Prescription or Edge? ADHD Stimulant Exemptions in Major League Baseball

Timeline

1. 2006MLB includes amphetamines in its drug-testing program for the first time; 28 ADHD exemptions are granted.
2. 2007ADHD exemptions rise to 103 of 111 total TUEs; 13 applications are not granted.
3. Jan 15, 2008The House Oversight Committee releases MLB's TUE statistics at a hearing on the Mitchell Report.
4. Nov 29, 2013MLB's annual drug report shows 119 exemptions for attention deficit disorder.
5. Sep 2014Orioles slugger Chris Davis is suspended 25 games after a second positive test for amphetamines.
6. Dec 1, 2014The annual report shows 112 ADHD exemptions; eight of ten stimulant positives were for Adderall.
7. Dec 2014Davis receives clearance to use Adderall in 2015.
8. Dec 1, 2025The annual report shows a record-low 54 ADHD exemptions.

The ethical issues

• Whether medical exemptions for stimulants protect sick players or create a loophole for enhancement.
• Medical privacy versus public confidence in exemption decisions.
• How rigorous diagnosis must be before a banned drug is allowed.
• Proportionate punishment for stimulant violations compared with steroid violations.
• Fairness between players with and without exemptions.

Stakeholders

Stakeholder	Interests & obligations
Players with ADHD	Access to effective treatment without stigma or punishment.
Players without exemptions	Competing on equal terms against opponents who may gain from stimulants.
MLB (Commissioner's Office)	A credible drug program and the sport's reputation.
MLB Players Association	Protecting players' medical privacy and due process.
Independent Program Administrator and Expert Panel	Sound medical decisions free from pressure by either side.
Fans and Congress	Assurance that baseball's drug rules are not being evaded.

The case

Background

Stimulants have a long history in baseball. Amphetamines sharpen focus and attention, which the Toronto Star noted is particularly valuable in a sport of short bursts of exertion and concentration amid long stretches of inactivity.^[8] According to the Toronto Star, Hall of Famer Tony Gwynn told the New York Times in 2003 that he believed half the league had used amphetamines during his career, calling it “a rampant problem.”^[8]

Major League Baseball (MLB) and the Major League Baseball Players Association (MLBPA) added amphetamines to their drug-testing program for the first time in the 2006 season.^[3] But the same drugs are also medicines. Adderall, an amphetamine, and Ritalin are commonly prescribed for attention deficit hyperactivity disorder (ADHD), a condition affecting attention and impulse control.^[3][8] The question was how to stop stimulant use for an edge without denying treatment to players who need it.

The rules and governance

Baseball’s drug rules are not imposed by a league or an outside agency alone. They are part of the Joint Drug Prevention and Treatment Program, negotiated between MLB and the union. The current agreement, covering 2022 to 2026, lists amphetamine, methamphetamine and dozens of related drugs as banned stimulants.^[1]

A player can use a banned substance if he receives a therapeutic use exemption (TUE). Under the current agreement, a player with “a valid, medically appropriate prescription” from a licensed physician qualifies if he has “a documented medical need” under accepted U.S. or Canadian medical standards. A player with an exemption who tests positive for that drug has not violated the program. Team physicians are generally prohibited from prescribing banned substances for players.^[1]

Exemptions are decided by an Independent Program Administrator (IPA), jointly selected by the two sides and unaffiliated with MLB, any club or the union. The IPA cannot discipline players; that power belongs to the Commissioner’s Office.^[1] For stimulants, the agreement sets out a two-track process. If an MLB-certified clinician diagnosed the player using the Adult ADHD Clinical Diagnostic Scale and the player submits all required documents, including an impairment scale and, for renewals, pharmacy records, the IPA may grant the exemption. Otherwise, the application goes to an Expert Panel of three independent psychiatrists with expertise in adult ADHD. A panel member can request pharmacy records and further tests, speak to the player and his family, or require an evaluation by a certified clinician. A recommended denial must come with written reasons, and the player can challenge it.^[1]

Penalties for stimulants are lighter than for steroids. Under the current program, a first positive test results in follow-up testing, not suspension; a second brings a 50-game suspension, a third 100 games, and a fourth up to a permanent ban.^[1] In 2014, a second offense brought 25 games.^[7][8]

The program also requires the IPA to publish a report by December 1 each year listing the number of tests, the substances behind positive tests and the number of exemptions “broken down by category of medication (ADHD, hypertension, etc.).”^[1] Individual players’ exemptions remain confidential.

The numbers jump

In 2006, the first year of amphetamine testing, 35 exemptions were granted to the 1,356 players on 40-man rosters who were subject to testing; 28 were for ADHD medications. In 2007, 111 exemptions were granted to 1,354 players, and 103 were for ADHD. Thirteen applications were not granted and two were withdrawn.^[2]

The figures emerged at a January 15, 2008, hearing of the House Committee on Oversight and Government Reform on George Mitchell’s report about drug use in baseball. According to The Washington Post, MLB had previously declined to release them, and a committee spokesman said lawmakers sought them because Mitchell had reported that the union and MLB refused to give them to him.^[3] Representative John Tierney said the incidence of attention-deficit disorder in baseball was eight times that of the normal population. Commissioner Bud Selig acknowledged the numbers were “a little higher” than typical, and he and union chief Donald Fehr stressed that only the independent administrator could grant exemptions.^[3]

Medical experts disagreed. A Harvard psychiatrist told the Post the rate among players was not out of line with the general male population, but he could not explain the sudden jump. Gary Wadler, who chaired the World Anti-Doping Agency’s prohibited-list committee, said: “If that happened in society, we would have a health epidemic on our hands.” The Post noted that the U.S. Anti-Doping Agency granted 27 ADHD exemptions in 2007 among roughly 10,000 athletes.^[3]

Exemptions under the spotlight

The numbers stayed high. The IPA’s 2013 report listed 122 exemptions, 119 of them for attention deficit disorder. All eight positive tests that led to discipline that year were for stimulants, seven of them Adderall.^[4] The 2014 report listed 113 exemptions, all but one for ADHD. Ten of the twelve positive tests leading to discipline were for stimulants, and eight of those were Adderall.^[5][6] The Associated Press reported that MLB and the union said ADHD was more frequent in young adult males than in the general population.^[6]

In September 2014, Baltimore Orioles slugger Chris Davis, who had led the majors with 53 home runs the year before, was suspended 25 games after a second positive test for amphetamines. He said he had previously had permission to use Adderall but was not cleared for it in 2014. He missed the last 17 games of the regular season and all seven of the Orioles’ playoff games. In December, his manager, Buck Showalter, said Davis had been approved to use Adderall in 2015.^[7]

The Davis case sharpened the debate. A drug that had cost him a suspension was now permitted. The Toronto Star reported that about 10 percent of players had ADHD exemptions in 2014, compared with an adult prevalence of 4 to 6 percent. A University of Toronto sports medicine physician called the rate “highly suspicious,” saying players were either being over-diagnosed or “faking it.” An ADHD researcher offered a different view: some cases were surely not legitimate, she said, “but probably most are.”^[8]

Aftermath

Over the following decade the number of ADHD exemptions fell steadily. The IPA’s report for 2025 listed 57 exemptions: 54 for ADHD and one each for hypertension, a sleep disorder and hormone function.^[9] The Associated Press called the 54 ADHD exemptions a record low, down from 61 the previous year and 119 in 2013. Testing grew over the same period, to 11,700 tests in 2025.^[9][10] The reports do not explain the decline, and no public data show whether stricter diagnosis, changes in the player population or other factors account for it.

The core dilemma

Stimulants treat a real medical condition but can also improve focus and alertness in healthy players. Baseball had to decide how to let players with ADHD get treatment without letting exemptions become a way around the stimulant ban, and how to reassure the public without exposing private medical information.

Competing values

• Access to treatment vs. competitive fairness: denying medication harms patients; granting it too freely harms clean competitors.
• Medical privacy vs. transparency: individual records stay secret, but trust needs evidence.
• Collective bargaining vs. outside standards: the rules are negotiated by the parties, not set by an independent anti-doping agency.
• Proportionality vs. deterrence: lighter penalties for stimulants may be fairer or may encourage risk-taking.

Strongest arguments

For the exemption system: ADHD is a recognized condition, and the program requires a documented medical need, specialist diagnosis and independent review.^[1] Exemptions are decided by an administrator independent of both sides, and some applications are refused.^[1][2] MLB and the union said ADHD is more common among young adult men.^[6] Aggregate numbers are published every year, and they have fallen sharply.^[9][10]

For skepticism: Exemptions nearly quadrupled the year after testing began.^[2][3] Exemption rates were roughly twice the adult population’s, and experts called them suspicious.^[3][8] Stimulant penalties were mild, and a player suspended for Adderall could later be permitted to use it.^[7][8] Because individual decisions are confidential, the public cannot judge whether they were sound.^[1]

Applying the frameworks

Rights-based

A rights perspective starts with the player’s right to medical care and to privacy about a diagnosis. Forcing players with ADHD to choose between treatment and their career would violate those rights. Other players also have a right to fair competition. A well-run exemption system tries to honor both: it allows treatment on proof of need and keeps details private, while setting standards strict enough to protect everyone else.

Justice & fairness (Rawls)

Behind a veil of ignorance, not knowing whether you would have ADHD, you would want an exemption system to exist. You would also want it to be hard to game, because you might be the clean player facing an opponent with an unearned advantage. Rawlsian fairness supports independent specialist review, consistent standards and aggregate public reporting, the main features MLB adopted.

Utilitarian

A utilitarian weighs the benefits of treating players with genuine ADHD against the harms of misuse: unfair results, health risks from stimulants and damage to the sport’s credibility. Rigorous diagnosis increases net benefit if it screens out false claims without discouraging genuine patients from seeking care. The fall in exemptions since 2014 could reflect better screening, but the data alone cannot show it.

Walk it through: the Simple Decision Model

1. Spot the issue: A player asks to use a banned stimulant to treat ADHD.
2. Gather facts: Diagnostic history, clinical scales, pharmacy records and the player’s testing record.
3. Test options: Grant on a doctor’s note; require diagnosis by a certified clinician; refer to an expert panel; deny.
4. Check codes and law: The Joint Drug Program’s exemption rules and the collective bargaining agreement.
5. Decide and document: Give written reasons, especially for a denial.
6. Communicate and follow up: Publish aggregate numbers, require renewals and monitor positive tests.

What’s settled and what’s contested

• Settled: MLB began testing for amphetamines in 2006; ADHD exemptions rose from 28 to 103 the next year; exemptions are decided by an independent administrator and expert panel; the 2025 report listed 54 ADHD exemptions.^[1][2][3][9]
• Contested: Whether the high exemption rates reflected real illness or a loophole; whether stimulants give a meaningful edge in baseball; why exemptions later declined.^{[3][6][8][10]}

Why this case matters

Baseball’s ADHD exemptions show how a medical exception can test a drug ban. Exemptions are necessary for fairness to patients, but they can be exploited and are hard to audit from outside. The case shows how independent review, specialist standards and public reporting can build trust, and how the line between treatment and enhancement depends on who is taking the drug and why.

See also: The Mitchell Report and Baseball’s Steroid Era.

Key terms

Therapeutic use exemption (TUE)

Advance permission for an athlete to use a medically necessary substance that would otherwise be prohibited.

Equalizer vs. enhancer

Whether a technology or adaptation restores a level field (adaptation) or gives an advantage beyond it (augmentation).

Rules vs. spirit of the game

Rules are the written minimum; the spirit is the fairness and respect the rules exist to protect. Rules set the floor; spirit sets the ceiling.

Trust

The public’s belief that what they are watching is real. Integrity failures are ultimately failures of trust.

Paternalism (hard and soft)

Restricting someone’s choices for their own good. Hard paternalism overrides competent, informed adults; soft paternalism steps in when information or autonomy is compromised.

Multiple points of view

Analyzing a dilemma from each stakeholder’s position in turn (athlete, parent, coach, administrator, official, bystander) before reaching your own reasoned view.

Definitions from the Ethics Cases glossary.

Discussion questions

1. Should an athlete be allowed to use a drug that would enhance performance in others if it treats a diagnosed condition?
2. Is a rate of exemptions twice the general population's rate evidence of abuse? What else could explain it?
3. Should stimulant violations be punished as severely as steroid violations?
4. How much should the public know about who has a medical exemption?

Sources

1. Major League Baseball's Joint Drug Prevention and Treatment Program (2022–2026) — Major League Baseball / MLB Players Association
2. Major League Baseball (40-man roster players) Therapeutic Use Exemption Summary Statistics for 2006 and 2007 — House Committee on Oversight and Government Reform
3. Drug Exemptions Triple in MLB — The Washington Post
4. Independent program administrator issues annual report (2013 Public Report) — MLB.com
5. Baseball's annual PED report has been released — NBC Sports
6. Report shows Adderall caused most positive tests for stimulants in MLB drug program — The Spokesman-Review (Associated Press)
7. Showalter: Davis gets exemption — ESPN
8. MLB's exemption rate for ADHD drugs 'highly suspicious' — Toronto Star
9. Independent Program Administrator Issues Annual Report (2025 Public Report) — Major League Baseball / MLB Players Association
10. Exemptions for ADHD drugs in MLB drop to record-low 54 — ESPN (Associated Press)