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The use of any Prohibited Substance by an athlete for medical reasons is possible by virtue of a Therapeutic Use Exemption (TUE).

Regulatory framework

The therapeutic use exemptions procedures are regulated by The World Anti-Doping Code International Standard for Therapeutic Use Exemptions (TUE). The World Anti-Doping Code International Standard for Therapeutic Use Exemptions is a level 2 mandatory International Standard developed as part of the World Anti-Doping Program.  According to the WADA World Anti-Doping Program TUE Guidelines (Version 1.0 23.01.2007) a Therapeutic Use Exemption (TUE) is an authorization to take a Prohibited Substance under well defined and restricted conditions. An application for a TUE shall be made in accordance with the International Standard for TUE.

A TUE must be obtained for the use of any substance on the Prohibited List. Depending on the substance itself and the route of administration, either a standard TUE or an abbreviated TUE (ATUE) can be granted. All athletes who need a medical treatment including a Prohibited Substance or Method and are subject to testing must obtain a TUE from their relevant Anti-Doping Organization (ADO). In order to obtain an approval for a TUE, athletes must have a well documented medical condition supported by reliable and relevant medical data.

WADA Prohibited List 2008

According to the Prohibited List the following comments are mentioned in the context of TUEs:
  • S3. Beta-2-Agonists
    As an exception, formoterol, salbutamol, salmeterol and terbutaline when administered by inhalation, require an abbreviated Therapeutic Use Exemption. Despite the granting of any form of Therapeutic Use Exemption, a concentration of salbutamol (free plus glucuronide) greater than 1000 ng/mL will be considered an Adverse Analytical Finding unless the Athlete proves that the abnormal result was the consequence of the therapeutic use of inhaled salbutamol.
  • S5. Diuretics and other masking agents
    A Therapeutic Use Exemption is not valid if an Athlete’s urine contains a diuretic in association with threshold or sub-threshold levels of a Prohibited Substance(s).
  • M2. Chemical and physical manipulation
    Intravenous infusion is prohibited. In an acute medical situation where this method is deemed necessary, a retroactive Therapeutic Use Exemption will be required.
  • M3. Gene doping
    The non-therapeutic use of cells, genes, genetic elements, or of the modulation of gene expression, having the capacity to enhance athletic performance, is prohibited.
  • S9. Glucocorticosteroids
    All glucocorticosteroids are prohibited when administered orally, rectally, intravenously or intramuscularly. Their use requires a Therapeutic Use Exemption approval. Other routes of administration (intraarticular /periarticular/ peritendinous/ epidural/ intradermal injections and inhalation) require an Abbreviated Therapeutic Use Exemption except as noted below. Topical preparations when used for dermatological (including iontophoresis/phonophoresis), auricular, nasal, ophthalmic, buccal, gingival and perianal disorders are not prohibited and do not require any form of Therapeutic Use Exemption.

If the medication of an athlete is required to take to treat an illness or condition happens to fall under the Prohibited List, a Therapeutic Use Exemption may give that athlete the authorization to take the needed medicine.

Granting a TUE

The criteria for granting a TUE are:  
  • The athlete would experience significant health problems without taking the prohibited substance or method,
  • The therapeutic use of the substance would not produce significant enhancement of performance and
  • There is no reasonable therapeutic alternative to the use of the otherwise prohibited substance or method.

With the help of the World Anti-Doping Code, WADA has issued an International Standard for the granting of TUEs. The standard states that all International Federations (IFs) and National Anti-Doping Organizations (NADOs) must have a process in place, where athletes with documented medical conditions can request a TUE, and have such request appropriately dealt with by a panel of independent physicians called a Therapeutic Use Exemption Committee (TUEC). IFs and NADOs, through their TUECs, are then responsible for granting or declining such applications. An international level athlete, or athlete who is entered in an international event, must submit his TUE Application to his IF, which is responsible for accepting applications and granting TUEs. For other athletes who are members of a country’s national registered testing pool, TUE Applications must be submitted to the athletes’ NADOs. The procedures for applying for and granting a TUE are outlined in the International Standard for Therapeutic Use Exemptions, published by WADA.

TUE application

Getting Form

 
ATUE (Abbreviated Therapeutic Use Exemption)
short form for athletes use beta-2-Agonists administered by inhalation or glucocorticosteroids administered by intraarticular , periarticular, peritendinous, epidural, intradermal injections and inhalation
 
 

TUE (Therapeutic Use Exemption)
standard form for athletes use another drugs as beta-2-Agonists administered by inhalation or glucocorticosteroids administered by intraarticular , periarticular, peritendinous, epidural, intradermal injections and inhalation

 
  • International-level athletes (athletes included by an IF in its Registered Testing Pool and other athletes prior to their participation in any International Events) have to fill English version of ATUE or TUE (from WADA website or IFs website)
  • National-Level athletes and athletes participating in National Events have to fill NADOs version of ATUE or TUE
 

Filling Form

Only by a medic doctor
  • for International-Level athletes in English or French
  • for National-Level athletes in Nationallanguage
 

Sending Form

 

  • International-Level athletes send to IFs 21 days before an event (not for glucocorticosteroids)
  • for National-Level athletes send to NADOs 21 days before an event (not for glucocorticosteroids)
 

Issue Decision

 
 
  • for International-Level athletes from TUE Committee of Ifs (decision will be sent to the athlete within the 30-day deadline; decision to determine the time )
  • for National-Level athletes from TUE Committee of NADOs (decision will be sent to the athlete within the 30-day deadline; decision to determine the time)
 

Appeal Against

 
  • First instance: to WADA
  • Second instance: to the Court of Arbitration for Sport (CAS)
 
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