A Diabetes Drug's Outsized, Contested Role in Horse Racing's Anti-Doping Crusade

Trainer Mike Lauer is now a month past serving what he believes was an unjust 75-day suspension because a Thoroughbred under his care at Horseshoe Indianapolis tested positive last summer for metformin, a drug used to treat diabetes in people. With more 20 million patients taking it, metformin ranks as the nation's third-most-prescribed human medicine, according to the consumer healthcare website Healthgrades.

Before Lauer's case made it to an official arbitration hearing, the 72-year-old conditioner with five decades of licensure was able to present enough evidence to the Horseracing Integrity and Welfare Unit (HIWU) for the agency to conclude that the likely source of the metformin was “unintentional contamination” by a groom who had ingested his doctor-ordered blood sugar-regulating tablet at lunch, then touched the mouth of Mowins (Mohaymen) while fitting the gelding with a bit and bridle for an Aug. 5 race.

But even though that negotiated HIWU resolution stated that “Mr. Lauer's degree of fault is in the light range” and that he “fulfilled his personal responsibility to be knowledgeable of the Anti-Doping and Medication Control Program and to inform all personnel associated with the care, treatment, training, or racing of his Covered Horses,” the evidence was only enough to reduce–not eliminate–Lauer's potential penalties of a two-year suspension and $25,000 fine, which are HIWU's standard sanctions for banned substances.

The “banned” category is the most serious class of drug offences under Horseracing Integrity and Safety Act (HISA) rules. Those substances are considered the most harmful and egregious, and are never supposed to show up in tests on any covered Thoroughbred.

Lauer and his wife, Penny, detailed to TDN how they spent $45,838 over a five-month span trying to clear Lauer's name and keep his training business afloat while fighting the ruling, which ended up with a $2,600 fine in addition to the 2 1/2-month suspension.

But, the Lauers said, they can't calculate the direct costs of the logistical headaches they endured while trying to temporarily disperse a 50-horse racing stable among five new trainers for the time that Mike was ineligible to compete.

Nor, the Lauers added, does the financial outlay take into account the lost income from Mike's being unable to ply his trade, purse money from two of Mowins's races that had to be forfeited, or the credibility blow the ruling inflicted upon the outfit's reputation.

They also aren't sure that their groom was even the correct source of the metformin positive, even though the groom came forward and volunteered the timetable of events that Mike Lauer agreed to when signing his “case resolution without a hearing/final decision” document.

Lauer told HIWU investigators that he, too, takes metformin as prescribed by a doctor, although he said he had not touched Mowins anywhere near the gelding's face in the week before the positive test. The Lauers also said they paid $1,100 to have testing done on the Shelbyville, Indiana, water source that supplies the track's stable area, and it revealed traces of metformin.

Mowins | Coady

As a trainer since 1976 with an 11.7% win rate from 9,988 starts that is not suggestive of performance-enhancing drug use, Lauer's stock in 2023 was spread across three divisions stabled in Kentucky, Ohio and Indiana, and his entrants ranged from a horse who ran third in the GI Man o' War S. at Belmont Park to lower-end claimers who routinely competed at Belterra Park.

Lauer has only three previous medication violations listed against him on The Jockey Club's online rulings database. All were for penalty category C (the lowest level of severity) infractions that occurred in races in 2009 and 2018 (twice). They resulted in fines of $250, $1,000, and $1,500 as per then-in-effect racing commission standards in Kentucky and Indiana, plus a 10-day suspension for the latter positive because it was his second violation within a one-year period.

Lauer said he's doing the best he can to put HIWU's bureaucratic rodeo behind him while focusing forward now that he's permitted to train again. But it seems every time he tries to clear his mind of the ordeal, some little reminder of it pops up to skewer him anew.

Like a couple weeks back when Lauer was attending a horse auction, and an industry acquaintance approached him and said by way of greeting, “Well, I see they caught ya!”

Lauer ignored the wiseguy's remark. Still, the stigma of it stung.

“You get little cracks like that,” Lauer said. “But we lost clients. We lost a ton of money, and I mean a ton. And we went through a ton of aggravation. My life's not back to normal, and I don't know when it will be.”

Penny Lauer, a part-owner of Mowins, the gelding whose urinalysis came back positive for metformin after he ran third at 21-1 odds in an allowance sprint, put it this way:

“Just the fact that Mike's name was plastered all over having a positive test, people take that info and run with it. Everybody thinks you're cheating. We had to change so many things [for horses owned by Penny and other longtime clients] to be able to run, and pay people that we wouldn't normally had to pay if Mike was able [to train]. We did nothing wrong, yet took a big hit for it. Metformin is not cheating. We didn't put it there. It was just there.”

Penny Lauer continued: “There are so many people that touch and care for a horse every day, and even more people on a race day, that a trainer, no matter how much care you take with safe protocol, it is impossible to even know what you come into contact with.

“If you want to believe what HIWU laid out regarding the probability of where this metformin came from, we are talking about possibly a dusting from a pill, on the hands of the groom that transferred it to the bit that the groom put in the horse's mouth, and the horse eventually peed out, and [was] not [detected in tests of] blood,” Penny Lauer said.

“And you think this actually made a difference in the performance of this horse?” Penny Lauer asked rhetorically. “Ridiculous!”

And confusing. The Lauers said that even after hiring an attorney and having their own back-and-forths with HIWU, plus a pre-conference call with an arbitrator, and after speaking to scores of veterinarians, stewards, and racing commission officials in an effort to seek supporting information to bolster their case, they still don't have a clear understanding of why metformin is considered a purported performance-enhancer.

Nor do the Lauers know why the diabetes drug's presence in a horse carries such draconian penalties.

They also said they have no clue as to why the five positive tests for metformin since HIWU took over the sport's drug testing in May 2023 have resulted in widely varying outcomes.

In October, two trainers–Javier Morzan of the mid-Atlantic region and the New Mexico-based Guadalupe Munoz, Jr.–had metformin charges against them withdrawn after an internal HIWU review of its six accredited laboratories discovered different limits of detection in blood for metformin, a problem that HIWU officials said has since rectified by harmonizing those detection values across all labs.

In November, Angel J. Castillo Sanchez, a conditioner based in the mid-Atlantic, resolved a metformin positive in one of his trainees by signing an “admission of rule violation and acceptance of consequences” agreement with HIWU that resulted in an 18-month suspension and $12,500 fine.

In December, Anthony Farrior, the leading trainer at Charles Town, had charges from a metformin positive triggered at Laurel Park dropped. He had requested testing of the split sample, but HIWU determined the specimen's volume was “insufficient for analysis,” so the complaint was withdrawn.

Another metformin positive from June has yet to be resolved by HIWU. Trainer Jonathan Wong remains under provisional suspension in a case involving a test from a maiden-breaking filly at Indiana Grand.

Jonathan Wong | Benoit

Wong, too, faces up to a two-year suspension and a $25,000 fine. He has publicly disclosed that he has a valid metformin prescription to control his own diabetes. Despite being out of work since July 2 while his case makes its way through the system, Wong told TDN back in August he had “zero problems” with the concept of HISA, and that its oversight was “much needed.”

But, added Wong, “when you're completely not awarded any opportunities from day one until your hearing, that's pretty much being charged as guilty until proven innocent. I feel like I've been locked up and had the key thrown away.”

Perspective is Everything

Widening the lens, the metformin positives can be grouped into a broader issue that involves other drugs ingested by people whose residues sometimes show up in equine drug tests. Some of those substances, like methamphetamines and cocaine, are drugs of human abuse with a low likelihood of having been intentionally administered to enhance a horse's performance. But because of their illegal and dangerous nature, they are in the “banned” category.

For example, there are currently five pending methamphetamine violations awaiting adjudication by HIWU. Five others have already been ruled upon, all from horses in the stable of Prairie Meadows trainer Dick Clark, who admitted the violations and accepted the consequences of being ruled off for 90 months and a $62,500 fine, the largest penalties on record since the inception of HIWU.

Lauer told TDN he believes HIWU is going after easier human-drug contamination targets rather than rooting out true horse dopers. His belief is that anxiety over getting caught for something that is essentially out of one's control is causing innocent horse trainers to get out of the business.

“I wish HIWU would catch somebody,” Lauer said. “All they're catching is [the equivalent of] parking tickets. That's all they're passing out, and they're just crucifying trainers for things like metformin and meth.”

TDN emailed Lisa Lazarus, the chief executive officer for the HISA Authority, asking if she'd answer several overarching questions: Is this the way HIWU and HISA are really supposed to work? Are the Authority and HIWU comfortable with the idea that trainers–even some who were initially supportive of HISA–are expressing legitimate fear over getting their lives derailed by accidental contaminations?

Lazarus agreed to a phone interview to discuss the situation. Over the course of about 35 minutes one morning last week, she gave her perspectives on metformin, inadvertent contamination cases, and the evolution of her agency.

Opponents of HISA might not like some of what she said. But give Lazarus credit: This sort of back-and-forth dialogue about real-life concerns over medication control policies had been notoriously difficult for TDN (and other media outlets) to engage in with racing commission personnel prior HIWU's advent, back when those agencies controlled the nation's drug testing under state-by-state rules.

(Disclaimer: Because Lauer opted not to give permission for Lazarus to speak to TDN about any aspects of his case that haven't already been made public via HISA and HIWU documents, Lazarus was unable to go too deeply into specifics about Lauer's negotiated settlement.)

And before Lazarus would tackle any general questions, she wanted to get a few points on the record for perspective and background. She asserted that HISA and HIWU are not tone-deaf to industry complaints, and she said there is evidence to show that the agencies have been proposing new policies when they realize the original ones aren't working the way they were intended to.

Those changes, Lazarus said, have included altering how provisional suspensions for likely inadvertent contaminations get reported, providing ombudsman assistance and pro-bono legal resources for trainers who can't afford to hire a lawyer, and a renewed focus on getting racetracks to clean up receiving barns and other common areas where horses might be subject to environmental contamination.

Lisa Lazarus | The Jockey Club photo

Lazarus also stressed that while catching alleged cheaters and keeping them from getting an illegal edge is a main concern for HISA and HIWU, the agencies are also mandated to focus on horse welfare, which drives some of the reasoning on how substances that are generally considered human drugs of abuse are handled.

“Somebody who's on meth shouldn't be walking a 1,200-pound animal around the backside,” Lazarus said, underscoring the obvious safety hazard that scenario presents.

“Horses shouldn't have to be exposed to drugs that the trainers and grooms are taking,” Lazarus explained. “There should be some degree of care, even if it's not obviously anywhere near the culpability of an intentional administration to get a performance advantage.

“Trainers tell me all the time that they treat their horses better than they treat their children,” Lazarus said. “Well, you wouldn't let your child be exposed to meth. And so it's a professionalization that we're trying to achieve and we think is important.”

Lazarus continued: “I don't doubt that you have trainers that share with you the concerns that you've raised. And we try to be really responsive to those and to show empathy and engage, and where we need to make changes, we do.

“But I've also had so many trainers call me and say that for the first time, they feel like they have a chance when they compete, that they don't feel like they have to use substances or compete with somebody else's pharmacy,” Lazarus said.

“I've also heard anecdotally that there are a number of horsemen that had artificially high win percentages that have now been normalized,” Lazarus said.

“The most objective thing in the universe, in my view, is you take a sample from the horse, it goes to the lab, and it comes back positive or negative,” Lazarus said, defending HIWU's methodology.

“There's no subjectivity in that. There's no judgment. We can only be governed by that,” Lazarus said. “Otherwise you get into this–what I think was a problem with the state racing commissions–'Who's a good guy/who's a bad guy? He had a clean record/He didn't have a clean record.'

“We can't operate like that, because you lose all credibility,” Lazarus said. “You're not objective. One of the best things about HIWU is that they're a totally objective organization. They don't have local relationships. They don't know, most of the time, who these trainers are. The sample, the positive test, is always adjudicated the same way.”

The Fault Continuum

Still, Lazarus said, HISA and HIWU have recognized that changes are needed with regard to human-drug positives that are likely caused by contamination, and she said the agencies have responded by proposing fault-based rule changes that are expected to be approved by the Federal Trade Commission (FTC). At the same time, Lazarus added, HIWU is holding off on adjudicating exposure cases for human drugs of abuse until the FTC makes a decision on the proposed rule tweaks.

“In that sense, trainers have been able to benefit from what we expect to be these new relaxed rules without having to wait for the FTC to approve them,” Lazarus said. “We're going to continue to try to bring in ideas like that, to lessen the burden [on trainers] and to help us really identify what needs to be addressed and to take care of what doesn't need to be addressed…

“Our new system is all about fault,” Lazarus continued at a different point in the interview. “And when you have a high degree of fault, you'll have a higher penalty. When you have a low degree of fault you'll have a much lower penalty.”

But while those changes will, in theory, mitigate positive tests from illegal street drugs like methamphetamines and cocaine, the new standards won't apply to a commonly prescribed diabetes pill like metformin.

Why not?

“We look at [metformin] as a potential risk, so we don't put it in that category,” Lazarus said. “We do have intelligence that metformin is being used intentionally to enhance performance.”

HISA and HIWU aren't obligated to disclose the exact nature of such intelligence. That would be akin to handing over their enforcement playbook to alleged dopers, the reasoning goes.

When asked specifically what metformin might do to make a horse run faster, Lazarus said she believed it might be able to improve endurance. She later had a HISA staffer email supporting information that stated metformin “does impact glucose metabolism, so it could have an effect on overall performance.”

Those views aren't widely shared by everybody, though, and published research on metformin's alleged role as a performance-enhancer (in either humans or horses) is not definitive.

In human athletics, metformin is not prohibited by either the World Anti-Doping Agency or the  United States Anti-Doping Agency. Anecdotally, some bodybuilders take it because they believe it helps them appear more “cut” in terms of reduced body fat, which has led to misperceptions that it can build muscle. Other broad claims contend that metformin can reduce inflammation or provide anti-aging benefits in people.

In U.S. horse racing, metformin has been listed as a Class 2/Penalty Category B drug under the Association of Racing Commissioners International (ARCI) classification system since 2018.

A mid-level designation, Class 2 drugs are defined by ARCI as substances “that have a high potential to affect performance, but less of a potential than drugs in Class 1. These drugs are 1) not generally accepted as therapeutic agents in racing horses, or 2) they are therapeutic agents that have a high potential for abuse.”

But are the positive tests for metformin being triggered more by coincidental contaminations or by intentional administrations?

The winter 2023-24 issue of The Horsemen's Journal contained a “Fact or Fiction” article that touched on veterinary perspectives of the five recent HIWU positives for metformin.

The article stated that “Metformin is so ubiquitous in the environment that it can be found in drinking water whenever it is looked for, including at the racetrack [Horseshoe Indianapolis] where two of the violations were found. Metformin use is so common in humans that many studies have been conducted to determine if it has an effect on athletic performance, and the overall conclusion of those studies is that the only measurable effect is increased perception of exertion. This effect would detract from performance rather than enhance it.”

Lazarus said that HIWU's methodologies for metformin testing are designed to screen out accidental contaminations and to differentiate them from intentional administration.

“I'm not saying that every horse that tests positive for metformin is an intentional abuse,” Lazarus explained. “Obviously, there are very innocent explanations, and there are explanations where that fault continuum should be in the [trainer's] favor. I'm just saying that there are situations where it is being used to enhance performance, and that's where we have to be more careful about it than we might have to with meth or cocaine…

“The level at which the laboratories have agreed to call metformin a positive, in their view, sort of rules out inadvertent exposures,” Lazarus said. “It doesn't necessarily rule out someone putting their hand in the horse's mouth after they take metformin. But it's intended to really limit it to either a gross negligence or an intentional situation…

“Mr. Lauer's [test on Mowins] wasn't one of them, because it was obviously above [the limit for a positive],” Lazarus said.

Lazarus dismissed the contention that metformin in a water supply can cause a violation.

“It's not possible to get a positive test through metformin in the water,” Lazarus said. “The [testing] level that we have excludes the possibility.”

That's why achieving harmonization on testing levels at laboratories is so crucial for HISA and HIWU, Lazarus said.

“We're harmonized on more than 300 [substance levels] right now,” Lazarus said. “But obviously, some substances that are prohibited have never been detected. So they have to be detected first for the labs to agree on a level of detection. So there is some degree of that that is always going to be ongoing, as science tries to catch up with the very small percentage of the industry than might be trying to use substances nefariously for gain. There's always a risk that those folks are sometimes a little bit ahead of the labs…

“However, because the system is based on fault, if you do come, like Mr. Lauer did, with an explanation, and that explanation is credited, then obviously you are going to get a more lenient sanction,” Lazarus said.

“So in [Lauer's] case, his suspension was 2 1/2 months out of a potential of 24 months,” Lazarus said. “And his fine was about 10% of the maximum fine. So that just shows how HIWU viewed his fault on that continuum.”

'Happy' or 'Hell'?

Lauer steadfastly believes he was wronged by HIWU and HISA, while Lazarus firmly asserts the systems at those agencies worked exactly the way they were intended to.

Surely, there must be a middle-ground perspective. TDN sought out Alan Foreman, who is widely recognized as one of the nation's leading racing law and equine attorneys, to see what he had to say on the subject.

In September 2023, Foreman, the chairman and chief executive officer of the Thoroughbred Horsemen's Association, agreed to serve as an impartial go-between, or ombudsman, on behalf of HISA, HIWU, and horsemen. In this role, he provides confidential advice and assistance at no cost to trainers, owners and other HISA-covered persons, while communicating feedback to the agencies about how they can improve their programs. When Foreman took the job, he pledged to donate all compensation paid by both sides to the Thoroughbred Aftercare Alliance.

Alan Foreman | Horsephotos

This means Foreman is usually the first person trainers contact when HIWU notifies them of an alleged infraction. Lauer sought him out, and he said they spoke for several hours when Lauer first learned of the ruling against him. But in keeping with his obligations as an ombudsman, Foreman told TDN he would not be able to discuss Lauer's case in detail because of confidentiality requirements.

However, one of the first general points Foreman made about Lauer's case that he said should be heartening to horsemen is that Lauer was able to resolve his charge without having to go through with the full-blown hearing process.

“Up until now, it's required a trainer to go through the expense and the difficulty of prevailing in an arbitration,” Foreman said.

“There are changes in the pipeline,” Foreman said. “We've been discussing this and pushing for these changes for some time. There is a change presently that has been submitted by HISA to the FTC with respect to the drugs of illicit human use that would give to HIWU the discretion to resolve those cases, and they can do so by concluding that it is more likely than not that the positive was the result of contamination. 'Inadvertent exposure' is the term I like to use, as opposed to an intentional administration.

“So if HIWU is satisfied that the positive test was not the result of an intentional administration, the penalty is now reduced to a maximum of 60 days, and that can be mitigated down based on facts and circumstances. And assuming the FTC approves these changes, that would allow HISA and HIWU to resolve this with the trainer short of having to go to arbitration,” Foreman said.

“It would be handled similarly to the way racing commissions handled them before HISA and HIWU went into effect,” Foreman said. “And that was a part of the system that was not broken, and did not need fixing. I think there was satisfaction that the racing commissions were correctly handling those kinds of cases. And the handling was, if a positive test was reported, obviously the horse was disqualified because it had a drug in its system. But the trainer penalty was substantially mitigated.

“In many jurisdictions, the trainer was not penalized,” Foreman said. “The disqualification of the horse was deemed to be a sufficient penalty. Some jurisdictions may have imposed a fine or a short suspension. But nothing like the drastic penalties that are being imposed now, which can be career-ending [for] something that a trainer probably could not have prevented.”

Foreman continued: “This area of contamination seems to be the most vexing area. My own personal observation, at least based upon the calls that I get, is that the number of banned substance violations has substantially decreased. I'm not seeing that many, at least [for] those where trainers are calling me, or I need to refer people out to attorneys. That seems to have calmed down. What has surprised me [is] I thought that there would be a large number of positive tests in the controlled substance area, the therapeutic medications, because we were going to screening limits, because we were going to international standards.

“We were, in many respects, backing out the withdrawal time, or the time within which a drug should be administered to a horse, to 72 hours, as opposed to previously, with the non-steroidals, we had gone from 24 to 48 hours. But that hasn't materialized. There have not been a substantial number–at least compared to prior [findings from] HISA and HIWU–of positives as a result of the new system. Which to me is a very positive indication for the industry,” Foreman said.

“The horsemen have been adjusting to the new system, and it's working,” Foreman said. “That doesn't mean that horsemen aren't scared to death when they see these contamination violations and they're concerned about what is happening to these trainers. At least we're attempting to get that under control. And when I say we, I'm certainly trying to do it on behalf of the industry. I don't work for HISA. I don't work for HIWU. But they have been listening. I think they've been coming to grips with the problems they created here. I think they're hearing the outcry from the industry and they are adapting to it…

“So slowly but surely, changes are taking place,” Foreman summed up. “That's what I've been advocating for.”

Lazarus, in her separate interview, corroborated Foreman's observation that the banned substance violations are decreasing.

“When we first launched the program, about 40% of the positives were for banned substances, what we would categorize as doping,” Lazarus said. “That has completely dropped, [so] I think that has had a genuinely important impact. There are also a number of investigations that are ongoing that I believe are going to have a very positive impact.

“[HIWU is] only seven months in, so I need a little bit more time to bring some of these things to fruition,” Lazarus said. “But I really believe that this is a strong, fair, balanced, effective program. And we're going to have to continually tweak and evaluate and be open to feedback. But I think overall, I am very happy with where we've stood on that balance.”

However, when asked if she concurred with Foreman that the contamination positives were the “most vexing” part of the system, Lazarus had a different take.

“I think what happens a lot is when one horseman gets concerned about something, and they speak about it on the backside, it becomes almost like an epidemic of concern,” Lazarus said. “And so that is probably the most difficult thing for us to deal with generally, is some of the misinformation, and some of the, kind of, 'fear-mongering' that I think is sometimes intended by our detractors.

“I think when we're at the year mark, there's going to be a fair amount of comfort with where we are,” Lazarus said. “I think if you ask any trainer, they will tell you that on the [controlled] medication side our program is fair and balanced and working. I haven't heard a single complaint about the medication program. The adjustment is the severity and the different system on the doping side. And I think that's important for the evolution of the industry and for us to get to a point where we're protecting the clean trainers.

“That's what it's all about, right? Protecting the trainers who are competing fairly, and also who have systems in place to avoid some of the mismanagement of medication or inadvertent exposure,” Lazarus said. “We're going to get better at that, and I think over time trainers are going to feel more comfortable with what they have in place and that the risks to them are very low, and that if they do have an inadvertent exposure, that we'll treat it fairly.”

As a way of wrapping up the conversation, TDN proposed an analogy to Lazarus: Would it be fair and accurate to say that in any large enforcement endeavor like an anti-doping control program, there are going to be growing pains as the system gets rolled out, and even if the agencies make corrections along the way, it's inevitable that there are going to be some trainers–like Mike Lauer–who end up being collateral damage as the result of HISA and HIWU's evolving methods of enforcement?

Lazarus didn't buy that line of reasoning.

“I don't consider him 'collateral damage,'” Lazarus said. “I think he actually received very fair sanctions under the circumstances. Under the previous state racing commissions, fault was never a consideration. It was a pure, strict liability thing [and] the consequences were extreme without any opportunity to defend….

“Mr. Lauer settled his case. That was his choice. He did not have to do that, but he decided to settle his case, and that was the resolution that he was happy to accept,” Lazarus said.

“Happy” is not how Lauer would describe the ending to his five-month ordeal with HISA and HIWU.

“Hell” was the adjective he chose.

“They were going to drag me out,” Lauer said, noting that even though his case never reached an actual hearing, he still got invoiced $13,700 for having initiated the arbitration process.

After submitting all his supporting documentation by the first weekend of December, Lauer said the attorney for HIWU “wanted to try and make a deal, and if we couldn't, he was going to ask for more time to submit his brief so the hearing [date] would have to be reset.”

Lauer said HIWU's initial offer of a $4,000 fine and 120-day suspension was “not acceptable” to him. The next offer was the $2,600 fine and 75 days with time served, which was to end his suspension by Dec 25, 2023.

Essentially, Lauer said, he accepted that settlement just to get his life back.

“My attorney said this is the best deal you're going to get without going to the hearing and a possible appeal and all that,” Lauer said. “Plus the money, and the extra time, and you have no idea if you're going to win or lose.”

Now that he's back in action, what's Lauer's takeaway message for other trainers who might find themselves in the crosshairs of HISA and HIWU over a metformin positive?

“Their whole operation is very intimidating,” Lauer said. “And it's aimed to be intimidating.”