5. Therapeutic Use Exemptions (TUEs)
What is a Therapeutic Use Exemption (TUE)?
Athletes, like all people, may have illnesses or conditions that require them to take particular medications or undergo procedures. If the medication or method an athlete is required to take to treat an illness or condition happens to fall on the World Anti-Doping Agency’s (WADA) Prohibited List, a Therapeutic Use Exemption (TUE) may give that athlete the authorization to take a substance or use a method that is prohibited.
Applications for TUEs are reviewed by a panel of experts, the TUE Committee (TUEC).
What are the criteria for granting a TUE?
All four following criteria must be met:
- 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;
- 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 ILS, where and when?
First, check if the medication or method you intend to take or use appears on the Prohibited List.
You have the responsibility to inform your doctors that you are an athlete subject to doping control, and your doctors should check the Prohibited List whenever they prescribe a medication / method to you. If the substance / method is prohibited, check with your doctors if there are any alternative treatments that are not prohibited. If not, you have to apply for a TUE.
Second, check your competition level to determine to which organisation, and when to apply for a TUE.
==> If you are an International-Level Athlete (= National team Lifesaving athletes that represent the top 15 nations based on the previous World Championship results.) you must apply to ILS in advance, as soon as the need arises, unless there are emergency or exceptional circumstances.
For substances prohibited In-Competition only, you should apply for a TUE at least 30 days before your next competition.
If you already have a valid TUE granted by your NADO, you must submit the TUE to ILS for recognition. You should not submit a new TUE application to ILS for the same substance or method.
==> If you are NOT an International-Level Athlete, ILS recognises a valid TUE granted by your NADO. If you are also not a National-Level Athlete as defined by your NADO, you must apply for a retroactive TUE after being tested by ILS.
Important note:
Unless your competition level requires or permits that you apply for a TUE retroactively, taking a prohibited substance before being granted a TUE could result in an Adverse Analytical Finding and potential anti-doping rule violation. However, as stated above, a retroactive TUE may be granted where a medical emergency or an acute medical condition occurs, where failure to immediately administer a prohibited substance or method could significantly put an athlete’s health at risk.
How to apply to ILS for a TUE?
ILS encourages TUE applications using the form available in ADAMS and submitting the required medical file through ADAMS. If you do not have an ADAMS account yet, please download the TUE Application Form, and once duly completed and signed, send it together with the required medical file to the ILS Anti-Doping Administrator at hq@ilsf.org.
Your TUE application must be submitted in legible English using capital letters or typing.
The medical file includes:
- 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, a summary explaining, in English, the key elements of the diagnosis, clinical examinations, medical tests and treatment plan must be provided.
Any TUE application that is not complete or legible will not be dealt with and will be returned for completion and re-submission.
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.
How to submit a request for recognition of your NADO’s TUE to ILS?
Your request for recognition must be submitted using the copy of your NADO’s TUE certificate, application form (in English]) and supporting medical file. Please send it to the ILS Anti-Doping Administrator at hq@ils.org.
It is not necessary to translate all medical information into English. However, an English summary explaining the diagnosis and key information about medical exams, medical tests and treatment plans is required.
Any request for recognition that is not complete or legible will not be dealt with and will be returned for completion and re-submission.
Keep a complete copy of the proof that your request for recognition has been sent to ILS and all medical information submitted in support of your application, and proof that it has been sent to ILS.
When will I receive a decision on my TUE application [or request for recognition]?
ILS’s TUEC’s decision will be communicated in writing to you within 21 days from the date of receipt of the complete TUE application [or request for recognition], including the required medical information, by ILS.
How about the renewal of 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 the expiry date, so that there is sufficient time for a decision to be made prior to the expiry of the current TUE.
What if my ILS’s TUE application is denied?
A decision to deny a TUE application includes an explanation of the reason for the denial. If it is not clear to you, please contact ILS to understand exactly why the TUE was denied. Sometimes, there may be a critical piece of information, diagnostic test, laboratory results missing, etc. Failing this:
You or your NADO may refer the matter to WADA for review no later than 21 days after the decision was rendered by the TUEC by sending the same information that you submitted to your TUEC and on which they based their decision to deny the TUE via registered mail at:
WADA Medical Director
World Anti-Doping Agency
800 Square Victoria
Montreal H4Z 1B7, QC
Canada
However, WADA is not obliged to proceed with such review. In that case, you or your NADO may appeal to the Court of Arbitration for Sport (CAS).
What if my NADO’s TUE is not recognized by ILS?
You and your NADO have 21 days to refer the matter WADA for review. You can appeal the decision by sending a registered letter together with the same information that was submitted to your TUEC and on which they based their decision to deny the TUE via registered mail at:
WADA Medical Director
World Anti-Doping Agency
800 Square Victoria
Montreal H4Z 1B7, QC
Canada
Pending WADA’s decision, your NADO’s TUE remains valid for national-level competition and Out-of-Competition testing only.
If the matter is not referred to WADA for review, the TUE becomes invalid for any purpose when the 21-day review deadline expires.
Can a TUE be retroactively approved?
You may only be granted retroactive approval if:
- Emergency treatment or treatment of an acute medical condition was necessary; or
- Due to other exceptional circumstances, there was insufficient time or opportunity to submit, or for the TUEC to consider, an application for the TUE prior to Sample collection; or
- The applicable rules required/permitted you (see Code Article 4.4.5) to apply for a retroactive TUE; or
- It is agreed, by WADA and by ILS that fairness requires the grant of a retroactive TUE.
How about confidentiality?
All the information contained in a TUE application and file 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 and in the TUE Application Form. All medical doctors of the TUE Committee and any other authorised recipients of your TUE request and related information are required to sign confidentiality agreements and/or are subject to professional confidentiality obligations.
Please review the terms of the Athlete’s Declaration carefully. In particular, please note that should you wish to revoke the right of the ILS’s TUE Committee to obtain the information related to your TUE request 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 ILS 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.
Contact information
For any further information and questions in relation to ILS’s personal information practices and in case you have a doubt as regards to which organization you should apply for a TUE, or as to the recognition process, or any other question with regard to TUEs, please contact: the ILS Anti-Doping Administrator at hq@ilsf.org.