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Racehorse Medication Ethics at the 2017 Breeders Cup

31/10/2017 by Sid Gustafson, DVM

In the midst of Australia's Spring Racing Carnival, Americans celebrated their own Thoroughbred racing end-of-year Championships under rules that allow horses to train, as well as race, on a cocktail of pharmaceutical medications. Veterinarian and journalist Dr Sid Gustafson reports from the 2017 Breeders' Cup in Del Mar, California, for Horses and People Magazine on racehorse medication ethics.

Intense medical intervention prior to competition is allowed in American horseracing but is not a viable, ethical approach. The more intensely horses are medicated to compete, the lower their welfare. The more medications required to sustain any population of animals, the further the deviation from their physical and behavioural needs. Rather than pre-race treatments, the ethical approach should aim to fulfil the horse’s long-evolved nature.

Del Mar, October 31st, 2017

The Del Mar Fairgrounds racing barns are well-ventilated, lung-friendly equine stables, a most refreshing air to breathe for the Horses and People. With lofty ceilings and open shedrows, the coastal air invigorates both horses and track folk, a feeling therapeutic and wholesome. Dustless. 

It can be a wet air at Del Mar, so close to the sea, and with this, let me say now that some trainers are suspect of heavy air, and its affect on their horses’ breathing and potential to bleed, not to mention their horses joints, feet, bone, and muscle. A light mist floated down near the track after the training hours on Monday, and there are rumours that outright rain may arrive by Saturday, and what affect might this have on the wind and limb of horses racing on Friday and Saturday?

The Breeders’ Cup horses are allowed to train, as well as race, on medication, such is the American horse training mindset. In America, most horses receive medication to race, a practice that is not tolerated by racing jurisdictions elsewhere. In Hong Kong, for example, medication is curtailed weeks before racing. The horses are not allowed to train on medication.

In California, many of the works and gallops are medicated, but not all, no. Certain horses here today maintain the banner of medication-free racing, most-notably and perseveringly, Mongolian Saturday, winner of the 2015 sprint at Keeneland, as well as Talismanic pictured above.

The Breeders’ Cup medication rules, as regulated by the California Horse Racing Board indicate that at 48 and 24 hours before racing, a Breeders’ Cup runner horse can be intravenously medicated with a Non-Steroidal Anti-Inflammatory Drug (phenylbutazone, flunixin or ketoprofen). An often utilized pre-race NSAID protocol, according to an attending veterinarian at Del Mar, is to inject Banamine (flunixin) 48 hours before the race, followed by an intravenous phenylbutazone 24 hours before running. 

Other approved therapeutic medications, such as Robaxin (methocarbamol) among others, can be administered “48 hours out,” as they say, as well. The horse can also be tubed (drenched) with electrolytes in this time frame, and many are to alleviate perceived dehydration. A nasogastric tube is passed through the nose and down the oesophagus to the stomach, and gallons of a mildly alkalinizing electrolyte solution are pumped into the stomach. 

24 hours before racing, the second NSAID can be administered. The dosages are limited by the testing protocols, which allow only certain levels of medications in the bloodstream at the time of testing before and after the horse races. These NSAIDs are usually administered intravenously. Intravenous vitamins and electrolytes can be given up until 24 hours before racing.  

Any Breeders’ Cup horse is allowed to be administered pre-race Lasix (furosemide, an alkalinizing agent and diuretic) at the behest of the trainer. The trainers are also allowed to call the Lasix dosage, between 3-10cc, to be given between 4 and 4½ hours before the scheduled post time. The Lasix has to be administered by an official California Horse Racing Board (CHRB) veterinarian. Premarin, or estrone, is not allowed to be given along with, or in place of the Lasix, as is currently allowed for non-Breeders’ Cup runners in California.

To appreciate the permitted medication allowed intensity for the Breeders’Cup, it is possible, then, for a Breeders’ Cup runner to receive multiple therapeutic injections 48 hours out, along with nasogastric fluids and electrolytes. At 24 hours out, the horse can be injected with a second NSAID, and be given intravenous fluids and/or vitamins. Between 4 and 4½ hours before racing, the horse can be injected with between 3 and 10cc of Lasix.

Read the article 'How to Play the Breeder's Cup Lasix' next.

There must be a better way

An appreciation of the evolved nature and behaviour of horses provides the foundation for the ethical veterinary care of equine athletes. The establishment of a veterinary-client-patient-relationship (VCPR) is instrumental in providing ethical care for the performance horse. Ethical veterinary practice supports the horse’s long-term health and welfare interests while avoiding pharmaceutical intervention in the days before the competition.

Horses evolved as social grazers of the plains, moving and grazing in a mutually connected and constantly communicative fashion on a near-constant basis. Contemporary equine health and prosperity remain dependent on providing an acceptable degree of this near-constant movement, foraging, and socialization. When horses are confined in stables for human convenience and performance interests, the horse’s natural preferences need to be re-created to a suitable degree to avoid exceeding the adaptation capacity of the horse. As the adaptability of the horse is exceeded, welfare is diminished and the need for medical intervention to remedy behavioral, health, and soundness deficiencies is intensified. Contemporary practices regularly exceed the competition horse’s adaptability, resulting in the need for extensive veterinary intervention to sustain health and competitiveness1.

The more medical care and pharmaceutical intervention required to sustain any population of animals the lower the population’s welfare2. Ethical veterinary care supports the horse’s best welfare interests, as well as the safety of the horse’s riders or drivers. The medical intervention of the equine athlete should be avoided in the days and hours before competition, as studies show that pre-competition medication is associated with increased vulnerability and diminished welfare3.

In order to properly support the health and welfare of equine athletes, the veterinary practitioner must be familiar with his/her patients both inherently and individually. Socialization, constant foraging, and abundant daily locomotion are the long-evolved requirements to promote and sustain optimal soundness, behavioural health, performance, and healing in competition horses.

Healthy horses function and perform more consistently and predictably in an unmedicated state. Contemporary pre-competition medication practices remove the horse’s ability to protect their health and sustain soundness by masking pain and suppressing symptomology and are therefore heavily regulated. Horses who require medication to alleviate medical conditions in order to compete are rendered vulnerable to further injury, and physical and behavioural dysfunction, imperilling the safety of both horse and horseperson.

Horses requiring medication to compete are often not fit to compete safely. Horses and horse folk are best served to compete free of short-term pre-competition pharmaceutical influence. Infirmities require appropriate medical care and rehabilitation before a competition is considered and resumed, rather than pre-competition medication to allay active medical problems. The equine practitioner should focus on post-performance evaluations and necessary therapies to sustain horse health on an enduring basis. An emphasis on fulfilling the medical, physical, and behavioural needs of the horse to prepare for the future competitions is the essence of ethical veterinary care of the competition horse.

Pre-competition medication practices that replace or supplant appropriate health care are not in accord American Veterinary Medical Association's (AVMA) Principles of Veterinary Ethics4.

Disregarding horse welfare in the name of human entertainment

For human entertainment, convenience, and revenue, horses are bred, isolated, stabled, conditioned and medicated to perform competitively. Contemporary pre-competition medication practices in the United States of America are often at the expense of the horse’s health, safety, and welfare. Many current medication practices violate the AVMA Principles of Veterinary Ethics, specifically the clause that states a veterinarian shall provide veterinary medical care under the terms of a veterinarian-client-patient relationship (VCPR).

The AVMA Principles of Veterinary Ethics state that it is unethical for veterinarians to medicate horses without a VCPR. Pre-competition pharmaceutical interventions to remedy insufficient attention and preparation for the horse’s long-evolved health requirements are seldom in the best interest of the horse. The medical and pharmaceutical practices which support equine competitive pursuits should be designed to enhance the health and soundness of the horse on a long-term basis, and should not be intended to enhance performance.

Pre-competition pharmaceutical intervention has been demonstrated to have an overall negative affect on the health and welfare of competitive horse populations. Where horses are allowed to be permissively medicated without a VCPR, injuries and catastrophic injuries are more prevalent. Horses are best served to be properly prepared to compete in a natural, non-medicated state. The pharmaceutical intervention of the equine athlete should be avoided in the days before a competition, as pharmaceutical intervention increases fragility. Intense and widespread pre-competition medication practices correlate with catastrophic injury vulnerability and diminished welfare5.

Equine athletic pursuits have historically been designed to measure the natural ability of horses and the trainer’s ability to bring out the horses’ natural ability. Equine competition was originally designed to measure the natural ability of horses rather than their medicated ability6. It is important that the welfare and veterinary care of the horse take precedence over economic and human interests. Horses are born to socialize, communicate, locomote, and chew on a near-constant basis. For behavioral and physical integrity, these preferences need to be re-created to an acceptable degree in the competition stable. The ethical practice of veterinary medicine includes providing clients with the guidance to provide appropriate husbandry, nutrition, conditioning, medical management, and behavioural fulfilment of their equine athletes.

Equine welfare is best supported when horses are properly prepared, physically and mentally sound, and fit to perform in an unmedicated state. Physically or behaviourally impaired horses who require medication to compete should not compete until they are able to compete without pre-competition pharmaceutical intervention. All sensation, behaviour, and proprioception should remain physiologically normal. Sensation and cognitive awareness should not be suppressed with pre-competition medication. This includes the use of sedatives, stimulants, and pain relievers of all sorts. Treatments should not interfere with functional physiology.

Sound horses properly prepared for competition have little need for pre-competition medication. Unsound or behaviorally dysfunctional horses should be medically and behaviorally rehabilitated in a fashion that restores soundness before training and competition are resumed. Medication is for infirm horses, and infirm horses should not compete. Horses who require medication to compete become increasingly unfit to compete safely. Rather than therapeutic intent, many pre-competition medication practices have become performance enhancing at the expense health and welfare of horse and rider.

It has been demonstrated through time that horses and their riders are best served to compete medication free. As a result, anti-doping laws have been established by all agencies that regulate equine competition. Veterinarians are required by both ethics and law to follow these regulations. Horseracing statistics support that the fewer medication horses receive the more favourably and safely horses compete7.

The safety of the competition horse is dependent on unimpaired neurological functioning. Unimpaired sensation and cognitive ability are necessary for a horse to compete safely and fairly. Any medications or procedures which negate or diminish sensation and awareness in the horse impair the ability of the horse to compete safely8.

The safety, longevity, and durability of the equine patient should be considered before short-term pre-competition medical solutions are implemented. Familiarity with the patient includes familiarity with stabling, genetics, behavior, and husbandry of the patient. Many, if not most medical conditions are a result of human mismanagement of equine stabling and conditioning. When the adaptability is exceeded, horses become unsound. Assessment of stabling conditions and athletic preparation practices are essential components of ethical equine care. Healing must be allowed to progress before competition and training are resumed. Client education is essential to create a husbandry situation conducive to equine healing. Restoration strategies that recreate the horse's social grazing and locomotion preferences facilitate and potentiate horse healing. Appropriate healing of many equine maladies is encouraged when the veterinarian provides appropriate medical care and carefully facilitates a scenario to provide the horse with appropriate physical rehabilitation and behavioural fulfilment. 

An interdependence exists between horse health and locomotion. Horses evolved to be near-constant walkers and grazers. Horses did not evolve to be confined in stalls and stables but rather evolved to live and move on a near-constant basis. Despite domestication and selective breeding for docility and captivity, horse health remains dependent on locomotion. Locomotion is inherent to digestion, to respiration, to metabolism, to hoof health and function, to joint health, and to behavioral fulfilment. When horses are deprived of adequate and abundant locomotion, they develop strategies to keep themselves and their jaws moving, as is their essential and inherent nature. Horses deprived of friends, forage, and locomotion are at risk to develop stereotypies to provide themselves with the movement they need to survive. The more stereotypies present in a population of equine athletes, the lower the welfare.

No longer is intense medical intervention prior to competition a viable, ethical approach. It has been demonstrated that the more intensely horses are medicated to compete, the lower their welfare. The more medications required to sustain any population of animals, the further the deviation from their physical and behavioural needs. Rather than pre-race treatments, the ethical approach includes the performance of extensive post-competition examinations to address any weaknesses or unsoundness as a result of the performance.

Alternatives to precompetition medication with non-steroidal anti-inflammatory medication (NSAIDs) and steroids include fulfilment of the horse’s long-evolved nature. Musculoskeletal soundness is attained by proper breeding, development, husbandry, and conditioning practices. Management of exercise-induced pulmonary haemorrhage is achieved by specific daily development of the horse’s pulmonary and cardiac function. Unwelcome competition behaviors are best managed by the fulfillment of the horse’s inherent behavioral needs, which include abundant daily socialization, locomotion, and nutrition.

Read the next article by Dr Sid Gustafson: How to Play the Breeders Cup Lasix.


  1. McGreevy, P.D. (2004). Equine Behaviour: A Guide for Veterinarians and Equine Scientists. Edinburgh: Saunders; 2004.
  2. Appleby M, Mench J, Olsson I, Hughes B (2011). Animal Welfare. CABI, Second edition; 2011. And Fraser D (2008). Understanding Animal Welfare: The Science in its Cultural Context. Wiley-Blackwell; 2008.
  3. Gustafson S, A Contemporary Approach to Equine Behaviour Education, Proceedings, World Veterinary Congress, 13 October 2011, held in conjunction with the International Veterinary Behaviour Meeting (IVBM).
  4. The AVMA Principles of Veterinary Ethics,
  5. Kentucky Horseracing Commission Raceday Medication Transcript, NOVEMBER 14, 2011
  6. Magner D 2004 Magner’s Classic Encyclopedia of the Horse Edison, New Jersey: Castle Books.
  7. Kentucky Horseracing Commission Raceday Medication Transcript, NOVEMBER 14, 2011
  8. Furr M, Reed S editors (2007). Equine Neurology; Wiley-Blackwell.
Recommended reading:
  • Chyoke A, Olsen S & Grant S 2006 Horses and Humans, The Evolution of Human-Equine Relationships,  BAR International Series 1560, Archeopress, England, ISBN 1 84171 990 0
  • Magner D 2004 Magner’s Classic Encyclopedia of the Horse Edison, New Jersey: Castle Books
  • McGreevy P 2004 Equine Behavior: A Guide for Veterinarians and Equine Scientists Philadelphia: Elsevier Limited. ISBN 0 7020 2634 4
  • Waran N, McGreevy P & Casey RA 2002 Training Methods and Horse Welfare in Waran N, ed The Welfare of Horses, Dordrecht, The Netherlands: Kluwer Academic Publishers, p151-180
  • Paul McGreevy BVSc, PhD, MRCVS. Equine Behavior, 2004, A Guide for Veterinarians and Equine Scientists. Second Edition, Elsevier; 2012, Chapter 13 Equitation Science
  • Budiansky, S. (1997). The nature of horses: Exploring equine evolution, intelligence, and behavior. New York: The Free Press.
  • Hausberger M, Roche H, Henry S, and Visser E.K. “A review of the human-horse relationship” Appl Anim Behav Sci 109, 1-24. 2008
  • Waran, N. McGreevy, P., Casey, R.A (2007). Training Methods and Horse Welfare, In The Welfare of the Horse (pp.151-180 ) Auckland, New Zealand.