Meldonium Explained


by Anthony Roberts

The biggest doping story of 2016 is Maria Sharapova failing a drug test at the Australian Open. Most of the general public was shocked at her testing positive – but within my crowd (read: steroid-people), the shock was at the actual compound itself: Meldonium.

Meldonium (alternately known under the trade name Mildronate) was added to the World Anti-Doping Agency (WADA) list of banned substances in January of 2016 – and by March, Sharapova had tested positive, admitting that she’d been using the drug for the past decade on her doctor’s orders.

Drugs make their way onto WADA’s prohibited list by meeting at least two of the following criteria:

1. It has the potential to enhance or enhances sport performance
2. It represents an actual or potential health risk to the athlete
3. It violates the spirit of sport

The first one is obvious – if a drug is performance enhancing, thats a strike against it. The second criteria applies to almost every prescription drug in the world – most drugs will have a potential side effect that could be considered a risk to an athlete’s health. And the third criteria is totally nebulous – basically, this is the most arbitrary of the three and allows WADA to ban any drug if th even if it doesn’t enhance performance.

This is why even drugs that don’t improve performance (MDMA, etc…) are on the list. But simply meeting two of the criteria (thyroid medication ***link to my thyroid article here***enhances performance and has potential risks) doesn’t mean a drug will be prohibited. As someone who has been intimately familiar with WADA over the course of the past decade, I will unequivocally state that they’ve got little idea what the spirit of sport actually is, much less the competence to effectively codify it.

Meldonium is used to treat a lack of blood flow to various parts of the body and is indicated for use in heart failure and coronary heart disease. The manufacturers claim that the drug “improves the physical capacity and mental function,” even in healthy people (although they also make the baffling claim that it does not alter athletic performance. However, it’s not a tremendous leap of logic to deduct that something that improves blood flow could conceivably improve performance. Its mechanism of action is thought to be primarily through increasing the size of blood vessels.

In this case, WADA claims to have found evidence that it was being used by athletes to increase performance through providing additional oxygen to the cardiovascular system and skeletal muscle. Allegedly, 17% of Russian athletes and 2.2% of global athletes are or were using the drug.

If those figures are correct, they offer the most compelling evidence for meldonium being a performance enhancer. The Russians are currently in possession of the most advanced doping program on the planet, and if 17% of their athletes are using it, then I’m going to give them the benefit of the doubt and say that they’ve accumulated enough relevant data to justify its use.

With that in mind, I have to admit that I don’t know anyone who’s experimented with this stuff. It’s never made an appearance on the black market (that I’ve seen), and it’s not an FDA approved medication, so nobody is out there trying to convince their (American) doctor to write them a prescription. That plus the fact that it’s only manufactured in Eastern European countries means very few athletes in the ‘States have experimented with it. I have a suspicion that it works, and probably very well – but as it stands, it’s detectable, difficult to obtain, and therefore unlikely to make an appearance on the black market.