Wrestling Doctor's Notes: WWE's Wellness Policy - Part 1, Breaking It Down | Smark Out Moment

Wrestling Doctor's Notes: WWE's Wellness Policy - Part 1, Breaking It Down

Posted by Ethan Neufeld Sunday, February 9, 2020
Welcome to another edition of Smark Out Moment WRESTLING DOCTOR'S NOTES where we discuss medical issues that are either being reported in the wrestling world or generally afflict wrestlers. As always, please review the disclaimer at the bottom of the post.

In light of the recent suspensions of WWE wrestlers due to reported Wellness Policy violations, some attention has been given in the wrestling news circle about the Wellness Policy and how it is utilized. Some claims are going around that it is an unfair policy, a nebulous policy, a mysterious policy, et cetera. This two part article series will be looking into this from a medical and partially legal perspective. I hope you find this educational and intriguing, and that we can all go forward empowered with more knowledge about this touchy topic than we have going in.

Part 1 will be an evaluation of the current Wellness Policy with a focus on how clear it is medically, how realistic it is, and what management implications about it we can infer in terms of how and when wrestlers are suspended. Part 2 is going to focus on anabolic steroids, so any discussion on that topic will be deferred until then.
wrestler medical reports WWE superstars injuries


This entire topic is a minefield from the very start. First and foremost, even the name of what we're discussing isn't direct. "Wellness Policy." We all know that this means "the policy that checks your body fluids intermittently to see if you are or are not using illicit or otherwise irresponsible substances." That's not "wellness" exactly is it? But it's a more positive term and one that is adopted by nearly any organization that tests for such things.

Wellness Policies that are -  at heart - screening exams for drug abuse are not unique to WWE by any stretch of the imagination. Nearly every athletic commission has them in some form and posts the details of said policy openly. Numerous private corporate enterprises subject their employees to similar protocols as part of their contract. And as a physician I can tell you personally, I've been screened aggressively for any hint of illicit drug or medication abuse by every hospital that I've covered.

For years WWE did not have any formal drug testing in place. Books have been written about the "old school" period of wrestling spanning the territory days to the Hollywood phase of wrestling of WWE when men where men and if you showed up drunk you wrestled DRUNK DAMMIT! I am not a wrestling historian to the degree of a Callum Wiggins and won't discuss this further other than to say that drug and alcohol abuse by wrestlers was so commonplace that it was basically assumed and the goal was to just make sure you were good enough to perform.

Meeeeeeeean! WHOO! Geeeeeene! Where's mah drink Gene?
The Nature Boy Ric Flair is not exactly known for clean living during his NWA days. Image courtesy of the WWE Network.

In light of multiple tragic events that were either directly or indirectly tied to anabolic steroid, drug, and/or alcohol abuse, WWE instituted its Wellness Policy in 2006. This appears to have been directly related to the extremely tragic passing of Eddie Guerrero which is a story that I cannot do justice to here. Other untimely deaths related to drugs/alcohol/steroids had occurred previously of course, but Latino Heat's passing for one reason or another was the catalyst. I do not have access to the policy as it existed at that time and cannot comment on how it has changed since then, but news reports indicate it hasn't changed much other than perhaps a relaxation on penalizing marijuana use.

How Drug Testing Works

When we talk about "drug testing" we are almost referring to the testing of urine. When a drug or medication is consumed it is either broken down by the body's metabolic processes or directly excreted. The liver does much of this work, and some breakdown products are actually excreted by the liver in our bile. But the vast majority of drugs/medications ultimately are excreted in some form via our kidneys. It is for this reason that our urine is in so many ways a window to our health. Nearly every drug has some metabolite (breakdown product) that ends up in the urine and can therefore be tested.

But how is this tested? I'm not talking about the physical aspect by the person being tested, he or she pees into a cup obviously. What I'm getting at is that not all urine tests are equal. There are two major types. The Immunoassay is the most commonly used test and utilizes synthetic antibodies that are designed to attach to their molecule of interest. If enough antibodies attach to enough of their substance of interest, the analysis will be read as positive. While that sounds super scientific (it is) and pricey, it's pretty straightforward. This sort of biologic technology is very commonplace and Immunoassays are the cheapest and fastest way of testing urine. The drawback is that while it's a very sensitive test, it leads to a lot of false positive examinations. Meaning, a person may not be using a drug but the result comes back positive. This is usually because there is some other substance in their urine that is close enough to the drug metabolite being tested that the antibody gets confused.

The gloves are important people. I can't stress that enough.
This is a dramatized picture as the allotment of urine is done automatically by a machine. But you get the idea. Image courtesy of medscape.com.

The second option is called chromatography and it is more specific ("accurate") for a drug being tested but far more expensive. It may be used as a confirmatory test if an initial Immunoassay test is positive. A much wider range of drugs can be tested with this method as well, so some institutions may use it as a first-line tool if they want to be comprehensive and not deal with false positive exams.

Companies may also test saliva and hair as part of their drug testing regimen. Many drugs and/or their metabolites not only get dumped in our urine but may also get deposited in our salivary glands and our hair. It takes a variable amount of time for a drug's metabolites to appear in our urine, but some appear in saliva much more quickly (or might be present in the mouth from recent use). Saliva testing is typically used to cover for drug use that may be too recent to detect by urine. Conversely, some drugs can get metabolized and passed through our urine fairly rapidly, but may have deposited in hair follicles and be present for 90 days! Hair follicle testing is typically used for amphetamines, marijuana, PCP, cocaine, and opioids.

The WWE Wellness Policy states that wrestlers have all three tests performed each time (urine, saliva, and hair) but it does not state whether Immunoassay or chromatography is used. Since it doesn't talk about doing confirmatory testing and the number of things they test for is enormous, I suspect they use chromatography.

WWE's Current Wellness Policy

I have to give big credit to WWE because their Wellness Policy is easily accessible in its complete form to anyone who is willing to type a few words into Google. You can find it here. It's a dense, not all that compelling read (unless you're me I guess).

WWE is a publicly traded company so this shouldn't be too surprising. Any investor would want to have this information available on the WWE corporate site as much of the value of the company would ride on which superstars are active which could be influenced by the Wellness Policy. If I was an investor, I'd want to know exactly why someone like a Daniel Bryan, Roman Reigns, or Brock Lesnar (like that would ever happen ...) is suspended.

Look out Vince! The money avalanche is heading right for you!
This man is going to have his policies well written and publicly available. It's what's best for business. Image courtesy of ringsidenews.com.

I asked my two close attorney colleagues to look over the Wellness Policy and provide their opinions. After rolling their eyes at me for being a wrestling enthusiast, they reluctantly agreed after I reminded them of my assistance in righting some booze-fueled transgressions of theirs from college. For the record, one is a workman's compensation litigator and one is a contract lawyer, both particularly equipped for this task. Both agreed that the Wellness Policy is written and phrased succintly and unambiguously with few - if any - legal loopholes. What this means is that a WWE performer who signs with the company should be fully aware of this policy at the time of signing and that the details and implications are clear as day.

Big Takeaways From the Wellness Policy

1. Everything Is Tested.

The policy lists every single drug/medication that is tested for and I can't think of a single illicit drug or potentially psychoactive medication that isn't included. Nigh comprehensive lists of both illicit and legal drugs are spelled out by name in exhausting detail. This is a good thing, ambiguity is bad in this situation.

No surprise that the most massive list of banned substances is the list of anabolic steroids. This will be discussed in Part 2. But some other items are interesting. Pseudoephedrine is listed specifically, which is Sudafed or the "D" part of allergy medications that have a decongestant property. The policy states that a wrestler will be in violation if they find evidence of "The use of pseudoephedrine in a manner which is inconsistent with the instructions provided by the drug manufacturer (e.g., use in concentrations or amounts in excess of the recommended manufacturer’s dosage.)" The reason for this is because pseudoephedrine can be used to make methamphetamine (meth). It's actually not even hard to do ... but let's not go there! This is why if you buy Sudafed you have to sign a form in most states. So if a wrestler took a bit too much Sudafed, they could test positive and be in violation.

Diuretics are also listed in detail. Diuretics are medications that promote urination and are used medically in patients with excess fluid in their body for various reasons. Body builders looking to make their physique more impressive have been known to abuse diuretics to essentially dehydrate themselves to look more cut. But more importantly, someone may take a diuretic to dilute their urine which can help them pass a urine drug screen. It's interesting then that testing positive for a diuretic leads to a policy violation because it's assumed the wrestler is trying to hide something.

Two medications are banned completely, even if a performer has a prescription. These are carisoprodol (Soma) and meprobamata (Miltown). These medications are muscle relaxants and are prescribed typically in patients with chronic pain complicated by muscle spasms. These are very "dirty" drugs to us physicians, meaning they have a ton of side effects. They also can be abused for their mind altering effects, and can be fatal if used in excess. While I find it surprising that they are completely banned, it's not shocking if that makes sense.

2. Alcohol and Marijuana are a Slap on the Wrist

It would be ridiculous to think that WWE wouldn't allow wrestlers to drink alcohol. And with the increasing extent of cannabis legalization, enforcement of a cannabinoid free policy would likely not be possible.

That being said, wrestlers are not allowed to be "under the influence" when at a WWE event of any sort from arrival to departure. If s performer is believed to be intoxicated from any source, they can be tested at the time and - if positive for alcohol and/or cannabis - be penalized. The penalty though is a $2500 fine per violation and is not a suspension.

Brrrrroooooooooo! No seriously, where am I bro? Is that a Hot Pocket? Bro, is that a Hot Pocket?
I'm sure Matt Riddle is incredibly grateful for WWE's relatively lenient stance on marijuana. Image courtesy of medium.com.

3. Wrestlers have to have their prescriptions on point

The key phrase used in the policy is "non-medical use." Meaning that WWE tests for medications and the wrestler will get penalized for evidence of a drug's use if it's for non-medical purposes. If - on the other hand - they have a prescription from a licensed physician for the medication, they're okay. The exception being the two medications listed above.

A wrestler needs to have a prescription on file with WWE for any medication that they would test positive for. However, they have 72 hours to provide said prescription to the WWE if they test positive for something that wasn't documented. This actually seems pretty fair to me, 3 days is more than enough time to get something faxed over if you have a legitimate prescription.

4. There's some leniency built in

Overall it's a "three strikes and you're out" policy. The first violation leads to a 30 day suspension, the second violation leads to a 60 day suspension, and the third violation leads to termination. Of note, the phrasing is that the the wrestler "will be terminated and WWE will publicly disclose the WWE Talent's name and that the WWE Talent's contract was terminated for a third violation of the policy." Damn, that's almost biblical with how harsh it sounds.

But there's some hope. For one, if a wrestler is terminated for this reason it is only for 1 year. At that point they could return to the WWE assuming they are accepted and jump through more than a few hoops.

There is also a redemption program where a wrestler who has two violations can enter an 18 month program where they undergo counseling and further testing. Upon successful completion the wrestler can have one or both violations stricken from their record.

Lastly, if a wrestler self reports his or her drug/medication abuse they will be provided with medical and mental health assistance without incurring a violation on their record.

Possible Issues

If you're still with me, congratulations.

As I said above, from a legal standpoint the WWE Wellness Policy is well written and fairly unambiguous. It states what is tested, when it's testing, how often testing occurs, and why it's done. It lays out the penalties, exceptions, and ways to mitigate said penalties. But just because something is clear doesn't mean it accurately addresses the problem at hand. And we could argue all day whether the policy is a "fair" one. There are two really big areas of the policy that I see as being potentially being misused by the WWE.

1. "Random" Testing

Each wrestler is tested a minimum of 4 times per year with the testing occurring "randomly." My immediate questions are as follows. How is this randomness implemented? Is there a bag with every performer's name in it with random draws, or is there someone who can decide to "randomly" test a wrestler they don't like more often than others? Also, 4 times is the minimum. So is Brock getting tested only 4 times while say, Primo and Epico are getting tested 10 times? You can easily see a scenario where a more outspoken or otherwise contentious performed gets tested more "randomly" than others. And honestly, do any of you really believe that they're making Brock Lesnar pee in a cup 4 times a year?

Primo has a lot of reasons to be upset. Including waking up every day as Primo Colon.
I seriously doubt all wrestlers get tested with the same overall frequency. Why risk testing Brock as much as Primo? Image courtesy of prowrestlingsheet.com.

2. Reasonable Suspicion

This would terrify me. "WWE may require WWE Talent to submit to a test or tests, including, without limitation, urine, blood, saliva, hair, and/or breath tests, if there exists reasonable suspicion that a WWE Talent has violated any part of this Policy or has diminished ability to perform as a result of using any prohibited substance."

They can test someone an unlimited number of times if they "have suspicion" that a wrestler is under the influence of a substance. Now to be fair, they list the behaviors that would lead them to be suspicious. Obviously if a wrestler is unstable on their feet, slurring speech, acting bizarrely aggressive, or literally has a needle in their arm ... that would be suspicious. But here are some other behaviors that they list:

- Unexplained lateness (some people are just like that)

- Nose constantly runs (allergies)

- Chronic forgetfulness (again, some people are just like that)

- Aromas on or about the breath, body, or clothes (smelliness isn't good, but is that really a criteria?)

I'd love to believe that a wrestler would need to have a repeated pattern of unusual behaviors or combination of these findings, but it's troublesome that this is so open to interpretation. If Rusev has bad seasonal allergies and has a runny nose, the WWE could immediately test his urine, breath, saliva, and hair without prior notice and be completely within the boundaries of their Wellness Policy. Sarah Logan could have one of those nights where she just couldn't sleep, show up with droopy eyes, and get screened. Again, you can see room for error and abuse here.

In Conclusion (Finally)

The biggest takeaway is this: when the news reports that a wrestler is suspended for a "Wellness Policy Violation," we have no clue what that means. A wrestler could be caught injecting heroin directly into their brainstem before going out to the WrestleMania main event and be in violation. Or, he of she could not get a legitimate prescription to the WWE within 72 hours of a positive test for Adderall. Both would be "Wellness Policy Violations."

The policy is openly available, explicit, and clear in its expectations. But how much of the policy is really intended to ensure the "wellness" of the wrestlers of the WWE and how much is designed to provide control to WWE corporate and cover their behinds from any liability should another Eddie Guerrero or Chris Benoit tragedy happen?

My money is on the latter. Thanks for reading.

Disclaimer: These articles are general discussions about medical topics/diagnoses. As we are not personally interacting with wrestlers and do not have intimate knowledge of their maladies, we cannot comment specifically on their medical courses unless information has been previously freely reported. These articles reference wrestlers as examples based on what is either reported by them or their companies, but what is said beyond that is only speculation based on the general course of a given diagnosis. Any information here should not be used for self-diagnosis. If you are experiencing medical issues yourself, I advise you to see a licensed physician for a full evaluation.


Ethan Neufeld is a snarky but avid wrestling fan, an amateur chef, an exhausted dad, and nerd to the core. He is also a board certified neuroradiologist and spine interventionist who contributes to the sciencey/medical stuff the occasionally leaks into the professional wrestling world. If you fancy, you can follow him on Twitter.


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