The Nick Backstrom Positive

Warning: wall of text ahead!  I'm not going to bother proofreading this, but I wanted to get it out there.  I've seen a lot of unsure information on the web today, and wanted to voice some science and editorial.  I'm sorry if I'm missing recently published information; I was on the bike all afternoon and started punching away at the keys as soon as I got back.

Today, Nick Backstrom was disqualified from the Sochi Olympic games, roughly 2.5 hours before he was set to take the ice in the Gold Medal game against Canada.  The reason for his DQ was a substance test of his coming back positive for psuedoephedrine.

Let's set things straight here: psuedoephedrine can absolutely be used to gain a competitive edge on your opponents.  It is a stimulant that is expressedly prohibited by WADA (World Anti-Doping Agency), and it is commonly known as the Sudafed that you have to get from behind the counter at your local drug store.  

According to Nick Backstrom, Team Sweden, and the Washington Capitals, he suffers from severe allergies, and uses an allergy medicine regularly to control his symptoms.  By the reporting, it appears he uses Zyrtec-D (good choice!)  Also reported is that his doping control test showed 190mg of psuedoephedrine.

The very first thing I want to clear up is the technical side of the chemical being in his system, and what that means.

The bit going around the sports reports of his test showing 190mg is an accidentally false statement.  The way they do the test (unless things have changed since WADA published its 2014 Banned Substances List), they look for concentrations of chemicals in urine.  Psuedoephedrine is actually legal by WADA's standards up to 150 MICROgrams per milliliter of urine.  If Nick Backstrom pissed a sample that contained 190 mg of psuedo, he is going to be the subject of a spinoff from Breaking Bad.  More than likely, someone misheard micrograms for milligrams, and along the story went.  From here on out, I'm going to assume he was popped and the findings showed 190 ug/ml.

WADA's limit of 150 ug/ml is set up to allow for the reasonable use of common medicines in amateur athletes.  In the sport I participate in, cycling, there are many opportunities for me to race at a high level where I will be subject to drug testing.  Rather than expecting every athlete under the sun to read the rules (which you are usually required to), they found it easier to put a threshold number out there so that someone who took a sudafed two days ago wouldn't have to go through a positive doping control.  

This 150 ug/ml limit is derived from a rounded estimation of how much pseudoephedrine you would expect to find from a urine analysis of someone who took a recommended day's worth of Sudafed.  See here for a WADA document detailing this.  This is actually really cool stuff that WADA thought things through so that you can take a day's worth of sudafed in whatever form it might be dosed out as, and after it breaks down in your body and you pee it out, you should be under the threshold!

Well, they only really thought about that first day of dosing.  In Nick's case, he is taking Zyrtec-D on a daily regiment.  The thing about drug testing is that different substances stay detectable in your body based on your own body's metabolism, as well as their basic half-life.  For Nick, taking Zyrtec-D every day keeps a concentration of psuedoephedrine going, its metabolites build up quicker than they can be totally cleared from the body.  The end result is that while he may only be taking a standard dose of Zyrted-D or Sudafed each day, he is pissing out a bigger number than WADA built in to their threshold level.  

I know this because I am an amateur athlete with major allergy problems.  Because I compete at the top level of amateur cycling, I educate myself on the rules that I sign my name to when I am issued a racing license.  A few years ago, I saw an allergist and tested highest level sensitivity to every allergen except for peanut butter (which is ironic, because I always thought I was allergic to PB!)  Right then and there, I was given an albuterol inhaler, a few epi-pens, and Zytec-D along with orders to go through a few years of weekly allergy shots.

Without thinking, I switched out to regular Zyrtec, and only used Sudafed when my sinuses became congested.  For me, I feel like crap when I take Sudafed and try to train.  I feel weak, a little feverish, and I bonk pretty easily.  Still, daily Zyrtec and allergy shots changed my life.  In years past, I would lose weeks of training in the spring due to various eruptions of hayfever and sinus infections.  I'd blow all my sick days and more because I was incapable of operating on a basic level.

This might be a conspiracy theory, but what if Backstrom's susceptibility to migraines is not a result of Rene Bourque's horrible elbow-to-the-head, but rather his allergies blowing up?

Rene Bourque should be universally booed in the DC Area

When I have a REALLY bad allergy day, things get so bad that I am sort of like white-blind or snow-blind.  I've gotten on the wrong Metro train before, gotten off at the wrong stop, went to get food and walked around the block mindlessly for 15 minutes because I am unable to constructively figure out what I am trying to do.  

I am also very sensitive to other athletes using allergies as a con.  While I was given an inhaler to use, I never do.  I feel that it opens your lungs up too much, and causes you to suck in whatever allergen you react to deeper than your body's natural defenses would otherwise allow.  I used my inhaler once before a race during allergy season, and I ended up wheezing really badly at the end all the same, and ended up sick for a week afterwards.  I once advised a fellow racer on seeking advice for how to deal with allergies.  He asked me so incessantly on where to go, who to see, and what it was that got me the inhaler...I answered him truthfully and in particular, that I advice against using an inhaler for racing and training.  Three weeks later, I am beside him at the starting line of a race and watch him pull an albuterol puffer out from his pocket and just go to fucking town on the thing.  'You are fucking kidding me' I muttered, and never spoke to him again.

With my personal story said, I understand Nick Backstrom's issue fairly well, and I also understand why WADA needs to have a line that you cannot cross...they problem is that they drew the line in the very middle of an extremely grey area.  

As an allergy sufferer, it is insane to think of traveling and sleeping in a hotel without loading up on antihistamines.  Sleeping on a foreign pillow can give me bad congestion and sensitivity to light.  When you travel to a different area, sleeping accommodations aside, you have to think of the new local ecosystem, what different types of grass or tree pollen there might be, and what time of the annual allergy calendar it is there.  At the Sochi games, Nick Backstrom did inform his team management that he took Zyrtec.  This is where things get even looser.

Backstrom earns his primary paycheck from an NHL team, the Washington Capitals.  The NHL seems to be responsible for drug testing its own players, rather than leaning on WADA or USADA (US Anti Doping Agency).  I don't know this for a fact, but I believe it to be true, as Nick and the Capitals state publicly that he's been taking this allergy medication for several years, and it has never been an issue.  Any USADA test would have triggered an adverse analytic finding, and this discussion would have been on a different day under much less devastating circumstances.  

The NFL is another example of a league that deals with athlete doping in-house.  You occasionally hear about positive drug tests (most recently, one of the Seahawks' secondary players taking adderall), but because it is kept in-house, the NFL can manage how (and possibly IF) the information is released to the public.  In this instance, under international rules, there is no league entity looking to protect itself and its players, similar to my sport of cycling.  Cycling continuously turns out doping positives because every single possible positive is IMMEDIATELY published and propagated.  There are some organizations in cycling that are responsible for hosting major races such as the Tour de France, but they have only loose associations with teams, and do not fully cooperate with teams.  As such, the sport is very 'open' which allows for new teams to participate, but it misses out on the stability that sports with built in governance enjoy (such as the major sports here in America.)

Back from that tangent, the takeaway is that Team Sweden and Nick Backstrom should have thought to register for a Therapeutic Use Exemption, or TUE.  A TUE is a document that you get a doctor to sign off on saying that you have a legitimate reason to use a prescribed amount of a banned substance because of clinical reasons.  

It is reasonable to say that Nick simply didn't think about this.  Being a member of the NHL, he likely doesn't have to worry about this sort of thing and it didn't cross his mind.  He did go as far as making sure Team Sweden knew about it, which leads to another wild thought: what if the team Doctor didn't think about a TUE because Zyrtec is not sold containing Psuedoephedrine in Sweden?  This is a wild, shot-in-the-dark explanation for how the ball may have been dropped multiple times by multiple people; I'm just trying to illustrate how this is all such a grey area that you could call it...50 shades of grey.

Finally, I will get to my pissed-off-fan-of-Nick-Backstrom side:  why in the hell did it take the IOC decide to disqualify him two and a half hours before the gold medal match?  As an athlete, I've raced against guys who have been busted for LEGIT performance enhancers: steroids, EPO and the like.  It always takes WADA and USADA months and months to actually do anything to someone who gets popped.  Meanwhile, the athletes who test positive area usually allowed to finish out their seasons before any announcements are made.  One particular local rider won a National Championship on the dope.  Months later, USA Cycling would DQ the result and award the win to the rider who placed second, but that rider never got to enjoy the victory.  They never got their photograph on top of the podium with the national champion's jersey on their shoulders.

In Sochi, at the highest level of competition, it seems only reasonable that, not only are they taking urine samples for doping controls, but they are running the tests on-site so that they can catch cheaters immediately.  The worst thing of this whole story is that, apparently, Backstrom's sample that tested positive for 190 micrograms per milliliter (or milligrams...whatever) was taken a WEEK ago. Edit: Reader Ron W points out that his sample was taken on Wednesday, which would allow three days to process and analyse his sample.  To stick to my ranting tone, I am not editing any further text. They let him play though games all week, and only two and a half hours before the biggest game of this man's life do they sent a man in a coat to escort Nick from the dressing room and inform him that he has been disqualified, that he cannot help his team bring home gold for their country.  Imagine what thoughts and sorrow must have been going through Nick's head as his teammates struggled to find the back of the net against Team Canada.  I'm sure he felt cheated, felt confused, and felt that he somehow let down his teammates.

Still, what if none of what I wrote is true.  What if his allergy story is just a story?  What if he was trying to one up his abilities in hockey by taking a drug?  If you were a professional hockey player, and would stop at NOTHING to win a gold medal in the olympics, what drugs would you take to play 'out of your mind' as they say?  Testosterone?  EPO?  Maybe you'd look into HGH?  How about a stimulant?  I heard adderall is all the rage in the NFL and crossfit gyms, it must be pretty good.  What about something simple and legal, like loading up on caffeine?  There are lots of studies about how caffeine is a legal performance enhancer that works...Naw, screw that.  Give me some psuedoephedrine!  I'll take one 24 hour tab, plus a tiny bit more, that will work way better!

Please.  I'm so glad that anti-doping attention can be placed on a beloved Swede who took Zyrtec-D, while the EPO positive of a biathlon athlete has gone mostly unnoticed.  I hope that that Nicklas receives the silver medal his team earned without him, and that his forced and untimely disqualification per a substance rule that should be adjusted is punishment enough.  Again, while it is awesome that WADA had the foresight to build in some tolerance for reasonable use, their 150 ug/mg limit should probably be bumped up just a little bit to accommodate therapeutic use spanning multiple days, but not so high as to accommodate abuse.

Picture ripped from RMNB

TL;DR: Nick Backstrom took Zyrtec-D daily to combat allergies.  WADA prohibits excessive use of the 'D' ingredient.  Their limit as to what 'excessive' is accommodates roughly 1 day's typical use of the drug.  Nick probably took it every day, so he was over the limit and produced a positive drug test.  This is against the rules, but the rules were not laid out to 'bust' people who took regular amounts of allergy medication.  Also, fuck the IOC for waiting until just before the gold medal match to disqualify Nick Backstrom.  Finally, I threw away all my maple syrup in my fridge.  (that's for you, Jared Neiters)