26 September 2014

On Chris Davis and the Use of Amphetamines in Baseball

This is a guest post by Luis Torres. Read more of his work at Taking Back Baseball. You can also follow him on Twitter.

It was announced earlier this month that Chris Davis of the Baltimore Orioles was suspended 25 games for amphetamine use. He was suspended for the rest of the regular season (17 games) and as many as eight playoff games, depending on how far the Orioles get in the playoffs. Specifically, as far as I know, Davis was taking prescription Adderall.

Adderall is the brand name for generic amphetamines. When sold illegally, it's better known as Speed. The amphetamine class of molecules also includes crystal meth. I'm going to go into the chemistry in a bit of detail, so in honor of Baseball Prospectus' Russell Carleton...

WARNING! GORY CHEMISTRY!



The term amphetamine (shown above) covers a specific class of phenethylamines that act as a powerful stimulant. It's best known as Adderall, a common treatment for ADHD and narcolepsy. It helps ADHD patients focus and concentrate, and since it's such a potent stimulant, it helps to keep narcolepsy patients awake.

Amphetamines have what is referred to as a chiral carbon. As some of you may or may not have learned in high school chemistry, a carbon atom has four bonds spaced out in a tetrahedral fashion. In other words, like a triangle-based pyramid where each point likes whatever the carbon atom is bonded to. When a carbon atom is bonded to four different atoms or groups, it is said to be chiral. Because of the three dimensional nature of the molecule, the mirror images of the molecules cannot be superimposed on one another so that all the groups match.


If you look at the two identical molecules above, you can see that in three dimensions, you can't rotate one molecule so that the four colored balls overlap. Each mirror image of the molecule is called an enantiomer, and can be distinguished as "left-handed" or "right-handed"*, because like enantiomers, your hands are really nonsuperimposable mirror images. Each enantiomer has identical physical properties, so why do you ask that we should care about this concept? Well, chirality can affect how a molecule binds to an enzyme. A left-handed molecule may bind well to an enzyme, while the right-handed molecule doesn't bind well at all, or vice versa. One enantiomer may provide a therapeutic effect, while the other may actually be toxic.

Adderall is a mixture of enantiomers. It's made up of 75% dextroamphetamine and 25% levoamphetamine. Dextroamphetamine is the more potent of the two, but the other enantiomer has its uses too. Even if it didn't, as long as it wasn't toxic, its presence wouldn't matter. Separating enantiomers is a difficult and costly process, so since the racemic mixture, which is what a mixture of enantiomers is called, of amphetamines is safe, that's what it's sold as**. In case you're wondering, Adderall isn't the same thing as crystal meth, but it's very, very close. Simply methylating the nitrogen (the "N") of the amphetamine molecule converts it to methamphetamine, which is the chemical name of crystal meth. Compared to Adderall, crystal meth is more neurotoxic and addictive, which is why it isn't prescribed. That, combined with its effects as an aphrodisiac and euphorant, is why it's a banned substance. Adderall, as we all know, is legal and safe when used responsibly, and not nearly as addictive as its methylated analogue. Amphetamines are actually a clear liquid. That's not amenable for human dosing, so the compound is reacted with hydrochloric acid in order to form a solid salt.

The pharmacology of amphetamines is pretty advanced, but if you’re really interested, I’d advise starting with the Wikipedia entry here.

END GORY CHEMISTRY

As is common knowledge among baseball fans, amphetamines, or "greenies" as they were called, were consumed like popcorn in the older days of baseball. There were clubhouses where it was the job of one of the attendants to make sure the bowl or jar of greenies was always kept full. Even all-time greats like Willie Mays and Hank Aaron have admitted to taking amphetamines.

The baseball season is a long, grueling marathon. It's 162 games long with only 18 days off, with a bunch of travel mixed in. Yes, baseball players get to travel on fancy chartered flights, but they frequently travel late at night and don't get to their destinations until the wee hours of the morning. They get what little sleep they can, and they get ready to play again that night. When that's what your life is like, you need all the help you can get to stay energized and focused. Let me be clear, though, that I'm neither condemning nor condoning the use of amphetamines. I'm simply explaining the rationale behind the players' motives. Of course, there's more to it than that. Amphetamines are considered to be a performance enhancing drug (PED). We'll get to the PED characteristics of the drug shortly.

Despite the fact that Adderall is a controlled substance and a suspected PED, a ballplayer is allowed to take amphetamines if he gets a Therapeutic Use Exemption (TUE) from MLB. Getting the TUE isn’t as simple as it used to be, as evidenced by Davis’s recent difficulties in obtaining one.

The way it used to work, a player just needed a prescription from an independent doctor. That’s not hard to do. Remember, there's no purely objective test for ADHD. It’s not like it’s something that can be diagnosed by testing your blood or taking a CT scan of your brain. Basically, if you don't actually have it, you just have to be very convincing. The fact of the matter is that all you have to do is to keep trying until a doctor will give you what you want. If one doctor shoots you down, just try another one. MLB won’t know of all the doctors that say no, just the one that says yes. Sadly, this also works with other drugs such as SSRIs and benzodiazapenes.

In 2011, realizing that they had left a loophole the size of Petco Park in their Adderall policy, the owners and the MLBPA worked out an agreement to increase the difficulty of obtaining a TUE. The new process involves as many as six psychiatrists conducting a multitude of interviews. Not only does this process do a better job in scrutinizing TUE applicants, it probably also succeeds in dissuading false applicants. This crackdown affected Davis when he was traded to the Orioles. He was granted a TUE during his time with the Texas Rangers. An important point to make is that it was not concluded that Davis had been cheating the system, but simply that the evidence was found not to be sufficient enough to continue his TUE.

According to a recent issue of the journal “Expert Review of Neurotherapeutics," somewhere between 2-5% of adults have ADHD. In MLB, that number is around 12%. Suspicious, huh? It certainly looks like the vast majority of players are still slipping through the cracks of stricter system. As mentioned before, there is no objective methodology to diagnose ADHD. As long as MLB continues to operate in this grey area of theirs, players denied a TUE are going to continue to risk taking Adderall anyway, which will unfairly label them as “cheaters” when the only difference between them and those with a TUE is a technicality.

One could make the argument that MLB might as well either completely legalize the drug or completely ban it. However, fully legalizing the drug could just raise all the same criticism that MLB suffered for allowing the steroid era, not to mention the health issues that could arise among players who would abuse Adderall without any restrictions in place. On the flip side, banning Adderall may just lead to the abuse of other stimulants such as Ritalin and Wellbutrin. How about simple caffeine pills? How do you regulate that?

Back to Davis. He ended up getting suspended because this was his SECOND violation. You only get a warning for the first offense. So why did Davis continue using after his first violation? There are three possibilities:
  1. He's not very bright. (Which I don’t believe.) 
  2. He's addicted. 
  3. He legitimately has ADD/ADHD, and therefore has a medical need to continue using.
From what I've read, Davis may really have had ADHD. Even if that's true, I'm sure he didn't mind the stimulative effects of the drug. It could be a mixture of the three reasons I gave. It's all speculative, and really, it's not that important. If Davis couldn't get the TUE, then he should've stopped using. While he was expected to regress some from his monster 2013 season, he was still expected to be a major contributor and an important part of the 2014 Orioles, and doing something that could get him suspended at any time was selfish and careless. Thankfully for O's fans, due to his dismal season, and what at the time was a huge 11.5 game lead in the AL East, Davis's absence has had a minimal impact.

Amphetamines as a PED has been a hot button topic in recent years. Like steroids, the "evidence" against them is anecdotal. It has been scientifically proven that Adderall will boost energy, focus, and cognitive abilities. The same cannot be said about its capability to boost baseball performance. Although steroids draw more ire from baseball fans, I'd argue that at least for position players, amphetamines are more of a PED than steroids. This is absolutely only a theory of mine. It is an untested hypothesis and therefore I have no scientific evidence to back this up. My reasoning is that a drug that boosts your energy and focus will boost a player's hit tool, i.e., make him a better hitter. Steroids can only boost your power, and the hit tool is more important than power. It's also reasonable to assume that it will boost a player's fielding skills. Again, being more alert and focused will help with fielding the ball better. Steroids may be able to help you throw harder, but range and fielding is more important than arm strength. For all you anti-steroid fans out there, think about this next time you condemn a player for steroid use, and don't forget the number of Hall of Famers that have readily admitted to taking greenies.

Players don’t seem to realize the dangers of amphetamine abuse. We’re all aware of the addictive dangers of the drug. What players need to be aware of is that taking too many amphetamines will IMPEDE physical performance. It can elevate your body temperature, which is more serious for athletes in other sports, but it can also lead to the rapid degeneration of muscles. Psychosis can even develop in amphetamine abusers.

I think it's absolutely unfair to call Chris Davis a cheater. There's no difference between Davis and all the players with a TUE. Furthermore, if Davis really does have ADHD, he's certainly less of a "cheater" than players who are faking the condition so that they can legally take Adderall.

While I'm on the subject of Chris Davis, I'd like to touch upon his season a little bit. Last season, Davis had a breakout year. He hit an excellent .286/.370/.634, good for a 168 wRC+ and 6.1 WAR. He also led the league with 53 HR and 370 total bases. His success was due to a mechanical adjustment in his swing. The power was always there, he was just finally able to make the contact necessary to make use of that power. Going into this season, he was expected to regress some. PECOTA had him projected at .259/.324/.479. I originally thought that was a bit of an extreme regression. The projection systems were taking his pre-2013 seasons into account, and obviously couldn't know of the adjustments he made at the plate. As it turns out, PECOTA was being too kind. This season, Davis has been terrible, hitting .196/.300/.404 with "only" 26 home runs. That's just a 93 wRC+. On the bright side, he is hitting for a lot of power, but it's not enough to overcome the low AVG and OBP. That power has barely kept him above replacement level offensively.

So what happened? Jeff Sullivan wrote a good piece for FanGraphs exploring this question, and it's well worth your time. With all due respect to Sullivan, I think the answer is simpler than he's proposing. For starters, he does have a .242 BABIP, which is almost 80 points below that of his career. All that bad batted ball luck will certainly normalize. Baseball Prospectus got a quote from a scout that explains things further:
His timing is off; his hands and wrists aren't working; he's a mess. It's to the point where you hope he's been playing with some sort of undisclosed injury this year, because even the batting practice displays are uncomfortable.
It looks like he's either hurt, or he got his mechanics all out of whack again. Add that statement to his low BABIP and natural regression, and you get a simple explanation for his struggles this year. The power is absolutely, positively still there. I don't believe we'll ever see 2013 Chris Davis again. I do think he's a mechanical adjustment and improved plate approach away from becoming an effective slugger again. I'm making it sound more trivial than it really is, but I think there's still the potential for a 4 WAR player in there.

Hopefully going into next season, Davis will get healthy (if that is the problem), make the adjustments he needs, and get that TUE he needs. I'm optimistic that he can once again become a major contributor to the Baltimore Orioles next season, and if they're lucky, maybe he can make an impact late in the ALCS or the World Series.

* Chemists don't use those terms. We use more technical terms, the explanation of which is probably too involved for a simple baseball column.

** That doesn't fly anymore. The FDA won't approve drugs that are a racemic mixture.

Reference:
  • Ramos-Quiroga, Josep Antoni; Nasillo, Viviana; Fernandez-Aranda, Fernando; Casas, Miguel, "Addressing the lack of studies in attention-deficit/hyperactivity disorder in adults," Expert Review of Neurotherapeutics (2014), 14(5), 553-567.

2 comments:

Anonymous said...

Wow, you know alot of chemistry. I didn't know all that about Adderall. My doc said I have ADHD and prescribed me with it. I can function better with it and I twitch less. If Davis does have ADHD they're making his life and baseball skills worse by banning it and then punishing him even more by suspending him. Coaches and staff should know there players enough to know if they need prescribed Adderall

Luis Torres said...

I'm actually a research chemist, which is why I know all that stuff!

I'm glad to hear that the medication is working for you.

If Davis does indeed have ADHD, then I feel sorry for him that the system has let him down.