Maria Sharapova has been suspended for 2 years by the International Tennis Federation (ITF). The penalty arises from her positive test for the banned drug meldonium (Mildronate). A three-member independent Anti-Doping Program Tribunal appointed by the ITF ruled that Sharapova intentionally and systematically used meldonium for the explicit purpose of enhancing her athletic performance.
Sharapova has publicly claimed that she was prescribed Mildronate solely for therapeutic purposes by a Russian medical doctor named Dr. Anatoly Skalny. While Sharapova may have been prescribed meldonium to treat a medical condition in 2006, Dr. Skalny also provided her with specific instructions on how to use Mildronate to enhance her athletic performance. Sharapova discontinued her relationship with Dr. Skalny in 2013 but continued to self-medicate with Mildronate while following Dr. Skalny’s guidelines.
The reasoned decision by the Independent Tribunal presented a damning case against Sharapova who fared extremely poorly when questioned about the many and significant shortcomings in her defense.
“After Ms Sharapova ceased in early 2013 to be under the care of Dr. Skalny there is no evidence that any medical practitioner was consulted about or prescribed the taking of Mildronate, or that the use of Mildronate was disclosed to any of the medical practitioners, with one exception, who were consulted by Ms Sharapova between 2012 and 2015.”
The only exception involved another Russian doctor – Dr. Sergei Yasnitsky, the team doctor for the Russian Olympic team. However, she kept her use of the performance-enhancing drug a secret from practically everyone in her entourage including all of the World Tennis Association doctors, her Florida-based family doctor and her American medical practitioners and cardiac specialists who consulted with her during this three year period.
“She also underwent MRI scans and ECG tests and examination by a number of specialists during this period, particularly in 2015. To none of the medical practitioners or specialists who treated her over 3 years did she disclose the fact that she was taking Mildronate. Her explanation in evidence is that none of them had asked what medication she was taking.”
The ITF Tribunal determined that her self-medication with Mildronate over the past 3 years had been done in the absence of any type of medical advice or supervision. Her inexplicable failure to discuss her self-medication of a heart and blood flow drug with cardiac specialists was highly suspicious if Mildronate was indeed used to treat an important heart condition.
In addition, Sharapova, even when directly asked about the medications she was taking, neglected to identify Mildronate. Sharapova always omitted Mildronate on doping control forms which explicitly required her to list “any prescription/non-prescripption medications or supplements… taken over the past 7 days.” In fact, she never reported using Mildronate to anti-doping authorities until the moment she was caught.
And rather than use Mildronate in a manner consistent with therapeutic use, Sharapova used the drug in a manner specifically intended to enhance her performance around important tennis competitions.
Dr. Skalny provided Sharapova with explicit directions on how to use Mildronate to enhance her athletic performance. Each Mildronate capsule contained 500 milligrams of meldonium.
“Mildronate 1-2 x 10, repeat in 2 wks (before training or competition)”
“1 hr before competition, 2 pills of Mildronate”
“During games of special importance, you can increase your Mildronate dose to 3-4 pills (1 hr before the match). However, it is necessary to consult me on all these matters (please call)”
“30 minutes prior to a training session: Mildronat – 1 Capsule. 30-45 minutes prior to a tournament Mildronat 2 capsules.”
Before meldonium was officially added to the World Anti-Doping Agency (WADA) prohibited substance list on January 1, 2016, WADA officials tested for the presence of meldonium during anti-doping control during a one-year monitoring period in 2015.
The use of meldonium was legal during this time and the results of the doping controls revealed that Sharapova used Mildronate in significant quantities during several of her competitions including the 2015 Wimbledon, 2015 WTA Finals in Singapore and the 2015 Fed Cup Final in Prague.
Once meldonium became illegal, Sharapova admitted using Mildronate before each of her 5 matches at the 2016 Australian Open on January 18th, 20th, 22nd, 24th and 26th in accordance with the recommendations provided by Dr. Skalny in 2006. She tested positive for meldonium following her quarterfinal loss to Serena Williams on January 26, 2016.
The Independent Tribunal accepted that Sharapova may have truly been ignorant of the rule changes that took effect on January 1, 2016. Nonetheless, the Independent Tribunal, in its Reasoned Decision, did not find Sharapova credible at all when she claimed she had no intention of using Mildronate to enhance her performance:
“That leaves the issue as to why Ms Sharapova was systematically using Mildronate before matches, and in particular at the Australian Open in 2016. In the tribunal’s view the answer is clear. Whatever the position may have been in 2006, there was in 2016 no diagnosis and no therapeutic advice supporting the continuing use of Mildronate. If she had believed that there was a continuing medical need to use Mildronate then she would have consulted a medical practitioner. The manner of its use, on match days and when undertaking intensive training, is only consistent with an intention to boost her energy levels. It may be that she genuinely believed that Mildronate had some general beneficial effect on her health but the manner in which the medication was taken, its concealment from the anti-doping authorities, her failure to disclose it even to her own team, and the lack of any medical justification must inevitably lead to the conclusion that she took Mildronate for the purpose of enhancing her performance.”