TUE

The Therapeutic Use Exemption (TUE) process is a means by which an athlete can obtain approval to use a prescribed prohibited substance or method for the treatment of a legitimate medical condition. Athletes should advise all medical personnel of their obligation to abide by the anti-doping rules of their sport and that any medical treatment received must not violate these rules.

When prescribed a substance or method, athletes should find out whether the medication is prohibited by checking the Global DRO. If the medication is not prohibited, athletes can start using the prescribed medication or treatment.

If the medication is prohibited, athletes should check with their prescribing physician or the sport’s medical personnel to see if there are any alternative medications or treatments that are permitted.

If there are no permitted alternatives, athletes should contact their National Governing Body (NGB) or follow the guidance below to find out what type of exemption is required and if a TUE should be applied for prior to use or after doping control.

Only in emergency situations (such as an allergic reaction, exacerbation of asthma, or the onset of Bell's palsy) should treatment begin without the necessary approval.

 

TUEs related to beta-2 agonist medication to treat asthma

Inhaled beta-2 agonists are prohibited at all times and require a Therapeutic Use Exemption (TUE), except for:

  • inhaled salbutamol when taken in dosages of less than 1600 micrograms in any 24 hour period
  • inhaled formoterol when taken in dosages of less than 54 micrograms in any 24 hour period
  • inhaled salmeterol when taken in accordance with the manufacturers’ recommended instructions

Inhaled terbutaline when taken in any dose is prohibited and requires a TUE.

The following documentation is required to support a TUE application related to the use of prohibited beta-2 agonist medication to treat asthma:

  • A complete and legible beta-2 agonist TUE application form
  • Lung function test results
  • Justification from the prescribing physician as to why permitted alternatives cannot be used

 

Standard TUE

For all other substances and methods, a standard TUE form is required. The following medical evidence is required:

  • History of medical condition
  • Evidence of diagnosis (such as hospital review letters, test results, examinations and investigations)
  • Evidence of using alternative permitted medications

The requirements vary depending on the level of the athlete. Athletes competing at a National-level should apply to NADA. International athletes (as defined by their International Federation) should apply to their IF.

An athlete not required to apply for a TUE prior to competition can make a retroactive TUE application to NADA. Any athlete requiring a retroactive TUE has five days post the receipt of an adverse analytical finding (AAF) to submit a retroactive application. Typically an athlete will receive a letter by courier to confirm an AAF and inform them of the requirements to apply for a retroactive TUE for the prohibited substance detected in their sample. The NGB or NADA may also contact the athlete to make them aware that this correspondence is on its way, in relevant circumstances.

We encourage any athlete who has been tested, without a TUE in place who may require one, to contact NADA to discuss the process to better understand their rights and responsibilities. Even if an athlete is eligible to apply for a retrospective TUE, checks should be made with the prescribing physician that the criteria and medical evidence needed by the Therapeutic Use Exemption Committee (TUEC) can be met before the athlete uses any prohibited substance or method.

Where an athlete sends their TUE application depends on their sport and level of competition. For the majority of sports, athletes competing at an international level will be required to submit their TUE application to the International Federation (IF) of their sport. National level athletes should submit their application to NADA.

Note: A TUE granted by the NADA TUE Committee should be mutually recognized by International Federations (IF) and other Major Event Organizers. (MEO). It is the responsibility of the athlete to check if their IF will recognize an existing TUE and how they should share a copy with their IF or MEO.