Rules Effective as of 1 January 2009

In light of the new IPC Anti-Doping Code and the new World Anti-Doping Code (WADC) International Standard (IS) for Therapeutic Use Exemptions (TUEs) that will come into force on 1 January 2009, the IPC takes this opportunity to go through the process of applying for a TUE.

Which rules apply for Therapeutic Use Exemption Management?

WADA has adopted an International Standard for the process of granting TUEs. Each International Federation (IF) shall ensure that a process is in place whereby Athletes with a documented medical condition requiring the use of an otherwise Prohibited Substance or Prohibited Method may request a TUE. This process is explained in the IF Anti-Doping Code and other relevant documents the IF has put in place for its TUE Management.

How do I know I need a TUE?

As an athlete, you may have illnesses or conditions that require the use of particular medications that are listed as a Prohibited Substance or Prohibited Method in the WADA Prohibited List.

If the medication you are required to take to treat an illness or condition happens to fall under the Prohibited List, you may request a therapeutic use exemption.

Pending on the sport and the period of medication intake, medication or methods can either be prohibited or not. You should carefully check the provisions in the WADC Prohibited List that applies at the time of medication intake. Different rules may apply for out-of-competition and in-competition periods, and some substances or methods may only be prohibited in particular sports.

Furthermore, a TUE request shall be evaluated in accordance with the following criteria:

• You would experience a significant impairment to health without taking the prohibited substance or prohibited method;
• The therapeutic use of the prohibited substance or prohibited method would not produce significant enhancement of performance;
• There is no reasonable therapeutic alternative to the use of the otherwise prohibited substance or prohibited method. 

Who grants TUEs?

Under the WADC, both International Federations (IFs) and National Anti-Doping Organizations (NADOs) must have a process in place whereby TUE requests can appropriately be dealt with by a panel of independent physicians called a TUE Committee (TUEC).

• TUE applications will be reviewed by the TUEC of the relevant organization;
• You will be notified of the decision taken by the TUEC, and a TUE Certificate will be issued;
• If the TUE is approved, you can only begin treatment from the start date of approval mentioned on the TUE Certificate you receive from the relevant organization;
• A retroactive approval may only be considered in exceptional cases.

You should not start using the substance before the approval date indicated on the TUE Certificate. You would then be using a Prohibited Substance or Prohibited Method without authorization and this could constitute an Anti-Doping Rule Violation (ADRV).

How can I apply for a TUE?

As an athlete, you must follow the subsequent steps:

• Contact your National Federation, International Federation (IF) or NADO; 
• Ask the relevant organisation for the TUE Application Form to be used; 
• Consult your physician and ask him/her: 
• • To fill out the TUE Application; 
  • To provide the required supporting medical documentation, as stated in the WADC International Standard for TUE. Note that there are particular requirements in the case of use of beta-2-agonists and glucocorticosteroids; 
• Forward the TUE Application and medical documentation to your IF or NADO; 
• Please be reminded that the TUE Application should be submitted in a timely manner, but at least 21 days before participating in an event, as stated in the WADC International Standard for TUE (you should check the applicable rules in the IF or NADO).

It is the responsibility of the Athlete to check that all information needed is submitted to the appropriate organization (IF or NADO).

The following significantly slows down the process of TUE Assessment and therefore increases the likelihood of exposure to a potential Anti-Doping Rule Violation (ADRV):

• Unreadable files: Applications should be submitted in English and preference is given to forms filled either by typing or by writing in capital letters; 
• Incomplete files: Make sure that all fields are properly filled out and that the needed medical documentation is added; 
• Statement to the necessity of the otherwise Prohibited Substance or Prohibited Method: The physician should describe why an alternative, permitted medication cannot, or could not, be used in the treatment of
  the medical condition; 
• Absence of signatures: Check that both the physician and the athlete sign off the TUE Application form. Note that in the case of minors, the signature of a parent or legal guardian is mandatory.

Where should I submit my TUE Application?

Please be reminded that you are not allowed to submit your TUE Application to more than one organization. As shown in Figure 1 below, you should submit your TUE Application either to your International Federation (IF) or your National Anti-Doping Organization (NADO), depending on your status as an athlete as well as the sport you
compete in. 

The following are guidelines and clarifications to Figure 1:

• In case of IPC Sports, an international athlete is defined as: “Athlete designated by the IPC as being in the Registered Testing Pool for the IPC”. The list of athletes are included in the IPC RTP.
• In absence of a NADO, a TUE Application needs to be submitted to the IPC;
• Please be reminded that as a Major Event Organizer, the IPC is the sole anti-doping authority for all sports during the period of the Major Event (e.g. Paralympic Games, Paralympic World Cup, Parapan American Games).

Should you have any question or need further clarification, please do not hesitate to contact the IPC Anti-Doping Administration Manager at antidoping@paralympic.org.

The case of Asthma

With the new WADC International Standard for TUE, please be advised that for those of you having asthma and need to use beta-2 agonists and/or glucorticosteroids by inhalation, you will have to follow the following rules:

• If you are an international-level athlete and are part of an international Registered Testing Pool (RTP), you will need to apply for a Standard TUE prior to using the requested substance. The use of inhaled beta-2 agonists and/or inhaled glucocorticosteroids only is allowed with an approved TUE for asthma prior to using the substance.
• If you are an international-level athlete but are not part of an international RTP but are taking part in an international event, it is up to your IF to either deliver a TUE prior to the event or to provide a retroactive TUE in case of an adverse analytical finding (AAF). In the case of IPC Sports, IPC will be in touch with you to check on the retroactive approval of a TUE upon notification of an AAF.
• If you are a national-level athlete, it is up to your NADO to either approve the TUE or to provide a retroactive TUE in case of an AAF.

In any case, you may request a Standard TUE to the applicable organization if you wish to do so.

Please be advised that all international-level athletes need to have an existing and current medical file available should you ask for a TUE retroactively in case of an AAF. If no such current medical file is available, no retroactive TUE can be considered.

The case of non-inhaled non-systemic glucocorticosteroids

In the case of non-inhaled, non-systemic glucocorticosteroids, you will have to provide what WADA identified as a “Minimum Declaration”.

• You will need to submit a simple statement of use mentioning the diagnosis, the substance taken, the route of administration and the contact details of the medical doctor who administered the treatment;
• It is up to the relevant anti-doping organization to ask for more than the “Minimum Declaration”;
• Please be advised that for topical use of glucocorticosteroids, neither a TUE nor a “ Minimum Declaration” is requested.

In the case of submission of a Minimal Declaration to IPC (for IPC Sports only), the IPC Minimal Declaration Form is preferably to be used.

Emergency TUE

Under the provisions of the International Standard for TUE, applications for TUE will not be considered for retroactive approval except in the following situations:

• In cases of emergency treatment or emergency of an acute medical condition;
• In cases of exceptional circumstances where there was insufficient time or opportunity for an athlete to submit, or a TUE Committee to consider, a TUE Application prior to doping control;
• In cases of use of inhaled beta-2 agonists, for whom conditions set forth under the International Standard for TUE apply.

Medical emergencies or acute medical conditions requiring administration of an otherwise Prohibited Substance or Prohibited Method before a TUE Application can be made, are uncommon. Similarly, circumstances requiring expedited consideration of a TUE Application due to imminent competition are infrequent.

Mutual Recognition

The IPC recognizes TUE Certificates issued by NADOs for athletes competing in IPC Sports, with the exception of TUE Certificates for athletes who are member of the IPC Registered Testing Pool (RTP). Athletes who are included in the IPC Registered Testing Pool have to apply to the IPC to retrieve a TUE.

What happens if you have a valid TUE under the provisions of the current Code and International Standards for TUE?

Approved abbreviated TUEs (aTUEs) shall remain valid after the new International Standard for TUE come into force, i.e. after 1 January 2009 but in case the expiry date mentioned on the certificate is after 31 December 2009, the aTUE will come to an end at this date (31 December 2009) at the latest. You will then have to apply for a new TUE application in accordance with the process explained above.

For Standard TUEs that have been approved prior to 1 January 2009, please be advised that no change is to occur in expiry dates.

The IPC TUE Application & Notification Form must be completed by the athlete and medical professional in English and be signed and submitted by the NPC medical representative. Upon receipt of an application, the IPC TUE Committee will consider the circumstances surrounding the application. Sufficient time should be given for the IPC TUE Committee to make their decision. The IPC advises that at least two months are required to process an application, although in many cases it will be less.
It is important to note that the submission of an application does not mean automatic approval and athletes are advised not to use prohibited substances prior to receiving approval from the IPC, wherever possible.