Mid-Atlantic States Move To Restrict Clenbuterol Use

Continuing a decades-long regional effort to enact uniform medication, safety and welfare reforms, protocols and rules, a coalition of 31 regulatory and stakeholder organizations representing all seven states in the Mid-Atlantic region have unanimously agreed to work together to implement a new rule that will significantly restrict the improper use of the bronchodilator clenbuterol.

Under the current regional rule, clenbuterol may not be administered to a horse within 14 days of a race, and the concentration of the drug in a post-race blood sample may not exceed 140 picograms/ml. The new rule will eliminate the existing testing threshold, require regulatory approval in advance for a horse in racing or training that is prescribed the medication, mandate that the horse be placed on the Veterinarian's List, and bar the horse from racing until it tests negative in both blood and urine and completes a satisfactory workout observed by a regulatory veterinarian.

The move to restrict the use of clenbuterol in racing was made during a Mid-Atlantic Zoom meeting held Oct. 15, 2020. The meeting was attended by more than 60 stakeholder leaders from the seven states and regulatory jurisdictions that have committed to the Mid-Atlantic Strategic Plan to Reduce Equine Fatalities. During this meeting, N.Y.S. Gaming Commission Equine Medical Director Dr. Scott Palmer presented data collected from a recent out-of-competition sampling program. Dr. Palmer indicated that the Commission required all horses trained by federally indicted individuals to submit to hair testing for prohibited and impermissible substances prior to those horses being allowed to return to racing.

“The Commission's hair testing review found that clenbuterol was administered to a substantial number of these horses without evidence of a medical prescription,” Dr. Palmer said. “In addition to being a useful therapeutic medication to treat respiratory disease, clenbuterol has re-partitioning effects that can enhance muscle development. Clenbuterol should not be administered to racehorses without a legitimate treatment plan and a proper diagnosis. This new rule will eliminate the improper use of clenbuterol.”

Maryland began their rulemaking process on Oct. 22 and will apply the new restricted rule to both Thoroughbred and Standardbred racehorses. New York plans to propose a rule amendment in November. The other jurisdictions will follow suit, navigating the regulatory process necessary for enactment in each state for racing in 2021.

“The Mid-Atlantic's collective work has spearheaded significant industry medication reforms over the years, including the bans on steroids in 2008 and, most recently, the use of bisphosphonates in 2019 and thyroid supplementation earlier this year,” said Thoroughbred Horsemen's Association Chairman Alan Foreman, who has facilitated the Mid-Atlantic meetings since their inception. “The region's Uniform Medication and Drug Testing Program in 2014 ultimately became the National Uniform Medication Program. Everyone in the region, including regulators, racetrack operators, horsemen, breeders and veterinarians, is committed to the implementation of the Strategic Plan to Reduce Equine Fatalities. Working together, we have made, and continue to make, real change.”

The new clenbuterol rule is as follows:

  1. Clenbuterol use is prohibited in racing and training unless the following conditions are met:
    a. The prescription for clenbuterol is made for a specific horse based upon a specific diagnosis. The prescription and volume dispensed cannot exceed a treatment period of 30 days.
    b. The veterinarian must provide a copy of the prescription and diagnosis to the Equine Medical Director for review and approval. The horse may not receive clenbuterol before this approval is issued.
    c. Trainers must make daily notification to the official veterinarian of horse(s) in their custody having been administered clenbuterol. Notification shall be made on a form and by a deadline designated by the Commission.
    d. A horse administered clenbuterol shall be placed on the official veterinarian's list. The horse must meet all conditions for removal from the list including a timed workout and blood and urine sampling. Both samples must have no detectable clenbuterol.
    e. A horse may not enter to race until it has completed all the requirements in subdivision (d).
  2. If a clenbuterol is detected in a horse's post-race or out of competition sample and appropriate notification as outlined in subdivision 1(a) or (b) was not completed, the horse shall immediately be placed on the Official Veterinarian's List pending the outcome of an investigation. The horse shall be required to meet all conditions for removal from the veterinarian's list outlined in subdivision 1(d), above.

The Mid-Atlantic stakeholders and regulators who have committed to the Strategic Plan include Delaware Park, DTHA, Delaware Racing Commission, Maryland Jockey Club, Maryland State Fair (Timonium), MTHA, Maryland Racing Commission, Maryland Horse Breeders Association, Monmouth Park, NJTHA, New Jersey Racing Commission, New Jersey Thoroughbred Breeders Association, Finger Lakes Racetrack, Finger Lakes HBPA, NYTHA, New York State Gaming Commission, New York Thoroughbred Breeders Inc., Penn National Gaming, Parx Racing, Presque Isle Downs, PTHA, Pennsylvania HBPA, Pennsylvania Horse Racing Commission, Pennsylvania Horse Breeders Association, Colonial Downs, Virginia Racing Commission, Charles Town, Mountaineer Park, Charles Town HBPA, Mountaineer HBPA, West Virginia Racing Commission, and the National Steeplechase Association.

Click here for a copy of the Strategic Plan.

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Even With Screening, Equine Cardiac Problems Prove Difficult To Catch

Regulatory veterinarians say it's not as easy as you'd think to pick up on heart problems in racehorses.

That was one of the takeaways from this year's Welfare and Safety of the Racehorse Summit, held this year through a series of online webinars due to COVID-19. In the conclusion of the series, veterinary epidemiologist Dr. Tim Parkin noted that while equine fatalities due to musculoskeletal injury have gone down in the decade he has tracked injuries, fatalities due to other causes have not improved. Musculoskeletal injuries make up 93 percent of fatal injuries, but on-track deaths can sometimes have other causes, like cardiac problems. Parkin said he believed the reason musculoskeletal injuries had gone down was because most of the health and welfare reforms initiated around the country thus far were focused on limbs and lameness.

The trouble is, cardiac problems aren't that easily detected in horses.

In 2016, we spoke to Dr. Sophy Jesty of the Charleston Veterinary Referral Center who is board certified in large animal internal medicine and cardiology. Jesty explained that horses do not have “heart attacks” the way humans do. A human heart attack is the result of a blocked artery which kills part of the heart muscle. Horses do not experience this, but they can experience things that look like heart attacks — including a ruptured aorta, which may be undetectable until the horse bleeds out internally and collapses, or an arrhythmia (abnormal beat).

At the time of that interview, regulatory veterinarians were growing more curious about the best way to screen horses for arrhythmias. In a separate session of the Welfare and Safety Summit this year, New York's equine medical director revealed he had done some informal screenings with an inexpensive handheld ECG device, but he didn't find much.

“One of the problems I encountered in our necropsy program we had a number of horses had experienced exercise-induced sudden death on our racetracks and nearly 70 percent of those horses were necropsy negative, meaning there was no obvious answer for what had happened,” said Dr. Scott Palmer. “This backs us in to the conclusion that cardiac arrhythmias could be the cause of death, and I thought, 'Gee, we probably ought to look at that a little bit.'

“Interestingly, I've examined more than 200 horses so far with this thing and have never found a cardiac arrhythmia where I'd say this horse can't race.”

In Maryland, veterinarians listen to horses with a stethoscope as part of the standard pre-race exam and have done so for the past four to five years, according to Mike Hopkins, executive director of the Maryland Racing Commission. Hopkins said the team of veterinarians estimate they have discovered fewer than ten cases of arrhythmias in that time. There were 3,883 starters in the state of Maryland last year.

Those familiar with arrhythmias in horses probably wouldn't find that surprising. Although the scientific community is still learning about cardiac problems in horses, many experts believe that some equine arrhythmias probably show up only when the horse is in work, and may be induced by the adrenaline rush a horse experiences in a race.

Palmer said that although he didn't find any rhythms of concern, that wouldn't discourage him from continuing to look.

“With that said, I believe that we should at least be looking at these horses for arrhythmias,” he continued. “I know horses have normal murmurs and I know they can have normal arrhythmias that disappear at exercise. I also know that horses do die of exercise-induced arrhythmias. I think the presence of atrial fibrillation or other significant arrhythmias, I think those horses should be scratched. And to be honest, if we don't look for it, we certainly never will find it.”

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