International Standard for Therapeutic Use Exemption (ISTUE)
The International Standard for Therapeutic Use Exemptions is a mandatory International Standard developed as part of the World Anti-Doping Program.
The purpose of the ISTUE is to establish
- the conditions that must be satisfied in order for a Therapeutic Use Exemption (or TUE) to be granted, permitting the presence of a Prohibited Substance in an Athlete’s Sample or the Athlete’s Use or Attempted Use, Possession and/or Administration or Attempted Administration of a Prohibited Substance or Prohibited Method for therapeutic reasons;
- the responsibilities imposed on Anti-Doping Organisations (ADO) in making and communicating TUE decisions;
- the process for an Athlete to apply for a TUE;
- the process for an Athlete to get a TUE granted by one ADO recognised by another ADO;
- the process for WADA to review TUE decisions; and
- the strict confidentiality provisions that apply to the TUE process.
WADA Therapeutic Use Exemption Guidelines
This TUE Guidelines document takes ADOs through the lifecycle of the TUE, starting with the criteria for granting a TUE.
The Guidelines bring forward key ADO responsibilities, including support of Athletes making TUE applications, recognition of TUEs, and communication of TUE decisions. Confidentiality provisions and WADA’s role in the review of TUE decisions are also addressed.
These Guidelines are not mandatory, but are intended to give clarity and additional guidance to Code Article 4.4 and the ISTUE, each of which is mandatory.
Therapeutic Use Exemption Process
What is TUE?
Athletes may have an illness or medical condition requiring a particular medication. If this medication appears on the Prohibited List, the athlete may be granted a Therapeutic Use Exemption (TUE) that gives the athlete permission to take the medication.
Why the need for TUE?
In some instances, there may not be alternative medication or method to treat the illness or medical condition. TUEs ensure that the athlete is able to obtain treatment for a legitimate medical condition, even if treatment requires a prohibited substance or method. With the authorisation to consume the needed medication, it avoids the risk of sanctions due to a positive test.
Who should apply for TUE?
Any athlete who may be subject to doping control must request a TUE before taking a prohibited medication. All information in a TUE request remains strictly confidential.
An Athlete may be granted a TUE if (and only if) they can show, on the balance of probabilities, that each of the following conditions is met:
a. The Prohibited Substance or Prohibited Method in question is needed to treat a diagnosed medical condition supported by relevant clinical evidence.
b. The Therapeutic Use of the Prohibited Substance or Prohibited Method will not, on the balance of probabilities, produce any additional enhancement of performance beyond what might be anticipated by a return to the Athlete’s normal state of health following the treatment of the medical condition.
c. The Prohibited Substance or Prohibited Method is an indicated treatment for the medical condition, and there is no reasonable permitted Therapeutic alternative.
d. The necessity for the Use of the Prohibited Substance or Prohibited Method is not a consequence, wholly or in part, of the prior Use (without a TUE) of a substance or method which was prohibited at the time of such Use.
When should one apply?
A TUE application must be made at least 30 days before taking part in an event. In exceptional cases or an emergency, a TUE may be granted retroactively.
Therapeutic Use Exemption Application Form
TUE must be obtained at least 30 days in advance.
Please download the TUE application form here:
TUE Application Form (English)
Other Useful Links
WADA Q&A on Therapeutic Use Exemption
WADA Checklists for TUE applications