McCullum confronts drug test ‘rumblings’
Brendon McCullum looked out at the thick smog engulfing the Feroz Shah Kotla ground in New Delhi as he warmed up for his Gujarat Lions side’s IPL match. He knew he was in for an uncomfortable day.
It was late April 2016 and pollution was choking the city, with some parts of Delhi recording air quality readings five times more than what the World Health Organisation considers ‘‘unhealthy’’. That year, Delhi’s High Court compared conditions in the city to ‘‘living in a gas chamber’’ after official statistics collated by the country’s Environmental Pollution Control Agency revealed 3000 premature deaths a year are the result of air pollution.
McCullum, who was diagnosed with asthma as a child, says he has always struggled when he plays in Delhi, but this day conditions were among the worst he had encountered. He took a series of puffs on his ‘‘reliever’’ inhaler to get through the game.
The former Black Caps skipper went on to belt 60 runs off 36 balls as the Lions scraped to a one-run win over the Delhi Daredevils. It would be the first of two lucky escapes in the game.
Six months later, McCullum received a notice of investigation from the Board of Control for Cricket in India (BCCI) informing him a urine sample taken after the game had returned an adverse analytical finding (AAF). The levels in his system indicated he had exceeded the maximum dose of salbutamol allowable under the World AntiDoping Agency (Wada) code.
His doctors and support team would spend the next three months fighting to avoid a ban.
Salbutamol, commonly known as ventolin and contained within a blue inhaler, is a specified substance on Wada’s prohibited list.
Athletes with asthma do not require a therapeutic use exemption (TUE) for ventolin as it is found to have little to no performance enhancing benefit to non-asthmatic athletes. There is, however, a maximum dosage set out by Wada of 800 micrograms per 12 hours, or 1600 micrograms per 24 hours.
Wada rules state any dosage above that is not consistent with therapeutic use of the substance and will be considered as an AAF unless the athlete proves, through a controlled pharmacokinetic study, that the abnormal result was the result of a therapeutic dose (by inhalation).
The overuse of asthma medication has come under the spotlight after British cyclist Chris Froome was found to have elevated levels of salbutamol in his system during the 2017 Vuelta a Espana. The publicity around Froome, who is still allowed to compete while he waits an outcome on his case, has seen the humble blue inhaler recast as a tool for doping.
But with several cases emerging in New Zealand of genuine asthmatics falling foul of the Wada rules, leading sports lawyers and medical experts have raised questions over the science and rationale behind the anti-doping agency’s rules for asthma medication.
In January 2017, McCullum was cleared of an anti-doping rule violation after a retrospective TUE was issued by a panel of independent medical experts in Sweden. But not before hundreds of collective man hours were spent on compiling medical records, evidence of previous TUEs that had been granted for ventolin prior to a rule change in 2010, testimony from medical staff and detailed atmospheric charts in Delhi on the day in question.
‘‘There was a bit of a process to go through to make sure they had all the information and ticked off the areas they wanted to see, but we went through it all and [the BCCI] were actually pretty good to work with in the end,’’ says McCullum, who is now breathing in the fresh country air in Matamata.
‘‘I certainly don’t see it as a failed drug test. It was just a case of we just need to seek clarification and apply for this.
‘‘I have no ill-feeling about [the process] and I also have no guilt or remorse about it because I needed a puff of my inhaler at that time.’’
While McCullum’s case eventually reached what Henry Moore, NZ Cricket Players’ Association player services manager, describes as a ‘‘commonsense outcome’’, other Kiwi athletes have not been so lucky.
In July 2016, the Sports Tribunal handed down one-month bans to All Whites midfielder Clayton Lewis and softballer Craig Wallace after both were found to have committed antidoping rule violations by exceeding the maximum dosage of salbutamol.
Like McCullum, Lewis, who tested positive following a national league match for Auckland City in Dunedin earlier that year, argued environmental factors were behind his overuse of the medication. In his submission to the Sports Tribunal, Lewis, who was 19 at the time, said he had two puffs on his inhaler the evening before the game, and a further eight in the three hours prior to taking the field because he felt wheezy due to the cold night air in Dunedin.
The tribunal concluded Lewis was not a drug cheat, however he had ‘‘failed to understand his responsibilities to check the status of all medications including limits on the amount that can be used’’.
On the back of these cases, Drug Free Sport NZ in its 2016/17 annual report issued a stern reminder to athletes of the care that needs to be taken with asthma medication.
‘‘It is disappointing to note that once again, some adverse analytical findings [positive tests] could have been avoided had athletes paid more attention to the medication and supplements they were taking and carried out some rudimentary checks,’’ the report stated.
‘‘Of particular note for asthmatics, while some inhalers are permitted, there can be limits on the concentration of the medication permitted in samples. Going over the limit will trigger a positive test, so it is important that inhalers are used properly and as prescribed by a medical professional.’’
Prominent sports lawyer Aaron Lloyd has worked on three cases over the last 24 months which involved adverse findings for asthma medications. He believes the rules are harsh on athletes who have a documented history of asthma, and incredibly complex.
In his most recent case, Lloyd represented a Melbourne-based rugby player, who tested positive for salbutamol following a game for the Samoa ‘A’ side. The athlete had been struggling with his symptoms in the humidity of the islands and got exercise-induced asthma.
He copped a three-month ban. Adding to the complexity is the differing scientific opinion on the performance enhancing benefit of salbutamol.
Research has shown that inhaled beta-2 agonists, the swift-acting medications that in asthmatics relieve constriction in the airways, have a negligible effect on performance among non-asthmatics, even when used in high doses.
However, there are several studies that do show, in non-asthmatics, oral administration of salbutamol at higher doses can improve endurance.
There is also evidence that salbutamol has been prescribed among athletes – particularly cyclists – at much greater rates than the general population, ringing alarm bells for anti-doping authorities.
For many years athletes needing a ventolin inhaler could apply for a TUE, which, if granted, allowed them to use the medication as needed. This requirement was scrapped in 2010, when Wada instead imposed a maximum dosage.
But Lloyd says there seems to be a discrepancy between Wada’s view that salbutamol in urine over 1000 ng/ml (nanograms per millilitre) is not consistent with therapeutic use, and recent New Zealand cases which show there are situations when athletes have had to use more than the maximum dosage to alleviate symptoms.
‘‘It’s untidy, but for whatever reason, the powers that be at Wada have decided that it is a substance that can be abused for some kind of performance enhancing benefit. And on that basis that’s why they’ve set these therapeutic levels,’’ Lloyd says.
‘‘Wada need to make sure they get the science behind what asthma drugs are permitted, what are banned and what are banned at certain levels right, because at the moment I don’t think the sporting community have the confidence that they’ve got the right balance.’’
In a statement, Wada said: ‘‘The current threshold and the decision limit for salbutamol have been reviewed and adopted by the antidoping community. They are based upon the available evidence from scientific studies conducted by a number of different research groups.
‘‘It should also be pointed out that in rare cases, when athletes need to take therapeutic doses of inhaled salbutamol for legitimate medical reasons above the permitted dosage, the athlete may be able to obtain a Therapeutic Use Exemption.’’
Drug Free Sport NZ chief executive Nick Paterson says while some of the science may be confusing, the antidoping agency’s stance is clear and unambiguous.
‘‘The default position for all of our cases is the athlete is ultimately responsible for anything that is in their body. If you have a substance of too high a level in your body, you are responsible as a professional athlete to know what is in your body,’’ Paterson says.
But Moore, of the NZ Cricket Players’ Association, is concerned that the regulations are placing even more hurdles in front of asthmatics competing in high performance sport.
‘‘If we see a prevalence now of genuine asthmatics being caught up in anti-doping violations because they have inadvertently exceeded the allowable limit because they have felt they needed their inhaler and took more puffs than they usually would have, then that seems the rules are not serving the right purpose,’’ Moore says.
‘‘As soon as you have an anti-doping offence against your name, you are tarnished with that forever and everyone considers you to be a drugs cheat, regardless of the factors behind it.’’
Even rumours of dealings with antidoping authorities has the ability to tarnish reputations, says McCullum. As the Black Caps great, who had retired from international cricket at the time of the incident, was cleared of any rule violations, his case it not a matter of public record and he had no obligation to make it such.
He chose to set the record straight about the incident and allow people to make up their own minds.
‘‘I’ve heard this sort of rumbling around in the background for a while and I actually said to my wife, ‘I don’t know why we don’t just deal with this now, I’ve got nothing to hide and it is better off just talking about stuff rather than having other people talking about it’. Otherwise it just grows and festers,’’ he says.
‘‘As far as I am concerned it was just a matter of making sure we got everything signed off properly, rather than it being a failed drug test.
‘‘I don’t bat for long enough for it to make a difference anyway,’’ he jokes.
All applications are considered by an independent TUE committee made up of experienced medical experts.