Lasix-free stakes racing comes to fruition in 2021

When the calendar flips to 2021, stakes racing in virtually all major jurisdictions in North America will return to a previous era with the elimination of the anti-bleeding medication Lasix.

Earlier this month, Maryland became the latest state to officially ban the use of race-day Lasix in graded stakes, starting in 2021. The unanimous decision by the Maryland Horse Racing Commission cements an identical house policy that already was set to go in effect in 2021 at Laurel Park and Pimlico, home of the Preakness Stakes.

The Stronach Group — owner of Laurel and Pimlico — has been at the forefront of eliminating Lasix from North American racing. This year, the company banned Lasix in 2-year-old races at its stable of tracks in Maryland, Florida and California, with the prohibition expanding to stakes races in 2021. In addition to those major states, regulators and/or track operators in Kentucky and New York also eliminated Lasix from juvenile races this season, with stakes to follow in 2021.

While action has been taken jurisdictionally, it all will be trumped no later than July 1, 2022, when the Horseracing Integrity and Safety Act takes effect. The new law puts in place a national regulatory body to oversee the sport, and medication is listed as a top priority.

The phase-out of race-day Lasix in North America follows decades of debate over its role in Thoroughbred racing. First approved for use in horses in 1974, Lasix — which is the well-known brand name of the medication furosemide — is designed to help prevent a condition called exercise-induced pulmonary hemorrhage (EIPH), or bleeding in a horse’s lungs caused by strenuous activity.

While first limited to use in known “bleeders,” rules became less restrictive over time until at its peak upwards of 95 percent of North American Thoroughbreds raced with the medication. However, its expansion came with criticism. Opponents have contended that if a horse bleeds, it should not be competing in the first place. Additionally, many believe Lasix acts as a performance enhancer in part by reducing water weight. 

To support those views, critics note the medication is banned in every other racing jurisdiction in the world. The U.S. is also expected to join those countries.

Dr. Dionne Benson, chief veterinarian of The Stronach Group, explained why the company felt now is the time for North America to join the rest of the world in phasing out Lasix.

“First, obviously there is a perception issue,” Benson said. “Whether you believe Lasix is an issue when it comes to integrity ... the public sees something that is concerning — that we allow horses to be medicated on race day. While some people may see it that, if a horse has an issue, let’s give it some medication and let it race, others may see it that if a horse has an issue, why race? So there is an issue of public perception that’s out there.

“Secondly, there is a concern that horses who would not necessarily need the medication were receiving it for the performance-enhancing effects. We know it exists. It’s not just being used for EIPH, and I’m not sure how you draw the line for those that need it for EIPH and those that are using it to keep up with the other horses."

As regulators and racetrack operators pivot away from Lasix in Thoroughbred racing, the nation’s largest horsemen’s organization has remained steadfast in its support of the medication.

“We always point to the fact if there was research or a better medication that is legal and non-performance-enhancing, we would be the first to sign up,” said Eric Hamelback, chief executive officer of the National Horsemen’s Benevolent and Protective Association. “But right now, all the science, all the research, points to furosemide — using Lasix — on race day four hours out as being in the best interest of equine health and welfare.”

This year’s multi-jurisdictional ban on race-day Lasix for 2-year-olds manifested on an international stage at the Breeders’ Cup at Keeneland. Of the 70 juveniles entered to run on “Future Stars Friday,” only five had previously been administered the diuretic.

Now as some members of that crop embark on the official road to the 2021 Kentucky Derby, they will need to remain Lasix-free to make the starting gate on the first Saturday in May. Upon revealing the official prep schedule, Churchill Downs announced qualifying points for the Kentucky Derby will be awarded only to horses that compete without the medication.

As New York and Maryland also go Lasix-free for their stakes in 2021, this will be the first time all three Triple Crown races will be run without the medication since Kentucky legalized its use in 1975.

First phase

The wheels were set in motion to phase out race-day Lasix in April 2019, when a group of U.S. racetracks pledged to eliminate the drug from juvenile races in 2020 and stakes races starting in 2021. The coalition, which included all tracks owned by The Stronach Group and Churchill Downs Inc., as well Keeneland, Del Mar, Lone Star Park and others, hosts close to 90 percent of the graded and listed stakes conducted during a season.

According to trainers contacted for this report, the rollout of Lasix-free racing resulted in few problems with their 2-year-olds. Episodes of epistaxis — the most severe form of EIPH, where a horse bleeds through the nostrils — were rare. However, with EIPH known to be a progressive disease — and studies showing at least 30 percent to 40 percent of horses display some level of internal bleeding after strenuous activity — many horsemen remain concerned about what might lie ahead for those juveniles.

Hall of Fame trainer Mark Casse, a proponent of race-day Lasix, is among those who said there were few problems running 2-year-olds without Lasix in 2020. But Casse added that was largely to be expected.

“I never really did think [a Lasix ban] would have much of an impact with our younger horses,” Casse said. “Where the issue starts to arise is when they get older. My concern has always been, what’s the alternative to Lasix?

“I think with the stakes and young horses, it is not going to be much of a problem. But where I think it will hurt is in the claiming ranks and the lower-level allowances,” Casse continued. “There are going to be some horses that just aren’t going to be able to run anymore. And the way it is now [with Lasix], everyone is kind of on a level playing field. But when you eliminate Lasix, you’re going to get more people taking edges and cheat. The trainers that want to do the right thing will be at a bigger disadvantage.”

Trainer Bob Baffert is annually loaded with well-bred, high-priced juveniles. He has stated previously that if Lasix is so controversial, then “just get rid of it.” The Hall of Famer noted it will be up to trainers to adjust to the new rules.

“As far as the 2-year-olds this year, I haven’t run that many, but I haven’t had any issues,” Baffert said. “We’ll just have to see what happens with the older horses. There are some bleeders, so we’ll all have to adapt. I think everyone is going to be on a learning curve.”

Benson said anecdotal evidence indicates that the elimination of Lasix in 2-year-old racing this year led to fewer cases of heat exhaustion and a decrease in time between starts at tracks owned by The Stronach Group. Additionally, she said a review of the Equine Injury Database for tracks owned by The Stronach Group actually showed a decrease in epistaxis in the overall horse population.

Studies have found epistaxis, which is the most severe grade of EIPH, occurs in 0.1 percent to 0.2 percent of horses. However, according to numbers provided by Benson, the rate was lower at The Stronach Group tracks in 2020. In California, the epistaxis rate fell from 0.16 percent to .09 percent; in Florida, it went from .07 percent to .04 percent; and in Maryland it fell from .10 percent to .06 percent.

“So, we’re talking a reduction in absolute numbers and percentage of horses,” Benson said. As for why, she cited additional rule changes by The Stronach Group as possibly contributing to the reduction, including “backing up” the use of non-steroidal anti-inflammatory drugs to 48 hours before a race.

“Like with aspirin for humans, long-term use can change the red blood cells themselves and make you bleed easier. So maybe that contributed,” Benson said. “It could also be the horses were slower because they didn’t have Lasix.”

Casse operates one of the biggest stables in North America, averaging more than 1,250 starts each of the past five seasons. He said every horse is scoped after a race and estimates that in "30 to 40 percent of those, you will see some blood. For those that bleed externally, where you see it out their nose, it's one in a couple of hundred."

While supporters of a Lasix ban may trumpet its relative success in 2-year-old races, Hamelback maintains they continue to miss the point by focusing on only the most extreme cases of EIPH, which is graded on a scale of 1-4, with grade 4 being epistaxis.

“We hear the noise, we hear the combative sort of tone, ‘Oh horses aren’t dropping dead, or horses aren’t bleeding like you said they would. No, that’s not what we said,” Hamelback commented. “We said without Lasix, you’re going to have increased EIPH, which is detrimental to the horse. And that’s exactly what we’ve seen.

“Now, many within the regulatory system in particular are only trying to define an EIPH episode as if you see bleeding coming out of the nostrils. In the real world, grades 1 through 3 can be just as detrimental to the lungs from an infection standpoint,” Hamelback added.

Moving forward

Racetrack operators need race-ready horses to put on the show. Will this be negatively impacted by a wider Lasix ban in 2021? Benson acknowledged it is a valid question, given EIPH's progressive nature. That is part of the reason The Stronach Group has not sought a blanket ban on Lasix, she said.

“It certainly is a concern,” Benson said. “That’s why the next step we wanted to take was with stakes races — because when you look at your breeding population, we don’t even know how much breeding and genetics plays a role [in EIPH]. I won’t be surprised if you see an increase in epistaxis in the graded stakes this year. But then maybe we can selectively breed those horses that are less likely to breed bleeders. We’re not exactly certain what’s going to happen.

“What I do know is around the world they don’t use Lasix for any of their racing, dirt included,” Benson added. “They race on dirt in Australia. In South America they race on dirt, and all manage to race safely and successfully without it. I don’t think their trainers are any smarter than ours.”

One tool trainers have employed over the years to reduce the risk of bleeding is pulling a horse’s water in the leadup to a race. This is known as "drawing" and is designed to mimic the diuretic effect of Lasix. However, the practice of denying a horse water is ripe with its own ethical questions. 

Casse said he is not sure whether drawing is a strategy he will employ, adding there are other ways to help reduce the risk of bleeding.

“The biggest thing is you train them differently, maybe a little less stressful in the few days before the race,” Casse said. “Many horses, which some people don’t realize, may potentially bleed in a gallop. So I think I would train not quite as hard going into a race. I don’t even know that I’ll pull their water. Maybe pull it a couple hours or something like that. But there really won’t be a whole lot of change. We’ll just have to see what happens.”

Baffert echoed those sentiments while hoping for the best moving forward.

“I’m just so tired of hearing about it," Baffert said of the Lasix controversy. "We’ll try it and see if it works. Maybe it will be OK.”

As for Hamelback, he maintains that the Lasix ban is the result of "a lot of elite, club-like mentalities trying to make decisions for everyone else." Its full impact, including shrinking field sizes because of horses not being able compete, will be felt in the coming years, he said. 

Banning Lasix "is not the pulse of the entire industry. It is the pulse of the wealthy who can give their horse eight or 10 months off or never race them again, because at the end of the day it is not their livelihood they are putting on the line," Hamelback said. 

"This ban, or moratorium or whatever you want to call it, the full effects won't be felt for a couple or three years. I truly believe you're going to see even shorter fields because now horses are going to need more time between races to recover from EIPH," Hamelback added. "Or you're going to see many horses that can't start more than two, three, four times All because they can't be administered this very effective, legal medication."