THERAPEUTIC USE EXEMPTIONS (TUE)
Occasionally, athletes may have to take medication that contains a substance on the Prohibited List, to treat an illness or condition. Before taking the medication, they must apply for, and have a Therapeutic Use Exemption (TUE) approved by an Anti-Doping Organisation, which may give them the authorisation to take the needed medicine.
It is important to remember that it is the athlete’s responsibility to find out if any medication they take, to treat an illness or condition, does contain a substance on the WADA Prohibited List. National and International Level athletes must apply for a TUE BEFORE taking the medication (except in a medical emergency).
So if an athlete is prescribed a medication, or is undergoing a medical procedure, they must check with their doctor as to whether it involves any substances that are on the Prohibited List. If the medication/procedure contains a banned substance, the doctor should assess whether there is an alternative medication or procedure (that does not contain a banned substance) that can be used instead. If there is no suitable alternative medication, a TUE should be applied for.
The IPC & TUEs
The IPC functions both as an International Federation (IF) and a Major Event Organisation (MEO).
As an IF, the IPC processes TUEs for the following World Para Sports:
Further information on how to apply for a TUE can also be found on the respective World Para Sport Anti-Doping pages.
The IPC functions as the MEO for some multi-sport competitions such as the Paralympic Games.
Where to apply for a TUE
National Level Athletes
If you are a national level athlete, you apply to your National Anti-Doping Organisation (NADO). Contact your NADO, if you’re unsure about your national status.
International Level Athletes (ILA)
Athletes who have been identified as International Level Athletes, need to apply to the IPC for their Therapeutic Use exemption for the below listed sports.
A full name list of International Level Athletes in each IPC World Para Sport that are required to apply for a TUE to the IPC can be found on the respective World Para Sport anti-doping webpage:
If you are not in the above list, you need to apply to your NADO.
TUE application process
Athletes are required to submit a completed TUE application form with the support of their medical doctor.
An application will only be considered when submitted alongside the following supporting medical evidence:
- Comprehensive medical history and the results of all relevant examinations, laboratory investigations and imaging studies.
- Copies of original reports, letters and specialist reviews
- A detailed summary of any alternative medications tried (including names, dosages, duration of use, and effects) or clinical justification from the prescribing doctor that confirms that in their opinion there are no other reasonable permitted alternatives that exist to treat the medical condition.
- TUE Application form
New applications can be submitted via ADAMS or send via email to: TUE@paralympic.org
Athletes that already have a valid TUE
If you have a TUE from your NADO, it is not valid when competing at the international level unless it is recognised by the IF – or in the case of a major event, is recognised by the Major Event Organisation.
The IPC’s intention is to automatically recognise Therapeutic Use Exemptions (TUEs) from as many National Anti-Doping Organisations (NADOs) and International Federations (IFs) as possible. Unfortunately, at this time, the IPC does not have enough information on many NADOs and IF’s TUE Committees and their processes to make that decision.
Therefore, the IPC will automatically recognise TUEs as follows:
TUEs issued by NADOs and IFs listed below will be eligible for automatic recognition.
This is always subject to the requirement of 2021 World Anti-Doping Code Article 188.8.131.52 that “the TUE meets the criteria set out in the International Standard for Therapeutic Use Exemptions.”
For these NADOs and IFs, all substances will be automatically recognised EXCEPT for the following, which will require review by the IPC TUE Committee:
S0. Non-Approved Substances
S1: Anabolic Agents
S2: Peptide Hormones, Growth Factors, Related Substances and Mimetics
Prohibited Methods: M1, M2 and M3.
In order to best serve athletes, the IPC would like to grow this list with time and as the capacity for TUE processing is enhanced. We are open to hearing from your NADO or IF as to why you should be included on the automatically recognised NADO or IF list. Please submit any applicable information to email@example.com and we will gladly review this information.
An athlete who has received a TUE from her/his National Anti-Doping Organisation, needs to submit a request for recognition of the TUE by the IPC. This can be done by requesting your Anti-Doping Organisation that granted the TUE to make the TUE and supporting materials available via ADAMS to the IPC.
The IPC will only recognise TUEs that are recorded in ADAMS. The IPC may request extra supporting documentation.
Once a TUE has been approved, it is the responsibility of each athlete to renew their TUEs upon expiry, if necessary.
Checklists for Therapeutic Use Exemption (TUE) Applications
The following TUE checklists were designed by the World Anti-Doping Agency (WADA) to provide guidance and support to athletes, their physicians and Anti-Doping Organisations (ADOs) during the TUE application process:
- Attention Deficit Hyperactivity Disorder (ADHD)
- Adrenal Insufficiency
- Asthma- Intrinsic Sleep Disorders
- Cardiovascular Conditions
- Inflammatory Bowel Disease- Sinusitis/Rhinosinusitis
- Intravenous Infusions
- Male Hypogonadism
- Musculoskeletal Conditions
- Neuropathic Pain
- Renal Transplantation
- Intrinsic Sleep Disorders
- Transgender Athletes
International Federation List – Automatic Recognition
- Badminton World Federation (BWF)
- Boccia International Sports Federation (BISFed)
- Cerebral Palsy International Sports and recreation Association (CPIRSA)
- International Blind Sport Federation (IBSA)
- International Canoe Federation (ICF)
- International Cycling Union (UCI)
- International Equestrian Federation (FEI)
- International Federation of Cerebral Palsy Football (IFCPF)
- World Rowing Federation (FISA)
- International Table Tennis Federation (ITTF)
- International Tennis Federation (ITF)
- International Triathlon Union (ITU)
- International Wheelchair and Amputee Sport Federation (IWAS)
- International Wheelchair Basketball Federation (IWBF)
- International Wheelchair Rugby federation
- World Archery (WA) (In addition to the above list, TUEs granted for the use of a beta-blocker (P2) are not eligible for automatic recognition)
- World Curling Federation (WCF)
- World Para Volley (WPV)
- World Taekwondo (WT)
NADO List – Automatic Recognition (Countries)
- Australia: Australian Sports Anti-Doping Authority (ASADA)
- Austria: Nationale Anti-Doping Agentur Austria (NADA)
- Azerbaijan: Azerbaijan National Anti-doping Agency
- Belgium: (Flanders): NADO Flanders
- Belgium: (French Community): French Community NADO
- Bermuda: Bermuda Sport Anti-Doping Authority
- Brazil: Autoridade Brasileira de Controle de Dopagem (ABCD)
- Canada: Canadian Centre for Ethics in Sport (CCES)
- China: China Anti-Doping Agency (CHINADA)
- Colombia: COLDEPORTES (COL-NADO)
- Croatia: Croatian Institute of Public Health
- Czech Republic: Anti-Doping Committee of the Czech Republic
- Denmark: Anti-Doping Denmark (ADD)
- Finland: Finnish Center for Integrity in Sports
- France: Agence française de lutte contre le dopage
- Georgia: Georgian Anti-Doping Agency
- Germany: Nationale Anti-Doping Agentur (NADA)
- Greece: Hellenic National Council for Combating Doping (ESKAN)
- Hungary: Hungarian Anti-Doping Group (HUNADO)
- Ireland: Sport Ireland
- Italy: NADO-Italia
- Japan: Japan Anti-Doping Agency
- Kazakhstan: Kazakhstan National Anti-Doping Organization
- Kenya: Anti-Doping Agency of Kenya
- Korea: Korea Anti-Doping Agency (KADA)
- Latvia: Anti-Doping Bureau of Latvia
- Lithuania: Anti-Doping Agency of Lithuania
- Luxembourg: Agence luxembourgeoise antidopage (ALAD)
- Netherlands: Doping autoriteit – Doping Authority Netherlands
- New Zealand: Drug Free Sport NZ
- Norway: Anti-Doping Norway
- Peru: Comisión Nacional Antidopaje del Peru
- Poland: Polish Anti-Doping Agency (POLADA)
- Portugal: Autoridade Antidopagem de Portugal (ADoP)
- Romania: National Anti-Doping Agency of Romania
- Russia: Russian Anti-Doping Agency 'RUSADA'
- Serbia: Antidoping Agency of Serbia (ADAS)
- Singapore: Anti-Doping Singapore
- Slovakia: Slovak Anti-Doping Agency (SADA)
- Slovenia: Slovenian Anti-Doping Organisation (SLOADO)
- South Africa: South African Institute for Drug Free Sport (SAIDS)
- Spain: Agencia Española de Protección de la Salud en el Deporte (AEPSAD)
- Sweden: Swedish Sports Confederation
- Switzerland: Antidoping Switzerland
- Tunisia: Agence nationale antidopage (ANAD)
- Turkey: Turkish Anti-Doping Commission
- United Kingdom: UK Anti-Doping
- United States of America: US Anti-Doping Agency (USADA)
- Uruguay: Organización Nacional Antidopaje del Uruguay (URU-NADO)