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 or undergo procedures. 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?
If the medication or method an athlete is required to use to treat an illness or condition is prohibited as per the World Anti-Doping Agency’s (WADA) Prohibited List, a TUE may give that athlete the authorization to use that substance or method while competing without invoking an anti-doping rule violation (ADRV) and applicable sanction. Applications for TUEs are evaluated by a panel of physicians (TUE Committee).
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 athlete has a clear diagnosed medical condition, which requires treatment using a prohibited substance or method.
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.
Athletes who are subject to anti-doping rules would need a TUE to take a prohibited substance or use a prohibited method. You should verify with your National Anti-Doping Organsation (NADO) to know to whom you need to apply and if you can apply retroactively.
You have a responsibility to inform your physician(s) that you are an athlete bound to anti-dopig rules. You and your physician(s) should check the prohibited list for whatever substance/method you are prescribed. If the substance/method is prohibited, discuss non-prohibited alternatives. If there are none, apply for a TUE.
Remember that athletes have the ultimate responsiblity.
Contact your NADO if you are having difficulties.
How to apply to your NADO for a TUE?
Option 1: Only through ADAMS
You must exclusively submit your TUE application, including the required medical file, via ADAMS. If you do not have an ADAMS account yet, please contact your NADO to have your account set up.
Option 2: through ADAMS or paper format/electronic TUE form
Please download your NADO’s TUE application form, and once duly completed and signed, send it together with the required medical file to your NADO.
Therapeutic Use Exemption Application Form Template (SEARADO)
TUE must be obtained at least 30 days in advance.
Please download the TUE application form template here:
TUE Application Form (English)
Other Useful Links
WADA Q&A on Therapeutic Use Exemption
WADA Checklists for TUE applications