Athletes, like all others, may have illnesses or conditions that require them to take particular medications. If the medication an athlete is required to take to treat an illness or condition happens to fall under the Prohibited List, a Therapeutic Use Exemption (TUE) may give that athlete the authorization to take the needed medicine.

The criteria are:

• The athlete would experience significant health problems without taking the prohibited substance or method
• The therapeutic use of the substance would not produce significant enhancement of performance, and
• There is no reasonable therapeutic alternative to the use of the otherwise prohibited substance or method.

Under the World Anti-Doping Code, WADA has issued an International Standard for TUEs. The standard states that all International Federations (IFs) and National Anti-Doping Organizations (NADOs) must have a process in place whereby athletes with documented medical conditions can request a TUE, and have such request appropriately dealt with by a panel of independent physicians called a Therapeutic Use Exemption Committee (TUEC).

IFs and NADOs, through their TUECs, are then responsible for granting or declining such applications.

If you are an international level athlete or if you are entered in an international event for which a TUE issued by your International Federation (IF) is required, you must submit your TUE Application to your IF, which is responsible for accepting applications and granting TUEs. If you are a national level athlete you must submit your TUE Application to your National Anti-Doping Organization (NADO).

Athletes must not submit TUE Applications to more than one organization.

WADA does not accept TUE Applications from athletes.

Special protocols for TUE Applications may be in effect during Major Events

If you are entered in a Major Event, you are advised to inquire of your IF or NADO whether there is any variation in the TUE submission protocol for the Event. Major Events include those organized by international multi-sport organizations that function as the ruling body for any continental, regional, or other international event (e.g. IOC, IPC, FISU).

WADA’s role in the TUE process is two-pronged. First, the Agency, through its TUE Committee (TUEC), has the right to monitor and review any TUE granted by a federation or anti-doping organization and, pursuant to such review, to reverse any decision. Second, an athlete who submits a TUE Application to a federation or anti-doping organization and is denied a TUE, can ask WADA to review the decision. If WADA determines that the denial of the TUE did not comply with the International Standard for TUEs, the Agency can reverse the decision.

The process for an athlete to apply for a TUE is fairly simple. Each athlete must:

• Contact his or her International Federation (IF) or National Anti-Doping Organization (NADO) (whichever applies) and ask for the TUE Application process. Applications are usually submitted through ADAMS or using a paper form.
• Have his or her physician fill out the TUE Application form and produce the required supporting documentation and forward it to the IF or NADO (whichever applies). Athletes should remember that according to the International Standard for TUEs, the TUE Application should be submitted at least 30 days before participating in an event.

Tips on applying for a TUE

• Complete the form through ADAMS, or by typing (if possible) or hand written in block capital letters. If the form is not legible, it is deemed incomplete and will be returned to the athlete.
• If faxing the form, ensure that you include all the required documentation and keep a copy of the request as well as a record of the transmission or acknowledgement of receipt.

TUEs are granted for a specific medication with a defined dosage. They are also granted for a specific period of time and do expire. The athlete needs to comply with all the treatment conditions outlined in the TUE Application.

Once a TUE has been granted by an International Federation (IF) or National Anti-Doping Organization (NADO), it will inform WADA, who will then have the opportunity to review this decision. If the decision does not conform to the International Standard for TUEs, WADA may reverse it and deny the TUE. WADA's decision is not retroactive.

You or your granting authority can appeal to the Court of Arbitration for Sport (CAS) for a final decision.

When filling out the doping control form, make sure that you declare the substance or medication being used and that you specify that a TUE has been granted. If you have easy access to a copy of the TUE Approval form, it is preferable but not mandatory that you show it to the doping control official.

When the doping control authority receives the report from the laboratory, an initial review will take place to verify that the TUE is still in effect and that the results of the analysis are consistent with the TUE granted (nature of substance, route of administration, dose, time frame of administration, etc.). If the review proves satisfactory, the result of your test will be recorded as negative.

Under Article 10.0 of the ISTUE, if your TUE is denied by the granting authority (International Federation [IF] or National Anti-Doping Organization [NADO]), you may ask WADA to review the decision, provided you are either:

• An athlete belonging to an International Registered Testing Pool (IRTP);
• An athlete belonging to a National Registered Testing Pool (NRTP);  or
• An athlete competing in an IF-sanctioned international event for which a TUE is required.

The review process is as follows:

a) The request for review must be sent via registered letter to WADA’s Medical Director within 21 days of the decision by the TUE granting authority.  We ask you to include your full contact details, including your e-mail address.  WADA will inform you whether or not your case can be reviewed by WADA’s Therapeutic Use Exemption Committee (TUEC), as per article 10.0 of the ISTUE;

b) You will be asked to pay WADA an administrative fee of US$500.  If your request is accepted by WADA, further information will be provided regarding  payment of this fee;

c) WADA’s TUEC will review the same documentation as the TUE granting authority. WADA may ask you to provide additional information or documents;
 
d) WADA’s TUEC will render its decision within 30 days of its acceptance to review the case;
 
e) The original denial of the TUE will remain in effect until WADA’s TUEC reaches a decision. You are  therefore not permitted to use the substance while waiting for the decision from WADA’s TUEC.  If the TUE is granted by WADA’s TUEC, the TUE immediately goes into effect in accordance with the conditions outlined by WADA’s TUEC.

f) WADA’s TUEC’s decision may be appealed to the Court of Arbitration for Sport (CAS).

For athletes applying to an International Federation:
You can then appeal the IF decision to CAS for a final decision.

For athletes applying to a National Anti-Doping Organization:
You can then appeal the NADO decision to an independent review body in your country. If this body grants you the TUE, WADA could appeal this decision to CAS for a final decision.

Athletes concerned about confidentiality should note that all the information contained in their TUE Application will be kept strictly confidential as medical data. All members of the TUECs are required to sign confidentiality agreements and if they require advice from other scientific experts on a particular case, the name of the athlete will not be used when circulating the application outside the TUEC.

The procedures for applying for and granting a TUE are outlined in the International Standard for TUEs, published by WADA. You may also contact your IF or NADO for more information.

As of January 1, 2011, it is no longer necessary for athletes to file a declaration or use.

Yes. Athletes are advised to declare all medications and other substances that are being taken or have been taken in the previous seven days.