Medication rules in American Thoroughbred racing are built on trainer responsibility and there really isn't any other way. If a horse tests positive for a banned substance, or above the legal limit for an approved substance, the trainer gets the blame. But trainer Graham Motion, hit with the first medication violation in his 23-year career this week, questions the mechanics of such a standard.
"Trainers are responsible, but we can't control the way the samples get handled, we can't control security in the barn area and we go by guidelines given to us," he said Thursday. "If a horse has an infection I've got to give him antibiotics and I've got to ask five vets what antibiotics to give him. The answer depends on what state we're going to run in. It shouldn't be this way."
Trainer Rusty Arnold agrees with Motion, and said trainers sweat medication rules now more than ever because of the various withdrawal guidelines, sensitive testing procedures and the penalties in place.
"The lab testing has gotten so good and we're picking up therapeutic medications and taking purses and giving guys days based on that," Arnold said. "You've got to distinguish between something like that, something that has no bearing on performance, and something serious like a pain killer. I don't know the answer, but something's got to be done.
"Something's got to happen that distinguishes between a guy who wants to cheat and a guy who did nothing but treat a horse."
The Motion-trained Kitten's Point had some muscle stiffness and was prescribed methocarbamol, a muscle relaxant permitted in racing as a controlled therapeutic substance (a Class C drug under Kentucky rules). After winning the Bewitch Stakes at Keeneland in April, she tested above the legal limit of 1 ng/ml and was eventually - after confirmation by split sample and a stewards' hearing - disqualified from the win. Motion was fined $500 and suspended five days.
Motion appealed the decision based on the guidelines he and his staff followed. He maintains that no mistake was made. Motion said the treatment - which ceased seven days before racing - was conservative, and should not have resulted in a violation based on the withdrawal guidelines used in Kentucky and published as part of the National Uniform Medication Program. Methocarbamol, often used under the brand name Robaxin, is one of 24 controlled therapeutic substances listed. Each has a withdrawal time, threshold and dosage upon which the limits are based.
"I followed the guidelines, and after talking to all my staff, no one made any mistakes," Motion said. "We followed protocol, way beyond the recommendations but still came up with high reading. Yes the filly was on Robaxin. I can't do any more myself than conservatively follow the guidelines."
In response to a statement from Motion about the case, the Racing Medication Testing Consortium issued a reply Thursday, citing 2014 research conducted at the University of Florida's racing laboratory.
The statement text, from executive director Dionne Benson, included:
The Kentucky Horse Racing Commission recently suspended trainer Graham Motion for five days and fined him $500 for a medication overage involving the winner Kitten's Point in Keeneland's Bewitch Stakes. Kentucky officials determined that Kitten's Point had a methocarbamol (Robaxin) level of 2.9 nanograms per milliliter of blood when tested following the race. Robaxin is a muscle relaxant that both the RMTC and Kentucky recommend can be administered up to 48 hours before a race when following specific treatment protocols. Methocarbomol carries a 1.0 ng/ml race day threshold level. Motion has questioned the research underlying this threshold and the recommended withdrawal guidelines for methocarbomol in Kentucky.
The methocarbamol threshold is recommended by the RMTC and included in the Controlled Therapeutic Medication list that is part of the National Uniform Medication Program. The recommendation is based upon research that is published in Rumpler, M., et al., The pharmacokinetics of methocarbamol and guaifenesin after single intravenous and multiple-dose oral administration of methocarbamol in the horse, J. Vet. Pharmacol. Therap., 37(1): 25-34 (Feb. 2014). The threshold is based upon a single 15 mg/kg intravenous dose, but a subset of the horses was also subject to an additional oral dose regimen of 5 grams of methocarbamol every 12 hours for five doses. At 48 hours, all oral dose horses were below 1 ng/ml of plasma with the highest concentration being at 0.5 ng/ml of plasma.
These treatment protocols were set based upon a survey of AAEP practitioners, as is our standard practice. Practitioners indicated a range of doses and a range of treatment protocols - including, in some cases, a single 48-hour pre-race administration of methocarbamol intravenously. Many protocols and treatment plans are possible for horses. The RMTC publishes specific dose and route of administration protocols to provide the practitioner and trainer information on how to meet the regulatory threshold using the listed withdrawal guidelines.
If a trainer or veterinarian elects to administer a higher dose, use a different route of administration, or a longer duration of treatment than described in the recommendation, the withdrawal guideline will not apply to their situation. It is imperative that when a trainer elects to deviate from the threshold protocol that they do so in consultation with their veterinarians or - as permitted in Kentucky and other states - submit a sample for analysis prior to entry to help ensure the medication concentration is below the regulatory threshold.Depending on drug, especially oral preparations, there is always the possibility a horse was mistakenly treated or not all drug treatments were recorded.
Motion also challenges the regulation of medications to the level of nanograms/mL and picograms/mL. The RMTC has attempted to regulate as many medications as possible in blood. Such minute concentrations in blood are pharmacologically active for many drugs. The same is true for some drugs when found in urine. For this reason, several medications are regulated at concentrations expressed in picograms/mL in the horse. While picogram/mLconcentrations may seem small, the concentration of each of these medications falls below nanograms/mL in blood quickly. In fact, in every case where medications are regulated at thresholds expressed at pg/mL in blood, the concentration of each was below 1 ng/mL at 24 hours in research studies. In order to effectively regulate these beyond 24 hours, lower thresholds are required.
Motion's veterinarian Dr. Luis Castro said that, while the RMTC guidelines work for pre-race treatments, therapeutic use of methocarbamol regularly involves different dosing and schedules. Castro also pointed to soon-to-be published research on longer-term methocarbamol usage.
"As a pre-race, which the majority of Robaxin use at racetracks is, 48 hours works and it will clear," Castro said. "I know that because I use the RMTC study. But that's not based on a real-life, therapeutic dose that actually makes a difference."
Castro said a therapeutic dose involves a week or more of treatment - multiple tablets dissolved in water twice a day. While commonly called a muscle relaxant, Castro said methocarbamol actually affects the central nervous system to cause muscle relaxation. Kitten's Point's treatment with methocarbamol, originally prescribed by a veterinarian in California, was stopped seven days before she ran - in January at Santa Anita, in February and March at Gulfstream Park and in April at Keeneland - but continued during training.
Based on the information they had then, Motion and his veterinarians thought that was a cautious approach.
"When a horse is prescribed it, it's not a one-dose medication," Motion said. "We're going on guidelines based on limited research or what seems like limited research."
The RMTC maintains that the threshold was developed with extensive research. Castro agrees, but said the standards may soon change based on new science.
The veterinarian compared methocarbamol to flunixin and clenbuterol in terms of withdrawal times being changed because of new data from studies and improved testing standards. In both cases, violations helped spur longer withdrawal periods because researchers learned more about the drugs and their clearance rates. Flunixin moved from 24 hours to 48 hours, for example, and clenbuterol from a variety of time frames depending on the state to 14 days. At least one state jurisdiction, New York, lists a methocarbamol withdrawal time of 72 hours.
"I understood completely what we were doing didn't get addressed by the RMTC study," Castro said of Kitten's Point's treatment. "The fact that they recommended the 48-hour withdrawal is not carte blanche."
Castro pointed to the pending research as a spur for change.
"In the end we're going to find out better science," he said. "I have no doubt that this will change the methocarbamol withdrawal once it's published."
In the interim, Motion presses on with an appeal to the Kentucky Horse Racing Commission. The process will involve attorneys, experts, hours of work. He said the effort is about more than a $500 fine and a five-day suspension.
"For different reasons we feel like this is not being handled right," he said. "We need to defend ourselves and trainers in general. The system is a vicious cycle because the penalties are so small it's much easier to move on rather than fight them because we never get anywhere. We never deal with it or face up to the situation."
The trainer is a proponent of national medication rules, and agrees with the progress being made on that front. But also says there is work to be done.
"Everybody should be held to the same standard, every state, every lab, every room where they take the samples, there shouldn't be guesswork," he said. "Every time I treat a horse I say to the vet, ‘Are we OK with this medication?' Part of (the appeal) is personal, but I feel like the system is broken and I feel a responsibility to follow through with this."
Arnold wishes him luck.
"Will he win the appeal? I don't think so, because it's there. But maybe," Arnold said. "Seven days is the last known day (the medication was given) but mistakes happen everywhere. Or you can have a horse that carries it longer. The RMTC analogy is a guideline, we know that. You do the best you can, but you win a race and you're not happy for about a week."
Arnold passed some of the blame for the current climate to trainers.
"We're part of the problem," he said. "When somebody else has (a violation) nobody worries about the rules. I had a talk with (trainer) Tom Amoss once, and he said ‘You don't realize how alone you are on these things until you have one.' It's you and you out there by yourself. That's a horsemen thing and we can do better."