Almost 500 athletes may have been taking meldonium during 2015 European Games in Baku
Up to 490 athletes may have been taking meldonium during the 2015 European Games in Baku, according to research published in the British Journal of Sports Medicine.
Meldonium was placed on the World Anti-Doping Agency's banned list for 2016 and a number of athletes have already tested positive for it, including tennis star Maria Sharapova.
The research was carried out on behalf of the European Olympic Committees and contributed to WADA's decision to ban the use of meldonium in competitive sport.
The findings were based on information volunteered by athletes and medical teams as well as anti-doping tests given at the European Games last June.
Thirteen medallists were found to have been taking meldonium and the drug was detected in athletes competing in 15 of the 21 sports.
Sixty-six urine samples given during the European Games tested positive for meldonium but only 23 athletes declared using the drug even though it was perfectly legal to do so.
Meanwhile, only two national Olympic committees declared that they were importing meldonium into Azerbaijan.
Canoeing and kayaking produced the highest number of positive tests for meldonium, with 15 of the 48 athletes tested having it in their system.
The figure of 490 was arrived at by applying the percentage of athletes that were tested who had taken meldonium to the athlete body as a whole.
The authors of the report do admit that this is likely to be an overestimate because meldonium was only licensed for use in seven of the 21 competing countries.
But the report concludes: "These findings highlight the excessive and inappropriate use and prescribing of this prescription drug in a generally healthy athlete population."
The report also flags up that meldonium was added to the WADA monitoring programme in 2015 after anecdotal reports of use by athletes during the London 2012 Olympic and Paralympic Games.