By now, you’ve obviously heard the news – Medina Spirit, trained by Bob Baffert, tested positive for Betamethasone following his victory in the 2021 Kentucky Derby. This is clearly an evolving story and we are not here to litigate in public, but the topic is worth addressing, in a factual manner.
Let me start by saying that I’m a pharmacist by training but also add that I have no formal experience as it relates to pharmacy applied to horses. I’m approaching the news from this past weekend like many of you, from the perspective of a horseplayer. There are few opportunities where my vocation and “hobby” overlap and it goes without saying that I wish this wasn’t the situation that makes it possible.
Horse Racing Twitter is a melting pot of hot takes, red boarding, inside information, and tons of opinions – some of which are based on incorrect information. All of that was on full display early Sunday morning after a brief press conference on the Churchill Downs backside.
While we await the results of the “split sample” and other elements of due process to play out, I wanted to attempt to provide some clarity on the topic of Betamethasone.
Simply put, Betamethasone is a steroid. Specifically, it’s a corticosteroid and is most commonly used for its anti-inflammatory properties. Put differently, it should not invoke images of body-builders.
That’s not to dismiss the utility of Betamethasone in thoroughbreds, indeed it can potentially mask injuries and allow training and racing in horses that might not be able to without its use. As such, it’s tightly regulated.
It’s reported (via Baffert press conference) that Medina Spirit had 21pg/mL (Picograms per Milliliter) in his post-race sample from May 1st. In Kentucky, no amount is allowable, though in previous years a threshold of 10pg/mL was in place. There is a role for Betamethasone, as a therapeutic agent, and current Kentucky regulations require it not to be administered within 14 days of a race. Generally, when this guidance is appropriately followed, the drug is fully cleared from the blood (note, I didn’t say body). In fact, the drug is generally cleared within seven days so this is very a conservative guideline.
Many of Baffert’s defenders, along with the trainer himself, have pointed to the minuscule amount of the substance that was found in the sample. On Sunday morning he refers to the amount as “a trillionth of a gram” – and while not wholly incorrect, it’s my opinion that it is irrelevant.
The sample taken, and the amount reported, comes from blood. The drug is typically injected in a joint (intra-articular) as that’s the place in the body you want it to exert its effects. Most steroids, in horses, take about five times as long to clear from the joint as compared to blood. Another way to think about this – If it’s detectable in the blood, it’s most certainly still present at the injection site.
I’ve tried to come up with an analogy that will help the layperson understand this concept and it’s a challenge. But suppose you put some fertilizer on your lawn. And for whatever reason, the easiest way for you to measure how much you used was to take a soil sample from your neighbor’s yard. So you collect a sample from their yard and you detect a small amount of fertilizer – is that fully representative of what you put on your yard? No. Again, imperfect, but close.
More on the amount reportedly present in Medina Spirit on race day…Betamethasone is given (usually) as a 9mg intra-articular injection. Stay with me here. This means that 0.009 Grams are injected into the joint of the treated horse. That amount of drug is then diluted within the joint space and some of it makes its way to the blood – further dilution occurs. So the amount reported (21pg) is not a total amount, it’s a concentration, meaning the amount detected in each millimeter of blood sample. That’s important because typically, the highest levels detected after the customary injection is around 4ng/mL (nanograms per milliliter). Which is equivalent to 4,000pg/mL – so again, the hyperbole of “trillionth of a gram” is completely irrelevant. And without getting too technical, the half-life of the drug, in horse plasma is around eight hours. So every eight hours the amount of drug that is present would decrease by one-half.
This situation was further complicated on Sunday morning as Baffert vehemently stated that Medina Spirit had never been treated with Betamethasone. Assuming the split sample comes back positive, there are only a few possibilities that exist.
- Baffert is lying
- There was contamination
- Baffert isn’t lying – He just wasn’t aware of the treatment
- Something else caused the positive Betamethasone test
It seems unlikely that option 2 occurred as it’s been reported that no other samples (from other horses) were positive.
The implications of option 1 and even 3 seem obvious to me. There has to be accountability, full stop. As horseplayers, we all have opinions, and they’re different, so the punishments suggested will cover a range of possibilities.
Personally, option 4 is the scariest. Let me be very clear – I’m not suggesting the following is likely or for that matter, even possible. With the 2020 indictments of Jason Servis and Jorge Navarro, we learned that SGF-1000, while undetectable by current testing standards, can produce a “false positive” for dexamethasone – a corticosteroid, like Betamethasone. From a chemical structure standpoint, dexamethasone and Betamethasone differ by a single methyl group. They’re different to be sure but it’s like Coke vs. Pepsi. Could a false positive be in play here? I’m not sure, I don’t know enough about SGF-1000 to comment but if that statement from the FBI documents is accurate, it’s within reason.
Where we go from here is not the subject of this article. Personally, I was “brought” into this game by Bob Baffert as Real Quiet won the 1998 Kentucky Derby. It would be a shame and more than a little ironic if he were to help usher me out the door over 20 years later. Like you, I’m fed up, but for now, I’ll wait for the due process and go from there.