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Maria Sharapova’s meldonium doping scandal, explained

Maria Sharapova.
Maria Sharapova.
Kevork Djansezian/Getty Images
Alex Abad-Santos is a senior correspondent who explains what society obsesses over, from Marvel and movies to fitness and skin care. He came to Vox in 2014. Prior to that, he worked at the Atlantic.

Maria Sharapova's tennis career has demanded attention.

She burst onto the scene in 2004, blasting Serena Williams off Wimbledon's Centre Court with searing groundstrokes and a grunt that sounds like a peacock in distress. The beauty of Sharapova's game, when it's on, is that there's no need for surgical precision. When she's at her best, her tennis is complete, eye-popping obliteration.

The 6-foot-2 Siberian quickly assumed the role of tennis's glamour girl, and won the US Open two years later, in 2006. Two after that, in 2008, she once again played indomitable tennis and cruised to the Australian Open title. In 2012 and again in 2014, Sharapova conquered her worst surface — red clay — and took home trophies at the French Open.

Sharapova's tennis is now a topic of discussion once again. But this time, it's for a history-making act she wants no part of. Sharapova is the first premier tennis star in history to fail a doping test, and has admitted to using the banned endurance-enhancing drug known as meldonium.

What Maria Sharapova admitted

On Monday, March 7, Sharapova admitted that she had failed a doping test, because she had been using a substance called meldonium, which is banned by the World Anti-Doping Agency (WADA), for most of her pro career. But she says her failed test was due to the fact that meldonium was only recently banned and she failed to recognize the updated list.

"I had been legally taking the medicine for the past 10 years, but on January 1 the rules had changed, and meldonium became a prohibited substance, which I had not known," she told reporters at a press conference in Los Angeles.

Many pro and Olympic-level athletes have a team of people who support them — lawyers, handlers, assistants, coaches, managers — to ensure that oversights like this don't happen. To give Sharapova the benefit of the doubt, perhaps she keeps her team small and makes decisions herself.

However, it's notable that she had her sights set on the 2016 Olympics, which means another layer of officials whose job it is to make athletes aware of which substances WADA is monitoring and what's being banned. For example, one of the responsibilities of the United States Anti-Doping Agency (USADA) is athlete education, and in two separate documents it points out that WADA began monitoring meldonium in 2015 and also banned the drug. Russia's anti-doping agency issued a warning to athletes about meldonium last year.

Caroline Wozniacki, a former top-ranked tennis player, emphasized this point during a March 8 press conference, saying that athletes, including herself, work with doctors whose job it is to make sure they aren't using banned substances.

"I think any time we take any medication, we double- and triple- and quadruple-check, because sometimes even things like cough drops and nasal sprays can be on the [banned] list," Wozniacki said. "As athletes we really always make sure there's nothing in it that is prohibited."

What Sharapova did was frame her failed drug test as an oversight — like a common workplace mistake that could happen to anyone. We can all probably relate to missing an email or a phone call and never following up. And to Sharapova's credit, she took responsibility for the failed drug test.

What she and her team didn't go into is to why the drug was banned in the first place.

What meldonium does, and why WADA banned it

Meldonium is a drug that is typically prescribed to people with heart conditions. It's an anti-ischemic drug, which means it prevents the deprivation of oxygen to the heart, brain, or other organs. Meldonium does this by increasing blood flow.

The drug sounds normal enough. But the World Anti-Doping Agency didn't just start banning meldonium out of the blue. According to WADA, meldonium started showing up in athletes' drug tests frequently enough that the organization began monitoring the drug and which athletes were using it in 2015.

WADA then banned the drug in 2016 because it found athletes were (unsurprisingly) using it to boost their sports abilities, not to treat heart conditions.

"Meldonium was added [to the Prohibited List] because of evidence of its use by athletes with the intention of enhancing performance," WADA wrote in a statement regarding Sharapova's failed drug test.

For athletes, meldonium's cardiac effects can help maximize endurance and speed up recovery from the demands of training and competition. A study in the journal Drug Testing and Analysis on the use of meldonium in professional sports found that the drug can lead to increased "endurance performance of athletes, improved rehabilitation after exercise, protection against stress, and enhanced activations of central nervous system (CNS) functions."

Those are all benefits any athlete would want. But for tennis players, increased endurance and recovery are especially important. Tennis is one of the few sports where you don't need to be a hulk to dominate. While it certainly doesn't hurt to be muscular, a lot of the sport is based on technique and repetition. The more tired players get, the more their technique and the mechanics that go into each stroke begin to break down.

During grand slam tournaments, tennis players usually compete every other day and practice on their off days. Being able to speed up the turnaround would undoubtedly help any top player.

Because of the number of athletes using the drug and its effects, WADA has deemed the use of the drug unfair, and meldonium was classified as an S4 substance, along with other hormone and metabolic modulators. Many of these drugs either interfere with hormone function or regulate blood sugar and blood flow in the body.

Why Sharapova's claim looks shaky

Sharapova insists she wasn't using meldonium to dope. Rather, she said during her March 7 press conference that her doctor prescribed the drug to treat and manage several health issues that she began experiencing in 2006 and has been using it ever since.

"I had irregular EKG results as well as indications of diabetes with a family history of diabetes," she explained.

Grindeks, the Latvian company that manufactures meldonium, questioned Sharapova's claim and continual usage for such a long period of time. The company said a normal treatment period for patients taking meldonium for health reasons runs four to six weeks.

"Depending on the patient's health condition, treatment course of meldonium preparations may vary from four to six weeks," Grindeks said in statement to the Associated Press. "Treatment course can be repeated twice or thrice a year. Only physicians can follow and evaluate patient's health condition and state whether the patient should use meldonium for a longer period of time."

Sharapova's lawyer has claimed the athlete was just following her doctor's orders, but there's a clear disconnect between the drug company's statement about a four- to six-week treatment period (that can be repeated two or three times per year) and Sharapova's claim that she was taking it continually for health reasons for a full decade.

And if Sharapova was just following her doctor's orders, why was her doctor not up to date with WADA regulations?

Further damaging Sharapova's case is the fact that she isn't the only Russian athlete to test positive for the drug. On Monday, March 7, Ekaterina Bobrova, an ice dancer who has an Olympic gold medal to her name, also said she failed a doping test due to meldonium usage. The next day, March 8, Russian world champion speed skater Pavel Kulizhnikov's coach said Kulizhnikov had also failed a doping test for meldonium, according to the Guardian. And on Wednesday, March 9, Georgian Olympic wrestling silver medalist Davit Modzmanashvili admitted to using the drug.

It's very hard to believe that so many world-class athletes, including Sharapova, are taking meldonium for health reasons.

The serious consequences of Sharapova's failed drug test

Sharapova is currently the highest-paid female athlete in the world, according to Forbes. However, since she announced her failed drug test, sponsors including Nike, Porsche, and TAG Heuer have dropped her. And it's unclear whether she will be allowed to play professional tennis again.

Sharapova, according to the BBC, is facing up to four-year ban from the International Tennis Federation. She is currently 28 years old, which would put her at 32 when she returns. Thirty used to be the retiring age for tennis, but in recent years older players have won grand slams. A comeback wouldn't be impossible, and Serena Williams at 34 still dominates the game. But Williams is a once-in-a-lifetime player and an exception to the sport's generalities.

There's also the matter of Sharapova's legacy, and whether using an endurance-enhancing drug tarnishes her lengthy resume of accomplishments. Former tennis player Jennifer Capriati has stated firmly that Sharapova should be stripped of her titles. She's one of Sharapova's biggest critics.

Capriati's criticism raises a valid point: that the ban on meldonium, which is new in 2016, doesn't mean Sharapova or any other athlete didn't unfairly benefit from using the drug before it was banned. WADA's rule change isn't retroactive. And there are no doubt drugs WADA has yet to ban that help athletes enhance their performance.

But Sharapova does have some defenders. Russian Tennis Federation president Shamil Tarpischev said the test was "nonsense" and that it was a simple oversight made by Sharapova's doctors. He's one of the people out there who is willing to take Sharapova's word for it that her meldonium use in 2016 was just an oversight.

In a somewhat surprising turn, Sharapova received some kind words from Serena Williams, Sharapova's chief rival (although "chief rival" is being generous, as Williams has absolutely dominated their overall head-to-head matchups). Williams defended Sharapova during a March 8 press conference.

"Like everyone else, most people were surprised and shocked," she said. "But most people are happy with the fact she was upfront with what she had done in terms of what she had neglected. With that being said, she’s taking responsibility, which she was ready to do."

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