How do I get medication I am prescribed approved for sport?

The term ‘strict liability’ in anti-doping matters in sport essentially means that it is the athlete’s responsibility to ensure that anything he/she takes is not in breach of anti-doping regulations. Therefore, athletes taking medication must ensure that the medication is not listed on the World Anti-Doping Code Prohibited List (Prohibited List) or in breach of the relevant International Federations anti-doping rules. 

The World Anti-Doping Code Prohibited List and the IPC Anti-Doping Code can be found here or from the IPC or relevant National Paralympic Committee (NPC).

How can I tell if any of my medication is prohibited?

Firstly, athletes should not assume that the medical professional who prescribes medication has a full understanding of anti-doping related matters. It does not make a medication ‘legal’ in sport just because it is prescribed by a medical professional for a medical condition. 

Athletes must check to see whether or not medication is included in the Prohibited List. There are also a variety of useful resources on the internet, such as the UK Sport drug information database (www.uksport.gov.uk/did/), where a search can be made on the status of a substance in a particular sport. By entering the substance name, the athlete will be informed whether a substance is permitted or prohibited in or out of competition. 

The IPC strongly advises athletes, NPCs, coaches and administrators to check all substances with a medical professional with suitable experience in anti-doping related matters.

What if my doctor says I need the medication to treat my medical condition?

International level athletes with specific medical conditions requiring medication that are prohibited may apply for Therapeutic Use Exemption (TUE), to the relevant International Federation. The IPC has had a TUE process in existence since 1996, formerly known as the Medications Advisory Panel (MAP).

Who do I apply to for exemption?

For the following sports the IPC is the International Federation and therefore for these sports TUE applications should be made to the IPC. 

• Alpine Skiing
• Athletics
• Ice Sledge Hockey 
• Nordic Skiing
• Powerlifting
• Shooting
• Swiming
• Wheelchair Dance Sport

For all other sports, athlete should check the relevant rules of the International Federation (eg International Tennis Federation for Wheelchair Tennis).

How do I apply to the IPC to use a prohibited substance ?

The IPC TUE Application & Notification Form is available on the IPC website, from the IPC, or relevant NPCs. It must be completed by the athlete and medical professional in English and be signed and submitted by the NPC medical representative.

On 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 is 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.

How to increase the chances of successful application ?

Only include prohibited substances
Athletes must only make TUE applications for substances that are on the Prohibited List and should not just list all their medication in the application. NPCs, by signing the application form, must also ensure that the application form is completed correctly.

Legible documentation
The NPC or IPC TUE Committee may reject any application incorrectly completed or which is illegible. If it cannot be read, it cannot be approved.

Include good supporting evidence
Any application for therapeutic use exemption must include supporting evidence for the application to be considered. This is important as athletes are asking the IPC to approve the use of a substance that a sport and the World Anti-Doping Agency (WADA) considers inappropriate because of the potential for performance enhancement, fairness of competition or health reasons. Copies of medical records or letters can help clarify why medication is needed.

For example, if a diuretic has been prescribed for high blood pressure, it must be demonstrated why other permitted medication(s) to lower blood pressure could not be used in its place. Evidence from a medical professional outlining what other medication has been tried and why they had to be stopped would help clarify why a diuretic might be permitted in this case.

Conditions for a TUE to be granted

The following reasons must apply:

1. The athletes health would be impaired if the substance were withdrawn.
2. The therapeutic use would produce no additional enhancement of performance.
3. There is no reasonable alternative treatment.

What are abbreviated TUEs ?

WADA has determined that certain substances are ‘restricted’ and athletes need to only notify International Federations of their use. These include Beta-2 Agonists for a diagnosis of asthma (eg. Salbutamol by inhalation only) and glucocorticosteroids by non-systemic routes (ear drops, nasal sprays, eye drops, iontophoresis, and local and intra-articular injections).

Do I need to submit a form for an abbreviated TUEs ?

Beta-2 Agonists and glucocorticosteroids by non-systemic routes are prohibited in-competition. To use these substances in-competition, athletes must complete the IPC TUE Application & Notification Form However, some restricted substances are permitted to be used out-of-competition so if the treatment is short term then it is the athletes responsibility to allow sufficient time before the actual competition to allow the substance to clear so none remains in the body. In all instances, athletes should check with a medical expert with experience in anti-doping in sport.

How will I know if my application has been approved ?

The athlete’s NPC will receive confirmation from the IPC TUE Committee whether a TUE application has been approved and if so a certificate will be issued. In instances where an application is denied a letter of notification will be sent to the NPC. All communication from the IPC is through the NPC.  Athletes have the right to request WADA to review any decision made by the IPC. 

Is this a lifelong approval ?

For applications that are approved, the approval will be for a limited period of time (eg. 2 years). This period will be identified on the certificate.  Athletes will therefore need to seek further approval prior to the expiry of the existing certificate.

Where can I get more information on TUEs and Anti-Doping ?

The IPC Anti-Doping Code is available here or from the IPC or relevant NPC.  Article 6 details all rules and regulations regarding TUEs.

WADA has a variety of information available on their website specifically for athletes in their Athlete's Corner.

Remember it is the athlete who will suffer from an incorrectly completed application. An anti-doping rule violation may result if the substance is detected after sample collection without approval. Athletes are advised to treat the matter of TUEs very seriously and in all instances seek expert advice.

IPC Contact Details

Sophie Berwick
IPC Anti-Doping Administration Manager
Adenauerallee 212 - 214
53113 Bonn, Germany
Phone: +49-228-2097-130
Fax: +49-228-2097-209
E-mail: antidoping@paralympic.org