I had a little Twitter disagreement with injury guru Will Carroll the other day -- if you aren't following our twitter feed come on over and join @athomeplate1 -- about drugs used for treating ADD and ADHD being used as performance enhancing drugs.  Carroll feels they aren't, and I feel they are.

For those of you who don't know, ADD (Attention Deficit Disorder) drugs have a lot of beneficial effects when they work for people with that disease.  However they also do a lot of other things, including act as stimulants, increase focus and energy and improve reaction time.  Perhaps that's why within six months of amphetamines being added to the banned substances list, the number of baseball players applying for "Therapeutic Use Exemptions," or TUE -- essentially medical exemptions to use drugs such as Ritalin and Adderall -- rose from 28 to 103.

Upper, downer, what do you need?

Photo by ep_jhu, used under creative commons license.

Support for that theory was confirmed by Deadspin, which reported in 2009 that MLB had granted 108 exemptions for ADD and ADHD drugs.  According to Deadspin, at least 12 players who did not have exemptions tested positive for those same drugs.

None of those players appear to have been disciplined, let alone suspended for those positive tests.  In fact the only Major Leaguers suspended for PEDs that season were Manny Ramirez and reliever J.C. Romero.

So why did these guys slide? Because ADHD and ADD drugs are not considered PEDs under current guidelines.  If a doctor prescribes it, MLB is likely to rubber stamp it.

MLB has a system for handling medical exemptions, but it's not one that offers much in the way of transparency, especially to the fans -- save for an annual announcement of what exemptions were made over the past season.

As it stands now any player requesting a TUE must have the team doctor send the script to MLB's office where it is supposed to be evaluated by an independent administrator Dr. Bryan Smith.   But if Smith has the ability to put his foot down and say no seems to be questionable at best.  I can find no evidence that Smith has ever denied the request for a TUE.

That's probably due to legal liability issues, and it's a very slippery slope to try to take a stand on.  If a doctor recommends anything -- from synthetic testosterone, to ADD/ADHD drugs -- how can any administrator, even an MD, override another doctor's therapeutic regimen?

Of course, that's exactly what anti-doping programs are supposed to do.  They are supposed to make decisions about what drugs, therapeutic or otherwise, are going too far and giving players an unfair advantage.  The jury is still out on certain drugs, drugs which some individuals simply might be unable to function without.

To bar those drugs would be to take away the livelihood of a handful of ballplayers.  Maybe that's the right thing to do to keep the game clean, and maybe it isn't.  That's a very hard call to make from a moral point of view.

But while there are a handful of players who really need the drugs there is strong evidence suggesting that some players using these drugs are just gaming the system so they can get stimulants.

Perhaps the strongest case for that is simple statistics.  According to the New York Times in 2009, somewhere between 1-3.5 percent of all adults had ADD or ADHD.  The Mayo Clinic puts the number at about 4 percent.  But baseball's percentage is over 8 percent.

That doesn't make a lot of sense.  Baseball players, by in large, are among the best physical specimens of the species.  They have great reflexes, eyesight and muscle tone.  They work in a sport where lack of ability to concentrate is the recipe for failure.  Simply put, players who can't focus don't make it through the minors and more likely they don't even make it to high school ball.

So when baseball faced a 350 percent increase in players needing ADD/ADHD medications immediately after amphetamines were banned, alarm bells should have been ringing.   It was obvious that at least some players need their stimulants and will do what they have to in order to get them.

Yet baseball hasn't banned ADD/ADHD drugs.  Maybe that's because of fear over a public backlash for banning drugs that so many people, especially kids, need.  Maybe it's because MLB is afraid of the legal complications that could come from denying medical treatments.

At the very least, MLB needs to put a ban on player without TUEs using the drugs and taking steps to punish those who violate that policy.  Sadly that's not likely to happen anytime soon.

The problem is real.  There were 105 exemptions for ADD and ADHD last year.

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