The use of drugs and medications in competing performance horses is a common practice that is regulated by governing bodies. This paper analyzes The United States Equestrian Federation’s (USEF) rules and regulations regarding the use of drugs and medications in non-racing performance horses, the issues surrounding the current regulations, and recommendations for improvement. USEF categorizes drugs into three categories: permitted, prohibited, and restricted. Chapter 4 of the USEF Rulebook details the regulations surrounding drug administration to competing horses, including dose and time recommendations, persons responsible, drug testing, and penalties for violations. USEF’s drug regulations are thorough, although there are several fundamental issues impacting the effectiveness of the guidelines. The analysis of USEF’s rules concludes there is a need for harmonization with other governing bodies, continuing education for trainers, owners, and riders, and stricter enforcement policies to ensure a more safe and fair competition environment.