Therapeutic Use Exemption (TUE)
WHAT IS A THERAPEUTIC USE EXEMPTION (TUE)?
Athletes, like all people, may have illnesses or conditions that require them to take a particular medication/substance or undergo certain procedures/methods.
If the substance or method appears on WADA’s List of Prohibited Substances and Methods, athletes must obtain a Therapeutic Use Exemption (TUE) in order to have the permission to take it or use it.
TUEs can only be granted by Anti-Doping Organizations following a robust review process that is defined in WADA’s International Standard for Therapeutic Use Exemptions and involves evaluation by a panel of at least three physicians specialized in sports medicine and/or other relevant specialties.
An athlete who needs a TUE should apply as soon as possible. For substances prohibited In-competition only, the athlete should apply for a TUE at least 30 days before his/her next competition, unless it is an emergency or exceptional situation.
Q: Who must obtain TUEs from JJIF?
The JJIF Anti-Doping Rules (JJIF ADR) require that all International-level Athletes* who need to take medication/treatment which is on WADA’s Prohibited List must submit a Therapeutic Use Exemption (TUE) application to JJIF as follows:
- If the Athlete does not already have a TUE granted by his/her National Anti-Doping Organisation (NADO), he/she must apply directly to JJIF.
- If the Athlete already has a TUE granted for national-level competitions by his/her NADO, that TUE is not automatically valid for international-level competition and it is possible to apply to JJIF for recognition, provided that such TUE decision has been reported in accordance with Article 5.4 of the International Standard for Therapeutic Use Exemptions and therefore is available for review by WADA.
* International-level Athletes are defined in the JJIF ADR as reported below.
Q: What are the criteria for granting a TUE?
The criteria 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;
- There is no reasonable therapeutic alternative to the use of the otherwise prohibited substance or method;
- The requirement to use that substance or method is not due to the prior use of the substance or method without a TUE which was prohibited at the time of use.
For the TUE to be granted, all four criteria must be met.
Q: Which athletes are considered to be “International-Level Athletes”?
International-level athletes are defined as (1) Athletes with the following ranking: 1-10 in the JJIF Ranking list, available on the JJIF website; and, or (2) Athletes who compete in the Continental and World Championships or any other Event organized by JJIF or where JJIF is the ruling body.
Athletes who do not fall under the above-mentioned categories should submit TUE applications to their respective National Anti-Doping Agency (NADO).
Q: I am an International-Level Athlete. How and when should I apply to JJIF for a TUE?
- As soon as a new treatment is prescribed to you, you must check whether it involves prohibited substances or methods. If this is the case, a TUE application form (please see at the end of the page) must be completed, signed and sent to JJIF ([email protected]) by you or through your National Federation. In accordance with the JJIF ADR, TUE applications should be sent at least thirty (30) days before your next competition.
- TUE applications must be adequately documented with relevant medical records in order to be considered. According to the JJIF ADR, medical evidence confirming the diagnosis and explaining the reasons for the required treatment shall be transmitted along with the TUE application. The medical evidence must include a comprehensive medical history and the results of all relevant examinations, laboratory investigation and imaging studies. Please note that applications sent without medical evidence cannot be considered. Please refer your treating physician to the medical information available on WADA’s website to support the decisions of TUE committees. In case of doubts, contact [email protected]
- Once your application is received, JJIF may request additional information in order to document the clinical situation in accordance with WADA’s Standard for Therapeutic Use Exemptions. The JJIF TUE Committee has twenty-one (21) days to issue a decision once the full application (including sufficient medical documentation) is received. For this reason, you should send your TUE application at least 21 days prior to your next competition.
- If it is not possible for you to apply 30 days before the decision is needed, you must imperatively attest the urgent nature of the application in the form. JJIF tries to be as flexible as possible to accommodate these situations, however urgent applications should be exceptional, not routine.
- TUE applications cannot be considered for retroactive approval except in the cases mentioned in article 4.3 of the International Standard for Therapeutic Use Exemptions.
- Once a TUE is granted: (1) any change in substance, dosage, route of administration and/or frequency requires the submission of a new TUE application (ISTUE Art. 6.12); and (2) in case of persistence of the medical condition, it is the athlete’s responsibility to apply in advance for renewal of the present TUE prior to its expiry date.
Q: Can a retroactive TUE be granted?
TUE applications cannot be considered for retroactive approval except in the cases mentioned in article 4.3 of the International Standard for Therapeutic Use Exemptions which provides as follows:
“An Athlete may only be granted retroactive approval for his/her Therapeutic Use of a Prohibited Substance or Prohibited Method (i.e., a retroactive TUE) if:
- Emergency treatment or treatment of an acute medical condition was necessary;or
- Due to other exceptional circumstances, there was insufficient time or opportunity for the Athlete to submit, or for the TUEC to consider, an application for the TUE prior to Sample collection; or
- The applicable rules required the Athlete (see comment to Article 5.1) or permitted the Athlete (see Code Article 4.4.5) to apply for a retroactive TUE; or
[Comment to 4.3(c): Such Athletes are strongly advised to have a medical file prepared and ready to demonstrate their satisfaction of the TUE conditions set out at Article 4.1, in case an application for a retroactive TUE is necessary following Sample collection.]
- It is agreed, by WADA and by the Anti-Doping Organization to whom the application for a retroactive TUE is or would be made, that fairness requires the grant of a retroactive TUE.
[Comment to 4.3(d): If WADA and/or the Anti-Doping Organization do not agree to the application of Article 4.3(d), that may not be challenged either as a defense to proceedings for an anti-doping rule violation, or by way of appeal, or otherwise.] Once a TUE is granted: (1) any change in substance, dosage, route of administration and/or frequency requires the submission of a new TUE application (ISTUE Art. 6.12); and (2) in case of persistence of the medical condition, it is the athlete’s responsibility to apply in advance for renewal of the present TUE prior to its expiry date.”
Athletes selected for doping control must systematically (i.e. regardless of the presence of a TUE) declare on the doping control form the use of all prescribed and over-the-counter medications as well as supplements taken in the last 7 days.
Q: What happens if my treatment involves Prohibited Substances/methods and I do not have a TUE?
Using a prohibited substance or method on WADA’s Prohibited List before or without TUE approval will most likely result in an Anti-Doping Rule Violation (ADRV) in the event of an anti-doping test. It is therefore important that athletes check very carefully whether any treatment they are prescribed involves prohibited substances or methods. Athletes should also not assume that all medical professionals who prescribe medication have a full understanding of anti-doping-related matters in their sport. Athletes are advised to treat the matter of TUEs seriously and in all instances seek expert advice.