Salazar has emphatically denied violating antidoping rules. He has said that he and his athletes closely followed all protocols established by antidoping authorities.
But in the report, antidoping officials depicted Salazar as a medicine chest whose door swung open for the world-class athletes on Nike’s payroll. They said he provided or helped gain access to prescription-dose vitamin D; calcitonin; ferrous sulfate; Advair; testosterone; and various thyroid medications. Many of the drugs have no proven benefits for runners.
The antidoping agency began investigating Salazar and the Oregon Project in 2015, after former team members and a staff member described cheating within the program in a report by the BBC and ProPublica.
United States antidoping officials now believe that Salazar and a Texas endocrinologist administered an infusion procedure in violation of antidoping rules, colluded to cover it up and then lied to their athletes about its legality.
“Salazar’s conduct here is patently calculating, misleading and dishonest,” the antidoping officials wrote in the report, which was drafted in March 2016 as an appeal to the Texas Medical Board to compel the release of the endocrinologist’s medical files.
Salazar, who refused to cooperate with the antidoping agency’s investigation, did not respond to interview requests. Nike declined to respond to questions about the report.
Ritzenhein declined to comment on specifics of his time with Salazar, instead deferring to his sworn testimony in the report, in which he and other athletes described an environment in which they felt immense pressure to do as their coach instructed or lose their livelihoods.
The Nike athletes, the report said, “were acutely aware that these opportunities could be withdrawn at Alberto Salazar’s discretion and were dependent both upon Salazar’s favor and their own athletic performance.”
“These facts created huge pressure to conform to Salazar’s wishes and use substances and training methods advocated by him.”
A Start With Supplements
For Ritzenhein, getting a contract with Nike in 2004 was the culmination of years of hard work. “It’s every kid’s dream to sign a professional contract,” he said in a recent phone interview.
He moved to Oregon in 2007 but did not start working directly with Salazar and the Oregon Project until June 2009. He told antidoping officials that as soon as he joined the team, he “started taking a lot of supplements that Alberto had in a room in his basement, pretty much everybody on the team took them.”
In June 2010, after an unproductive season of injury, Ritzenhein and Salazar’s conversations moved from supplements to “synthetic thyroid,” Ritzenhein testified, saying it was “to help with low testosterone levels.” Blood work performed at Nike’s lab showed that Ritzenhein’s thyroid-stimulating hormone and his testosterone levels were both within the normal range. Regardless, Salazar sent him to see Dr. Jeffrey Stuart Brown, an endocrinologist who is known for his belief that synthetic thyroid medication enhances athletic performance.
The next day, Dr. Brown prescribed Levoxyl, a thyroid drug. (Levoxyl is not a banned substance.)
According to the report, Dr. Brown was Salazar’s personal physician and was being paid a monthly retainer to work with the Oregon Project athletes. Ritzenhein said he did not know any of this at the time.
Last summer, the United States Anti-Doping Agency, or Usada, tried and failed in court to compel a deposition from Dr. Brown. His lawyer said at the time that the agency was engaged in a “fishing expedition to see if they can find some kind of a problem.”
Dr. Brown is known in the track world for diagnosing hypothyroidism in distance runners. The condition involves an underactive thyroid that can lead to weight gain and fatigue, but is considered relatively rare among athletes.
Some experts say that thyroid hormone can serve as a stimulant, lead to weight loss and improve alertness among athletes.
“Throughout my career the health of my patients has, and always will be, my absolute priority,” Dr. Brown said in a statement through his lawyer. “I will not be bullied or coerced regardless of tactics used, and I intend to fully defend myself against any baseless allegations brought against me in any forum.”
In January 2011, Salazar became aware of research from the University of Nottingham in England that appeared to show significant improvement in performance when athletes raised their L-carnitine to extremely high, unnatural levels. (L-carnitine is a substance that occurs naturally in the body and helps convert fat to energy. As a supplement, it is not a banned substance, according to the World Anti-Doping Agency.)
After contacting the researchers, Salazar learned that one was about to bring an L-carnitine drink product to market. He spent thousands of Nike dollars on pallets of the preproduction drink and began distributing it to his runners, telling them that access to this special L-carnitine product was something to be kept secret. Salazar knew he would lose his advantage if competitors used it.
L-carnitine levels are notoriously hard to increase, however, so it would take up to six months of loading with the drink before the promised enhancement in performance could be realized on the track. Salazar was impatient; Ritzenhein had the 2012 Olympic marathon trials coming up in just two months.
The Nottingham researchers had written about a method in which they were able to infuse patients with L-carnitine to bring levels up thousands of times compared with the baseline. This procedure took 4 hours 10 minutes instead of six months of drink consumption. Acting with urgency, Salazar decided to test the process on an employee. Steve Magness, an assistant coach, was the chosen guinea pig.
Magness, who was at first unwilling, eventually relented to Salazar’s demands and soon took a preinfusion treadmill test. Medical records obtained by the antidoping agency showed that Dr. Brown then gave Magness a continuous gravity drip infusion of L-carnitine on Nov. 28, 2011, that lasted 4 hours 10 minutes. The records note that Dr. Brown used the same duration, method and solution of L-carnitine and dextrose outlined by the Nottingham researchers.
Even though L-carnitine is not a banned substance, the method of infusion used by Dr. Brown was prohibited, antidoping officials believe. Antidoping rules prohibit “infusions and/or injections of more than 50 mL per 6 hour period except for those legitimately received in the course of hospital admissions, surgical procedures or clinical investigations.”
Fifty milliliters is about three tablespoons of liquid, an amount that would not take four hours to infuse.
Dr. Brown left crucial information out of Magness’s medical records, the report said, including the quantities of L-carnitine that he infused. However, from Magness’s sworn testimony, the antidoping officials concluded “it appears very likely that the infusion volume administered to Steve Magness by Dr. Brown was at least 1000 mL (i.e., one liter).”
Magness said in a recent interview that he was not aware at the time that the treatment would be more than 50 milliliters and a violation of doping rules. “Both Dr. Brown and Alberto told me it was good with Usada and I mistakenly trusted them,” he said.
Magness described the results of his post-L-carnitine treadmill test as “almost unbelievable.” Salazar was enamored, and quickly focused on making sure Ritzenhein got the treatment as soon as possible.
After learning about the procedure, however, Ritzenhein said to Salazar: “Is this legal? This doesn’t sound legal.”