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TUEs

Athlete health and welfare is important, and there are protocols for athletes to follow if they are ill and have to take medication which contains prohibited ingredients. 

The athlete must advise all medical personnel involved in any treatment, that they have an obligation to abide by the anti-doping rules of their sport, and that any medical treatment received must not violate these rules.  

In some cases, an athlete with a legitimate medical condition may need to use a prohibited substance or method if there are no other suitable permitted medications or treatments they can be used. In this case they will need to apply for a Therapeutic Use Exemption (TUE).

The facts - what you need to know about TUEs
  • Therapeutic Use Exemptions normally need to be applied for in advance for National and International-Level athletes.
  • Applications will only be considered when submitted alongside detailed medical evidence supporting the use of the prohibited substance or method.
  • UK Anti-Doping sets out the competition levels within each sport which are determined to be National-Level for the purposes of TUE applications.
  • International Federations set out the pool of athletes which are considered as International-Level within their sport based on their inclusion within the International Federation Testing Pool or involvement in International events.
  • National-Level athletes need to apply to UK Anti-Doping for their TUEs. Whereas, International-Level athletes are required to apply to their International Federation for their TUE.
  • All TUE applications are processed by UK Anti-Doping in accordance with the WADA International Standard for TUEs
  • Athletes competing at a level not considered to be National-Level are not required to obtain a TUE in advance of use of the prohibited substance or method, but instead are required to obtain a retroactive TUE with UK Anti-Doping if they are subject to Doping Control.
  • Even if an athlete is eligible to apply for a retroactive TUE, checks should be made with the prescribing physician that the criteria and medical evidence needed by the TUE Committee (TUEC) can be met before the athlete uses any prohibited substance or method.
  • 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 notify UK Anti-Doping of their intention to apply for 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.
Do you need a TUE?

1) Check to see if any medications you are using are prohibited by using the Global DRO website. If the medication is not prohibited, you can start using the prescribed medication or treatment.

2) If the medication is prohibited you should check with your prescribing physician to see if there are any alternative medications of treatments that are not-prohibited.

3) If the medication is prohibited and there are no permitted alternatives, you now need to work out if you need a TUE in advance or a retroactive TUE.

What should I submit to obtain a TUE?

Asthma

Inhaled beta-2 agonists are prohibited at all times and require a TUE, except for:

  • Inhaled salbutamol when taken in dosages of less than 800 micrograms in any 12 hour period
  • Inhaled formoterol when taken in dosages of less than 54 micrograms in any 24 hour period
  • Inhaled salmeterol when taken in dosages of less than 200 micrograms in any 24 hour period

Inhaled terbutaline and inhaled vilanterol are prohibited when taken in any dose and therefore require 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 (linked below)
  • Lung function test results
  • Justification from the prescribing physician as to why permitted alternatives cannot be used

Attention Deficit Hyperactivity Disorder (ADHD)

Athletes requiring a TUE for a prohibited substance to treat ADHD should be familiar with the following documents (linked below):

  • ADHD TUE Policy
  • ADHD TUE Application Form

Frequently Asked Questions on ADHD

Q: My diagnosis of ADHD following the performance of a diagnostic schedule was several years ago and I’m unable to retrieve a copy of these records, what should I do?

A: Please contact the clinic where the diagnosis was made as it is likely that these records have been stored. In the event that you are still unable to retrieve these records, the UKAD TUE Committee may request that an updated diagnostic schedule is performed to support your TUE application or TUE renewal.

Q: I have already attended my annual review appointment but the review letter does not meet the new requirements for renewing my TUE, what should I do?

A: Please submit a completed ADHD TUE application form alongside a copy of your most recent specialist review letter. The UKAD TUE Committee will assess your renewal application and will be able to confirm which additional medical evidence is required to grant a long-term TUE. A short-term TUE may be able to be granted whilst you obtain any missing medical evidence.

Q: I’m no longer under the care of a specialist and my GP prescribes my ADHD medication, what should I do?

A: Please contact UKAD if you are experiencing difficulties in obtaining a specialist review as we may be able to assist by providing you with a list of psychiatrists who you could approach.

Q: What is the process for accessing a psychiatrist on the UKAD Register?

A: UKAD will be able to provide you with the contact details of a psychiatrist who is able to offer a review session within a short period of time. The costs incurred for such a review are the responsibility of the applicant.

For all other substances and methods, a standard TUE form (linked below) 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
Where to go for further advice

Use the drop down menu below to check the TUE requirements within your sport based on your competition level.

Also contact your National Governing Body for further advice and guidance.

Or email UKAD for any specific queries on medications at tue@ukad.org.uk.

Where to send a TUE application

Where an athlete sends their TUE application depends on their sport and level of competition.

As described above, athletes competing at an international level will be required to submit their TUE application to their International Federation. National level athletes should submit their application to either their NGB or to UK Anti-Doping.

Post (send via recorded delivery):

TUE
UK Anti-Doping
Fleetbank House
2-6 Salisbury Square
London EC4Y 8AE

Confidential Fax: 0800 298 3362

Email: tue@ukad.org.uk

Keep a copy of the TUE application and proof that it has been sent.

Note: A TUE granted by the UKAD TUE Committee may not be mutually recognised by International Federations and other Major Event Organisers. It is the responsibility of the athlete to check if their International Federation or the Major Event Organiser will recognise an existing TUE granted by UKAD.

Emergency medications

Athletes may in the course of emergency treatment (e.g. surgery or an A&E admission) be provided with drugs or methods which are prohibited in sport. Please see our guidance on when a TUE is necessary here.

Exacerbation of asthma advice

Guidance on applying for a TUE for the use of oral prednisolone following the exacerbation of asthma is available here.

Hay fever advice

Athletes who are wishing to use over-the-counter or prescribed medications to treat hay fever should check the hay fever medications document.

Those athletes requiring a TUE for a prohibited substance used to treat hay fever must submit their applications in advance of treatment and provide medical evidence to justify their therapeutic need.

For further details on TUE applications for the treatment of hay fever, please see our Hay Fever Guidelines. Athletes are reminded to check any medications on Global DRO.

When to apply for a TUE

Athletes defined by UKAD as being within the National TUE Pool of their sport are required to apply for a TUE in advance of use of a prohibited medication or method.

Check the competition levels within each sport below to assess whether you are considered to be within the National TUE Pool.

International level athletes, as defined by their International Federation, are required to apply directly to their International Federation for any TUE required.