At a virtual meeting on Sept. 28, Maryland horsemen tried to understand what the newest change in corticosteroid testing in the state will mean for them. The Maryland Racing Commission last week approved a motion to remove testing thresholds for five different corticosteroids and begin using the laboratory's limit of detection for all five drugs.
While that sounds like a big change, experts on the call said it's mostly intended to bring testing into line with the regulations the commission approved in 2019.
In the wake of the Santa Anita fatality spike of 2018-19, The Stronach Group and the California Horse Racing Board determined that backing out the last acceptable administration for intra-articular corticosteroids and other drugs was beneficial to equine safety, because it reduced the likelihood that the drugs could cloud a veterinarian's assessment of a horse pre-race and also the chance for a horse with an underlying problem to continue running. In 2019, with this background in mind, Maryland adopted Association of Racing Commissioners International (ARCI) model rules backing up the administration of intra-articular corticosteroids including prednisolone, betamethasone, isoflupredone and triamcinolone, from seven days pre-race to 14 days pre-race.
The problem, officials say, is that the testing laboratory contracted at that time — Truesdail Laboratories of Irvine, Calif., — did not change the threshold they used to determine whether a sample was positive for corticosteroids or not. From that regulation change in 2019 until April 2021 when the contract expired, it was illegal to give the drugs in the joint closer than 14 days pre-race, but the only way the commission could have caught someone was through surveillance, or if they turned in a treatment sheet showing an administration in the prohibited timeframe. Testing was only going to pick up an administration within one week.
(This wasn't the first or only issue racing jurisdictions discovered with Truesdail, which in 2015 was the subject of a quality control audit by the Indiana Horse Racing Commission which found that seven positive tests were missed over a 26-day period.)
When Industrial Laboratories of Wheat Ridge, Colo., began testing for Maryland, it implemented a threshold that would catch corticosteroids at 14 days. The lab also implemented thresholds to match the 72-hour withdrawal requirement given for intramuscular or intravenous administration of dexamethasone, which is also a corticosteroid.
That's when there were a handful of high-profile positives, including one from trainer Claudio Gonzalez. Gonzalez and others told the commission they had been giving dexamethasone inside the 72-hour window but at a lower dose and had previously had no trouble with positives.
The trouble with using a threshold, according to Racing Medication and Testing Consortium executive director Dr. Mary Scollay and The Stronach Group's equine medical director Dr. Dionne Benson, is people get focused on the threshold itself. (And some trainers like Gonzalez figure out how to beat thresholds by giving lesser doses closer in to races.) What regulators are hoping trainers will begin doing instead is following withdrawal guidelines.
“It quite frankly is the best and only way to regulate these drugs,” said Alan Foreman, chairman of the Thoroughbred Horsemen's Association.
By removing thresholds, track officials and the commission believe they can more precisely recognize when someone has violated administration rules. Now, these corticosteroids will be tested at the limit of laboratory detection — which the laboratory generally does not want to publish. All the public knows is that limit of detection is greater than 0. British data suggests that the safest timeframe for IV or IM dexamethasone administration in a “limit of detection” scenario is five days. Scollay stressed that it isn't illegal for trainers to give that drug through either IV or IM injection at 72 hours, but that could come with an increased risk of a positive test. It's also true, however, that different labs have different limits of detection, and that should be worrying to horsemen who travel.
“You should not, with confidence, cross state lines and say I was giving it at 72 hours in Maryland and I'm going to be ok in California doing it the same way, because chances are you may not,” she said. “Their limit of detection may be lower … that's where the five-day guidance comes in. It gives you that added safety for labs that may have a lower limit of detection.”
Intra-articular corticosteroid injections are regulated by date of administration, not lab results, though lab results can help regulators catch someone breaking the rules on those.
According to Benson, these changes will go into effect Nov. 2. At that point, the lab will begin reporting whatever corticosteroids it can see in a sample.
“The risk [of a positive test] is no different than it has been,” said veterinarian Dr. Tom Bowman, who chairs the Equine Safety Health and Welfare Advisory Committee of the Maryland Racing Commission. “The level of awareness [is] — you now know that five days out is safer than three days.”
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