University of Oklahoma pitcher Jonathan Gray will be one of the first picks in tonight's major league baseball draft, but he has already made headlines off the field.
Earlier this week Gray tested positive for Adderall. While baseball fans debate whether the test result will affect his chances of being the No. 1 pick, there is a more important question. Is Adderall use a problem in baseball and sports in general?
Adderall is a stimulant medication used to treat attention deficit hyperactivity disorder (ADHD). Professional sports leagues, the NCAA, World Anti-Doping Agency and the International Olympic Committee currently allow use of Adderall and other ADHD medications by athletes. Since Adderall potentially has performance-enhancing benefits, athletes must have appropriate documentation about their ADHD evaluations, diagnoses and prescriptions. Gray reportedly did not have a prescription for the medication.
Patients with ADHD can have difficulty maintaining focus and struggle with hyperactivity and impulse control. Adderall and other ADHD medications can help those patients maintain focus and concentration. Up to 10 percent of American children are believed to have the disorder. Symptoms often decrease as patients get older, but 4.4% of adults suffer ADHD.
Dr. Aaron Gray, Sports Medicine Specialist and Family Physician at the University of Missouri, thinks that the use of Adderall and other ADHD medications is actually much more common among college students. “It is known as the smart pill — something to use when studying for exams.”
Dr. Gray notes that college athletes face the same academic stresses but have the added time commitments of their sports. “Some of our football players spend 80 hours a week between football, class and studying,” he said. It's possible that student-athletes use these medications to battle fatigue. Some of them have obtained prescriptions from their doctors, but it seems likely that many get the medications from their friends who have valid prescriptions.
It is clear that college athletes are at least asking about these drugs. A 2010 study in the journal Sports Health showed that the majority of inquiries about banned medications made by college athletes to the NCAA Resource Exchange Center pertained to stimulants like Ritalin and Adderall.
Using Adderall to combat fatigue wouldn't explain the use among professional athletes. Suspicions of widespread amphetamine use in baseball and football have grown in recent years. Deadspin recently estimated that about one in every 10 MLB players either has a Therapeutic Use Exemption for Adderall or has tested positive for it — a much higher percentage than the adult population with ADHD generally.
Use of Adderall by baseball players to gain an advantage shouldn't surprise fans. Batters might better focus on the ball and ignore noise and other distractions. Pitchers might benefit from improved concentration. Relief pitchers who have spent hours sitting in the bullpen might feel they can get “in the zone” much quicker on these drugs.
Use by football players might be more surprising. In addition to better concentration, these ADHD medications are thought to make athletes more aggressive, feel less pain and provide a sense of euphoria.
It is worth pointing out many football observers speculate that recent positive tests for Adderall in the NFL are actually a means of covering up positive tests for steroids and other banned substances. As part of its agreement with the players' union, the league cannot disclose the banned substance that triggers a player's positive test result. They argue that athletes caught with Adderall would not face the harsh criticism from fans like they might with steroids.
Regardless, it is important for athletes to know that the Drug Enforcement Administration classifies these medications as Schedule II controlled substances because of their addictive potential. Dr. Gray also points out that they could elevate core body temperatures, increasing an athlete's risk for heat illness.
It is also possible that athletes with underlying heart abnormalities could have elevated risks for abnormal heart rhythms and sudden death. Athletic trainers and team physicians must know all the players using these medications.
That is the problem with Adderall, though. It is possible to know and follow the athletes with documented ADHD. We don't know how many athletes get the drugs from others and use them illegally. Maybe Jonathan Gray's positive test and the handful of them in baseball and football are just sporadic cases. Or maybe they are signs of a much bigger problem.
Editor's Note: Dr. David Geier is an orthopaedic surgeon and Director of MUSC Sports Medicine. For more information about baseball injuries and other sports medicine topics, go to Dr. Geier's blog at drdavidgeier.com.