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Anti-doping - Therapeutic Use Exemptions (TUE)

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Knowledge level: Beginner

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Article posted: 25/01/2014

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There may be times where a rider needs to take a prohibited substance for legitimate medical reasons. Riders may need to justify this to doping authorities by applying for a Therapeutic Use Exemption and the below information explains how this can be completed.

If the medication is prohibited, riders should check with their prescribing medical practitioner if there are any alternative medications or treatments that are permitted before considering the need to apply for a TUE.

What is a Therapeutic Use Exemption?

The Therapeutic Use Exemption (TUE) process is a means by which a rider can apply for approval to use a prescribed prohibited substance or method for the treatment of a legitimate medical condition.

Riders should advise their medical personnel of their obligation to abide by the anti-doping rules of their sport and that any medical treatment received must not violate these rules. When prescribed a substance or method, riders should themselves find out if that medication is prohibited by checking Global DRO.

If the medication is not prohibited, riders can start using the prescribed medication or treatment.

If the medication is prohibited, riders should check with their prescribing medical practitioner if there are any alternative medications or treatments that are permitted before considering the need to apply for a TUE.

When should a rider apply for a TUE? 

There are two types of TUEs in relation to the timing of their application:

  1. 1) Riders will need to apply for a TUE in advance of using the prohibited medication.
  2. 2) In the other case, if a rider is using a prohibited medication for therapeutic purposes they would apply if and when they are selected for testing.

The option a rider must use is dependent on the level of competition at which they perform. The general principle is that higher level riders (those who receive British Cycling funding or are on a registered testing pool) need a TUE in advance of use. The majority of British Cycling race licence holders will not require a TUE in advance. To ascertain when they should apply for a TUE riders can use this link. This link will also explain which organisation the rider needs to apply to for the TUE (UK Anti-Doping or the UCI), as this also varies depending on the level of competition. Under the 2015 Code, international-level riders will apply to the UCI for a TUE and national-level riders will apply to UKAD for a TUE.

If a rider is not required to apply for a TUE in advance, but they are selected for doping control, they are required to make a retroactive TUE application for any prohibited medications. Riders should apply to UK Anti-Doping for a retroactive TUE no later than 10 working days following sample collection. An exception is when riders are using terbutaline inhalers – if the rider is selected for doping control they should wait to see if an adverse analytical finding is reported. If it is, the rider must then submit a retroactive asthma TUE application along with the results of a lung function test to confirm they have asthma.

If a rider does not need to apply for their TUEs in advance, they need to make checks with their medical practitioner that the criteria and medical evidence needed by the Therapeutic Use Exemption Committee (TUEC) (see below) can be met before using any prohibited substance or method. If a rider tests positive for a prohibited substance and their retroactive TUE application is rejected, they may have committed an Anti-Doping Rule Violation!

In the event that a rider needs to be administered with a prohibited substance in an emergency situation, the rider should apply for an emergency TUE as soon as possible following the administration of the substance. Riders in this situation can contact UK Anti-Doping or British Cycling for guidance on this.

Criteria and evidence required for granting a TUE

TUE applications need to meet all of the following criteria before a TUE will be granted:

• The rider would experience significant health problems without taking the prohibited substance or method

• The therapeutic use of the substance would not produce enhancement of performance

• There is no reasonable therapeutic alternative

• Use of the prohibited substance or method is not needed because of previous doping.

The following evidence is needed to support a TUE application:

• Medical history

• An accurate diagnosis. For chronic conditions, up-to-date review letters that confirm treatment monitoring should be provided.

• Alternatives have been considered or trialled.

Where can riders obtain TUE application forms?

If a rider needs to make a TUE application they should obtain a TUE form from the appropriate organisation (see above), which will either be UK Anti-Doping, the UCI, or a major games organiser (such as the IOC). There are some sections of a TUE form that must be completed by a rider and some by their medical practitioner.

There are two types of UK Anti-Doping TUE forms:

An asthma TUE form should be used when applying to use an asthma medication that contains a prohibited substance. If a rider is submitting a asthma TUE form they also need to include the results of a lung function test that prove the need for these substances. This can be arranged through a riders GP.
A standard TUE, supported by the information listed above, should be used for any other substance or method.

How are TUE applications considered?

Once a TUE application form is submitted it will be checked by the recipient organisation and then passed on to the TUE Committee (TUEC), which will be three physicians with relevant and appropriate experience. Decisions are made using the four criteria outlined above and are guided by WADA’s medical information.

The International Standard for Therapeutic Use Exemptions (ISTUE) states that a decision will be made within 30 days of receipt of a TUE form and all requested supporting information, so riders should leave plenty of time where possible. UK Anti-Doping usually turns TUE applications around in seven days. In the UK, if the TUEC denies an application riders can appeal first to UK Anti-Doping, who will appoint a TUE appeal panel. The appeal is normally turned around in seven days. If the rider is unhappy with their decision they can then appeal to WADA, but they must do so within 21 days and pay WADA an application fee.

TUEs for competitions

Riders should be clear on which competitions their TUE covers. The UCI may have different requirements surrounding TUE applications, and may not accept TUEs granted by UKAD. They may have a specific form and request different information. It is the responsibility of the rider to understand the expectation of the UCI or event organiser prior to competing. Riders should contact the UCI or British Cycling anti-doping staff to check their TUE requirements.

If a rider has a valid TUE in place they should carry the TUE number with them at all times as they will need to declare that on the Doping Control Form should they be selected for doping control. It is good practice to carry a copy of the TUE form with them.

More information on TUEs can be found here, specific guidance for TUEs for hay fever can be found here and the ISTUE can be found here. Riders and support personnel can contact UK Anti-Doping with any questions about TUE’s.

Key message:

For the majority British Cycling race licence holders they will not require a TUE in advance of testing. However they should remain aware of what they take and check their medications regularly. Any medications used should be declared on testing paperwork. Riders not requiring a TUE in advance must be prepared to complete a TUE if tested within 10 days. If riders have any queries regarding this they should contact British Cycling or UKAD.

For further information visit www.ukad.org.uk

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