The Banned Substance List Holds the Keys to Better Baseball

Permitting practical, therapeutic, and supervised use of anabolic steroids which are currently banned by Major League Baseball may reduce recovery time and increase fan interest.

Major League Baseball has published a list of every single banned substance that has been revised and re-evaluated over the years. The list is divided into 3 major categories; Drugs of Abuse, Stimulants, and PED’s. Of these three categories I am in full agreement that the stimulants and drugs of abuse that have been banned by Major League Baseball are rightfully banned.

Drugs of abuse, as defined by Major League Baseball are “Any and all drugs or substances included on Schedules I and II of the Code of Federal Regulations’ Schedule of Controlled Substances (“Schedule I or Schedule II”), as amended from time to time, shall be considered Drugs of Abuse” Some of the drugs included in this category are cocaine, codeine, heroin, MDMA, LSD, and PCP. Stimulants are drugs that improve brain to body communication. Amphetamines are the commonly known types of stimulant drugs and are a part of Major League Baseball’s banned substance list under the stimulant category. Drugs under these categories that reside on the MLB’s banned substance list are justifiably there. These drugs are known as addictive and the side effects of these substances aren’t in any way shape or form useful or safe for players to experience while on the field. For example, there is no reason for a batter, pitcher, or fielder to come up to be playing in a game while tripping on a drug such as LSD. There is no benefit of this to the batter, pitcher, or fielder and as a matter of fact there really are only downsides to these drugs as it alters the mind and could induce hallucinations which obviously could become quite dangerous when playing a physical sport with fast moving parts. So now that I’ve made my stance clear on the fact that I’m in agreement with the absence these particular banned substances, let’s look toward the other category of banned substances.

The category that I believe Major League Baseball needs to reevaluate for legalization is the PED’s category. One of the subcategories of PED’s is Anabolic Agents which are defined by Major League Baseball as “Any and all Anabolic Androgenic Steroids included in Schedule III of the Code of Federal Regulations’ Schedule of Controlled Substances (“Schedule III”), as amended from time to time, shall be considered a Performance Enhancing Substance covered by the Program.” Some notable anabolic agents that are included on the list are trenbolone, testosterone, oxymetholone, nandrolone, boldenone, and oxandrolone. The function of these anabolic agents is to increase strength by adding muscle mass. The way that works is by mimicking the functions of hormones like testosterone that our body’s produce. Many of these drugs were used by abusers in the 90’s and 2000’s which led to their ultimate ban. However, I believe that these drugs have a place to be made useful in Major League Baseball by being used for medical and rehabilitation purposes.

I’m not saying that if a player experiences some hamstring tightness that it gives them a free pass to go injecting themselves with all kinds of anabolic steroids and growth hormones. That would be utterly ridiculous and ultimately put the stigma back around PED’s that they’re out of control and too often abused. The problem they experienced in the league already is similar to any other form of drug abuse. Look at opioid abuse for example, a person experiences a painful injury and a as a result they get some opioid pain killers from someone. They weren’t prescribed the drug but now they can’t get enough because they used it improperly without any professional diagnosis just like players did with steroids in previous years.

The elimination of abuse is possible and the implementation of use is made possible as well. Let’s refer to opioids again as reference. A doctor prescribes a patient an opioid and it’s taken correctly, the patient will use the medicine as intended because it’s what they need and it was professionally recommended and administered to them. So now take anabolic steroids into consideration. There will be a specific medical staff responsible for specifically dealing with steroid administration and supervision. Proper administration of anabolic steroids reduces chances of abuse. Proper administration of anabolic steroids will also reduce injury recovery time.

The Anabolic Answer

I fully understand the history of PED abuse in baseball and why Major League Baseball went to the extremes they went to in hopes to prevent the power trips and blatant abuse of steroids that we saw in the 1990’s and 2000’s. But there are cases where these banned substances are a necessary means of recovery for athletes. In “Major League Baseball’s Minor League Drug Prevention And Treatment Program” they have a section dedicated specifically to allowing players to take prohibited substances called “Therapeutic Use Exemption” or “TUE” which allows players to use certain substances if they really must. I believe that MLB should consider easing the process of getting an exemption and adopt a system in which post-injury evaluation system to determine if banned substances could make an impact on recovery rates.

In this system, players would have a baseline test at the start of every season. The tests would monitor their physical capabilities such as strength, speed, agility, and baseball related movements. A big part of these tests would also be drug testing before these tests to make sure players are clean for the baseline along with blood testing to determine levels of certain biological/chemical factors. Once players have a baseline test, they can be evaluated post-injury in comparison to their baseline tests. The league would have to create specific thresholds in comparison to baseline tests for exemptions. What I mean by this is that if a player experiences an injury that doesn’t completely diminish their capabilities but sets them back in a minor way, they may not qualify for use of a banned substance. Where if a player experiences an injury that sets them down quite a bit from their baseline tests, they may have a much higher chance of qualifying for an exemption. A system like this would obviously require major supervision and likely it’s own committee but if it means improving injury recovery and keeping players on the field then it should by all means be considered.

By implementing this program, it would bring a drastically different approach to anabolic steroids in Major League Baseball from the previous steroid era which showed extreme abuse of the drugs. It may sound like I’m stating the obvious, but the implementation/legalization of anabolic steroids would make them something that a team medical staff is able to administer and monitor. If the only allowed use of the drugs is under medical supervision, there is no way that abuse can happen under the rules and regulations of the proposed system. It’s possible that by making anabolic steroids available as a treatment may actually be a way to minimize and get rid of anabolic steroid abuse within Major League Baseball.

One of the key reasons I’d like to see the MLB adopt a system similar to this is because of oblique injuries. In a study done on oblique injuries from the 2011 season to the 2015 season, 259 players at the major league level suffered oblique injuries resulting in 6,132 days missed. Batters/Position Players averaged 3 weeks missed per injury with over an 8% chance of re-injury. Starting Pitchers averaged nearly a month missed with a re-injury rate of around 5% and relievers averaged about 24 days missed with a re-injury rate of nearly 10%. The average days missed on recurrent oblique injuries is also higher compared to the days missed from the primary injury. These injuries are not a day to day type of injury and a statistical analysis of recovery methods shows that some players required injection of a corticosteroid, a legal steroid in Major League Baseball. However, administering the corticosteroid still didn’t speed up recovery process as it took players 30 days to recover post injection.

I think it’s quite interesting that players didn’t have any kind of improvement in recovery rates post injection from corticosteroids. So I decided to take a deeper dive into corticosteroids as a recovery method for sports injuries and stumbled upon a pretty informative article. The article “Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme” by Peter Brukner, Andrew Nealon, Christopher Morgan, Darren Burgess, and Andrew Dunn discusses hamstring injuries among football players and the recovery methods used. They mention one player who used corticosteroids as a recovery method and here’s what they said “an epidural corticosteroid injection was performed…Postinjection the player reported a general improvement in his feeling of ‘freedom’ on the right side and felt able to swing his legs through fully…Five days later he started another pre-season game. After 5 min, he sprinted with the ball and crossed the ball with a whipping action and immediately felt some tightness in his hamstring, without an associated feeling of tearing or pain, and was thereafter unable to sprint with confidence.” Quite an interesting order of events as it seems that corticosteroids essentially mask the pain/ease symptoms but might not actually repair muscles.

Maybe corticosteroids may not in fact help with any kind of recovery, so let’s dive into the article “Taking Anabolic Steroids After a Sport Injury” by Samuel Mckenzie from the media outlet News Medical Life Sciences, which studies the effects of corticosteroids vs anabolic steroids in relation to muscle strains/contusion injuries. One specific experiment was conducted on rats who suffered muscle contusions and the results are quite informative. The article states “Initially, the corticosteroid group showed great improvements to twitch and tetanic strength, but later these improvement reversed and resulted in the degeneration of the muscle. The anabolic steroid group showed no initial improvements, but by 14 days showed significant improvements to twitch tetanic strength without the degeneration of the muscle. The authors concluded that that corticosteroids were helpful in the short-term but detrimental to long-term muscle repair and anabolic steroids could improve muscle repair and aid in the healing of muscle contusion injury.” If we know that corticosteroids don’t lead to long term healing and actually degrade our muscles, anabolic steroids need to be heavily considered for treatment. Baseball’s best players shouldn’t be off the field with injuries when we have proven remedies that are readily available to increase their recovery rates.

If we know one thing it’s that times are certainly going to forever change. With the changing of the times we learn from our pasts. I think Major League Baseball is far enough beyond the era of steroid abuse and the advances made in medicine, technology, and overall knowledge could make it so that we never see steroid abuse like we saw in the 1990’s and early 2000’s in Major League Baseball again. We’ve come to a time where we’ve essentially mastered the negatives of these banned substances so we’re probably smart enough to figure out a way in which only the positive effects are used in an appropriate manner.

Abuse Can be a Big Deal but Use is a Way to Heal

There’s an old saying that everything is okay in moderation. There are some instances where that simply isn’t true. However, in the case of circumstantially legalizing certain banned substances in Major League Baseball I think this saying holds true.

In previous decades, we saw players get juiced up on all different kinds of androgenic steroids, anabolic steroids, human growth hormone, and every other kind of extreme drug that would induce muscle mass and cause players to turn into the massive, chiseled, greek god like beings. This obviously caused evident competitive advantages as players who had previously been mediocre became these powerful home run threats at the plate and rise to stardom after being the scrawny role player. The problem that arose during this time period was the blatant abuse of performance enhancing drugs and of course the problem it created with competition.

But because of this time period in Major League Baseball, I believe that not only has Major League Baseball learned how to crack down on steroid abuse but the scientific and technological advances made since then would allow the implementation of these substances as healing agents to go smoothly. Everything can be tracked now for the most part so monitoring players levels of injury, monitoring drug levels, collecting data, and whatever else needs to be done to ensure the program runs correctly shouldn’t be an issue.

If there was a downside to some of these PED’s being implemented into Major League Baseball, it would have to be the risk that some of these drugs can have on an individuals health. The article “Androgenic anabolic steroid-induced liver injury: two case reports assessed for causality by the updated Roussel Uclaf Causality Assessment Method (RUCAM) score and a comprehensive review of the literature” is a case report that assess two people who used anabolic androgenic steroids and experienced anabolic androgenic steroid (AAS) induced liver injury as a result of doing so.

The first person they studied was a 30 year old man with a history of taking creatine supplements for performance but claimed he’d never taken AAS. The man claims to have been experiencing jaundice and diarrhea in the recent past. As the first part of his assessment they measured levels in his liver. The results are as stated “His bilirubin was 181μmol/L, alkaline phosphatase (ALP) 66 IU/L, alanine transaminase (ALT) 257 IU/L and creatinine (Cr) 97 μmol/L.” His levels in ALP and Creatine levels were in a normal range but that’s not the case for his bilirubin and ALT levels. According to UCSF Health, a normal level range for ALT is between 4 and 36 IU/L. If I’m any good at math, he’s quite passed that range by a few hundred. According to Mount Sinai Health Library, normal levels of bilirubin are between 1.7 and 20.5 μmol/L. Yet again, the mathematician in me says these levels are high by quite a bit. His symptoms worsened over the next week or so and he eventually had to be admitted to the hospital where they found chronic hepatitis B. The hepatitis was easily managed but something was still wrong. He admitted to use of an AAS upon further questioning as his liver biochemistry worsened. To make a long story short, his levels kept spiking to dangerously high levels and it took a series of medication, medical practices, and 2 months time for his levels to return to normal after stopping steroids.

The reason his case is important to mention when discussing potentially implementing drugs similar to the ones he was using back into Major League Baseball is because he’s in a similar demographic to a majority of the league’s players. That demographic of course being men around 30 years old (MLB average player age is 26-30 years old in 2022 according to Statista).

I can’t say for certain players in the league who look at a case like this man’s will be ok with using substances similar to the ones that this man used as it compromised his health. But what I can say is that the man in this case took these drugs on his own without any prescription or any kind of supervision. We know this because when asked about use of AAS use the article states “He used Creatine supplements for performance enhancement but denied AAS use”. This of course was prior to him admitting his use of an AAS after he learned about the severity of his liver biochemistry. He could’ve taken ridiculous amounts of these drugs and had no clue the harm he was doing until he finally was assessed by a doctor.

Before I go any further I want to clarify that I don’t think that a case like this man’s is impossible for a player to experience as a result of Major League Baseball adopting a system as previously mentioned to regulate PED’s. But I do believe that the chances would be quite low considering the amount of time, effort, supervision, technology, equipment, and knowledge that would be backing a program that’s being implemented in a multi billion dollar industry. Let alone the league itself, each team is so incredibly wealthy that staffing a group of people who’s sole priority is to monitor these players during their recovery while using PED’s would be something that owners would be more than willing to spend their money on. Owners spend so much on star caliber players that it is worth every penny to do everything in their power to keep them on the field where they can do what they’re getting paid to do. When the stars of the game are on the field more consistently, it makes it so much more enjoyable for fans to watch games knowing that night in and night out the best of the best will be going at it. What was once a skid mark on the face of baseball (the skid mark being PED’s) could really be a “game-changer” for the future of Major League Baseball.

References

“Major League Baseball’s Minor League Drug Prevention And Treatment Program.“. (2021). Retrieved March 6, 2023,

“Epidemiology and Impact of Abdominal Oblique Injuries in Major and Minor League Baseball Christopher L. Camp,* MD, Stan Conte,†‡ PT, DPT, ATC, Steven B. Cohen,§ MD, Matthew Thompson,|| MD, John D’ Angelo,{ BS, Joseph T. Nguyen,# MPH,
and Joshua S. Dines,** MD. Retrieved March 6, 2023

“Recurrent Hamstring Muscle Injury: Applying the Limited Evidence in the Professional Football Setting with a Seven-Point Programme.” Brukner, Peter, Andrew Nealon, Christopher Morgan, Darren Burgess, and Andrew Du; British Journal of Sports Medicine. BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine, June 1, 2014. . Retrieved March 29, 2023,

*All sources below accessed on April 12th, 2023*

Androgenic anabolic steroid-induced liver injury: two case reports assessed for causality by the updated Roussel Uclaf Causality Assessment Method (RUCAM) score and a comprehensive review of the literature

Major League Baseball rosters by average player age in 2022

Alanine transaminase (ALT) blood test

Bilirubin blood test