Use of Medication & TUE

What is a Therapeutic Use Exemption (TUE)?

As an athlete, you may have an illness or medical condition that requires a particular medication. If this medication contains a substance or requires a method of administration that is on the List of Prohibited Substances and Methods, you may apply for a Therapeutic Use Exemption (TUE). A TUE allows you to use the medication or method as it will not afford your competitive advantage in your sport, but rather ensure you can compete in a proper state of health. A TUE ensures that athletes can be treated for medical conditions even if the treatment involves using a prohibited substance or method while avoiding the risk of being sanctioned.

How do I find out if my treatment is prohibited?

Medications prescribed by a doctor or boughtctly over-the-counter may contain prohibited substances.. As an athlete, if you intend to take a medical treatment, you must check if your medication, brand or ingredient, contains a prohibited substance or if your treatment is considered to be a prohibited method. It is also important to inform your doctor that you are subject to Anti-Doping Rules.

Please note that the Prohibited List is updated annually, you should recheck the status of any treatment you continue to use before the start of each calendar year.

It is also important to know that most categories on the Prohibited List only include some common examples and are not exhaustive. Therefore, the fact that a substance is not on the Prohibited List does not mean that it is not prohibited. You can check your medication in several ways:

A. Check the medication, brand and ingredient, or method against the Prohibited List:

  • Check the label on the medication, some medications only contain a full ingredient list on the box rather than on the bottle.
  • Check the active ingredients it contains. Please note: ingredients can be different in the same product when purchased in different countries, so you will need to check the list each time.
  • Go to the Prohibited List and check to see if any of the medication’s active ingredients appear.
  • Make sure you also check the dose of the medication you are taking.

B. Use an online drug reference tool

Global DRO is among those useful tools you can use for the checking medication for prohibited substances. This online drug reference database provides information about the anti-doping status of specific medications and ingredients. Global DRO has information for medications only sold in Australia, Canada, New Zealand, Switzerland, the United Kingdom, and the United States. Other countries have similar databases. If using Global DRO, please make sure to search using the correct spelling of the medication brand or substance name and the exact dosage and route of administration.

Find more information on specific online drug references here or contact your National Anti-Doping Organisation (NADO) or reach out to the ICSD Anti-Doping Department.

What are the criteria for granting a TUE?

  • TUEs must meet all of the following four criteria to be granted. For more details please refer to the WADA International standard for Therapeutic Use Exemptions (ISTUE) Article 4.2:
  • The prohibited substance or prohibited method in question is needed to treat a diagnosed medical condition supported by relevant clinical evidence; and
  • The therapeutic use of the prohibited substance or method will not produce any additional enhancement of performance beyond a return to the athlete’s normal state of health following the treatment; and
  • The prohibited substance or method is an indicated treatment for the medical condition, and there is no reasonable permitted therapeutic alternative; and
  • The necessity for the use of the prohibited substance or method is not a consequence of prior use, without a TUE, of a prohibited substance or method at the time of use.

Should I apply for a TUE, and if so, where and when?

Follow these steps to find out if you need a TUE and where/when to apply for it.

Step 1: Check if the medication or method you intend to use is on the current Prohibited List.

Step 2: Check your competition level to determine when and to which organisation you must apply for a TUE.

If you are an International-Level athlete, you must apply to the ICSD in advance, as soon as the need arises, unless there are emergency or exceptional circumstances. It is permitted that an International-Level athlete may apply to a National Anti-Doping Organisation for a TUE indicating intention to compete in an international sport event. You are an International-level athlete if you meet the following criteria:

  • You are an athlete entered by a National Deaf Sports Federation to participate in an ICSD-sanctioned event.
  • You are included in the ICSD Registered Testing Pool (RTP) or Team Testing Pool (TP).

If you are not an International-Level athlete, you must apply to your National Anti-Doping Organisation for a TUE. Please note that if you already have a TUE granted by your National Anti-Doping Organisation, such a TUE is only valid at the national level. In this case, you should submit a request to the ICSD Anti-Doping Department for recognition of the TUE for international competition.

What is the retroactive TUE and how to apply?

You may only apply retroactively for a TUE, but must still meet the basic conditions listed in the section “What are the criteria for Granting a TUE?”, to ICSD Anti-Doping Department if:

  • Emergency or urgent treatment of a medical condition was necessary.
  • There was insufficient time, opportunity or other exceptional circumstances that prevented you from submitting, or for the ICSD Anti-Doping Department to consider, an application for the TUE prior to sample collection.
  • You are not an International-Level Athlete or National-Level athlete who is not under the jurisdiction of the ICSD or National Anti-Doping Organisation and were tested.
  • You tested positive after using a substance Out-of-Competition that is only prohibited In-Competition.

How to apply for a TUE?

An application from an International athlete to the ICSD Anti-Doping Department for grant or recognition of a TUE should be submitted as soon as the medical need for the prohibited substance or method arises, and at least 30 days before the athlete’s next competition.

ICSD Anti-Doping Department encourages TUE Applications to be submitted via ADAMS, together with the required medical information. If you do not have an ADAMS account yet, please contact your NADO or ICSD at doping@ciss.org. Please download the ICSD TUE Application Form, and once duly completed and signed, send it together with the required medical file.

ICSD Anti-Doping Department recommends the use of a secure file sharing system to safely share an application and supporting medical documents, rather than attaching themctly to the email. If a system is not available, athletes should, at a minimum, protect their documents with a password that can be shared separately with ICSD Anti-Doping Department.

The TUE application will be only considered when submitted with a clearly stated diagnosis and alongside the following supporting medical evidence:

  • Comprehensive medical history and the results of all relevant examinations, laboratory investigations and imaging studies.
  • Copies of original reports, letters and specialist reviews.
  • Detailed summary of any alternative medications tried, including names, dosages.
  • Duration of use, and effects, or clinical justification from the prescribing doctor that confirms that in their opinion there are no other permitted alternatives that exist to treat the medical condition.

Any TUE Application that is not complete or not legible will not be dealt with and will be returned for completion and re-submission.

To assist you and your doctor in providing the correct medical documentation, we suggest consulting the WADA’s Checklists for TUE applications for guidance and support, and Medical Information to Support the Decisions of TUECs for guidance on specific common medical conditions, treatments, substances.

Athletes should keep a complete copy of the TUE Application Form, and of all materials and information submitted in support of that Application, and proof that it has been sent.

Timing, Decisions & Renewal of TUEs

A panel of physicians, called the TUE Committee, review TUE Applications. Applications will be approved if the conditions set by WADA’s International Standard for Therapeutic Use Exemptions are satisfied.

In normal circumstances, a decision from the ICSD TUE Committee should be completed within 21 days of receipt of a complete Application, or request for recognition. To ensure there is sufficient time for the process, athletes who require a TUE should apply at least 30 days prior to the start of a ICSD-sanctioned competition where they will be participating.

Please note that failure to provide the required information or an illegible Application may result in being denied and/or returned. If the information provided is inconclusive, you may be requested to supply additional information, which will delay the processing of an Application. If an athlete has an acute medical condition arising within the 30-day period prior to a competition, the Application should still be submitted.

The athlete will be notified regarding the decision of the TUE Committee in writing. The TUE Committee will issue a Certificate on ADAMS. It will specify the Prohibited Substance or Method, the route of administration, the dose, and the expiry date. Athletes must comply with all the treatment conditions in their granted TUE Certificate.

Each TUE has a specific duration, at the end of which it expires automatically. If 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 well in advance of the expiry date, so that there is sufficient time for a decision to be made before your current TUE expires.

The presence, use, possession or administration of the prohibited substance or method must be consistent with the terms of your TUE. Therefore, in the event that, after your TUE is granted, you require a materially different dosage, frequency, route or duration of administration, you must apply for a new TUE.

What if my TUE Application is denied by the ICSD Anti-Doping Commission?

You will be informed about the TUE decision, which will include an explanation of the reasons for denial of the Application. If it is not clear to you, please contact the ICSD Anti-Doping Department to understand exactly why the TUE was denied. The Application may simply not be legible, or incomplete. In such cases, you should resubmit your Application with the required information completed.

If the Application was denied because the ICSD TUE Committee considered that you did not fulfil all criteria for granting a TUE, you and/or your National Anti-Doping Organisation can submit a request to WADA via registered mail or secure online method to medical@wada-ama.org to review the decision no later than 21 days after notification of the ICSD TUEC decision. You should send the same information that you submitted to ICSD, and on which the decision to deny the TUE was based on to WADA.

Confidentiality

All the information contained in a TUE Application, 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 ICSD TUE Application Form. All members of the ICSD TUEC and any other authorised recipients of your TUE request and related information are subject to a professional or contractual confidentiality obligation.

Athletes are strongly advised not to use any prohibited substance without a valid TUE. Athletes who possess or use the prohibited substance or method prior to receiving notification that their TUE has been granted do so at their own risk. Athletes should also verify if the substance or method they are using is legal in the specific country or state where they compete or plan to compete. For example, cannabis or opioids are illegal in various states and countries and there may be serious legal consequences for transgressing those rules regardless of whether one was granted a TUE.

Contact Information

For any further information and questions in relation to which organisation you should apply for a TUE, or as to the recognition process, or any other question about TUE, please contact at doping@ciss.org

TUE Application Form

Therapeutic Use Exemptions Frequently Asked Questions

At-a-Glance - Therapeutic Use Exemptions

Series of Therapeutic Use Exemption (TUE) Checklists, which provide guidance and support to athletes, their physicians, and National Deaf Sports Federations during the TUE application process.

These Checklists are based on the Medical Information to Support the Decisions of TUECs documents, which were developed by WADA and external medical specialists primarily for TUECs. The Checklists – which cover the most commonly seen conditions – list the requirements for completing the TUE Application Form, including the medical evidence that must be submitted along with it.

International Committee of Sports for the Deaf strongly urges all NDSF to use these Checklists in their interactions with athletes and applying physicians.

TUE Checklist - ADHD

TUE Checklist - Adrenal Insufficiency

TUE Checklist - Anaplylaxis

TUE Checklist - Asthma

TUE Checklist - Cardiovascular Conditions

TUE Checklist - Diabetes

TUE Checklist - Female Infertility

TUE Checklist - Growth Hormone Deficiency

TUE Checklist - IBD

TUE Checklist - Intrinsic Sleep Disorders

TUE Checklist - IV Infusion

TUE Checklist - Kidney Failure and Kidney Transplantation

TUE Checklist - Male Hypogonadism

TUE Checklist - Musculoskeletal Conditions

TUE Checklist - Pain Management

TUE Checklist - PCOS

TUE Checklist - Renal Transplantation

TUE Checklist - Sinusitis Rhinosinusitis

TUE Checklist - Transgender Athletes

TUE Application FormTUE Application Form