Summary of the Summit: Update from the Racing Medication and Testing Consortium

Racing Medication and Testing Consortium Update

I offer this report, truth to be told, with more than a little trepidation–my knowledge of the uses and effects of these drugs is close to nil.  I am simply passing on what was said, though, in the hope that some of you find it interesting/useful, and that I am presenting the information in a way that makes sense.

Dr. Scot Waterman, a vet and executive director of the Consortium, began by making explicit the RMTC’s mission:  to develop, promote and coordinate, at the national level, policies, research and educational programs that seek to ensure the fairness and integrity of racing and the health and welfare of racehorses and participants, and to protect the interests of the racing public.

The focus of his presentation was the use of NSAIDs (non-steroidal anti-inflammatory drugs) and corticosteroids.

He began with NSAIDs, noting that until recently, the existing rule permitted one NSAID to be administered 24 hours prior to a race; guidance for the use of NSAIDs suggested a single intravenous administration with no other NSAIDs to be administered within 48 hours at a minimum.  Its use was regulated via threshold; that is to say, how many micrograms of the drug were present at the time of testing.

At the time of the rule, published literature indicated that the acceptable thresholds provided no risk to the horse and that they would provide no unacceptable level of pain relief to the horse at the time of the race.

Within the last few years, regulatory vets said that rule as it existed affected their ability to conduct pre-race exams.  According to Waterman, when the rule was developed seven years ago, the pre-race exam wasn’t a consideration (though he did not say why—I wonder why the pre-race exam wasn’t a consideration then.  Anybody?).

One of the Consortium’s committees then conducted an extensive literature review of existing published information on NSAIDs and felt that its findings lent credence to the regulatory vets’ claim.  The Consortium’s options, then, were to move the rule from 24 hour administration of Bute to 48; to reduce the permitted threshold for NSAIDs; or to make no change at all.

The question, Waterman said, was whether a single administration 16-18 hours before the exam allows vets to see what they need to see.  In answering that question, the RMTC committee suggested changing the threshold and remaining consistent with the guiding rule for a single IV administration 24 hours out from the race.  Full details of the rule change are in the RMTC’s press release.  Waterman indicated that the Consortium would need more data in order to regulate the two other approved NSAIDs at 48 hours.

Waterman pointed out that two racing jurisdictions saw an increase in catastrophic injuries when the Bute threshold had been raised from 2 mcg/ml to 5 mcg/ml.  When the threshold was dropped back to 2mcg/ml, one of the jurisdictions saw the catastrophic injury drop.  He cautioned that no work has been done to see if a cause and effect relationship exists between the changes in threshold and injury rate.

Waterman reported that approximately 20% of horses were above 5mcg/ml at the time of the pre-race exam.  Given that the results were above the concentration about which the vets were concerned, they were a critical factor in determining that the current threshold for Bute was too high.

Moving on to a discussion of corticosteroids, Waterman acknowledged that they were “much more complicated” than NSAIDs.  They are categorized by the Association of Racing Commissioners International as Class 4 drugs, and they are a diverse group of drugs with a wide range of uses.  They are also, he said, hard to test for and can be administered through multiple routes.  The ARCI rates drugs on a scale of 1 to 5, with 1 having the highest potential to affect a horse’s performance.

Because of the drugs’ Class 4 status, many states choose to use their testing budget elsewhere; Class 4 corticosteroids are thought to have more of a therapeutic than a cheating effect, and racing jurisdictions have to choose their testing priorities because of limited budgets.

According to Waterman, anecdotal reports of abuse, particularly intra-articulation, or injection of corticosteroids directly into joints, became an area of concern to the RMTC.

Pennsylvania adopted a seven-day ban on intra-articulation of corticosteroids, raising questions of how well that ban can be enforced.  Waterman pointed out that current methods are not sensitive enough to regulate for long periods of time, and the RMTC is funding studies to improve blood testing, as well as looking at markers to see how long the effect of an intra-articulated corticosteroid lasts.

The goal of the corticosteroid study is to deliver a comprehensive industry policy on the administration of corticosteroids to allow good uses but not dangerous ones.

With regard to penalties, Waterman reported that the RMTC is trying to get racing stewards and commissions to use a consistent approach with penalties and is creating templates for commissions to use when issuing release on violations.  The goal is not, he emphasized, uniform penalties, but rather a uniform approach to determining penalties, which he hopes the checklist will facilitate, as it allows for aggravating and mitigating circumstances.

The RMTC is also working to educate the racing public on what’s problematic in the world of medications; its website archives rulings with explanations of drugs.  Open to the public, the rulings archive is available from the front page of the RMTC website; users will see a list of recent rulings with their penalties, and mousing over the name of a medication brings up information on the medication, its classification, and its uses.

Next up:  Report from the NTRA Safety and Integrity Alliance

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