What is trimetazidine, the drug reportedly behind an Olympic figure skating doping case?
So far, it's unclear when and where figure skater Kamila Valieva reportedly tested positive
The first big doping case at the Beijing Olympics involves one of its biggest stars. And it seems far from straightforward, not least because she is just 15 years old and has protections as a minor in the anti-doping rule book.
The country at the centre of it? Russia. Again.
Here's a look at the drug that Kamila Valieva of the ROC — short for Russian Olympic Committee and the name under which the country is competing because of previous doping violations — is suspected of taking, and how the situation might play out in coming days.
What is the drug?
The medication trimetazidine is a metabolic agent that helps prevent angina attacks and treats the symptoms of vertigo, according to the European Union's medicines agency. It can increase blood flow efficiency and improve endurance — both crucial to any high-end athletic performance.
It is on the prohibited list managed by the World Anti-Doping Agency in the category of "hormone and metabolic modulators."
When did she test positive?
It is so far unclear when and where Valieva tested positive, and unclear which organization had responsibility for first handling the case and which WADA-accredited laboratories have been involved.
At 15, she was mostly under the radar entering this season, even as a former junior world champion.
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Valieva won a world-level event in Sochi in November and then became national champion after competing on Dec. 24-25 in St. Petersburg. At that later event, the Russian national anti-doping agency, known as RUSADA, would have had the option to test her.
In January, she won again at the European Championships in Tallinn, Estonia, where the International Skating Union should have overseen collecting samples, especially from medalists.
On Jan. 27, the official Olympic period started, and the IOC had authority for the anti-doping program, which it delegates to the International Testing Agency.
Previous doping cases
The most famous case of trimetazidine in sports doping involved Chinese swimmer Sun Yang.
The three-time Olympic champion served a three-month ban in 2014 in a ruling that was initially not published by China's anti-doping agency. WADA did not use its right to challenge that Chinese judgment with an appeal to the Court of Arbitration for Sport.
Because it was Sun's first doping offence, he was punished more severely for his second, and more high-profile, offence of refusing to co-operate with a sample collections team at his home in China.
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Russian bobsledder Nadezhda Sergeeva tested positive for trimetazidine at the 2018 Pyeongchang Olympics. She was disqualified from the two-woman bob event and served an eight-month ban.
Who will handle the case?
The athlete-testing program for the Olympics is run by the International Testing Agency, based in the IOC's home city of Lausanne, Switzerland. The ITA also designed a pre-Olympic program of targeted testing of athletes or sports deemed high-risk or who its experts decided had undergone too few tests.
Typical doping cases during the Olympics are handled and announced by the ITA, which imposes a provisional suspension that removes an athlete from competition.
Athletes and their teams can challenge those decisions at CAS, which has representatives in Beijing to handle urgent cases. It has a Games-time panel of judges to specialize in doping cases.
Valieva's case could involve, as reported, a sample taken before the official Olympic period began — either at an international ISU event, the national championships or during a training period in an "out of competition" test.
At the Tokyo Olympics, Nigerian sprinter Blessing Okagbare was pulled from competing ahead of the 100-metre semifinals when a pre-Games test returned as positive. Her suspension was imposed by track and field's Athletics Integrity Unit.
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RUSADA would likely manage the case against Valieva if the positive sample has been taken in Russia.
The agency is trying to re-establish credibility in world sports. During ongoing fallout in the scandal of state-backed Russian doping and coverups, RUSADA was ruled non-compliant by WADA.
The two-year slate of sanctions imposed by CAS — including the ban on Russia's team name, flag and anthem at the Summer Games in Tokyo and the Winter Games in Beijing — is due to expire in December. WADA could yet try to extend it.
Valieva's case also should eventually involve the International Olympic Committee because she and the ROC team already competed and won the figure skating team event.
Stripping titles and re-allocating medals could fall to an IOC disciplinary committee chaired by Denis Oswald, a Swiss lawyer and longtime member of the Olympic body.
Age a factor
Another complicating factor is Valieva's age, which can offer exemptions or leniency as a "protected person."
The World Anti-Doping Code definition of a "protected person" includes athletes who have not yet turned 16 at the time of a doping violation.
The circumstances of Valieva's case should also focus on the advice and decisions of her team officials and coaches.
An investigation of "athlete support personnel" is mandatory when a protected athlete is implicated in a doping case.
If doping is proven, a 15-year-old athlete like Valieva faces a maximum two-year ban instead of four. The minimum sanction is no ban and a reprimand "depending on the protected ... athlete's degree of fault."
While public disclosure of cases is mandatory for adult athletes, for minors the question of identifying them "shall be proportionate to the facts and circumstances of the case."
