Meldonium Use in Sports: Analysis of Athlete Data from Baku 2015 Games

This essay examines the use of meldonium by athletes during the Baku 2015 European Games, highlighting the discrepancies between self-reported declarations and laboratory test results. The analysis draws upon data from the European Olympic Committees (EOC) Medical and Anti-Doping Commission, revealing a significant under-reporting of meldonium use among athletes from various National Olympic Committees (NOCs). The study also explores the potential reasons for this under-reporting, including concerns about anti-doping surveillance and a lack of transparency. The essay concludes by emphasizing the need for improved engagement with athletes and enhanced awareness of the performance-enhancing potential of meldonium, advocating for more effective strategies in the fight against doping in sports.

A research conducted by the Medical XPress (2016, March 9), highlights the fact that the use of
meldonium among athletes is increasingly huge. The Baku 2015 European Games that took place in
Azerbaijan, between 12th and 28th June 2015, the use of meldoniumhit the headlines. A report by Stuart et
al. (2016) confirms that indeed there was a huge consumption of meldonium by dozens of the 5632
competing athletes. Investigations on the use of meldonium have consequently prompted the World Anti-
Doping Agency (WADA) Monitoring Program, to enlist the drug under surveillance for substances
associated with doping.
Notwithstanding medical regimes allowing the use of meldonium in a number of countries in
Eastern Europe, WADA Monitoring Program feels the need to raise awareness for future decisions on the
use of meldonium prescribed to athletes. The anecdotal reports obtained from the London 2012 Olympic
and Paralympic Games (Stuart et al. 2016) supports this claim. However, it remains unclear as to whether
a legitimate use of meldonium by majority of athletes in the Baku 2015 European Games, is a reason to
discredit the use of meldonium. A possible solution to this question can be given by sources of data and
analysis carried out.
The European Olympic Committees (EOC) Medical and Anti-Doping Commission was mandated
to analyze the data samples, that included a declaration by athletes and their medical teams, and a urine or
blood sample. A procedural testing of these samples was done in WADA’s distinct laboratories and the
results were to form part of the Monitoring Program surveillance. The results were obtained from 864
tests performed either on urine that had 762 tests and 102 samples tested for blood. However, despite 80%
(525) of the 662 athletes making a self-reported declaration for medication among the tested athletes, only
3.5% (23) of the 662 athletes declared having administered meldonium at the period of the Games.
Nevertheless, the laboratory tests confirmed that it was not the 23 athletes alone that confirmed to have
used meldonium but a total of 63 out of the 662 athletes tested.
Furthermore, this under reporting of the presence of meldonium among athletes continues to raise
questions most especially when data was collected on the medicines imported by the NOC teams. The

report indicates that the Games Medical Services received declarations from only 2 out of 50 NOCs at the
Games on actual importation of meldonium into Azerbaijan. With primary reasons to be prescribed by
their team doctors, it is evident that information is intentionally withheld particularly where only two
countries confirms to have active use of meldonium, but an addition of 4 more countries is confirmed by
athletes who disclose its use on the doping control forms. Lastly, we can draw solid conclusions that both
the NOC and athletes chose not to disclose the possession of meldonium through importation or otherwise
personal supplies, whether on legitimate use or not (Stuart et al. 2016).
The widespread use of the drug among athletes and the lack of full disclosure to its possession
and use, is a reason to worry especially to the WADA. The use of meldonium in the Games was
confirmed to 15 out of 21 sports, and this was a sample of 46 out of the 50 participating NOCs. While
assessing the under-reporting claims observed among the self-reported tests forms by athletes who
confirmed to use the drug, it is quite impossible to get information about the countries of the general
widespread use of meldonium by countries. The anonymous reporting is itself a challenge when such
cases are investigated, however, confidential details of athletes should be observed.
Assessing the prevalence of the drug is also important to consider its accessibility and availability
to athletes across Europe. For instance, in countries that use meldonium for medical use and prescribe it
to athletes, addup its total usage as analyzed by the WADA laboratories. Although, at most seven
countries, whose athletes competed at Baku 2015 Games, had legitimate use of meldonium for medical
purposes, it was a small representation of 23% of the total athlete population at the Games. Stuart et al.
2016, agrees that there was a strong correlation between countries registered to administer meldonium
and the prevalence use of the drug by athletes. This arises a possibility of athletes whose countries
prohibit the use of meldonium, to acquire it through importation routes. Therefore, it is arguably
estimated that the entire athlete population that might have used the medicine could range between 112
and 490 athletes.

As there could be an overestimation through these extrapolations since a test was only done to a
sample of the athlete population.There is reason to believe that the evidence of huge under-reported cases
of this drug use by athletes was aimed to prevent the anti-doping agencies to know about the use of
meldonium among the athletes. The causes of such incidences could be many that relates to how the
WADA Monitoring Program handles the surveillance and the feedback received from athletes. It is
important that new techniques be implemented that will provide transparency and create awareness in the
fight against doping.
In my opinion as concluded by the research study with Gorgens et al. (2015), indeed meldonium
has potential for enhancing performance particularly among elite athletes. Therefore, this understanding
can be shared well in advance to all countries, athletes and their medical teams. It is of great significance
that WADA Monitoring Program develops ways of engaging athletes to allow full disclosure about their
prescribed medication or nutritional supplements.
References
Gorgens, C., Guddat, S., Dib, J., Geyer, H., Schanzer, W., &Thevis, M. (2015). Mildronate (Meldonium)
in professional sports-monitoring doping control urine samples using hydrophilic interaction
liquid chromatography – high resolution/high accuracy mass spectrometry. Drug and Testing
Analysis
Medical XPress. (2016, March 9). Widespread use of meldonium among elite athletes, research shows.
British Medical Journal, retrieved from: https://www.medicalxpress.com/pdf376741689.pdf
Stuart, M., Schneider, C., & Steinbach, K. (2016). Meldonium use by athletes at the Baku 2015 European
Games. Br Journal of Sports Medicine, vol. 50, pp. 694-698