Alliance (WHOA), a national organization supported by a number of leading organizations and individuals.

While everyone wants a level and safe playing field, there are disagreements about how to get there. Many horsemen’s groups and veterinary associations strongly oppose a race-day ban on Lasix and argue that the legislation would create an equine welfare crisis by eliminating an effective treatment for a common problem. For the Act’s many supporters, the legislation’s intent is to protect the sport’s integrity and to reverse much of the public’s low opinion about horse ­racing.

The Medication Conundrum

Vets on the Ground

Regulation of prohibited substances in both racing and showing is a continuum: The policymakers who write the rules are at one end; the enforcers who collect and test samples and administer the regulations are the middlemen; and at the end are the practicing veterinarians who often are far removed from the rule-makers but still bound by the regulations.

Jeff Blea, DVM, is a partner in VonBluecher, Blea, Hunkin Inc. Equine Medicine and Surgery, a racetrack practice in Sierra Madre, California. He also is a former president of the American Association of Equine Practitioners, an organization that opposes the Horseracing Integrity Act. Blea supports the idea of uniform medication rules, one of the Act’s goals, but he isn’t convinced that federal intervention is the answer.

“Uniformity in the rules is what we need,” Blea says, “and we’re getting there. We have a program in place, and we’re already marching toward uniformity.”

Racing commissions have adopted the RMTC’s National Uniform Medication Policy (NUMP) in full in 11 states and in part in 21 other jurisdictions. One set of rules, applied in every racing state, will help eliminate confusion for veterinarians when horses ship from track to track.

“The better horses will run in races all across the country,” Blea says. “And part of a veterinarian’s responsibility is to know the rules. If one of our horses is going to a state that has adopted the uniform rules, I already know that the rules there will be the same as mine here in California. But if not, I might have to call someone in that state and ask about the rules.”

The biggest challenge moving forward, he adds, is better public relations for a program that already is working.

“We have to communicate to the public that things are improving,” he says. “So many things have come about in the last few years. We need to tell the world what we’re doing and why we’re doing it and then keep telling them.”

On the other side of the country, on Long Island, Sara Langsam, VMD, is a partner in the New York division of TFB Equine. She divides her time between New York and Kentucky and has experience navigating the regulatory waters from state to state. The NUMP has helped bring a measure of consistency to regulations in many jurisdictions, Langsam says, but the process is “going more slowly than anyone imagined.” (Inconsistent regulations typically are not an issue for sport horse competitors, who in most disciplines compete under the same rules no matter where the competition is held.)

“The inconsistencies in the rules can be frustrating,” she adds, “especially with clients who are racing in several states. The different regulations affect a lot of the day-to-day work you do. You have to know what the expectations of the owner and trainer are for a horse. Is there a possibility that the horse will be racing anytime soon, and where? You have to do your homework, so you can advise your clients properly and professionally to avoid a positive test.”

About federal intervention in drug regulation, Langsam is guardedly optimistic.

“It’s okay if it brings uniformity,” she says, “but it has to be done properly, and we need good voices to speak for our industry. The boots on the ground, the people who live it every day, we understand our industry better than anyone else. And we know it’s a pretty clean sport.”

A persistent worry across the industry is that prohibited substances might be used to supplant good horsemanship.

“There are always bad actors out there who reach for something in a bottle or tube to improve performance, rather than focusing on the training, fitness, and welfare of the horse,” Schumacher says. “But we emphasize that the vast majority of our trainers and members strive to comply with our drugs and medications rules.”