NEW YORK — Major League Baseball collected nearly 12,000 drug tests this year. Only two came back dirty.
But that is not the number grabbing headlines from the MLB’s annual drug report. Instead, it is the dramatic decline in something that once raised eyebrows across the sport: ADHD exemptions.
Just 54 players received permission to use medication for attention deficit hyperactivity disorder this season. That marks an all-time low since MLB began tracking the data. The number has dropped more than 50 percent from 119 exemptions in 2013.
For Yankees fans and baseball observers alike, the trend raises questions about what changed. Did fewer players suddenly have ADHD? Or did the league tighten the rules?
The numbers behind MLB testing machine
The annual MLB report from independent program administrator Thomas M. Martin arrived Monday. It covers the period from the 2024 offseason through the 2025 World Series.
MLB collected 11,700 drug tests during that stretch. That total sits just below the record of 11,783 set two years ago. The testing included 9,400 urine samples and 2,300 blood samples used to detect Human Growth Hormone.
With roughly 1,200 players on 40-man rosters across the 30 clubs, that averages out to nearly 10 tests per player. Yet only two produced positive results that led to discipline.
Those numbers suggest either the testing program works as a deterrent or players have found ways to beat the system. The league prefers the first explanation.
The two players who got caught
Atlanta Braves outfielder Jurickson Profar was the first domino to fall. MLB suspended him for 80 games on March 31 after he tested positive for Chorionic Gonadotrophin. That hormone helps the body produce testosterone.
Profar had just signed a three-year, $42 million deal with Atlanta. He called the suspension “the most difficult day of my baseball career” and denied knowingly taking the banned substance.
“I have been tested my entire career, including eight times last season alone, and have never tested positive,” Profar said in a statement. “I would never willingly take a banned substance, but I take full responsibility and accept MLB’s decision.”
Philadelphia Phillies closer Jose Alvarado became the second MLB suspension on May 18. He tested positive for external testosterone. The 80-game ban also made him ineligible for postseason play.
Phillies president Dave Dombrowski said Alvarado’s positive test came from a weight loss drug he took during the offseason.
“It’s not something he did knowingly,” Dombrowski said. “I believe that, the way he talked to me.”
ADHD exemptions hit historic low
The steeper drop involves therapeutic use MLB exemptions for ADHD medication. Players with legitimate diagnoses can receive permission to use drugs like Adderall, Ritalin and Vyvanse. Without an exemption, those stimulants would trigger a positive test.
The 54 exemptions this year represent a steady decline from recent seasons. There were 61 last year. The number sat at 91 as recently as 2019. Go back to 2013 and you find 119 players with approved exemptions.
That peak prompted criticism that the league was too lenient. Some suspected players were gaming the system to gain a competitive edge. Stimulants can improve focus and reaction time, valuable assets for hitters facing 100 mph fastballs.
MLB Deputy Commissioner Dan Halem has previously defended the exemption process. He said the sport’s experts maintain that ADHD is more frequent in young adult males than in the general population.
The league and players’ union did not immediately respond to requests for comment on the new numbers.
Based on my research, here’s what we know about ADHD prevalence in baseball:
The numbers tell an interesting story
ADHD appears to be more common among MLB players than in the general population. According to published data, 8.4% of MLB players received Therapeutic Use Exemption for ADHD stimulant medication in the 2017-2018 season. Compare that to the general adult population, where ADHD affects roughly 4-5% of adults.
The historical trend:
The exemption numbers have fluctuated significantly over the years:
- 2006: 28 players
- 2007-2009: Around 103-108 players
- 2013: 119 players (the peak)
- 2019: 91 players
- 2024: 61 players
- 2025: 54 players (record low)
Why might baseball players have higher ADHD rates?
Researchers suggest “ADHD may be more common in elite athletes than in the general population, since children with ADHD may be drawn to sport due to the positive reinforcing and attentional activating effects of physical activity.”
“Common symptoms of ADHD may enhance athletic performance. Some athletes with ADHD naturally excel in baseball and basketball, which involve quick movements and reactive decision-making, due to these athletes’ inherent impulsivity.”
The controversy:
There is “a persistent suspicion that some baseball players may be feigning ADHD symptoms in order to gain an exemption for stimulant use. This perception has led to large organizations like the MLB reducing the number of exemptions allowed over time.”
Some critics have questioned whether “ADHD really is twice as common in baseball players, or are many of these ballplayers simply gaming the system to gain a pharmacological edge on the field?”
The current 54 exemptions represent about 4.5% of the roughly 1,200 players on 40-man rosters, which is actually now closer to general population estimates. Whether the earlier higher numbers reflected legitimate diagnoses, looser standards, or some level of gaming the system remains debated. What’s clear is that MLB has significantly tightened its evaluation process over the past decade.
Beyond ADHD: other exemptions revealed
The overwhelming majority of therapeutic exemptions remain tied to ADHD. Only three MLB players received exemptions for other conditions this year.
One MLB player was approved for hypertension medication. Another received clearance for a sleep disorder drug. A third obtained an exemption related to hormone function.
Those numbers have remained relatively stable over the years. The ADHD decline stands out because it once represented a significant chunk of the player population.
What explains the dramatic drop
Several factors could explain the declining exemption numbers. The league tightened its evaluation process for ADHD claims over the past decade. A special expert panel now reviews applications more rigorously.
Player education may also play a role. Teams now routinely warn prospects about the consequences of testing positive. The 80-game suspension for a first offense carries serious financial penalties. Players forfeit nearly half their season’s salary.
The Profar case illustrated those stakes. His suspension cost him roughly $5.8 million of his $12 million salary. Alvarado lost about $4.5 million of his $9 million payday.
For Yankees players and others across the league, the message remains clear. The testing net is wide. The penalties are steep. And the era of questionable ADHD exemptions appears to be over.
The full report from the Joint Drug Prevention and Treatment Program is available through MLB and the players’ association.
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