Therapeutic Use Exemptions (TUEs)

Athletes have an anti-doping right to medical treatment and protection of health. To uphold this right, an athlete can obtain a Therapeutic Use Exemption (TUE) which allows them to use the specific prohibited substance or method for legitimate health reasons in the context of sport if strict conditions are met.

All four of the following strict criteria must be met in order for a TUE to be granted:

1. The Prohibited Substance or Method is needed to treat a diagnosed medical condition, backed by clinical evidence. Note: It might be used for necessary diagnostic tests rather than a treatment.
2. Using the Prohibited Substance or Method won’t enhance performance beyond what would be expected from returning to normal health. Note: Each athlete’s normal health must be assessed individually.
3. The Prohibited Substance or Method is the recommended treatment for the medical condition, and there are no permitted alternative treatments. Note: The doctor must justify why this treatment is the best option and alternatives don’t always need to be tried first.
4.  The need for the Prohibited Substance or Method isn’t due to past use of a Prohibited Substance or Method without a Therapeutic Use Exemption (TUE).

Applications for TUEs are evaluated by a panel of physicians of different nationalities. All TUE applications to the ITA are evaluated by members of the ITA International TUE Committee (ITUEC).

Athletes who are subject to anti-doping rules need a TUE to take or use a prohibited substance or method.

An athlete should apply as soon as possible when they learn it is necessary for them to use a prohibited substance or method. Approval must be obtained before the prohibited substance or method is used unless in emergency situations.

No. A coach does not require a TUE to possess prohibited substances or methods. However, a coach must have “acceptable justification” for holding the banned substance or method, which may include medical prescription (insulin for diabetes, e.g.) or for dealing with acute and emergency situation (epinephrine auto-injector, e.g.) All support personnel should however understand and adhere to the anti-doping rules that apply to them as, for example, the administration of a prohibited substance to an athlete is a rule violation and may result in a coach being banned from sport.

1. Inform your physician you are an athlete subject to anti-doping rules.
2. Check if the required medication or method you intend to take or use is prohibited as per the WADA Prohibited List (you can ask your NADO for support or use GlobalDRO – see Checking Medication)
3. If your medication is on the Prohibited List (substance and/or method) talk to your physician about permitted alternatives.
4. If there are no permitted alternatives, you need to apply for a TUE.
5. Use the TUE Assistant to understand which category of athlete you are (International-Level or National-Level) and who to apply to.
6. Athletes who must apply to the ITA’s Therapeutic Use Exemption Committee (ITUEC) do so via an online form or directly in ADAMS (Anti-Doping Administration & Management System). In both cases, athletes must complete the TUE Application form along with their physician and gather the necessary medical documentation. This information should then be submitted via ADAMS or, if an athlete does not have an ADAMS account they should submit their application via this online form.

IMPORTANT! Make sure your application is complete and legible, otherwise it will be returned for resubmission

If you are a National-Level Athlete, submit your TUE application to your National Anti-Doping Organisation.

Keep a complete copy of the TUE application form and all medical information submitted in support of your application, and proof that it has been sent.

A medical file, which must include:

• A comprehensive medical history, including documentation from the original diagnosing physician(s) (where possible).
• The results of all examinations, laboratory investigations and imaging studies relevant to the application.
• Details about the prescribed treatment including substances, methods, dosages, timeframes etc.

Any TUE application that is not complete or legible will not be dealt with and will be returned for completion and resubmission.

You should keep a complete record of your TUE application and the medical evidence that was submitted. You should also keep proof that your TUE application was sent.

The TUE Application and evaluation by the ITUEC is free of charge for athletes but any costs incurred in making the application and in supplementing it as required by the ITA’s ITUEC are the responsibility of the athlete.

To assist you and your doctor in providing the correct medical documentation, we suggest consulting the WADA’s Checklists for TUE applications for guidance and support during the TUE application process, and Medical Information to Support the Decisions of TUECs for guidance on specific common medical conditions, treatments, substances, etc.

If you already have a TUE granted by your NADO:

Your NADO’s TUE is only valid at the national level, and you must submit a request for recognition to the ITA’s ITUEC.

If you are NOT an International-Level Athlete and you have been tested by your International Federation (IF), your  IF  recognises a valid TUE granted by your NADO (i.e., it satisfies the ISTUE criteria for granting a TUE); unless you are required to apply for recognition of the TUE because you are competing in an International Event.

If you are NOT a National-Level Athlete or an International Level Athlete and you have been tested by your IF, you have the possibility to apply for a retroactive TUE to the ITA’s ITUEC.

You need to submit a request for recognition to the ITA’s ITUEC in writing [email protected] quoting your ADAMS TUE reference number.

Keep a complete copy of the proof that your request for recognition has been sent to the ITA’s ITUEC.

You and/or your National Anti-Doping Organisation (NADO) have 21 days from the date of decision to refer the matter to WADA for review.  The email address to enquire and/or send the request for review is: [email protected].

Alternatively, you may send to:

WADA Medical Department
World Anti-Doping Agency
Stock Exchange Tower
800 Place Victoria (Suite 1700)
P.O. Box 120
Montreal (Quebec) H4Z 1B7
Canada

The same information that was provided to your NADO should be submitted to WADA.  Please use a secure online method unless sending by registered mail.

Pending WADA’s decision, your NADO TUE remains valid for national-level competition and out-of-competition testing only.

If the matter is not referred to WADA for review, your NADO must determine whether the original TUE that was granted should remain valid for national-level Competition and Out-of-Competition Testing.

The ITA’s ITUEC aims to give a decision as soon as possible, and usually within 21 days from the date of receipt of the complete TUE application, or request for recognition, unless in exceptional circumstances.

Athletes must understand the TUE requirements of the Major Event(s) they are competing in. Generally, there will be specific TUE requirements before and during Major Events and TUE recognition may be required.

You may only apply retroactively for a TUE to ITA’s ITUEC if:

• You required emergency or urgent treatment of a medical condition.
• There was insufficient time, opportunity or other exceptional circumstances that prevented you from submitting the TUE application or having it evaluated, before getting tested.
• As per the International Federation anti-doping rules you were not permitted or required to apply in advance for a TUE.
• You are a lower-level athlete who is not under the jurisdiction of an International Federation or National Anti-Doping Organisation and were tested.
• You tested positive after using a substance Out-of-Competition that was only prohibited In-Competition (for example glucocorticoids).

Note that the TUE criteria must still be met (see Q.2 above), including that there was no permitted alternative treatment(s).

In rare and exceptional circumstances and notwithstanding any other provision in the ISTUE, you may apply for and be granted retroactive approval for a therapeutic use of a prohibited substance or method, if considering the purpose of the Code, it would be manifestly unfair not to grant a retroactive TUE. An Anti-Doping Organisation may grant an Athlete’s application for a retroactive TUE “for fairness” only with the prior approval of WADA (and WADA may in its absolute discretion agree with or reject the Anti-Doping Organization’s decision).

Important note:
Using a prohibited substance or method without a TUE may result in an Anti-Doping Rule Violation.

You are strongly advised to have a medical file prepared and ready to submit for evaluation if ever you test positive for a Prohibited Substance or Method and seek to obtain a retroactive TUE.

An emergency situation is one in which an athlete’s health would be severely impacted without immediate medical treatment which requires the use of a prohibited substance or method. In such events, there would be insufficient time to consider a TUE application as athlete health must be prioritised.

Each TUE has a specific duration, at the end of which it expires automatically. Should you need to continue to use the prohibited substance or method, it is your responsibility to submit a new application for a TUE with updated medical information ahead of the expiry date, so that there is sufficient time for a decision to be made prior to the expiry of the current TUE. 

Important note:

The presence (following sample collection), use, possession or administration of the prohibited substance or method must be consistent with the terms of your TUE. Therefore, if you require a materially different dosage, frequency, route or duration of administration, you should contact the ITA’s ITUEC, as you may be required to apply for a new TUE. Some substances and dosages, e.g. insulin, are often modified during treatment and these possible fluctuations should be mentioned by the treating physician in the TUE application and would usually be accepted by the ITA’s ITUEC.

A decision to deny a TUE application will include a written explanation of the reason(s) for the denial. If it is not clear to you, please contact the ITA’s ITUEC to understand exactly why the TUE was denied. Sometimes, there may be a critical piece of information, diagnostic test, laboratory results missing, etc. In which case, you should re-apply to us.

You and/or your NADO may refer the matter to WADA for review no later than 21 days after notification of the ITA’s TUEC decision.

You should send the same information that you submitted to us, and on which the decision to deny the TUE was based on, via a secure online method or by registered mail at:

WADA Medical Department
World Anti-Doping Agency
Stock Exchange Tower
800 Place Victoria (Suite 1700)
P.O. Box 120
Montreal (Quebec) H4Z 1B7
Canada

The email address to enquire and/or send the request for review is: [email protected]

It should be noted that WADA is not obliged to proceed with a request for a review. In that case, you and/or your NADO may appeal to the Court of Arbitration for Sport (CAS).

All the information contained in a TUE application, including the supporting medical information and any other information related to the evaluation of your TUE request is kept strictly confidential and treated in accordance with the Athlete’s Declaration contained in the ADAMS TUE and in the TUE Application Form. All members of the ITA’s ITUEC and any other authorised recipients of your TUE request and related information (as described in the Athlete’s Declaration) are subject to a professional or contractual confidentiality obligation.

Please review the terms of the Athlete’s Declaration carefully. In particular, note that should you wish to revoke the right of the ITA’s ITUEC to obtain the information related to your TUE in accordance with the Athlete’s Declaration, your TUE application will be deemed withdrawn without approval [or recognition] being granted.

Your TUE request-related information will be retained by the ITA’s ITUEC and any other authorised recipients for no longer than necessary for the purposes stated in the Athlete’s Declaration, in accordance with the International Standard for the Protection of Privacy and Personal Information.

Each TUE application is reviewed only when submitted in full, including comprehensive medical evidence. Each application is then evaluated against WADA’s strict criteria by a committee of at least 3 experienced physicians of different nationalities. This process is consistent internationally, ensuring fairness for all athletes. WADA has a final right to review and overturn any TUE that would not be in line with the International Standard for Therapeutic Use Exemptions (ISTUE).

You can contact the ITA’s ITUEC  and the ITA TUE team at [email protected].