An excretion study and a WADA letter lead to 8-year ban for Priyanka Panwar

A technical letter from the World Anti-Doping Agency (WADA) to all the accredited laboratories regarding the metabolites of Oxethazaine last February coupled with an 'excretion study' and an expert opinion provided by the Director of the National Dope Testing Laboratory (NDTL) clinched the argument against quarter-miler Priyanka Panwar in a doping case decided recently.

Panwar was handed an eight-year ban, this being her second offence after the more famous one involving her and five other 400m runners who were preparing in 2011 for the London Olympic relay qualification.

The 2011 offence was one involving a steroid, methandienone, alleged to have come from the Ginseng reportedly purchased by the Ukrainian coach of the 4x400 team, Yuriy Ogorodnik, in China.

This time, Panwar tested positive for the injectable stimulant mephentermine and its metabolite phentermine in a sample collected at the Inter-State meet in Hyderabad in July, 2016.  Surprisingly the case dragged on, eventually being decided more than a year after the sample collection.

The National Anti-Doping Agency (NADA) and the Anti-Doping Disciplinary Panel (ADDP) surely look headed towards setting records for long-winding arbitration proceedings.

The eight-year ban should more or less end the career of the 29-year-old Uttar Pradesh runner who shot into prominence in the 2011 season by being among the contenders for a place in the 4x400m relay team for London Olympics before being sidelined through the sensational doping fiasco that ruined India’s qualification bid.

Non-specified stimulant

Mephentermine is a non-specified stimulant meaning its finding in a dope test would result in the athlete facing the same type of consequences as that for steroids. To elaborate, there would be an automatic provisional suspension unlike none in the case of a specified stimulant or substance, and the athlete would be required to prove that he or she did not take the drug intentionally to enhance performance to avoid a four-year sanction.

Panwar argued through her lawyer, Vidushpat Singhania, that she had ingested the drug mephentermine through a medicine (Mucaine Gel) prescribed by one Dr Vipin Sharma for stomach pain. She produced the prescriptions and even had the doctor depose before the panel.

It is a fact that two of the metabolites of Oxethazaine which is one of the ingredients of Mucaine Gel are mephentermine and phentermine.

Armed with the WADA technical letter on Oxethazaine and the excretion study on the drug conducted by the Cologne laboratory and her own lab, the Director of NDTL, Dr Shila Jain, presented evidence that eventually clinched the argument against the athlete.

Panwar had failed to mention the medicine (Mucaine Gel) on the doping control form though there were prescriptions dated 02-01-2016 and 07-05-2016. The panel dismissed one dated 12-12-2016 as irrelevant to the case since her sample was collected on 02-07-2016.

Dr Sharma deposed before the panel but did not say he had advised her to take it on an SOS-basis (as and when pain recurred), a point that went against the athlete.

NADA argued that the mephentermine/phentermine ratio was much higher than the “less-than-one” level that would have indicated use of Oxethazaine. In fact it was 36 times it was disclosed to the panel.

The WADA technical letter plus the report that the NDTL Director submitted about the metabolite concentration levels finally clinched the argument conclusively as far as the panel was concerned.

WADA technical letter

This is what the WADA letter to all the directors of accredited laboratories stated:

“1. Check the Sample Doping Control Form (DCF) for a declaration of use of Oxethazaine;

2. Test for the presence of Oxethazaine major Metabolites, namely β-hydroxyphentermine and β-hydroxymephentermine. Both of these Metabolites are detected in much higher concentrations than Phentermine and/or Mephentermine following the administration of Oxethazaine”.

If it was proved that use of Oxethazaine (Mucaine Gel or Stoin for example) had produced the metabolites β-hydroxymephentermine and β-hydroxyphentermine then the lab was supposed to report the result as “negative’.

Not even traces

The panel observed: “In the present case, both beta-Hydroxy metabolites of Oxethazaine were not seen even not in traces then how the athlete can take the plea that she took ‘Mucaine Gel” prior to the questioned event. This clinches the issue and the Panel has come to the conclusion, keeping in view the clarification given by Dr Shila Jain by sending reply on 06/06/2017 as well as cross-examination conducted on 30/06/2017 that Ms. Panwar has probably ingested Mephentermine and Phentermine directly and not through Mucaine Gel. The Panel has also kept in mind the concentration level of the questioned sample which was Mephentermine 11.0ng/ml and Phentermine 300mg/ml and the same was on much higher side. Therefore, the burden lies upon the athlete to prove that she had no fault (sic) or negligence for taking the benefit of Article 10.4 of the NADA Code 2015 which she could not discharge by alleging to have taken Mucaine Gel prior to the questioned event.”

On being asked by the panel to get from the NDTL details of the concentration of mephentermine and phentermine, Dr Jain also reported that as per the study conducted by NDTL and Cologne laboratory, beta-Hydroxy mephentermine and beta-hydroxy-phentermine were major metabolites of Oxethazaine and were found in urine at much higher concentration than mephentermine and phentermine.

In Panwar’s case, Dr Jain said, both Beta-Hyrdoxy metabolites of Oxethazaine were not seen, even not in traces which indicated that the “athlete might have not taken Oxethazaine”.

The fact that the laboratory tested for hydroxy metabolites of mephentermine and phentermine despite there being no mention of Mucaine Gel on the doping control form could suggest such tests were carried out at a later stage.

Singhania’s contention that the laboratory had subjected the sample to re-analysis and perhaps used them for research purposes despite being expressly forbidden by the athlete, was rebutted by NDTL.

During cross-examination, Singhania asked Dr Shila Jain:

“Has any testing been conducted after providing laboratory package of the athlete’s sample to the athlete?”

Answer: ‘No”.

Would it have been against the rules to test the sample again to establish whether Mucaine Gel was ingested or not? After all, a hearing panel could have ordered such a test to be carried out in order to come to a conclusion whether it was a direct ingestion of mephentermine or a permitted drug that caused the positive result.

Excretion studies

Dr Jain said in both the excretion studies, based on one single volunteer ingesting one single dose (10-20mg) of Oxethazaine it was found that the Hydroxy metabolites were 5-10 times higher in concentration than mephentermine and phentermine.

It was not clear whether the NDTL study was a recent one, whether it was done after the order was reserved in the Panwar case initially or whether it was done after the panel raised the issue of concentration levels of mephentermine and phentermine on 22 May, 2017.

The panel concluded that from the evidence presented and the opinion of Dr Jain it was clear that the positive result was the consequence of mephentermine use and not that of the permitted medicine, Mucaine Gel.

The defence counsel argued that Dr Jain’s testimony should not be relied upon, that metabolism of drug in the human body differed from person to person, that it depended solely on genetic factors, disease, age etc.

The panel rejected all such arguments and said “…when there was (sic) no metabolites, beta-Hydroxymephentermine and beta-Hydroxyphentermine found in the questioned sample, then how we can reach to (sic) the conclusion that she took Mucaine Gel and, therefore, the question of various factors like genetic factors, environmental factors, age and sex etc has (sic) not (sic) relevancy while disposing (sic) the matter.”

In mounting Panwar’s defence, Singhania also referred to the cases of tennis player Richard Gasquet (CAS 2009) and decisions in respect of Indian sportspersons.

Lawyer unconvinced

Singhania remained unconvinced by the procedures adopted by the laboratory and was even mulling the idea of complaining to the WADA about the additional tests or study allegedly conducted by NDTL. The lab had claimed that the athlete’s sample was not subjected to any further tests after it supplied the laboratory documentation package to her.

Panwar could not make the 4x400m relay team for Rio Olympics and later it was revealed that she had failed a dope test. She was part of the gold-winning Indian team at the Incheon Asian Games in 2014 and was considered a near-certainty for Rio till her performance slumped in the build-up period for the Olympics.

Her best for the 400m in 2016 was 54.23s and she was included only in the India ‘C’ team for the relay that was held at Hyderabad alongside the inter-state meet to provide the Indian team with a chance to ensure its Olympic berth.

The chairman of the panel, Mr. Ramnath, should be complimented for bringing out a detailed, reasoned order that went into 14 pages. Quite often ADDP orders are perfunctory in nature without either the argument made by NADA or the defence put up by the athlete or the conclusions arrived at by the panel being mentioned in clear terms. The other panel members were hockey Olympian Ashok Kumar and Dr Bikash Medhi.