Equine DrugEquine Drug Testing Methods

Stephen A Schumacher DVMStephen A. Schumacher, DVM

Mission of a Drug Testing ProgramTesting Program

• The safety and well-being of horses inbeing of horses in competition

• A level playing field for competitors

Horse WelfareHorse Welfare• Appropriate treatment

when needed

• Discourage inappropriate and indiscriminate use of commonly used medications

• Discourage attempts to mask conditions limiting performance by using drugs

• Mandate withdrawal from competition if horse is……NOT FIT TO COMPETE!!

USEF Program HistoryUSEF Program History

• Started in 1969 as the AHSA• Started in 1969 as the AHSA Spot Test Program; formally in 1970

• Collected 58 samples; 35 saliva and 23 i23 urine

• Initial funding was provided by 1 00• Initial funding was provided by 1.00 USD per horse, per competition fee

Program FactsProgram Facts

• The USEF has operated our ownThe USEF has operated our own laboratory since 1995

• Currently utilize 110-120 veterinarians

C t t ith th AQHA t i l t• Contract with the AQHA to implementtheir Drugs and Medications Program

• Contracts with other state and national associations for testingassociations for testing

Ohio Team…Ohio Team…

Current …..Current …..• Largest Sport Horse testing program

in the world• In 2008 we tested 17,767 samplesIn 2008 we tested 17,767 samples• We tested 810 days at USEF shows and

246 days at AQHA shows (total 1 056 days)246 days at AQHA shows (total 1,056 days)• 2008 Budget of 4.4 million USD

2009 B d t f 4 5 illi USD• 2009 Budget of 4.5 million USD• Funded by 7.00 USD per horse,

per competition fee

International TestingInternational Testing

F d ti E t I t ti l (FEI)• Federation Equestre Internationale (FEI)The international governing body of

t i t b f th IOCequestrian sports; member of the IOC

• Perform all sample analysis for the FEI in the p ywestern hemisphere; Argentina to Canada

In 2009 USEF anal ed nearl 1000 samples• In 2009, USEF analyzed nearly 1000 samples for the FEI

Collected and analyzed ~750 samples– Collected and analyzed ~750 samples– Represents 30% of the FEI testing worldwide

Components of a Successful Drugs and Medications ProgramDrugs and Medications Program

• EducationEducation

• Collection

• Analysis

• Adjudication

• Penalize

• Industry Opinion• Industry Opinion

EducationEducation

• 1 (800) number answered 24/7• 1 (800) number answered 24/7• Published Guidelines Pamphlet• On-line Access to Drug Rule and Pamphlet• Press Releases• National Show Veterinarian Seminars• FEI Veterinary Delegate Courses• FEI Veterinary Delegate Courses• Presentations at Competitions

Sample CollectionsSample Collections

• Blood is collected from each horseBlood is collected from each horse selected

• An attempt at urine collection is made• An attempt at urine collection is made • The Collection of samples is done in

d ith th I t ti l T tiaccordance with the International Testing Standards identified by WADA (World A ti D i A )Anti-Doping Agency)

• Separate A and B samples of both blood and urine are identified

Selection for TestingSelection for Testing

• Obligatory—pre-specified placings » 1st, 2nd, 3rd….Olympics, World Cups, etc.

• Random—method decided upon by t ti t i itesting veterinarian

• Spot specific reason necessitates• Spot—specific reason necessitates the testing of the horse

U l b h i» Unusual behavior

Sample CollectionsSample CollectionsWhat’s Required of Trainers: (Clear cut in Rules)

• Presenting the horse promptly for testing

• Assisting the veterinarian and/or his/her agent(s)Assisting the veterinarian and/or his/her agent(s) in procuring samples

• Avoiding any distractions to the horse• Avoiding any distractions to the horse

• Schooling, lengthy cooling out, bandaging and other delays shall be construed asother delays shall be construed as… “Non-Cooperation”… as bad as a positive test

Polite attitude and actions toward the testing• Polite attitude and actions toward the testing veterinarian and technicians

AnalysisAnalysis

• Analyze all submitted samplesAnalyze all submitted samples

• No pooling of samples

• Samples analyzed confidentially

• Quality Assurance program(s)

• Scope of testing is based on the abuse potential of the medication or substance

• Laboratory has to be capable!!!

AnalysisAnalysis

Qualitative vs. QuantitativeD R lDrug Rules

“Zero Tolerance” in inaccurate

AdjudicationAdjudication• Finding vs. Violation (i.e.. “Positive”)Finding vs. Violation (i.e.. Positive )• Investigation for submitted Temporary Use

Exemption (TUE); USEF and FEIp ( );• Each Finding is reviewed on its own merits• Permitted to have B sample analyzedPermitted to have B sample analyzed• Opportunity to respond to the Finding• Administrative Penalties• Administrative Penalties• Hearings

– Legal representation permittedLegal representation permitted• Hearing Committee/Tribunal is autonomous

AdjudicationAdjudicationWho’s Responsible?:Who s Responsible?:

• Trainer….Owner….

• Care, Custody and Control of the horse

T i C h• Trainer vs. Coach

• Multiple individuals may share p ythe responsibility

FEI it’ th Rid• FEI…it’s the Rider

Conneticut Team……?Conneticut Team……?

Penalize ViolationPenalize Violation• “Strict Liability” and Responsibilityy p y• Consistent and impartial • Penalty based upon:• Penalty based upon:

– Severity of the drug; legitimate medication?Prior violations (drug only)– Prior violations (drug only)

– PrecedentsQ tit f d f d (if tit ti l )– Quantity of drug found (if quantitative rule)

• Publish violation and penalty…DETERRENCE!!!!

PenaltiesPenalties• Censure and Return of Winnings (ROW)Censure and Return of Winnings (ROW)

– Can be very costly in racing…

• Fines:– $750 to >$5,000 (USEF)$750 to $5,000 (USEF)

• Suspension:• Suspension:– 1-6 months (USEF)– 1 month to >2 years (FEI)– 1 month to >2 years (FEI)

Industry OpinionIndustry Opinion

• A Violation has to be associated with a negative connotationg

• A good Drug Testing Program is notA good Drug Testing Program is not possible without industry support

• A “Laboratory” is not capable ofsolving all problemssolving all problems…

“Rules without enforcementRules without enforcement are worse than meaningless; they are hypocrisy.”

Dr John Lengel-Dr. John Lengel

Miniature Horse Team…Miniature Horse Team…

“We tend to meet any new it ti b i isituation by re-organizing -

and a wonderful method it can be for creating the illusion of

progress while producingprogress while producing confusion, inefficiency &

demoralization.”

Governor of Bithynia, who committed suicide in AD 65, Governor of Bithynia, who committed suicide in AD 65, having fallen foul of Tigellinus, favourite of Nerohaving fallen foul of Tigellinus, favourite of Nero

Classification of DrugsClassification of Drugs

• Permitted substances: use notPermitted substances: use not regulated by the USEF

• Restricted substances: amount of drug• Restricted substances: amount of drug allowed in blood and/or urine is quantitatively restrictedquantitatively restricted

• Forbidden substances: Potential to ff t f id f iaffect performance, provide an unfair

advantage, or potentially dangerous to the hhorse

Permitted SubstancesPermitted Substances• Antimicrobial agents

– Antibiotics(exception: procaine penicillin)Antifungal agents– Antifungal agents

– Anthelmintics– Antiprotozoal agents: Marquis (ponazuril) EPMAntiprotozoal agents: Marquis (ponazuril) EPM

• Anti-ulcer medications: Tagamet® (cimetidine), Zantac® (ranitidine), Gastroguard® andZantac® (ranitidine), Gastroguard® and Ulcerguard® (omeprazole)

• Anti-parasitic agentsp g

Restricted MedicationsRestricted Medications• Non steroidal anti-inflammatory drugs (NSAIDS)y g ( )

– Butazolidin® (phenylbutazone)– Banamine® (flunixin meglumine)Banamine® (flunixin meglumine)– Ketofen® (ketoprofen)

Arquel® (meclofenamic acid) generic or– Arquel® (meclofenamic acid) generic or compoundedEquiproxen® (naproxen) generic or compounded– Equiproxen® (naproxen) generic or compounded

– Surpass® (diclofenac) topicalE i ® (fi ib) d f t ti– Equioxx® (firocoxib) approved for use starting Aug. 2007

Restricted MedicationsRestricted Medications

• Robaxin® (methocarbamol)Robaxin® (methocarbamol)• Dexamethasone SP

Th b i• Theobromine (threshold for possible dietary origin)

Restricted Medication Dose and Time Recommendationsand Time Recommendations• Found on the USEF website

• Found in the Drugs and Medications G idelines last re ised A g st 1 2007Guidelines; last revised August 1, 2007

• Only recommendation not the rule***• Only recommendation, not the rule

• Only the listed routes of administration and O y t e sted outes o ad st at o a ddoses listed have been evaluated***

• Caution about the use of compounded medications***

Forbidden SubstancesForbidden Substances• Stimulants• Depressants • TranquilizersTranquilizers• Local anesthetics

A l i (t d l f t l t )• Analgesics (tramadol, fentanyl, etc.)• Psychotropic substances

– Reserpine (anti-hypertensive)– Fluphenazine– Dangerous, unpredictable side effects

Forbidden SubstancesForbidden Substances• Might affect performanceg p• Might interfere with testing

– Few drugs currently in this categoryFew drugs currently in this category– Lasix (furosemide)…not so much anymore

• Caution against the use of “herbal natural• Caution against the use of herbal, natural, holistic, etc.” productsIf th i t t i t “C l ” th h d it• If the intent is to “Calm” the horse, and it works…It is Forbidden! (even if it doesn’t work, it

)violates the spirit and intent of the rule)

Medications that may cause a Positive Drug TestPositive Drug Test

C• Corticosteroids– Azium® (dexamethasone) quantitative restriction

P d i l f bidd d 7 d– Prednisolone forbidden; recommend 7 days withdrawalBetamethasone forbidden; rec 7 days withdrawal– Betamethasone forbidden; rec. 7 days withdrawal

– Vetalog® (triamcinolone) forbidden; rec. 7 days withdrawal

– Methylprednisolone forbidden; rec. 14 days withdrawal

– Others