What is a Therapeutic Use Exemption (TUE)?

Athletes, like all people, may have illnesses or conditions that require them to take particular medications or undergo procedures. If the medication or method an athlete is required to take/use to treat an illness or condition is included in the World Anti-Doping Agency’s (WADA) Prohibited List, a Therapeutic Use Exemption (TUE) may give that athlete the authorization to take a substance or use a method that is prohibited.

A TUE is a certificate is granted for a set prohibited substance, in certain dosages, with a limited period of validity. An application for a TUE must be based on a documented medical condition and diagnosis and the TUE will only be granted under strict criteria laid out in the WADA International Standard for Therapeutic Use Exemptions (ISTUE).

Athletes must absolutely avoid taking a medication with a prohibited substance without a valid TUE.

Applications for TUEs are reviewed by a panel of experts, the TUE Committee (TUEC) who may give such permission.

What are the criteria for granting a TUE?

All of the four following criteria must be met (for more details, please refer to the WADA International Standard for Therapeutic Use Exemptions (ISTUE) Article 4.1):

1. The athlete has a clear diagnosed medical condition which requires treatment using a prohibited substance or method;
2. The therapeutic use of the substance would not produce significant enhancement of performance beyond the athlete’s normal state of health;
3. There is no reasonable therapeutic alternative to the use of the prohibited substance or method;
4. The necessity to use that substance or method is not a consequence of the prior use (without a TUE), of a substance or method which was prohibited at the time of use.

Who should apply for a TUE ? Where and when to apply?

First, check if the required medication or method you intend to take, or use is prohibited as per the WADA Prohibited List.

You can also check your medication online via a website such as Global DRO or ask your National Anti-Doping Organization (NADO) if it has one (the list of NADOs is available here).

You have the responsibility to inform your doctors that you are an athlete subject to doping control, and your doctors should check the Prohibited List whenever they prescribe a medication / method to you. If the substance / method is prohibited, check with your doctors if there are any alternative treatments that are not prohibited. If not, you have to apply for a TUE.

Second, check your competition level to determine to which organization, and when to apply for a TUE.

==> If you are an International-Level Athlete, you must apply to IFS in advance, as soon as the need arises, unless there are emergency or exceptional circumstances.

International-Level Athlete:

a) Athletes included in the IFS’s Registered Testing Pool and Testing Pool or any other Pool established by IFS.

b) Athletes who compete in any of the following International Events: Sumo World Championships, The World Games, World Combat Games.

For substances prohibited in-competition only, you should apply for a TUE at least 30 days before your next competition. Please refer to the section “How to apply to IFS for a TUE?” below.

If you already have a TUE granted by your National Anti-Doping Organization (NADO)

Your NADO’s TUE is only valid at the national level, and you must submit a request for recognition to the IFS. Please refer to the section How to submit a request for recognition of your NADO’s TUE to the IFS” below.

If you are NOT an International-Level Athlete and you have been tested by IFS, IFS recognizes a valid TUE granted by your NADO (i.e., it satisfies the ISTUE criteria for granting a TUE). If, moreover, you are also NOT a National-Level Athlete as defined by your NADO and you have been tested by IFS, you must apply for a retroactive TUE to IFS.

Can I get a retroactive TUE?

You may only apply retroactively for a TUE to IFS if:

Your competition level permits (i.e., you are not an International-Level Athlete as defined by IFS nor a National-Level Athlete as defined by your NADO; or
An emergency or urgent treatment of a medical condition was necessary; or
Due to exceptional circumstances, you had insufficient time or opportunity to submit, (or for the TUEC to consider), your application prior to sample collection; or It is agreed, by WADA and by IFS, that fairness requires the grant of a retroactive TUE.

Important note:

Using a prohibited substance before being granted a TUE could result in an Adverse Analytical Finding and a potential anti-doping rule violation.

In case an application for a retroactive TUE is necessary following sample collection, you are strongly advised to have a medical file prepared and ready to submit for evaluation.

How to apply to IFS for a TUE?

IFS encourages TUE applications using the form available in ADAMS, and submitting the required medical file through ADAMS. If you do not have an ADAMS account yet, please contact office2@ifs-sumo.org to have your account set up.

Otherwise, please download the IFS’s TUE Application Form,and once duly completed and signed, send it together with the required medical file to [office2@ifs-sumo.org].

using a password to protect your documents.

Therapeutic Use Exemption application form IFS(docx)

Your TUE application must be submitted in legible English (or French) using capital letters or typing.

The medical file includes:

A comprehensive medical history, including documentation from the original diagnosing physician(s) (where possible);

The results of all examinations, laboratory investigations and imaging studies relevant to the application;

Any costs incurred by the Athlete in making the TUE application and in supplementing it as required by the TUEC are the responsibility of the Athlete.

Any TUE application that is not complete or legible will not be dealt with and will be returned for completion and re-submission.

To assist you and your doctor in providing the correct medical documentation, we suggest consulting the WADA’s Checklists for TUE applications for guidance and support, and Medical Information to Support the Decisions of TUECs for guidance on specific common medical conditions, treatments, substances, etc.

Keep a complete copy of the TUE application form and all medical information submitted in support of your application, and proof that it has been sent.

How to submit a request for recognition of my NADO’s TUE to IFS?

Your request for recognition must be submitted to the IFS in writing quoting your ADAMS TUE reference number. Keep a complete copy of the proof that your request for recognition has been sent to IFS.

It is not necessary to translate all medical information into English. However, an English summary explaining the diagnosis and key information about medical exams, medical tests and treatment plans is required.

Any costs incurred by the Athlete in making the TUE application and in supplementing it as required by the TUEC are the responsibility of the Athlete.

Any request for recognition that is not complete or legible will not be dealt with and will be returned for completion and re-submission.

Keep a complete copy of the proof that your request for recognition has been sent to IFS.

You can also simply submit your request for recognition to IFS, quoting your ADAMS NADO’s TUE reference number, if provided

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

IFS’s TUEC’s decision will be communicated in writing to you within 21 days from the date of receipt of the complete TUE application [or request for recognition], including the required medical information, by IFS.

What about the renewal of my TUE?

Each TUE has a specific duration, at the end of which it expires automatically. Should you need to continue to use the prohibited substance or method, it is your responsibility to submit a new application for a TUE with updated medical information ahead the expiry date, so that there is sufficient time for a decision to be made prior to the expiry of the current TUE.

Important note:

The presence (following sample collection), use, possession or administration of the prohibited substance or method shall be consistent with the terms of your TUE. Therefore, in the event that, after your TUE is granted, you require a materially different dosage, frequency, route or duration of administration, you must apply for a new TUE.

What if my IFS’s TUE application is denied?

A decision to deny a TUE application includes an explanation of the reason(s) for the denial. If it is not clear to you, please contact IFS to understand exactly why the TUE was denied. Sometimes, there may be a critical piece of information, diagnostic test, laboratory results missing, etc. Failing this:

You and/or your NADO may refer the matter to WADA for review no later than 21 days after the decision was rendered by the TUEC by sending the same information that you submitted to your TUEC and on which they based their decision to deny the TUE via registered mail at:

WADA Medical Director

World Anti-Doping Agency

800 Square Victoria

Montreal, H4Z 1B7, QC

Canada

However, WADA is not obliged to proceed with such review. In that case, you and/or your NADO may appeal to the Court of Arbitration for Sport (CAS).

What if my NADO’s TUE is not recognized by IFS?

You and/or your NADO have 21 days to refer the matter WADA for review. You can appeal the decision by sending a registered letter together with the same information that was submitted to your TUEC and on which they based their decision not to recognize the TUE via registered mail at:

WADA Medical Director

World Anti-Doping Agency

800 Square Victoria

Montreal, H4Z 1B7, QC

Canada

Pending WADA’s decision, your NADO’s TUE remains valid for national-level competition and out-of-competition testing only.

If the matter is not referred to WADA for review, the TUE becomes invalid for any purpose when the 21-day review deadline expires.

What about confidentiality?

All the information contained in a TUE application, including the supporting medical information and any other information related to the evaluation of your TUE request is kept strictly confidential and treated in accordance with the Athlete’s Declaration contained in the ADAMS TUE and in the IFS’s TUE Application Form. All members of the TUEC and any other authorized recipients of your TUE request and related information (as described in the Athlete’s Declaration) are subject to a professional or contractual confidentiality obligation.

Please review the terms of the Athlete’s Declaration carefully. In particular, please note that should you wish to revoke the right of the IFS’s TUEC to obtain the information related to your TUE request in accordance with the Athlete’s Declaration, your TUE application will be deemed withdrawn without approval [or recognition] being granted.

Your TUE request-related information will be retained by IFS and any other authorized recipients for no longer than necessary for the purposes stated in the Athlete’s Declaration, in accordance with the International Standard for the Protection of Privacy and Personal Information.

Contact Information

For any further information and questions in relation to IFS’s personal information practices, Please click here to contact us.

If you have a doubt as regards to which organization you should apply for a TUE, or as to the recognition process, or any other question with regard to TUEs, Please click here to contact us.

OTHER USEFUL LINKS:

WADA International Standard for Therapeutic Use Exemptions (ISTUE)

WADA Q&A on Therapeutic Use Exemptions

WADA Checklists for TUE applications

WADA Guidelines for the 2021 International Standard for Therapeutic Use Exemptions (ISTUE)

WADA Anti-Doping Education and Learning (ADEL)

WADA Therapeutic Use Exemptions

list of NADOs