THERAPEUTIC USE EXEMPTIONS (TUEs)
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 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).
As the MEO for major multi-sport events such as the Paralympic Games, the IPC manages the TUE approval process for all participating athletes.
As the IF for the World Para sports listed below, the IPC receives and processes TUE applications from International Level athletes.
Where to Apply for a TUE
Where (and when) an athlete must apply for a TUE depends on their status as a national or international level athlete.
National Level Athletes
National Level Athletes must apply to their National Anti-Doping Organisation (NADO) for a TUE before taking the medication. Athletes should contact their NADO for advice if unsure of their status and about the application process.
International Level Athletes
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 of the World Para sports for which it is the IF - click on the links above to go to the sport specific anti-doping page where the International Level Athlete criteria is published.
Athletes who are specifically named on the International Level Athletes list, or who meet other criteria for being an International Level Athlete, must apply to the IPC for a TUE BEFORE taking the medication.
If an athlete does not meet the IPC's International Level Athlete criteria, they should contact their NADO to confirm their status and requirements regarding TUEs. Athletes who are neither National or International Level Athletes are not required to apply for a TUE unless they return a positive test. In this situation, a retroactive application must still meet all the requirements for approval.
TUE Application Process
Applications will only be considered if submitted with the following supporting medical evidence:
- Comprehensive athlete medical history including 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 their opinion that there are no other reasonable permitted alternatives that exist to treat the medical condition.
If a TUE is granted you will receive confirmation from the IPC with conditions about the dosage, frequency, route of administration and duration for use of the medication. If any of these conditions such as the dosage should change, the athlete must inform the IPC.
If a TUE is not granted, athletes can ask WADA to review the application or appeal in line with the relevant IPC's anti-doping rules.
TUE Application Checklists
The following TUE checklists, developed by the World Anti-Doping Agency, provide guidance to athletes, physicians and Anti-Doping Organisations (ADOs) on the requirements for a TUE application that will enable the TUE Committee to assess whether the relevant criteria for approval have been met.
- 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
Renewing an Existing TUE
TUEs are only approved for a specific period of time and will eventually expire. It is the athlete's responsibility to renew the TUE, if required, before it expires. A new TUE application form needs to be completed and submitted, together with a new medical report confirming the diagnosis and the outcome of any further investigations conducted (since the previous application).
Recognising Existing TUEs
When competing at the international level, if an athlete's TUE was issued by a NADO, it is only valid if it has been recognised by the responsible IF – or in the case of a major event, if the TUE has been recognised by the responsible MEO.
The IPC’s will automatically recognise TUEs issued by NADOs and IFs, where it has enough information about their TUE processes to make that decision - EXCEPT any TUEs approved for the substances listed below, which will require a review by the IPC's TUE Committee.
- S0. Non-Approved Substances
- S1: Anabolic Agents
- S2: Peptide Hormones, Growth Factors, Related Substances and Mimetics
- S.8 Cannabinoids
- Prohibited Methods: M1, M2 and M3
- P.1 Beta-Blockers (World Shooting Para Sport only)
- P.2 Beta-Blockers (World Archery Para Sport only)
An athlete who has received a TUE from her/his NADO, must submit a request for recognition of the TUE by the IPC. This is done by asking the Anti-Doping Organisation that approved the TUE to make the TUE and supporting materials available to the IPC via ADAMS .
The IPC will only recognise TUEs that are recorded in ADAMS.
Note: TUE recognition by IPC remains subject to Article 126.96.36.199 of the 2021 World Anti-Doping Code, which requires that “the TUE meets the criteria set out in the International Standard for Therapeutic Use Exemptions”. The IPC may request extra supporting documentation.
TUEs approved by the IFs and NADOs listed below are automatically recognised by the IPC (subject to the exceptions above).
If a NADO or IF wishes to be included on the automatic recognition list below, please submit applicable information to email@example.com for review.