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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.

World Para Alpine Skiing

World Para Athletics

World Para Dance Sport

World Para Ice Hockey

World Para Nordic Skiing (incl cross-country skiing & biathlon)

World Para Powerlifting

World Shooting Para Sport

World Para Snowboard

World Para Swimming

   

 

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 4.4.3.1 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

S.8 Cannabinoids

Meldonium

Prohibited Methods: M1, M2 and M3.

P.1 Beta-Blockers in World Shooting Para Sport only.


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 tue@paralympic.org 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.

TUE Renewal

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:

International Federation List – Automatic Recognition

  1. Badminton World Federation (BWF)
  2. Boccia International Sports Federation (BISFed)
  3. Cerebral Palsy International Sports and recreation Association (CPIRSA)
  4. International Blind Sport Federation (IBSA)
  5. International Canoe Federation (ICF)
  6. International Cycling Union (UCI)
  7. International Equestrian Federation (FEI)
  8. International Federation of Cerebral Palsy Football (IFCPF)
  9. World Rowing Federation (FISA)
  10. International Table Tennis Federation (ITTF)
  11. International Tennis Federation (ITF)
  12. International Triathlon Union (ITU)
  13. International Wheelchair and Amputee Sport Federation (IWAS)
  14. International Wheelchair Basketball Federation (IWBF)
  15. International Wheelchair Rugby federation
  16. 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)
  17. World Curling Federation (WCF)
  18. World Para Volley (WPV)
  19. World Taekwondo (WT)

NADO List – Automatic Recognition (Countries)

  1. Australia: Sport Integrity Australia (SIA)
  2. Austria: Nationale Anti-Doping Agentur Austria (NADA)
  3. Azerbaijan: Azerbaijan National Anti-doping Agency
  4. Belgium: (Flanders): NADO Flanders
  5. Belgium: (French Community): French Community NADO
  6. Bermuda: Bermuda Sport Anti-Doping Authority
  7. Brazil: Autoridade Brasileira de Controle de Dopagem (ABCD)
  8. Canada: Canadian Centre for Ethics in Sport (CCES)
  9. China: China Anti-Doping Agency (CHINADA)
  10. Colombia: COLDEPORTES (COL-NADO)
  11. Croatia: Croatian Institute of Public Health
  12. Czech Republic: Anti-Doping Committee of the Czech Republic
  13. Denmark: Anti-Doping Denmark (ADD)
  14. Finland: Finnish Center for Integrity in Sports
  15. France: Agence française de lutte contre le dopage
  16. Georgia: Georgian Anti-Doping Agency
  17. Germany: Nationale Anti-Doping Agentur (NADA)
  18. Greece: Hellenic National Council for Combating Doping (ESKAN)
  19. Hungary: Hungarian Anti-Doping Group (HUNADO)
  20. Ireland: Sport Ireland
  21. Italy: NADO-Italia
  22. Japan: Japan Anti-Doping Agency
  23. Kazakhstan: Kazakhstan National Anti-Doping Organization
  24. Kenya: Anti-Doping Agency of Kenya
  25. Korea: Korea Anti-Doping Agency (KADA)
  26. Latvia: Anti-Doping Bureau of Latvia
  27. Lithuania: Anti-Doping Agency of Lithuania
  28. Luxembourg: Agence luxembourgeoise antidopage (ALAD)
  29. Netherlands: Doping autoriteit – Doping Authority Netherlands
  30. New Zealand: Drug Free Sport NZ
  31. Norway: Anti-Doping Norway
  32. Peru: Comisión Nacional Antidopaje del Peru
  33. Poland: Polish Anti-Doping Agency (POLADA)
  34. Portugal: Autoridade Antidopagem de Portugal (ADoP)
  35. Romania: National Anti-Doping Agency of Romania
  36. Russia: Russian Anti-Doping Agency 'RUSADA'
  37. Serbia: Antidoping Agency of Serbia (ADAS)
  38. Singapore: Anti-Doping Singapore
  39. Slovakia: Slovak Anti-Doping Agency (SADA)
  40. Slovenia: Slovenian Anti-Doping Organisation (SLOADO)
  41. South Africa: South African Institute for Drug Free Sport (SAIDS)
  42. Spain: Agencia Española de Protección de la Salud en el Deporte (AEPSAD)
  43. Sweden: Swedish Sports Confederation
  44. Switzerland: Antidoping Switzerland
  45. Tunisia: Agence nationale antidopage (ANAD)
  46. Turkey: Turkish Anti-Doping Commission
  47. United Kingdom: UK Anti-Doping
  48. United States of America: US Anti-Doping Agency (USADA)
  49. Uruguay: Organización Nacional Antidopaje del Uruguay (URU-NADO)