What Will That Extra Urine Testing In The Medina Spirit Case Actually Tell Us?

Attorneys for Medina Spirit’s connections spilled a lot of ink last week to ensure their clients will have the opportunity to run extra tests on a split sample of the horse’s urine. They hope to demonstrate that the betamethasone detected in two rounds of testing after the Kentucky Derby was the result of a topical ointment applied for a skin rash, not an injected treatment to relieve pain or inflammation. The eventual goal, according to a civil suit filed in Franklin Circuit Court over that extra testing, will be to argue that a topical application of betamethasone isn’t prohibited by Kentucky regulations and that repercussions for trainer Bob Baffert and owner Zedan Racing should therefore be mitigated. A judge ruled on June 11 that the extra testing will go on, and it only remains for the Kentucky Horse Racing Commission and the horse’s connections to agree on how much urine will be tested.

The second objective, the question of whether administration route matters, will come down to a long (and probably dry) legal argument. The first objective, the proof of where the betamethasone came from, hangs on that extra testing, which means this is a good time to ask – can extra urine testing actually prove the origin of the betamethasone in question?

Maybe, says equine drug testing expert Dr. Rick Sams. But maybe not.

There are two ways that drug testing could try to establish whether the betamethasone came from an ointment or an injectable: by looking for the other ingredients in Otomax, the topical cream Baffert eventually said was used to treat a rash on Medina Spirit’s hindquarters, or by identifying the exact chemical makeup of the betamethasone in the sample.

Besides betamethasone, Otomax also contains gentamicin, an antibiotic, and clotrimazole, an anti-fungal. Post-race samples aren’t tested for most antibiotics or antifungals because those drugs are not acting directly on the body of the horse — they’re designed to combat bacteria or fungi. As such, most of them aren’t regulated in racehorses the same way an anti-inflammatory is, so it’s not surprising that these ingredients weren’t reported on the initial post-race test or in the split sample.

(Procaine penicillin is the common exception to this, since procaine is a numbing agent also used in other ways, outside the combination with penicillin. Penicillin is known to cause some discomfort in horses when injected, so it’s often formulated with procaine to make repeated administrations more tolerable.)

Sams worries however that it’s unlikely either of those drugs would have made it into the horse’s urine in a sufficient amount to be testable, because they were given as topicals. They were present in a topical application with the directive to work on a surface- level skin rash, so their purpose was to work on bacteria or fungi on the skin’s surface. He suspects they weren’t designed to be readily absorbed through the skin and into the bloodstream, since most of their work was to take place on the outside of the horse.

“I think the likelihood of gentamicin ever getting absorbed in sufficient quantities to show up in the urine is essentially zero,” he said.

In the case of clotrimazole, it’s present in very low levels in Otomax, making it even less likely it would be absorbed.

“There are no studies I can find that demonstrate any appreciable absorption of clotrimazole after topical administration,” Sams said.

It’s also not immediately clear how many accredited racing labs would be able to test for either substance, because it’s not part of the usual battery of post-race tests. A civil court hearing June 11 revealed that New York’s Equine Drug Testing Program housed at Morrisville State College will conduct the extra testing.

The other thing Zedan and Baffert hope the extra testing will reveal is the chemical makeup of the betamethasone detected in post-race sampling. Otomax contains betamethasone valerate, which is chemically different from betamethasone acetate and betamethasone sodium phosphate – the two versions of betamethasone used in injectable products. The words acetate, sodium phosphate, and valerate all refer to esters, which are chemical compounds derived from acids that are attached to a molecule of betamethasone.

“If one was to look for the valerate ester and find it, that would demonstrate that something other than the injectable preparation was administered to the horse,” said Sams. “But I think the chance of finding the valerate ester of betamethasone is zero, because the valerate ester has very low water solubility, and substances have to have water solubility to get excreted into the urine so I don’t think it ever gets into the urine as valerate.”

It’s possible that the legal team will ask the lab to look for betamethasone acetate and betamethasone sodium phosphate instead, with the idea that if they aren’t found, that would demonstrate the horse wasn’t given injectable betamethasone. Sams said the betamethasone acetate is, similarly to betamethasone valerate, not all that water soluble and therefore he wouldn’t expect to find it in urine, even if it had been administered to the horse. The sodium phosphate ester however, is very water soluble and that may be excreted into the urine readily. Sams has done previous research on a chemically similar ester and found it was pretty easy to detect.

Racing labs aren’t typically asked to determine which form of a drug like betamethasone is in a sample and Sams said he is not aware of any racing lab ever previously attempting to make this distinction.

So how helpful could this additional testing be? Its usefulness to Bob Baffert and Zedan Racing may be more about what it doesn’t show than what it does. If the testing confirms betamethasone but can’t determine which form is present, or finds no evidence of either injectable version, the attorneys may point out that there is no evidence to refute Baffert’s version of events.

Of course, Sams and many others have stated that they don’t believe Kentucky’s rules differentiate between routes of administration for regulated substances like betamethasone. Whatever Baffert and Zedan hope to learn from the extra testing they’ve fought for, they will no doubt look to challenge that belief in court proceedings that may stretch on for months or years to come.

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