Letter to the Editor: Joseph S. Bertino, Jr.

I have been following the story of Mr. Bill Mott and drug testing done here in my state of New York and the controversy involved. One issue had to do with the lack of an additional sample from a horse that was urine and drug tested after a race.

I am a Clinical Pharmacologist (humans), but some of the things that we know in humans can be applied to other species, especially horses. Let me state that I don't know, nor have I ever met Mr. Mott (although from time to time I have bet on horses that he has trained) and I am both a scientist and a Thoroughbred racing fan.

Analytical techniques: The regulatory guidelines by groups such as the FDA for quantitative (determining the exact amount of drug in a sample) and analytical techniques (assays) routinely require the use of an instrument called an LC-MS-MS machine (especially for small drug molecules). LC-MS-MS can be used unless there is no possibility of using this instrument for this type of assay (some drugs do not lend themselves well to biochemical assays and other techniques are used).

The advantage of this type of instrument includes the use of very small blood samples (usually serum and not whole blood less than 0.5 mL or even smaller samples) with the ability to find even miniscule amounts of drug in the sample. Thus, the contention that there was no more blood sample left (in the Mott case) puzzles me, since modern analytical techniques can use very tiny volume amounts. 10 mL would provide enough serum to assay a drug many times over if a sensitive, modern instrument was used.

If assay techniques being currently used require large sample volumes, that is unnecessary in this day and age. We can now do assays for multiple drugs on a single small serum sample (less than 0.5 mL). I am unsure what assay procedure the blood testing lab in New York State uses (based at SUNY Morrisville college), but again, modern instrumentation allows the use of very small amounts of serum and plasma to quantify drug amounts.

Since many drugs concentrate in the urine (for example, Lasix or furosemide), qualitative techniques can be used (that is determining if the drug is present or not in the urine). Instrumentation for qualitative analysis can therefore be much less sensitive. Urine drug screens can only tell that a drug is present, but it cannot tell how much drug a horse was administered or when the horse was given the drug. Also, urine drug screens cannot tell anything about the amount of drug in the blood (and in the horse) at the time the urine is collected.

Sampling for research applications in humans use a split sample technique. That means the body fluid sample is split 50-50, with one sample being sent to the analytical laboratory and the other half stored in a secure location in the event confirmatory analysis is needed. The issue of a split sample could be approached using the standard operating procedures that are used in drug testing in humans. Splitting of samples can be applied to any body fluid (urine or blood).

The issue, of course, is how to store these split samples since a large amount of -80C freezer space would be required. There are methods to reduce this storage problem that are used in humans and could be applied to horses that minimize or eliminate sample manipulation.

While these comments won't help Mr. Mott in his current case, it seems to me that the racing industry would benefit from reviewing its procedures as noted above, and if found to be “worn,” update to modern procedures for sample collection, storage and analysis. Doing this would reduce the type of situation that is currently under review for Mr. Mott.

Joseph S. Bertino Jr., Pharm.D., FCP, FCCP is the Editor-in-Chief of The Journal of Clinical Pharmacology

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