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Medication Update

Medication Update
 
By Kent H. Stirling, FHBPA Executive Director
May 27, 2010
 
The week of April 12, 2010 was a very interesting week in Lexington and not just because the 800 lb gorilla, Keeneland, was in action once again.  For me it was most interesting because the Racing Medication and Testing Consortium (RMTC) had their meeting followed by the Association of Racing Commissioners International and the National HBPA executive committee meeting.   The RMTC Board of Directors met on Monday and immediately discussed the proposed NSAID model rule which has become quite the hot topic since Dr. Tom David from Louisiana brought it up at our spring meeting a year ago.
 
Dr. David appeared before the RMTC Board then and strongly suggested the following which was in a letter he presented; “Illegal drugs are not the problem it’s the so called legal therapeutic medications that are over used and abused.”  Sorry, Stan Bergstein, but apparently it wasn’t actually “rocket fuel” after all.
 
Dr. David who is the medical director for Louisiana strongly felt horses that he and others checked during pre race vet exams were definitely under the therapeutic influence of Bute.  He contended that Bute made detection of inflamed joints, muscles and mild lameness difficult to detect, because at the time of the pre race exam the horse could have over 5 micrograms per mcg/ml of Bute in its system.   The RMTC/ARCI model rule threshold for Bute is 5 mcg/ml, and this is the national threshold in all but a few states.
 
Bute is to be administered 24 hours prior to post time so, therefore, the horse when it races will have a blood sample that when tested will be under 5 mcg/ml.  If the horse races in the last race or at night, the pre race exam might take place 5 to 10 hours prior to racing, thus making it possible that the pre race vet exam is done at 14 to 19 hours after the administration of Bute which could then still have a pharmacological effect on the horse at the time of examination.
 
Dr. David wanted the time of the administration of Bute or any NSAID moved back to 48 to 72 hours prior to racing.  The RMTC’s Scientific Advisory Committee’s consensus was to go back to the 2 mcg/ml level threshold at 24 hours prior to the race as it supposedly was previously in some states.  But did those states really have a 2 mcg/ml threshold?
 
In 1998, I did a comprehensive study of Bute rules within the United States that was printed in the NHBPA Medication Guide.  The only state with a 2 mcg/ml Bute threshold was Illinois which mandated that 2 warnings be given before horsemen could be assessed a fine not to exceed $500.  By the way, 150 starts in a calendar year bought the trainer one more warning before a fine. In 1998 Maryland was at 2.6 mcg/ml with a warning from 2 – 2.6 mcg/ml.  New Jersey and Delaware were both 2.6 mcg/ml before a fine.
 
It seemed that the 2 mcg/ml “train” was not going to be stopped and a 30 year old threshold was about to be brought down by a single medical director (there were more than one medical director involved later).  Interestingly two of these three medical directors were long time practitioners on the backside whom I never read or heard that they ever suggested that the 5 mcg/ml level be lowered while they were practicing veterinarians.
 
I asked that at least the threshold be set at 2.6 mcg/ml with a possible phase in period before penalties.  I was met with silence and a denial of the 2.6 mcg/ml threshold.  Several of the practicing vets present at the meeting said that lowering the Bute threshold to 2 mcg/ml would only increase the use of corticosteroids which are worse for the horse.   There was also a question of the buildup of daily oral bute in the horse’s system plus the IV injection of bute at 24 hours prior to race time causing the horse’s bute level to exceed 2 mcg/ml.
 
Nevertheless, the motion was made for a 2 mcg/ml recommendation from the RMTC and it passed 16 to 2.   In my memory, it was the first time ever at an RMTC meeting that a threshold passed with dissenting votes.  In one year at the behest of a single medical director, later joined by others, the level on Bute and probably other NSAIDs changed while horsemen everywhere have waited 5 years for promised thresholds on Glycopyrrolate (Robinul), Pyrilamine (Equihist), Methocarbamol (Robaxin), Detomidine (Dormosedam), Butorphanol (Torbugesic), Lidocaine (Xylocaine), Mepivacaine (Carbocaine) and Acepromazine.
 
The above eight therapeutic medications will all have a threshold at some time in the near future below which level no call or detection of any of them will require a penalty of any kind.  But guess what?  A detection of any of the eight at any level currently will mandate a minimum penalty of a 15 day license suspension, a $500 fine and a loss of purse.  This means that good old “zero tolerance” is back in play for testing all these therapeutics.  Nowhere is a steward or regulator notified in the Model Rules that a threshold is soon due for all eight.
 
For five years I have begged the RMTC that the forty plus therapeutics waiting thresholds be put in bold print or have an asterisk printed by them in the ARCI Classification Guidelines for Foreign Substances.  This would permit Stewards either to not penalize at all or penalize in moderation for low detections of any of the therapeutics in question.
 
Obviously, I have had no success in this endeavor.
 
More surprises awaited us at the ARCI Model Rules and Practices Committee Meeting.  The committee members sat at a U shaped table with a little table at the top of the U for those who wanted to present something to the committee members.  It seemed quite formal and daunting at first to a shy horseman, but Chairman Larry Eliason, does a good job of running his committee fairly and openly and putting audience participants at the little table at ease. (I particularly like his cell phone rule…if it rings you buy everyone in the room a drink).
 
Discussion began on the proposed RMTC model rule on Out of Competition Testing.  This rule left the RMTC with the horsemens’ groups in lock step that this rule be used only for detecting blood doping and gene doping agents which unlike other drugs can’t be detected in a post race test.  We feared that regulators would try to open it up for other drugs and the witch hunt would begin for testing for a plethora of other drugs with the poor owner once again footing the bill.  A ten year license suspension was strongly suggested for anyone caught using these blood or gene doping agents.
 
A regulator from a major racing state suggested that their state was going to open the Out of Competition Testing rule up to all Penalty Class A drugs and not just blood and gene doping agents and suggested the ARCI Model Rule Committee do the same.  The example given was that a trainer could be using amphetamines to train on before a race, and regulators can’t prevent them from doing it.
 
I immediately went to the small table and stated, that out of competition testing was only for gene and blood doping which must be done at least five days before a race to be effective and which would not be picked up in a post race test.  I was asked if I was stating that I condone the use of amphetamines five days or so before a race.  I replied that I do not but that while amphetamines were a Class 1 drug and should never be used on a horse, Class 1 drugs numbered only about 48 and I thought that there were over 250 penalty Class A drugs.  In other words, not all Penalty Class A drugs are Class I drugs, and far from it.  It turns out I was wrong, there are over 450 Penalty Class A drugs and 79 of them are for Class III drugs.
 
Next to speak was the past president of ARCI, Joe Gorajec, from Indiana who stated, “I find myself in a most unique and surprising situation.  I actually agree with Kent Stirling on this.”  I also was in the surprising and unique situation of having a top regulator agree with me on medication.  I certainly hope this doesn’t negatively impact Joe’s career.