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.
"It's not that [an ADHD sufferer] can't focus; it's that he attends to too many things. A batter needs to attend to the pitcher and the pitcher only, not distractions from the stands and the like. Adderall allows him to do that," Lustberg said.
The drug also sharpens hand-eye coordination and cuts reaction time, which can help a hitter make contact. In the case of a strong man like Davis, that can lead to more home runs, Lustberg said.
Amphetamines are so potent that the United Nations considers them a Schedule II controlled substance, which means they have limited medical use and a high potential for abuse, according to the federal Food and Drug Administration.
But it wasn't until the winter of 2006 — the year in which former Sen. George Mitchell started gathering data for his 2007 report on steroid use — that baseball explicitly banned the stimulants.
As many baseball fans know, that year's collective bargaining agreement brought severe new penalties for steroid use, including a 50-game ban for a first positive test. Fewer probably realize it also brought the first penalties for amphetamine abuse.
Then as now, Major League Baseball tested every major leaguer for banned drugs twice a year, once during spring training and once, randomly, during the regular season.
The first time a player tests positive for amphetamines, the result is kept confidential. The player isn't even required to inform his team.
A second positive, though, spells an automatic 25-game suspension. A third means another 80 games. A fourth can bring lifetime banishment.
But the new disciplinary rules weren't enough, the players union and owners jointly decided. The game beefed up its screening procedures in 2011.
Under the new regimen, players seeking Adderall exemptions still had to provide a doctor's diagnosis for ADHD — or for narcolepsy, a rarer condition for which the drug is also used — but that was now just the first step.
Today, officials send that paperwork to any of several dozen certified consultants such as Goodman, the Johns Hopkins psychiatrist. Those consultants then determine a clinical diagnosis, using a process that includes a comprehensive 90-minute interview covering the applicant's medical history.
They might ask his childhood friends about long-term behavior patterns or cross-check for past conditions linked to ADHD — low birth weight, bed wetting, parental histories of hyperactivity.
Armed with such information, baseball's independent program administrator, currently Dr. Jeffrey M. Anderson of the University of Connecticut, then has a choice: He can make a ruling himself or consult an expert panel of three more psychiatrists.
"It's not a willy-nilly process," said Greg Bouris, a spokesman for the players association.
But the new system hasn't stamped out Adderall use.
Fully 9.9 percent of big leaguers have therapeutic-use exemptions for ADHD today, more than twice the incidence in the general population. Major League Baseball and its players association both say they don't track the number of applications.
At least 10 players have been suspended for Adderall use, starting with Detroit Tigers shortstop Neifi Perez, who became the first when he received a 25-game ban for Adderall in 2007, then 80 more for a second violation.
Three more infielders make the list, including Davis and former Oriole Miguel Tejada, who got a 105-game suspension in 2013. A catcher, two outfielders and three pitchers (including former Oriole Troy Patton last December) also were sanctioned.
Because traces of Adderall stay in the bloodstream for no more than 48 hours — and players can hasten its dissolution by such tricks as ingesting vitamin C — such players could have been playing the odds, betting it was unlikely they'd be tested when vulnerable.
If that was Davis' plan, he lost big. He'll sacrifice at least $961,475 in salary while sitting out. He missed the Orioles' celebration as they clinched their first division title in 17 years. And, as teammates like Nick Markakis and Adam Jones sharpen up for October baseball, he'll be playing in the Florida Instructional League.
The slugger known as "Crush" reports to Sarasota early next week, the team announced Friday.
If fans are wondering what Davis was thinking, Lustberg said he has an idea, and he believes it transcends chemistry.
We live in an increasingly competitive society, he said, and that can cloud anyone's judgment.
"I don't care whether you're a student, a salesman or a home run hitter, you're watching what everybody else is doing," he said. "We're all looking for an edge."