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What is Therapeutic Use of Substances and Methods Prohibited in Sport?

In some cases, athletes may be prescribed drugs containing prohibited substances in sport or prohibited methods that are prohibited under the WADA Prohibited List to treat an illness. A TUE allows athletes to receive treatment without an Anti-Doping rule violation (ADRV) or sanction.

TUE requests are reviewed by a panel of physicians who are members of the TUEC (Therapeutic Use Exemption Committee).

TUEs issued by a National Anti-Doping Organization are only valid for national-level competition and out-of-competition testing.

What are the criteria for issuing a TUE?

All 4 criteria must be met (for more information, see International Standard for Therapeutic Use Exemptions, Article 4.2).

- The Prohibited Substance or Prohibited Method in question is needed to treat a diagnosed medical condition supported by relevant clinical evidence. The Use of the Prohibited Substance or Prohibited Method may be part of a necessary diagnostic investigation rather than a treatment per se.

- 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. An Athlete’s normal state of health will need to be determined on an individual basis. A normal state of health for a specific Athlete is their state of health but for the medical condition for which the Athlete is seeking a TUE.

- The Prohibited Substance or Prohibited Method is an indicated treatment for the medical condition, and there is no reasonable permitted Therapeutic alternative. The physician must explain why the treatment chosen was the most appropriate, e.g. based on experience, side-effect profiles or other medical justifications, including, where applicable, geographically specific medical practice, and the ability to access the medication. Further, it is not always necessary to try and fail alternatives before using the Prohibited Substance or Prohibited Method.

- 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.

Who, where and when should apply for a TUE?

Athletes who are subject to Anti-Doping rules must obtain a TUE in order to use a Prohibited Substance or Prohibited Method. You should ask RAA RUSADA where to apply for a TUE and whether you can apply for a retroactive TUE.

Check if the required drug or method is prohibited - drug verification service.

You must tell your doctor(s) that you are an athlete and must comply with the Anti-Doping rules. You and your doctor(s) must check the medicinal product you have been prescribed for substances prohibited in sport. If the substance/method is prohibited, discuss non-prohibited alternatives - if not, apply for a TUE. Remember that athletes are responsible for complying with Anti-Doping rules. Contact RAA RUSADA if you have any questions.

Also contact RAA RUSADA to determine your competition level and TUE requirements.

If you are an athlete of the national level (i.e. an athlete who takes part in competitions included in the Unified calendar plan of interregional, all-Russian and international sports events and sports events with the status of "All-Russian": Russian championship, Russian championship, Russian Cup and other official All-Russian sports competitions, unless you are an international-level athlete in accordance with the criteria established by the relevant international federation), you must apply for a TUE with RAA RUSADA in advance, as soon as the need arises, except in urgent or exceptional circumstances.

For in-competition-only substances, you must apply for a TUE at least 30 days before the start of your next competition. Please see the section “How to apply for a TUE at RAA RUSADA?” below.

If your level is lower than the “national level” (as defined above), you are eligible to apply for a retroactive TUE after passing a testing procedure organized by RAA RUSADA or any other Anti-Doping Organization (ADO).

IMPORTANT:

A TUE issued by RAA RUSADA is only valid at the discovery level. If you are or are becoming an international-level athlete or compete in a major competition, this TUE will not be high-level unless recognized by an International Federation (IF) or Major Event Organization (MEO). You accept the responsibility for verifying what is automatically assumed to be a TUE issued by RAA RUSADA, such an IF or MEO.

RAA RUSADA is available to help you determine your level and credibility of your TUE application and, if necessary, help you change your RAA RUSADA TUE into IF or MEO for recognition. Please, if necessary, stay with us: +7 (499) 271-77-61, rusada@rusada.ru.

Can I get a retroactive TUE?

You can submit a retroactive TUE request to RAA RUSADA only in the following cases:

a) when providing emergency medical care or assistance in case of a sharp deterioration in health;

b) there was insufficient time, opportunity, or other exceptional circumstances that prevented the Athlete from submitting (or from being considered by the TUEC) a TUE request prior to Sample collection;

c) the athlete is not a national and international level athlete and has passed the testing procedure;

d) in the case of out-of-competition therapeutic use of prohibited substances that are prohibited only in-competition, for example, glucocorticoids (these athletes are strongly recommended to have a complete set of medical documents confirming compliance with the criteria for issuing a TUE, see above). This provision applies when an athlete uses for therapeutic purposes out of competition a substance that is prohibited only in-competition, but there is a risk of the substance remaining in the body in-competition.

In exceptional circumstances, an athlete may apply for and be granted a retroactive TUE if, having regard to the purpose of the Code, it would be manifestly unfair to deny a retroactive TUE. An Anti-Doping Organization may approve a retroactive TUE under this provision only with WADA's prior approval (WADA may, in its sole discretion, accept or reject RAA RUSADA's decision).

IMPORTANT:

Use of a prohibited substance or method without a TUE may result in an Anti-Doping rule violation.

In the event that a retroactive TUE request needs to be made after Sample collection, it is strongly recommended that medical records be prepared and submitted for evaluation.

How to apply for a TUE at RAA RUSADA?

You may apply for a TUE through ADAMS along with the required medical documentation (NOTE – all relevant fields in ADAMS must be completed in English). If you do not have an ADAMS account yet, please contact us to set it up: +7 (499) 271-77-61, rusada@rusada.ru

You can also download the TUE application form RAA RUSADA and, once the form is duly completed and signed, submit it with medical documentation in any of the following ways:

- by e-mail (rusada@rusada.ru),

- at the address: 125284, Moscow, 6A Begovaya St.  

The TUE request must be completed in block letters, signed by the treating physician, and accompanied by a complete medical history, including documentation from the physician(s) who first made the diagnosis (where possible), the results of all examinations, laboratory tests, and imaging studies that are related to this request. In accordance with the decision of the TUEC, any additional information, tests, imaging studies and other information that the TUEC deems necessary to consider the request for a TUE may be requested from the athlete or his doctor. TUEC may also seek assistance from other medical or scientific experts if necessary.

Requests that are illegible or incomplete will not be considered and will be returned for resubmission in a legible and complete manner.

To help you and your doctor provide detailed medical documentation, we suggest reviewing the TUE Request Forms and the TUEC Decision Support Medical Information for advice on specific common diseases and treatments.

Keep a copy of the TUE application form and all medical records, as well as proof that you submitted the request for review.

TUE Process for Major Competitions

Major Event Organizations (MEOs) require athletes to apply for recognition of a TUE if the athlete is required to use a prohibited substance or method in a given competition.

If you have a TUE issued by RAA RUSADA and plan to participate in major competitions such as the Olympic Games, you should contact MEO for information on the TUE recognition process.

When will I receive a decision on my TUE request or request for recognition of a TUE?

TUEC RAA RUSADA makes decision usually within 21 days from the date of receipt of a fully completed TUE application form, including the necessary medical documentation.

What if I need to renew my TUE?

Each TUE has an expiration date, after which it will automatically expire. If you need to continue using a prohibited substance or method, you must submit a new TUE with updated medical information before the TUE expires. Please note that TUEC needs time to review the TUE, so a new TUE must be submitted well in advance of the expiration of the TUE.

IMPORTANT:

The presence (after Sample collection), use, possession, or administration of a prohibited substance or method must comply with the terms of your TUE. Therefore, if you need to make a significant change in dosage, frequency, method or duration of use, you should contact RAA RUSADA as you may need to submit a new TUE. Some substances and their dosages, such as insulin, often change during treatment, and these possible changes must be specified by the treating physician in the TUE request and are usually approved by the TUE.

What should I do if RAA RUSADA refused to issue a TUE?

A decision to deny a TUE includes a written explanation of the reasons for the denial. If you have any questions, please contact RAA RUSADA to find out exactly why you were denied a TUE. Sometimes important information, laboratory and instrumental test results, etc. may be missing. In this case, you should contact us again.

You can also appeal the decision of the TUEC to the National Center for Sports Arbitration. More information: http://sportarbitrage.ru/

What should I do if the permit issued by RAA RUSADA is not recognized by my international sports federation?

You or RAA RUSADA have 21 days to refer the case to WADA after notification of non-recognition of the TUE. You must send the same information that you provided to RAA RUSADA and on the basis of which the TEC made a decision, in a secure online way or by registered mail to:

WADA Medical Department

World Anti-Doping Agency

Stock Exchange Tower

800 Place Victoria (Suite 1700)

P.O. Box 120

Montreal (Quebec) H4Z 1B7

Canada

Email address for sending a request: medical@wada-ama.org

Pending a decision by WADA, a TUE issued by RAA RUSADA remains valid only for National Competitions and Out-of-Competition Testing. If the case is not referred to WADA, RAA RUSADA will determine whether the issued TUE should remain valid for National Competition and Out-of-Competition Testing.

Is medical information confidential?

All information contained in the TUE request, including any supporting medical documentation, and any other information that relates to your TUE request, is strictly confidential and will be treated in accordance with the Athlete Declaration contained in the TUE section of ADAMS TUE and on the TUE Application Form. TUE RAA RUSADA. All TUEC members and any other entities that process your TUE request and related information (as described in the Athlete Declaration) are required to maintain strict confidentiality.

Please read the “Athlete Declaration” clauses in the TUE request carefully. In particular, please note that if you wish to revoke TUE RAA RUSADA's right to receive information related to your TUE application, your TUE application will be treated as withdrawn without authorization in accordance with the Athlete Declaration.

Information about your TUE request will be kept by RAA RUSADA and any other authorized organizations for no longer than is necessary for the purposes specified in the athlete's request, in accordance with the International Standard for the Protection of Confidentiality and Personal Information.

Contact Information.

For any additional information on issues related to the activities of RAA RUSADA in relation to personal data, you can contact Data.Privacy@rusada.ru.

If you have questions regarding which organization you should apply for a TUE to, or the process for recognizing a TUE, or any other matter, please contact:

+7 (499) 271-77-61

by e-mail (rusada@rusada.ru)

at the address: 125284, Moscow, 6A Begovaya St. 

pdf
International Standard on Therapeutic use Exemptions, January 2021
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TUE Application Form
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TUE Physician Guidelines: Intrinsic Sleep Disorders
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TUE Physician Guidelines: Growth Hormone Deficiency (adult)
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TUE Physician Guidelines: Growth Hormone Deficiency (children and adolescents)
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TUE Physician Guidelines: Asthma
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TUE Physician Guidelines: Anaphylaxis
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TUE Physician Guidelines: Cardiovascular Conditions - The Therapeutic Use of Beta-blockers in Athletes
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TUE physician guidelines: Male Hypogonadism
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TUE physician guidelines: Sinusitis/Rhinosinusitis
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TUE physician guidelines: Renal Transplantation
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TUE physician guidelines: Inflammatory Bowel Disease
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TUE physician guidelines: Attention Deficit Hyperactivity Disorder (ADHD) In Children and Adults
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TUE physician guidelines: Infertility/Polycystic Ovarian Syndrome
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TUE physician guidelines: Post Infectious Cough
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TUE physician guidelines: Transgender Athletes
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TUE physician guidelines: Adrenal Insufficiency
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TUE physician guidelines: Musculoskeletal Conditions
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TUE physician guidelines: Diabetes Mellitus
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TUE physician guidelines: Pain Management
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TUE physician guidelines: Intravenous Infusions and/or Injections