Orioles slugger Chris Davis, suspended recently for using a banned stimulant, was caught amid a leaguewide crackdown that began three years ago as players' use of Adderall spiked, according to sports physicians and other experts.
Amphetamines — a drug with addictive properties — have long been a part of the game's darker side. Even the home run record-setting Hank Aaron acknowledged using the stimulants, once commonly known as "greenies." The action by Major League Baseball sheds light on growing concern about amphetamines — a type of drug that has become increasingly potent.
But big league demand for Adderall, which can jump-start a player's energy and focus for up to five hours, appeared slight until just a few years ago.
In 2006, Major League Baseball granted 28 players medical exemptions for the drug, all for attention-deficit hyperactivity disorder, the neuropsychiatric illness it's most often used to treat. The following year, the number skyrocketed to 103, or more than 8 percent of all players, according to statistics provided by the sport.
That number has gradually risen since. Last year's total of "therapeutic-use exemptions" for ADHD was 119, the most ever.
Baseball took note — and action. In 2011, club owners and players worked out a special agreement to stiffen the criteria used in the exemption process.
From that point on, applicants like Davis, who once needed no more than a prescription from a single independent doctor, have had to face a multilayered process involving as many as six psychiatrists conducting dozens of interviews.
Their inquiries can touch on anything from employment history to a history of concussions.
"There was a sudden surge in positive tests, and baseball decided it needed a new plan," said Dr. David Goodman, a Johns Hopkins University psychiatrist and certified Major League Baseball consultant on ADHD and stimulant use. "If this process determines you have ADHD, you have it."
Davis, who sources say had permission to use the drug during his three years with the Texas Rangers, was denied the exemption when he applied to renew it in 2012 after being traded to the Orioles.
That didn't mean the sport had concluded the player had been cheating, Goodman said. But it did mean a battery of specialists found insufficient evidence that he had a medical need for Adderall.
"Any [conclusion] beyond that is speculation," said Goodman, who was not involved in Davis' case.
Major League Baseball won't say when Davis recorded his first positive test for the drug — under the current Joint Drug Agreement, that's confidential.
Baseball doesn't even discipline players for the first positive test. Players are warned and subject to six extra random drug texts in the next year. A second positive test results in a 25-game suspension without pay like the one Davis got two weeks ago.
Given those disciplinary standards, his first positive could have occurred sometime late last season when Davis set an Orioles record with 53 home runs, 20 more than his previous best. It also could have happened sometime earlier this year.
"When a player has a sudden spike in performance like that, that's when the authorities might just decide to take a second look at what's going on," said Dr. Richard Lustberg, a licensed psychologist in New York and member of the American Psychological Association who specializes in sports psychology.
Davis immediately apologized through a statement released by the Major League Baseball Players Association, but has not otherwise publicly addressed his positive test or suspension.
The Orioles sent the slugger to their spring training complex in Sarasota, Fla., last week, where he is expected to play in instructional league games to stay sharp.
Baseball has a long history with amphetamines. And there's no mystery why. As far back as 1969, players used greenies for the kind of energy boosts that could help them through the grind of a 162-game season.
Former pitcher Jim Bouton described the rampant use of the drugs by players in his 1970 book "Ball Four." Along with Aaron, Hall of Fame slugger Mike Schmidt admitted using them.
In a way, the appeal has only grown.
Adderall, a compound of mixed amphetamine salts that increases activity of certain neurotransmitters in the brain, is a refined version of the stimulants used years ago. "Adderall" has come to mean any psychostimulant with those chemical properties.
It's commonly prescribed for children with attention deficit disorders, which may make its use seem safe.
Research shows it's highly effective in treating ADHD, a condition that begins in childhood and is marked by poor concentration, hyperactivity and impulsive behaviors that can impair functioning into one's adult years.
Today's amphetamines, though, do more than address that illness or increase stamina. They can deepen one's capacity to concentrate, and that's a boon for any athlete, with or without ADHD.