Maria Sharapova's failed drug test reveals a huge misunderstanding about doping

Maria Sharapova's failed drug test reveals a huge misunderstanding about doping

Maria Sharapova, one of the best women's tennis players in the world, failed a drug test at the Australian Open, she announced in a press conference on March 7.

She tested positive for meldonium, a substance that was banned by the World Anti-Doping Association (WADA) in January after reports that it was being used as a performance enhancer.

Doping may evoke images of muscled men injecting steroids, but performance-enhancing drugs have become much more complex — and harder to police — in the 16 years since WADA's founding.

Last year, a study noted that even though only about 1-2% of professional athletes fail drug tests, survey-based estimates show that as many as 14-39% are doping in some form. That suggests that most of the chemical performance enhancement in professional sports flies under the radar.

Athletes looking for an edge often don't need what steroids provide; they may be seeking more nuanced (and less detectable) improvements, like increased endurance or faster recovery times. As a result, they're turning to micro-dosing, relying on undetectable hormones, taking advantage of unconventional drug-delivery methods (like skin patches), and using substances that have not yet been banned, whose effects and safety profiles are often largely unknown.

That's transformed doping into something that is both rampant and also nearly invisible — except for these scattered moments when it bubbles up into a public scandal.

The dust-up over meldonium, which has been monitored since 2015 but was not officially prohibited until January, is a perfect example of the cat-and-mouse game WADA plays with athletes, constantly trying to keep up with the ever-evolving science of performance enhancement.

Experts are actively trying to narrow what they acknowledge is a serious "gap between the number of athletes who dope and the number of athletes who are caught."

Last spring, a team that included some of the world's leading authorities on doping in sports raised the alarm on meldonium in a study published in the journal Drug Testing and Analysis.

It's "not on the radar of anti-doping laboratories as the compound is not explicitly classified as prohibited," the authors wrote. "However ... [it] demonstrates an increase in endurance performance of athletes, improved rehabilitation after exercise, protection against stress, and enhanced activations of central nervous system (CNS) functions."

Meldonium's usage in sports, the authors went on, "is arguably not (exclusively) [for] medicinal reasons."

Later that year, when the nonprofit Partnership for Clean Competition tested 8,300 urine samples collected from athletes, they said a full 2.2% tested positive for meldonium.

As for Sharapova, she said during the press conference that her family doctor had been prescribing her meldonium for ten years to manage a variety of health problems. Her lawyer insisted that the dose was not high enough to enhance her performance.

"Medical practitioners need to be aware that, when treating athletes who are subject to drug testing, certain medicines that are not illegal to prescribe to the general community could result in the athlete breaching anti-doping rules," the chief medical officer of the Australian Institute of Sport wrote in a paper last year. "Some of these prohibited medicines are likely to stand out as being of concern for athletes ... while other[s] may not be so obvious."

That suggests that some athletes fail doping tests for innocent reasons: because of a doctor's oversight or a player's ignorance, as Sharapova is arguing. She was taking meldonium under its alternate name, mildronate.

Sharapova's case shows how a medication that can be useful and isn't associated with bulking up still might be part of a widespread doping problem. It’s become harder to determine whether someone needs a drug or is using it for a performance-enhancing boost.

Still, the company that makes meldonium, used in some countries for heart problems (though not approved in the US), says a four-to-six week course of treatment is standard, not a ten-year dosing regimen. "There is no way [meldonium] would be clinically indicated in a healthy young athlete," a Cleveland Clinic cardiologist told The New York Times.

As Brian Palmer explained in Slate, athletes who need medication on the banned list for a medical condition for which there are no alternatives can apply for a therapeutic use exemption with WADA.