An athlete, like any other person, may have illnesses or conditions that require use of particular medications as treatment, but substances he/she might take as treatment can fall under Prohibited list. In such case therapeutic use exemption (TUE) under strict conditions may provide an athlete authorization to take needed medicine while competing in sport with no resulting doping offence.
Any athlete including those with disabilities with a documented, legitimate medical condition may apply for TUE.
An exemption will be granted only in strict accordance with Code criteria. Under the World anti-doping Code WADA has issued an International Standard for granting TUE.
The route of TUE process can be in both ways depending on the international or national level of athlete. The athlete must establish whether he or she is classified and send the application form to NADO or IF (International federation). TUE request can be submitted to one body at the time. The list of athletes included in Testing pool shall be shared between various ADOs and should be regularly updated. IF should communicate with NADOs regarding testing pool. Cooperation between those institutions is needed to prevent duplication, but in practice that process of mutual recognition could be very difficult.
There are two application forms – the standard form (TUE) and Declaration of use (DoU). Declaration of use (DoU) is an easier administrative means of obtaining an authorization to take prohibited substances. Standard TUE is required for any treatment involving a substance or method on the Prohibited List for which an DoU cannot be obtained. Declaration of use is applied for glucocorticosteroids used by non systemic and inhaled routes, namely intraarticular, periarticular, peritendinous, epidural, and intradermal injection. Since 2010 salbutamol and salmeterol are also substances that need DoU. Administration of glucocorticosteroids by systemic route -parenterally, orally, rectally or by intramuscular injection, is indication for standard TUE application.
All International federations and National anti-doping organizations must have process in place whereby athletes with documented medical conditions can request a TUE. TUE committee may ask for additional investigations and diagnostic procedures and should include at least three physicians with a experience in the care and treatment of athletes. At least one expert should have a knowledge in the specific medical area of the request. It is very important that all the applications for TUE, submitted and send via fax or email on time could be evaluated properly. Based upon International standard for granting TUE, according to the new Code there is deadline and it is 30 day before competition. There are some situations when retroactive approval can be accepted like for example:
-There was not enough time for an applicant to submit.
Insulin dependent diabetes mellitus
Chronic inflammatory bowel disease
Attention deficit hyperactivity disorder
Adult growth hormone deficiency
Childhood and adolescence growth hormone deficiency
Adrenal insufficiency (Addison’s disease)
For all this mentioned above medical conditions there are guidelines. TUE can be granted for limited period of time.
Before entering in process of TUE every athlete should advice his/hers physician and following exact rules and guidelines exemption will be provided.
are two essays in Serbian language about TUE problems published in cooperation between Anti-doping Agency of Serbia and Sports Medicine Association of Serbia:
TUE IN SERBIA – WITH SPECIAL EMPHASIS ON THE APPLICATION OF GLOCOCORTICOSTEROIDS
Dr. Marija Andjelkovic, Dr. Nenad Dikic
Abstract: TUE (Therapeutically Use Exemption) is required before athlete wants to use the substances from Prohibited List. In last eighteen months Anti-doping Agency of Serbia (ADAS) registered 33 TUE process. From this number, 30 was ATUE (Abbreviated TUE) which is required for beta-2-agonist by inhalation and glucocorticosteroids by non-systemic routes. The most common medical disorder in TUE process in Serbia is musculoskeletal conditions (48%), and on second place is asthma (30%). The most presented prohibited substances are glucocorticosteroids (63%) and beta-2 agonists administered by inhalation (36%). Periarticular administered Diprophos is the most frequently used glucocorticosteroid, with a question is this route of administration strictly local and effective. Certain case studies of national and international federations will be presented in this article. In 2009. year there will be some changes in TUE process. For non-systemic and inhalative glucocorticosteroids, Declaration of Use is introduced, instead formerly ATUE, while inhalative beta-2 agonists required full TUE process.
TUE – FROM MEDICAL INDICATIONS TO SPORT ABUSE
Dr. Marija Andjelkovic
Abstract: TUE (Therapeutical Use Exemption) or Declaration of use, is required when athlete wants to use the substances from Prohibited List because he is injured or ill. Healthy man can take as a doping all medicaments that are used for treating eleven diseases that requires TUE. Glucocorticosteroids cure several illnesses from this list, but huge problem with them is often non-systemic use without real medical indication, which can cause harm eventually. Testosterone is a medicine for hypogonadismus and his abuse is common in young people who wants to look muscular. Diuretics are supstances that we can find in sports with weight categories, where is the aim to reduce overweight in a short time. Beta2-agonist Salbutamol is effective in therapy of asthma, and we can find him in doping-positive sprinters because he have bronhodilatatory effects. Eritropoetin treat anemia by increase eritrocites, therefor he enhance aerobic capacity and bicyclist use it for doping. Psychostimulants- modaphinil for healing narcolepsy, and metilphenidat or amphetamin for healing hiperactivity, can be doping supstances who give athlete power, sharpness and better results. Growth hormone, popular called- «source of youth or fat killer», together with testosterone, is useing to win muscular mass. It is obviosly that therapic effects of drugs are often abused in sport athletes.