THERAPEUTIC USE EXEMPTIONS (TUE)
Athletes sometimes need to take medication that contains a banned substance - if they get sick or injured, or have an ongoing medical condition that requires treatment, such as asthma or diabetes.
Except in a medical emergency, national and international level athletes must have an approved Therapeutic Use Exemption (TUE) in place BEFORE taking any medication that contains a banned substance. If a national or international level athlete tests positive due to a medication they have taken and they do not have an approved TUE in place, they will likely be charged with an anti-doping rule violation.
TUEs are approved by Anti-Doping Organisations and give athletes permission to take a medication that contains a banned substance .
IMPORTANT: It is the athlete’s responsibility to find out if any medication they want to take contains a banned substance (on the WADA Prohibited List).
If an athlete is being prescribed a medication or undergoing a medical procedure, they must ask their doctor if it involves any banned substances. Where a banned substance is involved, the doctor should then assess if there is an alternative medication (or procedure) that can be administered that does not contain a banned substance. If there is no suitable alternative, the athlete must apply for a TUE.
For more information about TUEs read the World Anti-Doping Agency's Frequently Asked Questions (FAQ) on TUEs
IPC's Role in the TUE Process
The IPC operates as both as a Major Event Organisation (MEO) and an International Federation (IF) for ten Para sports.
As the MEO for major multi-sport events such as the Paralympic Games, the IPC manages the TUE approval process for participating athletes.
As an IF, the IPC receives and processes TUE applications for the ten (10) World Para Sports listed below. Click on the links below for further information about the TUE application process for each sport.
Where to apply for a TUE
National Level Athletes
National Level Athletes must apply to your National Anti-Doping Organisation (NADO) for a TUE (before taking the medication). Athletes should contact their NADO for advice if they are unsure of their status.
International Level Athletes (ILA)
International Level Athletes must apply to their IF for a TUE.
The IPC publishes a list of named athletes and/or specific criteria for International Level Athletes for each sport - click on the links above to go to the sport specific anti-doping page where each list is published.
Athletes who are named on the list, or who meet other criteria for an International Level Athlete, must apply to the IPC for a TUE (before taking the medication).
Athletes who are not International Level Athletes List should contact their NADO to confirm their national status regarding TUE applications.
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 18.104.22.168 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.
TUEs are granted for a specific period of time and do expire. It is the athlete's responsibility to renew their TUE, if required, before it expires.
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: Sport Integrity Australia (SIA)
- 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)