Therapeutic use exemptions (TUE)

The International Standard for Granting Therapeutic Use Exemptions (TUEs) developed by the World Anti-Doping Agency provides the framework for athletes to use medicines on the ‘Prohibitive List’ to treat legitimate medical conditions.

This is important because athletes, like everyone else, may suffer from illnesses (for example, asthma) that require them to take particular medications. Provided that the need for medications is genuine, and subject to specific criteria, the use of medications should not impact on the ability of athletes to play sport. Athletes that have a duly authorised TUE will not be considered to have committed an Anti-Doping rule violation following a positive test result for the approved medication so long as the conditions of the TUE were fully met.

Starting in January 01, 2011, there are no longer substances or methods on the Prohibited List that require a Declaration of Use and therefore it is not necessary to file a Declaration of Use. Glucocorticosteroids administered by intraarticular, periarticular, peritendinous, epidural, intradermal and inhalation routes do not require Declaration of Use anymore. All glucocorticosteroids are prohibited when administered by oral, intravenous, intramuscular or rectal routes. Administration of glucocorticosteroids by systemic rout is an indication for standard TUE application.

All beta-2 agonists (including both optical isomers where relevant) are prohibited except salbutamol (maximum 1600 micrograms over 24 hours) and salmeterol when taken by inhalation in accordance with the manufacturers’ recommended therapeutic regime. Salbutamol and salmeterol when taken by inhalation at therapeutic doses do not require DoU anymore. The presence of salbutamol in urine in excess of 1000 ng/mL is presumed not to be an intended therapeutic use of the substance and will be considered as an Adverse Analytical Finding unless the Athlete proves, through a controlled pharmacokinetic study, that the abnormal result was the consequence of the use of a therapeutic dose (maximum 1600 micrograms over 24 hours) of inhaled salbutamol.

The TUE standard is an integral part of the International Convention against Doping in Sport because it is fundamental to international harmonization in the fight against doping in sport. Adherence to this standard ensures that the process for granting TUEs is the same across all sports organizations and countries.