A study published in the British Journal of Sports Medicine has revealed the potential scale of meldonium use in sport after athletes competing in 15 of the 21 sports during the 2015 European Games in Baku had the substance detected in their systems.
Meldonium was added to the World Anti-Doping Agency's (WADA) monitoring programme in January 2015 before being made a prohibited substance on January 1 of this year, with Maria Sharapova testing positive for the substance at the Australian Open.
The research was used to contribute to the surveillance of substances on WADA's watch list in 2015 and the findings were based on information volunteered by competing athletes and medical teams, as well as anti-doping tests at the European Games from June 12-28.
The use of the meldonium was detected in competitors across 15 of the 21 sports at the event in Azerbaijan, with the study stating the prevalence was "alarmingly high".
A total of 23 athletes from six nations declared personal use of the substance at the time of the Games, with 13 of them medallists, but 66 urine samples during the event and pre-competition tested positive.
Furthermore, just two of the 50 medical teams from National Olympic Committees declared the importation of meldonium into Azerbaijan, leading to concerns in the study over the under-reporting of meldonium use.
The research estimated that between 114 and 490 athletes may have been using meldonium at the time of the Games, though it was noted the upper boundary may be an overestimation based on the sample used.
The report concluded that "these findings highlight the excessive and inappropriate use and prescribing of this prescription drug in a generally healthy athlete population".