Nairo Quintana’s Predicament

Nairo Quintana has been disqualified from the Tour de France following the presence of Tramadol in two blood samples taken during July. Tramadol is a pain-killing opiod that is not a banned substance but the UCI prohibits its use in competition.

Tramadol is a strong opiod painkiller, often prescribed for acute pain following trauma or recovery from surgery. Chances are many readers have experience of it and memories of being completely zorched by it; the instructions in the packet can advise against driving or operating machinery, so you can see why it could be banned in sport. It’s also got strong addictive qualities.

Anecdotally riders were using tramadol for two reasons, first to train and race through injury, to numb the pain somewhere so that they could keep on riding. But also for more direct doping effect, it was used to numb pain in the finish of a race and riders were countering the drowsy effects with strong doses of caffeine; there were tales of riders causing crashes but it was a factor rather than the sole cause. Ordinarily if you need such a strong painkiller you shouldn’t be racing.

David Lappartient made banning Tramadol an election pledge in his successful campaign to become president. But the UCI could not convince the World Anti-Doping Agency (WADA) to add to add it to the Prohibited List so instead cycling’s governing body decided to go it alone, just as it did with the “no needles” policy before that prohibits the use of intravenous methods to use legal product. The UCI decided to ban it in-competition from March 2019 and via its own rulebook and to instigate its own tests. This was a good thing to do but bold as it means the UCI is acting outside of the legal and financial umbrella of WADA, instead it’s just a UCI rule, it’s not an anti-doping matter.

Quintana was tested during the Tour de France by the UCI. They take a blood sample from the finger via a pinprick and the dried sample is tested. The UCI reports “two dried blood samples provided by the rider on 8 and 13 July during the 2022 Tour de France revealed the presence of tramadol and its two main metabolites”. Note the time between the two samples as apparently the drug has a half life of about seven hours in the body so two tests several days appart suggests repeat use.

The rule (13.3.068 Infringements of the In-Competition Prohibition of Tramadol) says on the first infringement a rider is disqualified, fined and must pay the costs of the test. Given the UCI rule says two samples showed the presence of Tramadol Quintana is lucky these are not being counted as separate infringements, presumably they are being treated as one because he could not be alerted and sanctioned after the first case (if there was a second infringement it comes with a five month ban).

It’s a big problem for Quintana on the eve of the Vuelta. This is one of those toxicology tests where it’s positive or negative, there’s not much room for a grey area, and two tests make explaining accidental ingestion harder, although we will await what he has to say as of yet there’s nothing on his social media accounts, nor from the team (update 6.10pm: the team have issued a statement which says nothing other than remind people of the rules), (update 7.00pm: Quintana says he will appeal, says he is totally surprised). Yesterday he announced a three year extension of his contract with Arkéa-Samsic, presumably on the back of his Tour de France performance but given this is now nullified, he may have some explaining to do for the team and its sponsors.

It’s also a bombshell for the Arkéa-Samsic team. Tramadol is not available for sale freely in France, did the team doctor prescribe it, counter to the UCI rules? Hopefully not. Did Quintana bring his own private stash to the Tour de France, counter to the UCI rules and likely counter the team’s internal procedures? Hopefully not.

Arkéa-Samsic want promotion to the World Tour but Quintana’s disqualification means he and the team forfeits all the 450 points he collected in the Tour de France (400 for 6th overall, 50 for second place on Stage 11 atop the Col du Granon. They had been 14th in the three year standings as of 9 August (there’s no update on the UCI website this week: is someone on holiday; or did they need to publish the Quintana news first?) but arithmetically losing these points means they stay 14th but with now barely a cushion on BikeExchange, EF, Cofidis and Movistar. Promotion isn’t just about points either, it comes just as his team are submitting their dossier to join the World Tour which as well the sporting aspect (the points part), also contains an “ethical” criterion and there’s some explaining to do here, to put it midly.

Quintana could appeal to the Court of Arbitration for Sport, as is his right. There are two angles here, he can try to find fault with the procedural aspect of the Tramadol test protocols, things like the custody chain of samples and whether a mix-up was possible; or the laboratory procedure and whether it is flawed, prone to contamination and so on but note the two samples days apart, could both be handled incorrectly? Sure, theoretically yes but it would require double proof (update 7.20pm: posting on social media he has said this is what he’s planning to do, that the news of the positives was a surprise to him, he has never used Tramadol and will appeal) but any presence of Tramadol spells trouble the UCI rule here says “the mere presence of tramadol or its metabolites in a rider’s in-competition sample is sufficient to establish an infringement… …without consideration of the rider’s intent, fault or negligence”. The second angle is the grounds, can the UCI justify disqualifying riders for taking this opiate? This is a grey area as it’s not banned by WADA but it’s part of the rulebook alongside rules saying a rider can be excluded from a race for taking a short cut on the course or punching someone; but this second area would involve admitting he took it and good luck explaining how he got it during the race and his team will be nervous of him trying to take on the UCI.

Nairo Quintana’s sixth place in the Tour wasn’t quite a resurgence to past glories but it marked a return, his first top-10 in a grand tour since the 2019 Vuelta and it was almost everything his team could ask for, perhaps a stage win would have been the cherry on top. Now that’s all in the bin.

Repeat after me: this is not an anti-doping matter. Instead Quintana has failed a regulatory test set by the UCI for Tramadol, but one that comes with a hefty penalty, his sixth place in the Tour de France is now void. He can appeal here and we’ll have to wait and see what comes next.

91 thoughts on “Nairo Quintana’s Predicament”

  1. It’s hard to imagine Arkea-Samsic tolerating Quintana’s Tramadol taking which suggests he did so independently of the team. Also I recall that Quintana and his acolytes were searched by French police in late 2020. Apparently nothing was found – or at least no disciplinary action was taken, which is not quite the same thing. I also vaguely remember words from the sponsors at that time that they would walk if doping was confirmed. Maybe they will swallow today’s news though they can’t be happy and it will poison the team/sponsor relationship.

    Surely Quintana can’t now be in the right frame of mind to ride the Vuelta even if the selection is maintained. What a pity for Arkea, a likeable team with a decent roster – even without Quintana.

      • Minimal gain because the performance enhancing benefits of this are very debatable. It does not change the riders’ physique or structure at all. Comparing this to blood doping or EPO or cortisone is a non-starter.

        Honestly, what this is is pure stupidity. A super dumb attempt to gain an advantage using a substance that a) gives you zero benefit and b) puts you in a world of trouble.

        Arkea should rip up the extension and offer to resign him at 1/2 the salary.

        • Being able not to feel pain has very obvious short-term benefits. It allows you to push your body beyond what is normally possible by subduing its alarm signals.

  2. Does the loss of Quintana’s sixth place in the Tour mean that riders below move up one notch giving, among others, more UCI points to EF, IPT and Movistar and thus compounding Arkea’s points deduction?

    One of the apparent conclusions from the earlier investigation into Quintana was that structures semi-detached from the team (he had his own doctor, soigneurs, domestiques…) were inherently risky. Was nothing done?

    • It could do, but not yet… as of now Romain Bardet is still 7th in the UCI database for example. If Quintana appeals we could have a long procedure where the points situation, and conceivably the fate of a team, might rest on this decision but that’s all a technical possibility now rather than anything firmer.

  3. It’s not an anti-doping matter but it was used also for more direct doping effect. Right.

    Everybody’s walking the tightrope like Blondin on this and for various reasons there will be plenty who are unhappy to see the first rider fall foul of the rule be one with such a high profile.

  4. Tramadol was one of the ingredients in the infamous “finishing bottles” from way back when, when Quintana was racing. Apparently many used Tramadol and it would be very surprising if Quintana did not. Why he would still be using it now is a mystery – unless somebody messed up by, for example not having a masking agent. I suppose Arkea-Samsic management are not a happy bunch at the moment.

      • The motorbike incident took place during stage 18, the tests were positive after or before stages 7 and 11.

        The big mystery is that since a positive result is 100% certain if your finger gets pricked, it is a conscious choice to take the risk – unlike taking a substance that you perhaps erroneously believe won’t show up in a test, at least not above the threshold level.
        If 10 riders are tested every day, the likelihood of getting away with it is perhaps big enough to take the risk if the alternative is to DNF. But taking the risk twice and if the alternative is not being to fight for a stage win?

    • Quite so. It seems that Tramadol can both increase danger in the peloton and provide a performance advantage. The nuance between WADA rules and UCI regulation seems unimportant.

    • On the contrary, it is a crucial part of the matter. It is important, and not a matter of semantics, because fail a doping test and there’s a provisional suspension, a possible four year ban and in any appeal the UCI is backed by WADA etc, there’s a lot of precedent, accredit labs and more. Fail a tramadol test and it’s the UCI and it’s rulebook only, and this is the first instance. It’s two very different procedures and outcomes rather than being picky over words.

      If it helps to exaggerate with an example, imagine an employee found guilty of breaching their company rules but not criminal law, someone could say “they’re wrong, why bother with semantics” but it makes all the difference to the process, outcome etc.

      • And it will also be the first test of whether the UCI’s regulations have been written well enough to be enforceable.

        Precedent *may* be on the UCI’s side in the form of the successful phasing out of WADA testing for the presence of alcohol* in favour of sports enforcing it directly. The rationale for shifting the responsibility was that, like tramadol, it was a ban primarily for safety with it being advantageous to receive results immediately (and take appropriate enforcement action on the spot) instead of waiting months for WADA test results to come back.

        The UCI should be looking to further improve the testing/results system so as to return the results on the same day. A rider needing to take opiates to get through a stage race should be given an immediate medical disqualification, sent home to recover from their injuries properly with a couple of weeks of no racing.

        * 2017 was the last year it was on the list, by that time applying only to FAI (aeronautical sports), FIA (motorsport), UIM (powerboats and WA (archery).

      • So, this is the first time the UCI’s ban on Tramadol has actually caught someone (or an Infringement of the In-Competition Prohibition of Tramadol as the Rule Book says). As Quintana/Arkea-Samsic have said to be appealing to CAS (Court of Arbitration for Sport) which is their right under the UCI rules, this could run and run. (Froome’s run in with his salbutamol “problem” went on from September until June the next year, if I remember correctly) Legal precedent has to be set and whole bunch of questions have to be answered, like can Quintana get the samples tested himself to check they’re correct? As the normal WADA way of doing things is not relevant here, it’s all starting from square one.

      • It’s fair to say that this isn’t a case of breaching the anti-doping *rules*, or even “Anti-Doping Rules” with capital letters; it’s a breach of the medical rules. But that doesn’t stop it being an anti-doping *matter* (without capital letters), namely the taking of a prohibited substance to improve sporting performance. In the ordinary use of the word, this is a doping matter, even if not an Anti-Doping Rule Violation.

        To use your example, somebody who fiddles their expenses may have defrauded their company without committing Fraud in a criminal sense.

  5. Given the effect this may have on the three year ranking, a drawn out appeal process could be exactly the excuse the UCI needs to declare the race for the WT positions too close to call and award the extra licences.

    • Sounds a bit conspiratorial and remember different parts of the UCI handle different aspects, the Licence Commission is deliberately composed of non-cycling figures, it is presided by a former Swiss High Court judge. We’ve seen them raise concerns over Astana and Katusha in the past in a way that embarrassed the UCI management at the time.

      • This is the kind of insider knowledge and clarification that makes this blog such a cut above any other cycling information source. Most cycling websites treat the UCI like a black box.

      • I was thinking more of the fiasco at the start of the current three year licence period, where UCI management reacted to an inconvenient outcome of the regulatory process by simply inserting a new regulation allowing them to ignore the Licence Commission and adding a 19th WorldTeam.

        With respect to the 2013 Katusha fiasco, I recall the problem there was that the Licence Commission failed to act impartially and CAS ordered that the team be reinstated.

    • Everyone is already complaining that the size of the peloton is at its limits now, and that adding more teams would cause more crashes & other safety issues. There is no space for extra WT licenses really…

  6. Since Arkea is a member of the MPCC, I wonder how they will handle this? Is Tramadol considered “doping” by the MPCC? If so, would this be considered cause for expelling Arkea from the MPCC?

    • I don’t think the mpcc has any policy on tramadol other than prohibiting its use in events.

      And since the UCI added as an item that cannot be used in event i guess the mpcc position has already been applied. Its seems incredible that anybody bother to use it if the test is easy, effective and widely performed. I don’t know if this test is always done though. As its not a wada test it may require a different tester than the normal to take the sample.
      So from an mpcc point of view i would assume there position is already in affect as the uci has already nullified the results and requires no further input. But who knows.

      • WADA tells us that it monitors Tramadol use and that leads me to assume that it is routinely tested for when blood samples are taken.
        Therefore I would imagine that no separate tests need to be taken nor test personnels to be present.

        But indeed it would be “nice to know” how often a rider can expect to be tested during a GT.

        (If Quintana was tested twice and no more than twice during the Tour, that would give us a ball park number, but maybe he was tested more often than that?)

    • There’s not much of an extra rule burden. But the team’s press release last night was “nothing to see here, move on” when the MPCC angle would be to ask what happened, to launch an internal investigation to find the facts etc.

      • “nothing to see here, move on”. That’s not quite how I read the Arkéa press release.

        It’s simply factual:
        “Arkéa is aware of the two positive Tramadol tests on Quintana during the last TdF.”
        “UIC regulation prohibits in-competition Tramadol use since 1st March 2019 for medical reasons.”
        “This infraction does not lead to a suspension for the rider.”
        “Arkéa-Samsic won’t comment further.”

        No doubt the words were subject to considerable legal input.

    • It was (mainly) the MPCC that pressured the UCI to forbid Tramadol, so I’m sure *they* are very unhappy about this, and Arkéa might have some explaining to do at their next meeting…

  7. It seems odd that a leading rider would take the risk, they know they are going to be tested. I can see an up & coming rider doing so, they probably think the risk of getting caught v the chance of getting a contract on a WT is worthwhile but this? I wonder if we might be into another dissection of human biology ie he was prescribed Tramadol for perfectly valid reasons (it isnt a banned drug) some time before the Tour but that traces have remained in his body hence the blood test result.

  8. While Lance Armstrong was performing so well, I got tons of far fetched rebuttals – “wait and see” was my answer and still remains. Do you still believe that some riders do not take performance enhancing substances?

    • It doesn’t matter whether we believe or not. The point is that we cannot and shouldn’t in my opinion draw any wider conclusions based on this case.

    • I do “still believe that some riders do not take performance enhancing substances”.
      And some riders do.
      The proportion of each, who knows. It has always been so – as in every sport and wider life. We generally have little idea of what goes on behind closed doors.
      My position: I hope for the best and kind-of expect the worst.

      • While I don’t doubt that riders play as close to the line as possible, I don’t believe the rampant organised doping of the 90s/00s is underway. I would argue this case backs that up. If this were 15-20 years ago, Nairoman would probably be getting busted for Cera not a painkiller. But as others have said, doesn’t matter what we believe.

  9. While Lance Armstrong was performing so well, I got tons of far fetched rebuttals – “wait and see” was my answer and still remains. Do you still believe that some riders do not take performance enhancing substances?

  10. Opiates not being on the WADA prohibited substances list is the wider surprise.
    We all knew teams were using Tramadol and noticed its effect, particularly where a team was trying to crush all individual attacks with the so-called mountain train. It really worked, so it had to be banned because doing opiates as a routine can’t be good. There are retired riders who still suffer with it.
    So why hasn’t WADA added it to the lists?

    The UCI is definitely in the right for once!!

    • I suppose that WADA are reticent because in most sports, the effect of Tramadol is not going to result in things like crashes etc that can injure or even kill other competitors. Plenty of athletes will take prescribed painkillers to get through a match/game etc. To stop them because a doctor prescribes a legal painkiller might infringe on their opportunity to earn a living. With cycling or motorsport for example, misuse can effect others so it’s in a different category.

  11. If Quintana seeks to defend himself on a technicality or procedural error it won’t really help his team or himself. Excluding the most far-fetched explanations he either took the drug deliberately or accidentally. Which was it?

    His withdrawal from the Vuelta has always seemed inevitable. Why did he and the team procrastinate?

    • Quintana could well say he never took it and UCI’s testing is at fault. I guess that lawyers were behind the decision to not take part in the Vuelta. Quintana is not banned from racing.

      • I imagine the team and his teammates will be happy not to have Quintana’s presence and the associated media scrum. As for Quintana, he can’t have been in the right state of mind for a GT.

        As for the nuance between UCI regulation and WADA banned products, it’s only IR and his specialist readers who will care about the difference.

      • I’ve seen some people on other sites mention that there are other medications that contain Tramadol as an ingredient. If so, it’s entirely possible that Quintana took something else entirely but still tested positive for Tramadol. At the end of the day, though, a positive is a positive. The rider and the team medical staff need to be aware of every ingredient of everything they are taking. Barring “the test itself is not reliable,” I don’t see a defense here.

        • I’d be interested to know which products are available that have tramadol as a side ingredient, it’s very strong and in France not mixed with anything except sweeteners etc to make the pill easier to swallow.

          But as you say there’s a strict liability issue here, the UCI rules say the presence of the drug or its metabolites = infringement. I’m getting vibes of the Contador case all over again where he tried to explain accidental ingestion with some odd ideas but ultimately it didn’t matter, the sample was positive for a banned substance.

          Here’s part of the UCI rule: “the mere presence of tramadol or its metabolites in a rider’s in-competition sample is sufficient to establish an infringement of the In-Competition Prohibition of tramadol, without consideration of the rider’s intent, fault or negligence.”

          • This lust of medicines containing Tramadol from L’Agence nationale de sécurité du médicament et des produits de santé
            En association avec du paracétamol : IXPRIM, ZALDIAR, TRAMADOL/PARACETAMOL GENERIQUES
            En association avec du dexkétoprofène : SKUDEXUM”

            It took me 2 minutes to look this up. Active ingredients must be listed on the label and opiodes are only available on prescription so somebody with an athlete under testing protocols would have to make a big mistake not to know.

          • I did wonder if it could be a different version of a medicine issue – picked up something in Denmark (or earlier) that contains tramadol while the French version substitutes a different, non-restricted painkiller?
            It would still be a huge mistake by Quintana and/ or his team not to have checked but perhaps possible?

            Seems very odd to have kept using it after having given one sample, since it makes it very hard to argue it was a testing problem if selected for a second one.

        • It might be mixed with other painkillers & stimulants, and be sold under different trade names, but it would always be mentioned under its scientific name in the leaflet that lists the contents.

          And this happened in the middle of the TdF, so it’s not like he can claim to have taken an unknown painkiller to handle an emergency when no doctor was around… (Team doctors are usually available by phone/internet at all times to answer questions about medicines also, to avoid accidental doping violations with unknown medicines.)

  12. I think this case has exposed my own prejudices. As others have said above, why bother when the chances of getting caught are pretty high? It seems crazy to have tried. When Froome tested positive for salbutamol, I was like “well yeah it can’t be doping, why would he bother?”. When Quintana tests positive for Tramadol I’m like “Saying I’m surprised is very different to saying I’m innocent so he must be a cheat”.

    The argument does kind of make sense though, right? If it were me, and I’d been deliberately breaking the rule, I would stop after the first test because I’d be spooked. And it would give me plausible deniability if I then had a clear test later in the race.

    • There’s the old delay in prosecution you’re forgetting. You might get spooked. But you might also think to yourself that you passed and there is nothing to worry about. After all Lance and his team tested many times and it didn’t stop them. They knew they could pass and cheat. It’s like speeding drivers. They sometimes collect multiple tickets because they don’t realise that the authorities are taking their time in prosecuting them.
      I must admit that I’m a doping cynic but am mystified about the use of tramadol. It must be effective as they keep doing it.
      The politics of doping is a moral and ethical quandary.

  13. He probably doped, as the test is fairly conclusive, so he needs to take his punishment, per UCI rules.

    As to why he doped? He’s into his twilight years, where you need every “advantage” just to be top ten. Especially because I think he’s quite a few years older than his stated age.

    My experience with Tramadol has been totally underwhelming. It didn’t do much for my pain and didn’t affect me much at all, so I was surprised that it was commonly used in the peloton. But then again, opiates affect people quite differently.

      • (1) He has always looked way older than his given age.
        (2) “We all know” that in those faraway countries the year of birth is often a pure estimation.
        (3) “We all know” that in some countries athletes’ ages are falsified in order to gain their country fame at junior championships or to make them look even more talented than they are and thus more attractive to big professional clubs or teams.
        (4) We have all heard tha amusing stories behind the unusual names of Colombian cyclists and it is not at all unreasonable assume that a similar small and innocent clerical error could have made a future pro cyclist years younger than he is.

        PS I’m inclined to believe Nairoman is as old as it says on his passport.

  14. Sometimes I wonder if a rider believes He’s at a dead end and is unable to compete any longer & realizes it’s the end.

    Then, Considers doping because racing is over and if uncaught may continue but if caught nothing is lost; He already was done. The, there’s nothing to lose, mentality.

    So, in effect, He’s unpublishable.

  15. That should read, unpunishable. Since He was already gone… anyway. In a gambler’s sort of thinking He can only win.

  16. Quintana has enlisted Colombian sports lawyer Andrés Charria, famous for overturning the case against track cyclist María Luisa Calle in 2004. The UCI regulations state that “the mere presence of tramadol or its metabolites is sufficient to establish an infringement”, Chiarra is set to test that to the limit as he looks for possible explanations that those metabolites could have been produced by other – legal – substances, plus he questions the whole testing procedure including there not being a B-sample and the rider having to pay to be tested, (but the UCI owning the sample) the lab being used etc.
    Also as Tovarishch wrote that 120 tests were done at TdF (that’s about 6 riders per stage) was Quintana “targeted” as he was tested twice? Apparently he tested positive on stage 7 (when he came in 15th) and when he came 2nd on stage 11. It would be good to know who was tested and why.

    • We cannot exxclude the possibility that Quintana was tested more than twice; we only know that two tests were positive.
      But joking aside, it could be he was targeted or that riders are sorted into different “bags” and more names are picked from bag A than from bag B.
      Or it could be simply that the top three or five or ten are put in bag A and the rest in bag B. Who knows? For obvious reasons no one is going to tell us or the riders…

      • I would guess it was the Yellow Jersey plus the top 3 on the stage plus a couple at random or other jersey holders. Or, they might have done more tests on the harder mountain stages and in the second and third weeks. Which would explain Quintana’s positive test when he came in 15th.

        • Hasn’t the UCI made it common knowledge that their testing and investigations are, in fact, targeted? The Bahrain raids were evidently the result of a tip off, as were the recent investigations in Portugal. If they have reason to suspect a specific rider or team of breaking the rules, shouldn’t they be targeted for more tests? In my view that’s the system working exactly as it should.

          • I’ve been under the impression that the raids were part of larger anti-doping operations by the French and the Portuguese police and based on information gained through normal means of investigation. In other words: the raddis were not carried after UCI told the police about their suspicions.
            Or did I misunderstand – and you actually meant that you believe (or that it is “common knowledge”) UCI targets teams that have been raided by the police and riders who have helped the police with their inquiries? Or riders assoiated in any manner with someone who has?

            In my view we don’t really know enough and I find it rather lamentable that what little we know encourages us to “connect the dots” (because the doping history of the sport is what it is) even when some of the dots may or may not be where we think they are.

          • @Eskerrik Asko: Sorry, you’re correct, of course. I had in mind a series of videos about WADA that I watched a while back and confused WADA (the investigative body) with the UCI (the enforcement body). In these videos WADA made very clear their “targeted approach” to anti-doping. This is in part due to budgetary limitations, but is also the way law enforcement tends to operate generally. UCI does its own investigating, of course, but things tend to come from the outside in rather than the inside out. As for the tendency to “connect the dots,” point taken.

  17. One thing that has been somewhat missing in this discussion is context for the kind of analgesic Tramadol is, and I think this might help explain why it is not a WADA sanctioned drug, and why it was so widely used in endurance sports.

    Tramadol isn’t particularly a strong opioid drug. It’s a strong analgesic, but a fairly weak opioid at least when compared to drugs like morphine. It’s a synthetic opioid that works by a somewhat novel mechanism, acting directly on one class of opioid receptors (mu), while also inhibiting the re-uptake of certain neurotransmitters. The latter property gives it some anti-depressant and anti-anxiety properties that can be very useful in pain patients, but can also make quitting chronic use more problematic. Tramadol also doesn’t cross the blood-brain barrier well, which should give it fewer central effects compared to some opioids, though sedation is a major side effect, perhaps because one main metabolite is also very active.

    Tramadol was created in the 1960s and introduced in the UK and US in the 1990s (I believe it was already widely used in Europe), and became widely used as a “good” pain medication purportedly without the issues of stronger narcotics. It’s addictive and abuse potential was considered so low that it was initially a schedule V drug (US rating system, for typical prescription drugs). It was considered a good alternative to the Tylenol #3 (acetaminophen with codeine), which is another widely used pain medication containing a weak opioid.

    In 2014 it was moved to schedule IV because of increasing reports of addiction and abuse coming from law enforcement and rehab centers. Schedule IV drugs include benzodiazepines, for example (considered very low risk of substance abuse). Strong opioids, like morphine, Oxycodone, and Fentanyl, are schedule II (high risk of substance abuse), and require triplicate prescriptions in the States, just to give some more context.

    So this is a drug that was considered fairy harmless and quite safe for decades, became extremely widely prescribed, and only relatively recently has it been seen as a problematic drug. I can see how it would have been something that was widely seen as a legitimate “marginal gain” within much of the peloton until very recently.

    By the way, the fact that there are preparations of Tramadol with acetaminophen is another indicator that, like codeine, Tramadol is a weaker opioid. These combos are only effective because the effect of the opioid isn’t so profound as to wash out the effect of the acetaminophen, and they become synergistic. And I know of no other drugs that contain Tramadol as an unnamed component, though Tramadol itself is marketed throughout the world by a wide variety of names. All of these trade-named drugs, however, would list ‘tramadol HCl’ right next to the brand name. So the only way to take Tramadol without knowing you were taking it would be to not read the box or the bottle it came in.

    • I know people who actually know what they are talking about hate to give an opinion on matters that are outside their special field of expertise, but I can’t resist asking:

      What do you think about the line of defense Quitana’s lawyer apparently has chosen: to argue (and preferably to prove) that other drugs or substances can produce the same metabolites that are currently (if the defense is successful) viewed as proof of Tramadol use?

      (I know that the lawyer is going to pursue other lines of defense as well, but this is an interesting one – and similar to the one he used in the succesful defense mentioned in an earlier comment.)

      • That particular line of defense wouldn’t appear to be too fruitful. The UCI press release states that his samples showed evidence of Tramadol and both of Tramadol’s two active metabolites. The active metabolites are quite similar to Tramadol, and I don’t think any other drugs would or could generate those metabolites in the human body. One active metabolite (O-Desmethyltramadol) has been synthesized on it’s own but I see no evidence that it has ever been included in any actual medication. I find almost no info on the other active metabolite. But ultimately it shouldn’t matter, since per the UCI the blood samples indicated the presence of all three.

        Now, is it possible that there are other similar drugs/metabolites (i.e., they contain a a cyclohexane ring and a phenyl ring in some configuration) that could show a positive on the test? Seems unlikely assuming the test can accurately distinguish between Tramadol and the two metabolites (i.e., you could be positive for one but not the other two). A more productive defense might be to claim that the drug was used out of competition and by some fluke of Nairo’s metabolism he still had some in his system (i.e., something like the Chris Froome defense as I understood it), but this seems far fetched considering when during the Tour the tests were taken. Or they attack the credibility of the test itself (i.e., the machinery wasn’t properly calibrated, chain of custody wasn’t adequate, etc., etc.). Or . . . ?

        • It sounds like his lawyer will be going for the second option of blaming the tests, the procedure etc. The starting point is “my client did not take tramadol… therefore something has gone wrong” but he has to prove this, or raise enough doubts in front of the tribunal.

          • Do you have any idea what the timeline for the tribunal will be? Right now it doesn’t look like those 450 points will be crucial in the relegation battle, but stranger things have happened.

          • There’s no timetable and deliberately so, as if the process is rushed that itself is grounds for appeal. So it could go on and on, the tribunal will want to let Quintana’s side exhaust their arguments, although within reason. But it’s on Quintana’s side to raise and question matters, then expect answers.

          • Thanks. Just speculating, but my guess is that Quintana’s side will both draw things out to allow this to fade from the active news cycle, with the final decision perhaps happening in the off season. To do that I would guess they’ll try several arguments in parallel.

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