MLB makes significant improvements to the Joint Drug Agreement

Yesterday, Major League Baseball announced some pretty significant improvements to its Joint Drug Treatment and Prevention Program—making it the most intensive program of its kind in major American sports. The most obvious update is new suspension lengths for each violation: 80 games (without pay) for a first violation, 162 games (plus 183 days without pay) for a second violation, and a permanent ban from baseball following a third violation. The suspended player is also barred from postseason play the year in which his violation occurred—a key difference from the previous program.

There are many more things of note in the program's update than just the increases in the lengths of suspensions:

• In-season random urine testing will more than double from 1,400 to 3,200.
• Blood testing for hGH will increase—including in-season random samples—but to be completely honest, successfully detecting abnormally high levels of hGH is not an exact science just yet.
• Suspended players will be subjected to more stringent testing—consisting of six random urine tests and three random blood tests each year for the rest of his career.
• Each player will have at least one sample run under a special type of mass spectrometry (IRMS) each year, which is much more in-depth than the generic "pee in a cup" testing.
• All weight rooms are to be stocked with legal supplements on a year-round basis for players to use without the fear of resulting in a positive drug test.

Finally, I noticed they added DHEA to the prohibited substances list, and at first, it puzzled me. DHEA stands for dehydroepiandrosterone, and it is an already abundant hormone, especially in males, made naturally in the human body. However, as you enter your late twenties, DHEA levels decrease, so it may be understandable for players to want to replace what they've lost from their younger years.

Well, according to the Natural Medicines Comprehensive Database (requires subscription), DHEA has many uses, including "increasing strength, energy, and muscle mass." However, don't let that fool you because manufacturers of a non-prescription products like DHEA have pretty lax rules when it comes to describing the potential uses of their product. On the other hand, prescription drugs require rigorous testing done by the FDA before a use can be designated to the given drug.

Thus, if you continue reading, the effectiveness section of DHEA clearly states, "Although DHEA is often used for muscle development, preliminary research suggests DHEA does not affect muscle precursor cells called satellite cells, which are thought to cause muscular hypertrophy." Why just "preliminary research" you ask? Because like I stated above, non-prescription products aren't put through the stringent testing protocol required for prescription drug products.

To be honest, the high doses and length of treatment needed to have even a minimal positive effect on an athlete's performance can potentially lead to negative effects such as an increased risk of cancers, the development of diabetes, and increased blood pressure. If I am a twenty or thirty year old athlete, I don't know if I am willing to take that kind of health risk. Regardless, I was not really convinced that baseball players actually used this product for performance enhancement, and it appears that at least one reliable source agrees with me:

Adding dhea to the banned list is notable not because anyone uses it to dope, but because some players had tested + and said dhea caused it.

— T.J. Quinn (@TJQuinnESPN) March 28, 2014

Remember when I used some of my pharmacy notes for that cortisone shot post earlier this month? Well, I am doing it again—this time comparing the structures of testosterone and newly-prohibited DHEA:

As you can see, the two drug structures look pretty similar to the average human eye. Well, to expand on Mr. Quinn's tweet, some player probably tested positive for testosterone, and instead of owning up to the suspension, he hired a lawyer to make a case for him, find some loophole to get out of trouble. The lawyer probably did a quick Google image search and saw what he believed two very similar drug structures. In turn, the lawyer probably told the MLB that the positive test was actually due to DHEA (legal at the time) and not testosterone.There was one major problem for both the player and the lawyer, though. Telling the difference between the two is actually quite easy, especially for certified laboratory specialists hired by the MLB.

Thus, instead of having to deal with cases like this on a regular basis, the MLB decided it was best to just prohibit it completely. Players should probably thank the MLB for this because the adverse effects associated with the use of it far outweigh the benefits in my clinical opinion.

So, what else is on the list of prohibited substances?

The list of prohibited substances contains over 135 drugs and is broken up into three categories: drugs of abuse, performance enhancing substances, and stimulants. Instead of listing all the banned substances (booooringgg), I will list some commonly abused drugs from each category.

Drugs of Abuse: 8 on the list

Marijuana, cocaine, oxycodone, and morphine.

Performance Enhancing Substances: 70 on the list

Anabolic steroids (many types), testosterone, hGH, IGF-1, LH, hCG, anastrozole, tamoxifen, and clomiphene.

*Note: Many of these "PEDs" have common therapeutic uses in patients, and I dispense many of them on a regular basis.

Stimulants: 56 on the list

Amphetamine, ephedrine, methylphenidate (Ritalin), modafinil (Provigil), and phentermine (Suprenza).

I am actually quite surprised that lisdexamfetamine (an extremely powerful stimulant; brand name: Vyvanse) is not explicitly listed, but my guess is that since it is so similar to many other banned stimulants already on the list, it's illegality is implied.

What questions do you have?