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Therapeutic Use Exemption (TUE)

Since 2020, the management of TUEs is handled by the International Testing Agency (ITA).

Athletes, like all people, may have illnesses or conditions that require them to take a particular medication/substance or undergo certain procedures/methods. If the substance or method appears on the Prohibited List, athletes must obtain a Therapeutic Use Exemption (TUE) in order to have the permission to participate in their sport.

TUEs
Click here to visit the WADA's TUE webpage.

A TUE is a certificate granted by an Anti-Doping Organisation: WBSC for international level athletes, NADO for national-level athletes and MEO for athletes participating in an MEO event.
The certificate is for a set prohibited substance, in certain dosages, with a limited period of validity.

Criteria for Granting a TUE

All of the four following criteria must be met (for more details, please refer to the art. 4.1 of the WADA International Standard for Therapeutic Use Exemptions (ISTUE) - see the link in Documents & Regulations):

  • the athlete has a clear diagnosed medical condition which requires treatment using a prohibited substance or method;
  • the therapeutic use of the substance would not produce significant enhancement of performance beyond the athlete’s normal state of health;
  • there is no reasonable therapeutic alternative to the use of the prohibited substance or method;
  • the necessity to use that substance or method is not a consequence of the prior use (without a TUE) of a substance or method which was prohibited at the time of use.

Who should apply for a TUE to the WBSC, where and when?

First, check if the required medication or method you intend to take or use appears on the Prohibited List.
Please refer to the Global Drug Reference Online (Global DRO), the online country-specific drug reference database.

You have the responsibility to inform your doctors that you are an athlete subject to doping control and they should check the Prohibited List whenever they prescribe a medication or method to you: if it is prohibited, check with your doctors if there are any alternative treatments, otherwise you must apply for a TUE.
You should also assume that all doctors have not a full understanding of anti-doping-related matters in their sport.

Remember, athletes have the ultimate responsibility regarding this process. Contact your NADO or ITA to tue@ita.sport if you are having difficulties.

Second, check your competition level to determine to which organisation and when to apply for a TUE.

If you are an international level athlete ‒ defined as:

  • the athlete included in the WBSC Registered Testing Pool, WBSC Testing Pool and any other pool if established by WBSC;
  • athlete including para-athlete who participate in the following WBSC international events: WBSC World Cups and WBSC World Cups Continental qualifiers (for all disciplines but excluding events involving minors), World Baseball Classic, World Baseball Classic qualfiiers, Premier 12, Olympic Games and Olympic Games qualifying events and all other events included in the WBSC event calendar. The athletes participating in the aforementioned events shall be considered international level athletes starting two (2) months prior to the specific event in question.

For substances prohibited in-competition only, you should apply for a TUE at least 30 days before your next competition, unless one of the exceptions on retroactive TUEs apply.

In particular you must apply to WBSC if:

  • you don’t already have a TUE granted by your National Anti-Doping Organisation (NADO);
  • you already have a TUE granted by your National Anti-Doping Organisation (NADO), but this NADO is not in the list below *.

If you already have a TUE granted for national-level competitions by your NADO (in the list below *), that TUE is automatically valid for international level competition and it is not necessary to apply to WBSC for recognition, provided that such exemption has been granted in accordance with art. 5.4 of the International Standard for TUE.

* NADOs with agreement with WBSC for TUE mutual recognition: USA, JPN, KOR, CUB, MEX, TPE, CAN, AUS, NED, PUR, NZL, ARG, CZE, HKG, ITA, GER.

If you aren’t an international level athlete and you have been tested by WBSC, WBSC 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 as defined by your NADO and you have been tested by WBSC, you must apply for a retroactive TUE to WBSC.

How international level athletes apply to WBSC for a TUE?

Athletes should submit their TUE application together with the required medical file via ADAMS (see the dedicated section).

If you don't have an ADAMS account or if you have any challenges to send the form via ADAMS, please contact WBSC to tue@ita.sport and attach the following form filled in all its parts.
The TUE application must be submitted in English or French and in legible capital letters or typing. Any TUE application that is not complete or legible will not be dealt with and will be returned for completion and re-submission.

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ITA-TUE Application Form

The medical file 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.

If the medical file is not in English or French, a summary explaining, in English or French, the key elements of the diagnosis, clinical examinations, medical tests and treatment plan must be provided.

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, and medical Information to support the decisions of TUECs for guidance on specific common medical conditions, treatments, substances, etc.

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

WADA’s role in the TUE process is two-fold:

  • the Agency, through its TUEC, has the right to monitor and review any TUE granted by an ADO and, following such review, to reverse any decision;
  • an athlete who submits a TUE application to an ADO (WBSC or NADO) and is denied, can ask WADA to review the decision. If WADA determines that denial did not comply with the ISTUE, the Agency can reverse the decision. WADA itself does not accept TUE applications from athletes in the first instance.

Once a TUE is Granted

Any change in substance, dosage, route of administration and/or frequency requires the submission of a new TUE application (ISTUE art. 6.12).
In case of persistence of the medical condition, it is the athlete’s responsibility to apply in advance for renewal of the present TUE prior to its expiry date.

Athletes selected for doping control must always declare in its form (with or without a TUE) the use of all prescribed and over-the-counter medications as well as supplements taken in the last 7 days and any blood transfusions in the 3 months prior to blood samples.

What happens if a treatment involves prohibited substances/methods and you do not have a TUE?

The use or attempted use, possession, administration or attempted administration of a prohibited substance or method on WADA’s Prohibited List, before or without TUE approval, will most likely result in an Anti-Doping Rule Violation (ADRV).
For more general information about TUEs please visit the WADA TUEs section. For any request, clarification or doubt please contact tue@ita.sport.

Can i get a retroactive TUE?

An athlete may only apply retroactively for a TUE to WBSC if one of any of the following exceptions applies:

  • an emergency or urgent treatment of a medical condition was necessary;
  • there was insufficient time, opportunity or other exceptional circumstances that prevented the athlete from submitting (or the TUEC to consider) an application for the TUE prior to sample collection;
  • if an Anti-Doping Organisation (ADO) chooses to collect a sample from an athlete who is not an international level athlete or national level athlete, and that athlete is using a prohibited substance or method for therapeutic reasons, the Anti-Doping Organisation must permit the athlete to apply for a retroactive TUE;
  • due to national level prioritisation of certain sports, the athlete’s National Anti-Doping Organization did not permit or require the athlete to apply for a prospective TUE;
  • the athlete used out-of-competition, for therapeutic reasons, a prohibited substance that is only prohibited in-competition.

What happens at Major Events?

A Major Event Organization (MEO) requires athletes to apply for the recognition of their TUE if they wish to use a prohibited substance or method in connection with the event. If you have a TUE granted by WBSC and you will be competing at a major event, e.g. the Olympic Games, you should contact the MEO for information on their recognition process. Here you can find further details about the TUE process at the Olympic Games.

How to submit a request for recognition of my NADO's TUE to WBSC?

Your request for recognition should be submitted to WBSC in writing quoting your ADAMS TUE reference number. Keep a complete copy of the proof that your request for recognition has been sent to WBSC.  

When will i receive a decision on my TUE application or request for recognition?

The TUEC must render 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.

What if i need to renew my TUE?

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 ITA to tue@ita.sport as you may be required to apply for a new TUE.

What if my WBSC TUE application is denied?

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 TUE to tue@ita.sport 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. You and/or your NADO may refer the matter to WADA for review no later than 21 days after notification of the ITA TUEC decision. You should send the same information that you submitted and on which the decision to deny the TUE was based on, via a secure on-line 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 medical@wada-ama.org. 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).

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.

Will my medical information be treated in a confidential manner?

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 process. All members of the TUEC 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 TUEC 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 ITA and WBSC 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 - ISPPPI (you can find the link in "Documents & Regulations).

Important notes

Using a prohibited substance before being granted a TUE could result in an adverse analytical finding and a potential Anti-Doping Rule Violation.

In case an application for a retroactive TUE is necessary following sample collection, you are strongly advised to have a medical file prepared and ready to submit for evaluation.

WADA hosted on 22th and 23th April 2021 the TUE Virtual Symposium:

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WADA Virtual TUE Symposium 2021 - Brief Report

Nutritional Supplements

Extreme caution is recommended regarding supplement use.
For more information please consult the dedicated section.

For more detailed information, please consult:

WADA’s Q&A on TUEs