PEDs in MMA: The Trouble With Testing

When it comes to drugs in combat sports, Nick Lembo has basically seen it all. Like the time a fighter tested positive for PCP after a bout. Yes, angel dust, the hallucinatory drug that distorts reality, prompts violence and numbs the brain's pain receptors.

"That guy didn't feel anything during that fight," said Lembo, longtime legal counsel to the New Jersey Athletic Control Board.

Across the country in Nevada, Nick Diaz and his team are preparing to mount a defense that centers on the theory that his recent positive test for marijuana metabolites proved that his usage came out of competition, a result that would not see him serve any suspension even under the strict bylaws of the World Anti-Doping Agency (WADA) that monitors international sport.

Those two cases represent the two extremes of drug testing in sports. One is a black-and-white issue with a clear offense, the other is a matter of interpretation.

In MMA, drugs and drug testing have been at the forefront of debate recently, due to situations like Diaz’s positive test, Quinton "Rampage" Jackson’s testosterone replacement therapy (TRT) admission, and Muhammed "King Mo" Lawal’s nine-month steroids suspension, the result, he says of an over-the-counter supplement with a banned ingredient.

Those high-profile situations have intensified conversations about the way the sport is monitored. UFC president Dana White likes to say that because of government oversight, his athletes are the most regulated in the world, but a closer look shows that’s not the case everywhere.

The promotion’s most recent, show, for example, took place in Sydney, Australia, and was overseen by the Combat Sports Authority of New South Wales. Their spokesperson Michelle Neathercote, however, told MMA Fighting that "The Combat Sports Authority does not conduct drug testing. Any drug testing arrangements are a matter for the UFC." In those instances, the UFC acts as its own regulatory body, with its vice president of regulatory affairs Marc Ratner handling issues related to drug testing.

That’s not that unusual when the UFC goes international, and global business is a major piece of their expansion, with six out of their last 20 events taking place outside of U.S. borders and at least five others scheduled for 2012.

The UFC faced the same scenario in Tokyo just one week before it was in Australia. Some of their fastest-growing markets have yet to embrace drug testing. In Rio, where they will host their third event in a 10-month span this June, there is no commission enforcing drug testing. Even in Toronto, which hosted the largest event in North American MMA history, drug testing isn’t required. Office of the Athletics Commissioner senior advisor Richard Hustwick told MMA Fighting that testing is only done if it is written into bout contracts. The Athletics Commissioner will oversee the administering of the test, while the promoter pays for its cost.

Even stateside, there are problems. The state of Washington only has mandatory testing for title bouts. Other states, like Louisiana, have no formally written testing policy at all.

That often leaves the UFC in a position where it must help police itself, and leads to skepticism from the public who distrust their willingness to disclose results. On one hand, they have twice suspended star middleweight Chris Leben stemming from self-regulated events. On the other, they never divulged the positive drug test of Tyson Griffin at UFC 123 before it was discovered by MMA blog BloodyElbow.com over one year later. After news of the story broke, the UFC issued a statement saying that while they followed the Michigan Unarmed Combat Commission’s 100-day suspension, they noted that it was the state that "did not make this information public."

The fact is, there are still situations in which the UFC works hand-in-hand with state regulators to enforce drug testing, mostly by footing the bill.

Alvin Topham, who chairs the Louisiana Boxing and Wrestling Commission, detailed that process during an interview with MMA Fighting.

When the UFC comes to the state, as they did last September, they insist upon drug testing. The commission will administer the tests, select a laboratory to process them, and pay the initial bill. They will also be the first to receive the results, which they will eventually pass along to the UFC.

The promotion later reimburses them for the cost.

The reason for this setup? The expense. Topham told MMA Fighting that the commission doesn’t receive a single cent of funding from the state government. Instead, it is self-funded through event gate taxes and licensing. The costs of random testing all events would quickly whittle away their cash reserves, so instead, they concentrate on major shows, using the deeper pockets of bigger promotions like UFC and Bellator to pay for the screenings.

"They’re footing the bill, but the way we’re doing it is safeguarding against impropriety," said Topham, who has served on the commission since 1992. "If anyone questions my integrity, that’s fine. They can say what they want to say. But I have no investment in the UFC. I don’t work for them. This is an arrangement, and we’re ultimately administering the testing."

Many critics contend that fight week testing isn’t enough, anyway, that fighters should be tested out-of-competition. Just this week, the Nevada commission took advantage of a pre-fight press conference to test six UFC fighters scheduled to compete on a May 26 event, the first time that had been done. Regulators simply don’t have the budgets to test fighters when they’re one time zone away, let alone across the world, as often happens in MMA.

It's been suggested that the burden should be shouldered by the UFC.

According to White, while the promotion recently started drug testing newly contracted athletes, more extensive random, out-of-competition testing would also stretch the promotion’s resources thin.

"We have 375 guys under contract," he said. "We’re doing a zillion fights a year. We’re traveling all over the world and doing all these other things we’re doing. Now, do you really think that we can crack down and just f------ chase these guys around, everywhere they live, all over the world, and just randomly test these guys all the time? On top of all the other things we’re doing? You have to really sit back and think, to use a little reality and common sense."

Commissions Playing Catch-up on TUE's
While simple drug screenings are hard enough, the new battleground in drugs in sports is testosterone. Depending on who you ask, testosterone can be the best, worst and most confounding drug in the sports world, sometimes all at once, a viewpoint recently summed up by White.

"I think that this whole testosterone therapy (TRT) thing works for guys who absolutely need it, but I think it's a messy loophole," he said.

For those who legitimately need it, TRT can be a life-changer, addressing issues related to decreased muscle mass, over-fatigue, depression, osteoporosis, and as we all know from the commercials, sex drive. But the key is whether the use is legitimate. TRT, usually administered either through an injection, a patch or gel, successfully addresses these issues, but if abused, could offer an advantage to a professional athlete.

That’s particularly worrisome in MMA, where the consequences of PED’s extend far past what they may do to the offending party. It can be a problem for the unwitting opponent, as well as the pressure it places on everyone else to keep up.

"I think a lot of fighters, and it’s not an excuse but it is a reason, in the past used steroids not to get an advantage but because they thought they needed it to have a level playing field," Nevada state athletic commission executive director Keith Kizer told MMA Fighting. "My opponent’s doing it so I have to. I think we’re moving away from that. Most guys aren’t doing it and those who are doing it are hopefully getting caught by the commissions. But now I’m worried TRT is going to be that way. If my opponent’s doing it, I don’t want him to have an unfair advantage."

Publicly ask a professional fighter his opinion on TRT, and most likely you'll get one of two responses. Either they have no opinion because they don't consider themselves knowledgeable enough to comment on the subject, or they, like many in the population at large, consider it to be cheating.

"It’s a touchy subject," UFC middleweight Alan Belcher told MMA Fighting. "I know it's supposed to be a case-by-case basis, but probably like 99 percent of the time, they’re cheating. They’re lying and the doctor is helping them out."

The controversy even cuts right through friendships. Former M-1 light-heavyweight champ Vinny Magalhaes has worked with exempted TRT user Dan Henderson many times, but believes the therapy shouldn't be allowed in MMA.

"I’ve been in Dan’s camp for three years," he said. "Dan trains, he’d go months with 4-5 injuries. I kind of get why he feels like he has to do it. But for me, if you’re 40 years old, you’re not supposed to have the energy of a 25-year-old guy. If you feel like you can’t perform, maybe it’s just time for you to quit better than to cheat. Otherwise it’s going to become like, hell, I’m 27 but I want to have the strength of two horses so I’m going to take a bunch of steroids. It’s wrong, in my opinion."

Under proper doctor’s supervision, TRT isn't going to create a superman, but simply restore the body’s natural testosterone levels. The question then becomes, what is the proper supervision?

States that allow exemptions offer guidelines that must be followed before the exemption is ever granted. Nevada and New Jersey shared their rules with MMA Fighting, including the documentation that must be followed by any applicant.

In Nevada, a fighter must submit an application for a TUE at least 20 days before a fight. Along with it, he must provide results of no fewer than five tests, measuring things like total serum testosterone level (on separate occasions), luteinizing hormone, follicle stimulating hormone and measurement of hemoglobin and hematrocrit levels. The commission also reserves the right to require additional tests measuring serum prolactin and iron saturation, pituitary function testing, and MRI of the sella turcica. They must also be able to prove there is no reasonable alternative therapy.

According to Kizer, that stops many inquiries in their tracks.

In New Jersey, fighters must provide similar records, again demonstrating that levels have been consistently below even the low end of "low normal."

But other states have no such procedures in place for TUE’s or any other medically necessary drug. Some states, like Tennessee, handle situations on a case-by-case basis. Spokespeople for the Ohio and Illinois athletic commissions both confirmed that they currently have no procedure in place, though both said they are in the process of being drafted. Asked if Chael Sonnen, a TRT user, notified the state of his use prior to his UFC on FOX 2 matchup with Michael Bisping, Illinois Department of Financial & Professional Regulation spokesperson Susan Hofer told MMA Fighting, "Since we have no therapeutic use rules in place, there would have been nothing to compel an athlete to tell us if they were using any particular therapy in advance."

The same question was asked to a Department of Licensing and Regulation official in Texas, where Sonnen fought Brian Stann last October. She would not comment without first seeking the attorney general’s opinion, which was unavailable by press time. Instead, she referred MMA Fighting to their existing rules, which only requires an athlete to inform its executive director of prescription usages "at least 24 hours prior to the bout," too little time to determine need, according to most experts.

In an effort to address the issue, the Association of Boxing Commissions plans to address TUE’s at its upcoming July convention, which is attended by many of the country’s state athletic board heads.

"I’ve got questions myself," said Ohio’s Profato. "We’ll speak to their medical people on this and see where we’re going. I don’t know that we should bar people with TUE’s if they need it medically. Our goal is to make sure when two people get in the cage, neither fighter is at an advantage or disadvantage."

Even with procedures in place, some critics contend it’s not enough. When it comes to the growing use of testosterone, most states use a 6:1 testosterone to epitestosterone ratio (T/E) as their cutoff for flagging a positive result (WADA has used a more conservative 4:1 ratio since 2007). Others cite the testing as insufficient.

Most experts cite the carbon isotope ratio test (CIR) as the most effective means of catching cheats. Instead of looking at T/E ratio, it determines whether the substance in the body is natural or synthetic.

From the regulators’ points of view though, the expense related to the test makes it cost-prohibitive given their budgets. Though no one would go on record with the cost of the test, Dr. Anthony Butch, who is the director of the UCLA Olympic Analytical Laboratory -- the lab used by California to flag Chael Sonnen’s test in 2010 -- told MMA Fighting that a CIR is "typically at least five times more expensive" than a simple screening for testosterone metabolites, but far more effective.

"Given that some athletes do not see a significant elevation in the T/E ratio after taking testosterone, or a precursor of testosterone which would then trigger CIR testing, the CIR testing can be a more sensitive first-line test," he said.

If all of that has you beginning to drown in information right now, that’s exactly how it sometimes feels for regulators like Kizer and Lembo, who work for two of the sport's leading commissions. Because TUE’s can be applied not only to TRT, but drugs related to other conditions including attention deficit hyperactivity disorder, asthma and more. At least one commission, New Jersey, has in the past received a TUE request for medical marijuana, though Lembo would not say whether it was granted.

Right now, most of the leading state commissions have declined to disqualify athletes from competition for a medical condition out of hand, but it’s a hot-button issue regardless of the cause.

"If someone did abuse performance-enhancing drugs at 18 or 20, and they’re 32 now, I don’t know if you disqualify them because they did that," Lembo said.

For now, it's not ultimately his decision, anyway. New Jersey uses a review board consisting of three expert physicians who are blinded as to the athlete's identity as well as the other physicians in the decision-making process, its lead ringside physician Dr. Sherry Wulkan told MMA Fighting.

Over the years, New Jersey, like Nevada, has denied more TRT TUE's than it has granted.

The spotlight on this issue has focused squarely on MMA -- and more specifically, the UFC (Bellator's CEO Bjorn Rebney told MMA Fighting that he was unaware of anyone on his roster undergoing the therapy). But it's not solely an issue here. Other contact sports have also seen the phenomenon. NFL senior vice president of public relations Greg Aiello told MMA Fighting that "about half a dozen" TRT TUE's have been granted in the history of the program, going back to 1990. The NHL also confirmed that they grant exemptions for TRT, though they would not release specific numbers on their program.

That’s not to say that there aren’t athletes trying to beat the system. Even Kizer admits that its doubtful unapproved testosterone users will be caught if they stay within normal levels.

"It’s no different than non-approved use of steroids," he said. "If you cycle properly, you’ll probably be able to cheat the test, unfortunately. But that’s why we try to do in-training testing. People think it’s easy to beat a test. It’s not impossible by any means, but it’s not easy. All we can do is try to have better testing and more testing."

Now, here’s the kicker to all of this. Say you spend every last dollar your commission has to test every fighter on every card. You randomly test out-of-competition, you spring for the more effective but more expensive CIR testing. You do all that, and everything seems fine. Guess what? You might still have cheaters in your midst. In February, a WADA report suggested that their research indicated that they are only catching one in every five drug cheats, and they are considered the gold standard for testing.

It’s only going to get more difficult. According to multiple experts, the next frontier is gene doping, a process which injects DNA into existing genes to enhance athletic performance.

For now, it’s not known if there’s any usable test in existence that would catch a gene doper. Why? Because there’s no way to tell an athlete’s genetic code without already having it on file. And there’s no way to have it on file without having a biopsy. How many athletes are going to voluntarily submit to that in the name of fair play?

History has proven that wherever an opportunity to take an edge exists, someone will take it. Despite the best effort of regulators to test, of promoters to condemn, and of fans to rebuke drug cheats, the system seems destined to be imperfect, a cause ultimately both righteous and hopeless.

[Editor's Note: PEDs in MMA was a two-part series. The first installment, "PEDs in MMA: Amid TRT Controversy, a Hidden Danger," focused on the growing link between head trauma and pituitary damage leading to low testosterone.]