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Breaking down PEDs vs. substances of abuse

An inside look at how the NFL’s testing and punishment policies work. Dr. David Chao

Print This September 03, 2014, 05:01 PM EST

By any estimate, over a hundred current players in the NFL legally take Adderall, a form of amphetamine. How is it that Denver star receiver Wes Welker is suspended for the first four games of the season for reportedly testing positive for that same drug? Why should an offseason positive test for Adderall, which would have no performance enhancing affect during the season, lead to such significant punishment?

A closer look at the league’s drug testing policies and examination of the particular circumstances in Welker’s case will provide some answers, but may raise other questions. Let me make it clear that I am not an investigative reporter relying on inside sources. As a former NFL head team physician, I am simply applying what I know about league policy and interpreting the media reports against the background of my medical knowledge.

Adderall is legal in the NFL with a therapeutic use exemption (TUE). By my estimation, at least 10 percent of professional football players currently take it legally. The usage on college campuses is even higher with reports of over one-third of students admitting to having used Adderall.

Amphetamines come in varying forms. Adderall (and Adderall XR) are the most common forms of amphetamine used to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy. There is high abuse potential as an aphrodisiac and euphoriant. For example, MDMA, Molly and ecstasy are street drugs with an amphetamine base.

Since the abuse and performance enhancement potential of amphetamines is high, the NFL has tried to control Adderall by insisting on a TUE prior to its legal use. It is not allowed simply because a doctor has prescribed the medication. There is a rigorous process of documentation and review of medical records before a player is granted the exemption.

Wes WelkerWhile the details may still be in question, Welker will miss the first four games of the season.

I have had players try to get a TUE for Adderall and I can tell you the process is not easy. It requires a series of physician visits, tests and documentation. If an athlete has a documented history of ADHD from college or before and can demonstrate long-term medical usage, the TUE process is easier.

The growing number of legal prescription use in students has resulted in a “trickle up” phenomenon resulting in more and more NFL players on Adderall. In my 20 years of attending the NFL Combine, I steadily observed the increasing trend of college athletes being pre-diagnosed with ADHD and coming into the league already taking Adderall.

The NFL has two distinct drug testing programs. One is for substances of abuse and the other is for performance enhancing drugs (PED). Adderall currently falls under the PED policy. A first time positive test on the PED side results in a four-game suspension. A first transgression on the abuse side results in no time lost, but entry into the substance abuse program with regular year-round testing.

Welker clearly did not have a TUE that would have allowed him to use Adderall or we would not be discussing a suspension. The details around his positive test are unclear, but it is certain that he violated the PED policy as this is the only way a first positive tests leads to suspension.

Whenever there is drug related discipline, the details are never fully disclosed. As a matter of privacy, the NFL typically does not reveal the specifics or timing of any transgression. Much is left to conjecture and it is not known exactly when Welker tested positive. All we know is his appeal was two weeks ago and the final suspension was just handed down.

It has been reported that Welker’s positive test was a result of his taking Molly at the Kentucky Derby. It would be unlikely and extremely unlucky for this to have occurred. Besides, Welker vehemently denies taking any recreational drug or PED. The NFL PED policy is not set up to detect offseason Adderall use. Amphetamines clear from the urine within a matter of days. At least ten players per week per team are tested after all games, but only a maximum of six times per offseason per player. The in-season testing is designed to detect Adderall or other short acting stimulant use as it is typically done the morning after games. The offseason focus in on detecting steroid use, which stays in the system for a prolonged period of time and where offseason use might help a player in-season.

The irony here is even if Welker had taken amphetamines in the offseason, it wouldn’t have helped his game day performance. Because of this, it is rumored that Adderall may soon be moved to the abuse side. MDMA already falls under the abuse side. By the way, Welker is not known to be in the year-round substance abuse testing program, so if this pending shift happens, he wouldn’t ever be tested for it in May.

Another interesting twist is that Adderall has been used in treating the cognitive symptoms of concussions. Some could theorize Welker was prescribed Adderall after any or all of his three concussions sustained over the last 10 months. That just doesn’t seem to be the case based on timing. Besides, Welker likely would have pointed that out with his public statement. In any case, even if it was prescribed to treat his concussions, Welker would still have needed a TUE to avoid penalty.

So far it is not clear if Welker’s positive test was due to recreational use, competitive advantage, medical reasons, treatment of concussions, inadvertent ingestion or other unknown reason. I am sure more information will come out with time. As one can see, the issue of Adderall use and the NFL policy is complex. The bottom line is an athlete is responsible for what goes in his body. Absent a TUE, a finding of Adderall leads to an automatic four-game suspension.

Unfortunately, the current PED policy seems to penalize a player for something taken in the offseason that couldn’t help his game performance. The bright side is that in the end, four weeks off may be fortuitous for Welker. All reports indicated he would be returning to play in Week 1. Coming off his third concussion in 10 months, an additional month’s rest might actually be the best thing for him.

Follow David on Twitter: @profootballdoc

Dr. David Chao is a former NFL head team physician with 17 years of sideline, locker and training room experience. He currently has a successful orthopedic/sports medicine practice in San Diego.   

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