Dr. Linda Celia Ellis is a long-time tennis fan and writer for Last Word on Sports. Dr. Ellis has a Ph.D. in Cell Biology from the University of Toronto and spend 15 years lecturing in biology at several Canadian universities.



A few days ago Maria Sharapova announced that she had failed a drug test at the 2016 Australian Open. The drug involved is Meldonium, a drug popular in Eastern Europe, that was just added to the World Anti Doping Agency (WADA) banned substance list effective January 2016. Her punishment has yet to be determined by the International Tennis Federation, a process that could take months. Sharapova’s sponsors have been quick to desert her, with Nike suspending its relationship pending further investigation. Tag Heuer and Porsche have immediately bailed, announcing they will not renew their endorsement deals with Sharapova.

As an athlete, I believe in a fair playing field at all levels. And, as a trained cell biologist, I am observing how misinformed the general public is about athletes and performance enhancing drugs (PED). Whether or not Sharapova was intentionally cheating is not my focus in this piece. My intention here is to distinguish between the different types of PEDs and explain how the drug involved in this case could have possibly given the player an advantage or not.

The most commonly-used PEDs fall into a class of drugs known as anabolic steroids. The term anabolic refers to processes that build up proteins in cells. Typically anabolic steroids are synthetic versions of the male hormone testosterone. The effect of these drugs is to increase muscle mass in the body, thereby increasing athletic strength. In the past abuse of anabolic steroids was primarily seen in sports where brute strength was a determining factor in performance, such as weight lifting. As training techniques became more sophisticated, the use of steroids spread to sports where the increase in muscle power could be advantageous like swimming and short distance track events. Think back to the dominance of the Soviet Union and European countries in swimming before the use of these drugs was revealed. The side effects from this type of drug class are numerous including the development of severe acne and uncontrolled tantrums referred to as “roid rage”. Since these drugs were usually of synthetic or non-human origin, identifying them in a blood or urine sample was fairly routine work. Even if an athlete tried to mask their presence, the anti-doping agency was usually able to identify them.

Another drug that is used to build muscle is Human Growth Hormone, or HGH. Available in the United States by prescription only, this drug is primarily used to replace the hormone in people that are suffering from a deficiency of it due to a medical condition. The use of HGH by athletes became prevalent in the 1980s. Once the anti-doping agency was able to develop a test to identify the hormone in blood, it placed the drug on the banned list. American tennis player Wayne Odesnik is currently serving his second doping sentence for HGH use; his current ban extends for 15 years.

The next class of drugs and techniques focus on increasing the ability of the blood to deliver oxygen to the working muscles during endurance events, think Lance Armstrong and cycling events that cover long distances over several consecutive days. The main drug used for this purpose is known as Erythropoietin, a naturally occurring hormone in the body that stimulates the development of red blood cells known as erythrocytes. By supplementing the naturally-occurring amount of erythrocytes with Erythropoietin, the body produces more red blood cells and thereby increases the oxygen carrying capacity of the blood. Alternatively athletes will use a technique known as blood doping. A few weeks prior to competition the athlete has a quantity of blood removed from their body and stored. Over the next couple of weeks the body replaces the removed blood. Immediately prior to competition the athlete is then re-injected with the blood that was previously drawn. The result is an increased blood volume, again increasing the oxygen carrying capacity of the blood. The detection of foreign Erythropoietin has been more challenging for the anti-doping agencies. The use of blood doping was clearly indicated in an American cyclist whose blood contained foreign DNA, clearly showing a transfusion had taken place. The use of extra Erythropoietin increases the thickness of the blood and places more strain on the heart as it pushes the blood through the body. The increased amount of blood in the body after blood doping also places more strain on the athlete’s heart.

Meldonium is the drug at the centre of the Sharapova issue. This drug was developed in Latvia, and has never received FDA approval. It should be noted that this drug is available by prescription in some countries and it is available over the counter in other countries. The drug is designed to improve blood flow in patients who suffer from heart disease. As it improves blood flow it could theoretically improve athletic performance. WADA had been monitoring Meldonium use after it had become aware of a number of high-performance athletes were using the drug. The decision to add Meldonium to the list of banned substances effective January 1, 2016 appears to stem from the disproportionately high number of athletes using the drug and the theoretical ability to improve athletic performance. Scientific studies investigating and confirming a definitive causal relationship–the actual ability of Meldonium to improve player performance–do not appear to exist. Without actual studies, conclusions cannot be made as to whether Meldonium actually enhances athletic performance.

Sharapova has been taking Meldonium for ten years. The medication was prescribed for her by a physician to deal with a number of health issues. There is no definitive proof that the use of this drug enhances athletic performance. Sharapova has played five matches in 2016 since Meldonium was placed on the banned substance list. An extended suspension seems extremely harsh in terms of the situation. This, as every other case involving Meldonium until there is proof of actual performance-enhancing abilities, should be a case of innocent until proven guilty, and not a burning at the stake.

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