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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
Athletes should check Global DRO for confirmation about the prohibited or permitted status of their asthma medication. See also the information below on carrying out a lung function test.
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 UKAD. International athletes (as defined by their International Federation) should apply to their IF. For information on determining whether, and when, a TUE is required see the When to Apply for TUE section.
An athlete not required to apply for a TUE prior to competition can make a retroactive TUE application to UK Anti-Doping. 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 UKAD 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 UKAD 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 either their NGB or to UK Anti-Doping.
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Note: A TUE granted by the UKAD TUE Committee should be mutually recognised by International Federations (IF) and other Major Event Organisers. (MEO). It is the responsibility of the athlete to check if their IF will recognise an existing TUE and how they should share a copy with their IF or MEO.
Medical evidence to justify the use of a prohibited substance or method must be attached to the application form. A TUE application without medical evidence will not be reviewed by the UKAD TUEC.
Keep a copy of the TUE application and proof that it has been sent.
Athletes need to prove they have a clinical need to use an asthma inhaler that contains formoterol (when more than 54 micrograms over 24 hours is used), salbutamol (when more than 1600 micrograms over 24 hours is used) or terbutaline (any use).
This includes lung function test results, which a prescribing medical practitioner may not be able to offer. Where this is the case, athletes can contact a specialist screening centre. Athletes are also encouraged to contact their National Governing Body for further assistance.
Those athlete requiring a TUE for substance used to treat hay fever must submit their applications in advance of treatment and provide medical evidence to justify therapeutic use.
Athletes are reminded to check any medications on Global DRO.