Major League Baseball granted Orioles first baseman Chris Davis a therapeutic-use exemption for 2015, but not for Adderall, the medication that caused him to receive a 25-game suspension last season.
Davis told FOX Sports on Saturday that he instead was granted an exemption for Vyvanse, a different form of stimulant medicine for attention-deficit hyperactivity disorder.
Vyvanse, like Adderall, is an amphetamine. The difference is, Vyvanse lasts longer and is less likely to be abused for non-therapeutic reasons, making it the preferred choice of MLB and most psychiatrists, according to baseball’s medical director, Dr. Gary Green.
“It’s not wrong to prescribe the short-acting medications (such as Adderall),” Green said. “But the preference these days is to go with the long-acting ones. That’s what we recommend.”
Davis, 28, said he responded well to Vyvanse after trying it this offseason, and even preferred it to Adderall.
“That was part of the process — try the Vyvanse to see I liked it, if I liked it better or wanted to go back to Adderall,” Davis said. “I liked Vyvanse better.”
The question is whether Davis could go back to Adderall if he decided that he was not getting the desired results from Vyvanse.
When a player wants to switch mediations, he must submit paperwork in conjunction with his treating physician and notify baseball’s independent program administrator that he was making a change, Green said. The switch is not automatic; the approval of the administrator is required, according to others familiar with the process.
Davis received his 25-game suspension, covering the Orioles’ final 17 regular-season games and seven postseason games last season and Opening Day this season, after twice testing positive for unauthorized use of Adderall in 2014. Under the joint drug agreement between MLB and the players union, his initial violation resulted in follow-up testing, his second in suspension.
A third positive test would trigger an 80-game ban, but Green said it is “a relatively simple process” for a player to switch medications; Davis already has been diagnosed with ADHD.
“That’s why we want players to be monitored — (their) needs change,” Green said. “Sometimes someone is on a certain medication and they’re not responding. They need a change in the dosage. They need a change in the medication. That’s certainly allowed.”
Green could not specifically discuss Davis’ case due to baseball rules and laws protecting patient confidentiality. He said that baseball continues to grant exemptions for short-acting medications (Adderall also comes in an extended-release form). Baseball, however, does not provide a breakdown of the number of players that receive short-acting and long-acting stimulants, again citing confidentiality.
The sport granted 112 exemptions for ADHD last season, down from 119 the previous year, according to the league. Davis told reporters last month that he initially was diagnosed with ADHD in 2008. He said that he had an exemption for Adderall in previous seasons, but was denied one in 2013. He also did not have one in 2014, for reasons that are not clear.
Davis performed brilliantly without the exemption in ’13, slugging a club-record 53 homers. But he struggled last season, batting only .196 with 26 homers and suffering a left oblique strain. His suspension was announced on Sept. 12, and the Orioles completed their march to the AL East title and advanced to the American League Championship Series without him.
A three-man panel reviews player requests for exemptions before the start of each season, and the TUE covers a full year.
“The problem with the stimulant ADHD medications is that they can be used as a performance enhancer and they also can have therapeutic uses,” Green said. “Every drug-testing program in the world has to have a therapeutic-use exemption policy in order to allow people with a legitimate need for taking the medication to be able to take it.”
Green said new ADHD patients often are prescribed non-stimulant medications such as Strattera and Wellbutrin. If those medications do not work, then baseball will steer patients toward long-acting stimulants such as Vyvanse, Concerta and Adderall extended release.
“The reason for that is you get a more even distribution, it’s more effective and it’s less likely to be abused,” Green said. “Obviously, these things are scheduled drugs that all have an addiction potential.”
Vyvanse, according an article on Healthline.com, is less likely to be abused than Adderall because of the difference in how the body breaks down the drug.
“Vyvanse enters the body in inactive form,” the article said. “As you digest the drug, it slowly converts it into its active form. The effects can last for up to 14 hours.”
Davis, who will participate in the Orioles’ first full workout on Wednesday, will sit out Opening Day, then start anew.