January 2009

International Standard for Therapeutic Use Exemptions
The International Standard for Therapeutic Use Exemptions was first adopted in 2004
and became effective in 2005. The enclosed represents version 3.0 that incorporates
revisions to the International Standard for Therapeutic Use Exemptions that wereapproved by the World Anti-Doping Agency Executive Committee on 10 May and 20
September 2008. The revised International Standard for Therapeutic Use Exemptions
is effective as of 1 January 2009.
Published on 1 October 2008 by:World Anti-Doping Agency
Stock Exchange Tower
800 Place Victoria (Suite 1700)
PO Box 120
Montreal, Quebec,
Canada H4Z 1B7
URL: www.wada-ama.org
Tel:+1 514 904 9232
Fax: +1 514 904 8650
E-mail:info@wada-ama.org

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PREAMBLE
The World Anti-Doping Code International Standard for Therapeutic Use
Exemptions (TUE) is a level 2 mandatory International Standard developed
as part of the World Anti-Doping Program.
The basis for the development of the International Standard for TUE has
been a review of various procedures and protocols of International
Federations, the IOC, National Anti-Doping Organizations and relevant
sections in the revised International Standard for Doping Control (ISDC). A
WADA expert reference group reviewed, discussed and prepared the
document following wide consultation and consideration of submissions.
The official text of the International Standard for Therapeutic Use Exemption
shall be maintained by WADA and shall be published in English and French.
In the event of any conflict between the English and French versions, theEnglish version shall prevail.
The International Standard for TUE (version 3.0) will come into effect on 1
January 2009.

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TABLE OF CONTENTSPART ONE: INTRODUCTION, CODE PROVISIONS AND DEFINITIONS . 5
1.0

Introduction and Scope...................................................................... 5

2.0

Code Provisions ................................................................................ 6

3.0

Terms and Definitions........................................................................ 8
3.1 Defined Terms from the Code....................................................... 8
3.2 Defined Terms from the International Standard for TUEs.................12PART TWO: STANDARDS FOR GRANTING THERAPEUTIC USE
EXEMPTIONS ................................................................................... 13
4.0

Criteria for Granting a Therapeutic Use Exemption ................................13

5.0.

Confidentiality of Information ............................................................14

6.0

Therapeutic Use Exemption Committees (TUECs)..................................15

7.0

Therapeutic Use Exemption (TUE) Application Process ...........................15

8.0 Declaration of Use Process ....................................................................18
9.0 Clearinghouse .....................................................................................18
10.0 Transitional provision..........................................................................18

ANNEX 1: ......................................................................................... 20
Minimal requirements for the medical file to be used for the TUE process in thecase of asthma and its clinical variants ..........................................................20

ANNEX 2: ......................................................................................... 21
Therapeutic use exemption application form...................................................21

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PART ONE: INTRODUCTION, CODE PROVISIONS AND
DEFINITIONS
1.0

Introduction and Scope

The purpose of the International Standard for TUE is to ensure that theprocess of granting therapeutic use exemptions is harmonized across sports
and countries.
The Code permits Athletes and their physicians to apply for therapeutic use
exemptions (TUE) i.e. permission to use, for therapeutic purposes,
substances or methods contained in the List of Prohibited Substances or
Methods whose Use is otherwise prohibited.
The International Standard for TUE includes criteria for granting a TUE,
confidentiality of information, the formation of Therapeutic Use Exemptions
Committees and the TUE application process.
This Standard applies to all Athletes as defined by and subject to the Codei.e. able-bodied Athletes and Athletes with disabilities.
The World Anti-Doping Program encompasses all of the elements needed inorder to ensure optimal harmonization and best practice in international andnational anti-doping programs. The main elements are: the Code (Level 1),
International Standards (Level 2), and Models of Best Practice (Level 3).
In the introduction to the Code, the purpose and implementation of theInternational Standards are summarized as follows:“International Standards for different technical and operational areas within
the anti-doping program will be developed in consultation with the Signatories
and governments and approved by WADA. The purpose of the International
Standards is harmonization among Anti-Doping Organizations responsible for
specific technical and operational parts of the anti-doping programs.
Adherence to the International Standards is mandatory for compliance with
the Code. The International Standards may be revised from time to time by
the WADA Executive Committee after reasonable consultation with the
Signatories and governments.
Unless provided otherwise in the Code,International Standards and all revisions shall become effective on the datespecified in the International Standard or revision.”

Compliance with an International Standard (as opposed to anotheralternative standard, practice or procedure) shall be sufficient to conclude
that the procedures covered by the International Standard were performed
properly.
Definitions specified in the Code are written in italics. Additional definitions
specific to the International Standard for TUE are underlined.
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2.0 Code Provisions
The following articles of the Code directly address the International Standard
for TUE:
Code Article 4.4

Therapeutic Use

WADA has adopted an International Standard for the process of granting
therapeutic use exemptions.
Each International Federation shall ensure, for International-Level
Athletes or any other Athlete who is entered in an International Event,that a process is in place whereby Athletes with documented medical
conditions requiring the Use of a Prohibited Substance or a Prohibited
Method may request a therapeutic use exemption. Athletes who havebeen identified as included in their International Federation’s Registered
Testing Pool may only obtain therapeutic use exemptions in accordancewith the rules of their International Federation. Each International
Federation shall publish a list of those International Events for which atherapeutic use exemption from the International Federation is required.
Each National Anti-Doping Organization shall ensure, for all Athletes
within its jurisdiction that have not been included in an International
Federation Registered Testing Pool, that a process is in place whereby
Athletes with documented medical conditions requiring the Use of a
Prohibited Substance or a Prohibited Method may request a therapeuticuse exemption. Such requests shall be evaluated in accordance with theInternational Standard for Therapeutic Use Exemptions. International
Federations and National Anti-Doping Organizations shall promptly report
to WADA through ADAMS the granting of any therapeutic use exemption
except as regards national-level Athletes who are not included in the
National Anti-Doping Organization's Registered Testing Pool.
WADA, on its own initiative, may review at any time the granting of atherapeutic use exemption to any International-Level Athlete or nationallevel Athlete who is included in his or her National Anti-Doping
Organization's Registered Testing Pool. Further, upon the request of any
such Athlete who has been denied a therapeutic use exemption, WADA
may review such denial. If WADA determines that such granting or
denial of a therapeutic use exemption did not comply with theInternational Standard for Therapeutic Use Exemptions, WADA may
reverse the decision.
If, contrary to the requirement of this Article, an International Federation
does not have a process in place where Athletes may request therapeuticuse exemptions, an International-Level Athlete may request WADA toreview the application as if it had been denied.
Presence of a Prohibited Substance or its Metabolites or Markers(Article 2.1), Use or Attempted Use of a Prohibited Substance or aInternational Standard for Therapeutic Use Exemptions
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Prohibited Method (Article 2.2), Possession of Prohibited Substances andProhibited Methods (Article 2.6) or Administration or Attempted
Administration of a Prohibited Substance or Prohibited Method(Article 2.8) consistent with the provisions of an applicable therapeuticuse exemption issued pursuant to the International Standard for
Therapeutic Use Exemptions shall not be considered an anti-doping ruleviolation.
Code Article 13.4
Appeals from Decisions Granting or Denying a
Therapeutic Use Exemption
Decisions by WADA reversing the grant or denial of a therapeutic use
exemption may be appealed exclusively to CAS by the Athlete or the
Anti-Doping Organization whose decision was reversed. Decisions by
Anti-Doping Organizations other than WADA denying therapeutic use
exemptions, which are not reversed by WADA, may be appealed byInternational-Level Athletes to CAS and by other Athletes to thenational-level reviewing body described in Article 13.2.2. If the nationallevel reviewing body reverses the decision to deny a therapeutic use
exemption, that decision may be appealed to CAS by WADA.
When an Anti-Doping Organization fails to take action on a properly
submitted therapeutic use exemption application within a reasonable
time, the Anti-Doping Organization’s failure to decide may be considereda denial for purposes of the appeal rights provided in this Article.
Code Article 14.5

Doping Control Information Clearinghouse

WADA shall act as a central clearinghouse for Doping Control Testingdata and results for International-Level Athletes and national-level
Athletes who have been included in their National Anti-Doping
Organization's Registered Testing Pool. To facilitate coordinated test
distribution planning and to avoid unnecessary duplication in Testing by
the various Anti-Doping Organizations, each Anti-Doping Organization
shall report all In-Competition and Out-of-Competition tests on such
Athletes to the WADA clearinghouse as soon as possible after such tests
have been conducted. This information will be made accessible to the
Athlete, the Athlete's National Federation, National Olympic Committeeor National Paralympic Committee, National Anti-Doping Organization,
International Federation, and the International Olympic Committee orInternational Paralympic Committee.
To enable it to serve as a clearinghouse for Doping Control Testing data,
WADA has developed a database management tool, ADAMS, that reflects
emerging data privacy principles. In particular, WADA has developed
ADAMS to be consistent with data privacy statutes and norms applicable
to WADA and other organizations using ADAMS.
Private information regarding an Athlete, Athlete Support Personnel, orothers involved in anti-doping activities shall be maintained by WADA,
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which is supervised by Canadian privacy authorities, in strict confidence
and in accordance with the International Standard for the protection ofprivacy. WADA shall, at least annually, publish statistical reportssummarizing the information that it receives, ensuring at all times thatthe privacy of Athletes is fully respected and make itself available fordiscussions with national and regional data privacy authorities.
Code Article 15.4

Mutual Recognition

15.4.1 Subject to the right to appeal provided in Article 13, Testing,therapeutic use exemptions and hearing results or other final
adjudications of any Signatory which are consistent with the Code andare within that Signatory's authority, shall be recognized and respectedby all other Signatories.
[Comment to Article 15.4.1: There has in the past been some confusion in theinterpretation of this Article with regard to therapeutic use exemptions. Unlessprovided otherwise by the rules of an International Federation or an agreement withan International Federation, National Anti-Doping Organizations do not have“authority” to grant therapeutic use exemptions to International-Level Athletes.]

15.4.2 Signatories shall recognize the same actions of other bodies
which have not accepted the Code if the rules of those bodies areotherwise consistent with the Code.
[Comment to Article 15.4.2: Where the decision of a body that has not accepted theCode is in some respects Code compliant and in other respects not Code compliant,Signatories should attempt to apply the decision in harmony with the principles of
the Code. For example, if in a process consistent with the Code a non-Signatory has
found an Athlete to have committed an anti-doping rule violation on account of thepresence of a Prohibited Substance in his body but the period of Ineligibility appliedis shorter than the period provided for in the Code, then all Signatories should
recognize the finding of an anti-doping rule violation and the Athlete’s National AntiDoping Organization should conduct a hearing consistent with Article 8 to determine
whether the longer period of Ineligibility provided in the Code should be imposed.]

3.0 Terms and Definitions
3.1

Defined Terms from the CodeADAMS: The Anti-Doping Administration and Management System is a Webbased database management tool for data entry, storage, sharing, andreporting designed to assist stakeholders and WADA in their anti-doping
operations in conjunction with data protection legislation.
Adverse Analytical Finding: A report from a laboratory or other WADAapproved entity that, consistent with the International Standard forLaboratories and related Technical Documents, identifies in a Sample thepresence of a Prohibited Substance or its Metabolites or Markers (includingInternational Standard for Therapeutic Use Exemptions
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elevated quantities of endogenous substances) or evidence of the Use of a
Prohibited Method.
Anti-Doping Organization: A Signatory that is responsible for adopting
rules for initiating, implementing or enforcing any part of the Doping Control
process. This includes, for example, the International Olympic Committee,
the International Paralympic Committee, other Major Event Organizations
that conduct Testing at their Events, WADA, International Federations, andNational Anti-Doping Organizations.
Athlete: Any Person who participates in sport at the international level (asdefined by each International Federation), the national level (as defined byeach National Anti-Doping Organization, including but not limited to those
Persons in its Registered Testing Pool), and any other competitor in sport
who is otherwise subject to the jurisdiction of any Signatory or other sports
organization accepting the Code. All provisions of the Code, including, forexample, Testing and therapeutic use exemptions, must be applied tointernational- and national-level competitors. Some National Anti-Doping
Organizations may elect to test and apply anti-doping rules to recreationallevel or masters competitors who are not current or potential national caliber
competitors. National Anti-Doping Organizations are not required, however,to apply all aspects of the Code to such Persons. Specific national rules may
be established for Doping Control for non-international-level or non-nationallevel competitors without being in conflict with the Code. Thus, a country
could elect to test recreational-level competitors but not require therapeuticuse exemptions or whereabouts information. In the same manner, a Major
Event Organization holding an Event only for masters-level competitors could
elect to test the competitors but not require advance therapeutic use
exemptions or whereabouts information.
For purposes of Article 2.8(Administration or Attempted Administration) and for purposes of anti-doping
information and education, any Person who participates in sport under theauthority of any Signatory, government, or other sports organization
accepting the Code is an Athlete.
[Comment: This definition makes it clear that all international- and national-caliber
Athletes are subject to the anti-doping rules of the Code, with the precise definitionsof international- and national-level sport to be set forth in the anti-doping rules of
the International Federations and National Anti-Doping Organizations, respectively.
At the national level, anti-doping rules adopted pursuant to the Code shall apply, at aminimum, to all persons on national teams and all persons qualified to compete inany national championship in any sport. That does not mean, however, that all such
Athletes must be included in a National Anti-Doping Organization’s Registered
Testing Pool. The definition also allows each National Anti-Doping Organization, if itchooses to do so, to expand its anti-doping program beyond national-caliber Athletes
to competitors at lower levels of competition.
Competitors at all levels ofcompetition should receive the benefit of anti-doping information and education.]

Code: The World Anti-Doping Code.
Competition: A single race, match, game or singular athletic contest. For
example, a basketball game or the finals of the Olympic 100-meter race inInternational Standard for Therapeutic Use Exemptions
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athletics. For stage races and other athletic contests where prizes areawarded on a daily or other interim basis the distinction between a
Competition and an Event will be as provided in the rules of the applicable
International Federation.
Doping Control: All steps and processes from test distribution planning
through to ultimate disposition of any appeal including all steps andprocesses in between such as provision of whereabouts information, Sample
collection and handling, laboratory analysis, therapeutic use exemptions,
results management and hearings.
Event: A series of individual Competitions conducted together under one
ruling body (e.g., the Olympic Games, FINA World Championships, or Pan
American Games).
Event Period: The time between the beginning and end of an Event, asestablished by the ruling body of the Event.
In-Competition: Unless provided otherwise in the rules of an International
Federation or other relevant Anti-Doping Organization, “In-Competition”
means the period commencing twelve hours before a Competition in which
the Athlete is scheduled to participate through the end of such Competition
and the Sample collection process related to such Competition.
International Event:
An Event where the International Olympic
Committee, the International Paralympic Committee, an International
Federation, a Major Event Organization, or another international sportorganization is the ruling body for the Event or appoints the technical officials
for the Event.
International-Level Athlete:
Athletes designated by one or moreInternational Federations as being within the Registered Testing Pool for an
International Federation.
International Standard: A standard adopted by WADA in support of theCode. Compliance with an International Standard (as opposed to anotheralternative standard, practice or procedure) shall be sufficient to conclude
that the procedures addressed by the International Standard were performed
properly. International Standards shall include any Technical Documents
issued pursuant to the International Standard.

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National Anti-Doping Organization: The entity(ies) designated by eachcountry as possessing the primary authority and responsibility to adopt andimplement anti-doping rules, direct the collection of Samples, themanagement of test results, and the conduct of hearings, all at the national
level. This includes an entity which may be designated by multiple countries
to serve as regional Anti-Doping Organization for such countries. If thisdesignation has not been made by the competent public authority(ies), theentity shall be the country's National Olympic Committee or its designee.
National Event: A sport Event involving international- or national-level
Athletes that is not an International Event.
Out-of-Competition: Any Doping Control which is not In-Competition.
Prohibited List: The List identifying the Prohibited Substances andProhibited Methods.
Prohibited Method: Any method so described on the Prohibited List.
Prohibited Substance: Any substance so described on the Prohibited List.
Registered Testing Pool:
The pool of top-level Athletes establishedseparately by each International Federation and National Anti-Doping
Organization who are subject to both In-Competition and Out-of-Competition
Testing as part of that International Federation's or National Anti-Doping
Organization's test distribution plan. Each International Federation shall
publish a list which identifies those Athletes included in its Registered Testing
Pool either by name or by clearly defined, specific criteria.
Signatories: Those entities signing the Code and agreeing to comply with
the Code, including the International Olympic Committee, International
Federations, International Paralympic Committee, National Olympic
Committees, National Paralympic Committees, Major Event Organizations,
National Anti-Doping Organizations, and WADA.
Testing: The parts of the Doping Control process involving test distribution
planning, Sample collection, Sample handling, and Sample transport to thelaboratory.
Use: The utilization, application, ingestion, injection or consumption by anymeans whatsoever of any Prohibited Substance or Prohibited Method.
WADA: The World Anti-Doping Agency.

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3.2

Defined Terms from the International Standard for TUEs

Retroactive TUE: Therapeutic use exemption approved by a Therapeutic
Use Exemption Committee based on a documented medical file after alaboratory has reported an Adverse Analytical Finding (AAF).
Therapeutic: Of or relating to the treatment of a medical condition by
remedial agents or methods; or providing or assisting in a cure.
TUE: Therapeutic use exemption approved by a Therapeutic Use Exemption
Committee based on a documented medical file before the Use of thesubstance in sports.
TUEC: Therapeutic Use Exemption Committee is the Panel established by therelevant Anti-Doping Organization.
WADA TUEC: WADA Therapeutic Use Exemption Committee is the Panelestablished by WADA.

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PART TWO: STANDARDS FOR GRANTINGTHERAPEUTIC USE EXEMPTIONS
4.0 Criteria for Granting a Therapeutic Use Exemption
A therapeutic use exemption (TUE) may be granted to an Athlete permitting
the Use of a Prohibited Substance or Prohibited Method contained in theProhibited List. An application for a TUE will be reviewed by a Therapeutic
Use Exemption Committee (TUEC). The TUEC will be appointed by an AntiDoping Organization. An exemption will be granted only in strict accordancewith the following criteria:[Comment: This Standard can apply to all Athletes as defined by and subject to theCode, i.e. able-bodied Athletes and Athletes with disabilities. This Standard will beapplied according to an individual’s circumstances. For example, an exemption that is
appropriate for an Athlete with a disability may be inappropriate for other Athletes.]

4.1 The Athlete should submit an application for a TUE no less thantwenty-one (21) days before he/she needs the approval (for instance an
Event).
4.2 The Athlete would experience a significant impairment to health if theProhibited Substance or Prohibited Method were to be withheld in the courseof treating an acute or chronic medical condition.
4.3 The therapeutic Use of the Prohibited Substance or Prohibited Method
would produce no additional enhancement of performance other than thatwhich might be anticipated by a return to a state of normal health following
the treatment of a legitimate medical condition. The Use of any Prohibited
Substance or Prohibited Method to increase “low-normal” levels of any
endogenous hormone is not considered an acceptable therapeuticintervention.
4.4 There is no reasonable therapeutic alternative to the Use of theotherwise Prohibited Substance or Prohibited Method.
4.5 The necessity for the Use of the otherwise Prohibited Substance or
Prohibited Method cannot be a consequence, wholly or in part, of prior nontherapeutic Use of any substance from the Prohibited List.
4.6

The TUE will be cancelled by the granting body, if:
a. The Athlete does not promptly comply with any requirements orconditions imposed by the Anti-Doping Organization granting the
exemption.
b. The term for which the TUE was granted has expired.

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c.

The Athlete is advised that the TUE has been withdrawn by theAnti-Doping Organization.

[Comment: Each TUE will have a specified duration as decided upon by the TUEC.
There may be cases when a TUE has expired or has been withdrawn and theProhibited Substance subject to the TUE is still present in the Athlete’s body. In suchcases, the Anti-Doping Organization conducting the initial review of an adverse
analytical finding will consider whether the finding is consistent with expiry or
withdrawal of the TUE.]

4.7 An application for a TUE will not be considered for retroactive approval
except in cases where:a. Emergency treatment or treatment of an acute medical condition
was necessary, orb. due to exceptional circumstances, there was insufficient time oropportunity for an applicant to submit, or a TUEC to consider, anapplication prior to Doping Control, orc. the conditions set forth under 7.13 apply.
[Comment: Medical emergencies or acute medical situations requiring administrationof an otherwise Prohibited Substance or Prohibited Method before an application for a
TUE can be made, are uncommon. Similarly, circumstances requiring expeditedconsideration of an application for a TUE due to imminent competition are infrequent.
Anti-Doping Organizations granting TUEs should have internal procedures which
permit such situations to be addressed.]

5.0. Confidentiality of Information
5.1 The applicant must provide written consent for the transmission of all
information pertaining to the application to members of the TUEC and, as
required, other independent medical or scientific experts, or to all necessary
staff involved in the management, review or appeal of TUEs.
Should the assistance of external, independent experts be required, alldetails of the application will be circulated without identifying the Athlete
concerned. The applicant must also provide written consent for the decisionsof the TUEC to be distributed to other relevant Anti-Doping Organizations
under the provisions of the Code.
5.2 The members of the TUECs and the administration of the Anti-Doping
Organization involved will conduct all of their activities in strict confidence. All
members of a TUEC and all staff involved will sign confidentiality
agreements. In particular they will keep the following information
confidential:

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a. All medical information and data provided by the Athlete andphysician(s) involved in the Athlete’s care.
b. All details of the application including the name of the physician(s)involved in the process.
Should the Athlete wish to revoke the right of the TUEC or the WADA TUEC toobtain any health information on his/her behalf, the Athlete must notify
his/her medical practitioner in writing of the fact. As a consequence of such a
decision, the Athlete will not receive approval for a TUE or renewal of an
existing TUE.

6.0 Therapeutic Use Exemption Committees (TUECs)
TUECs shall be constituted and act in accordance with the following
guidelines:
6.1 TUECs should include at least three (3) physicians with experience inthe care and treatment of Athletes and a sound knowledge of clinical, sports
and exercise medicine. In order to ensure a level of independence ofdecisions, the majority of the members of any TUEC should be free ofconflicts of interest or political responsibility in the Anti-Doping Organization.
All members of a TUEC will sign a conflict of interest agreement. In
applications involving Athletes with disabilities, at least one TUEC member
must possess specific experience with the care and treatment of Athleteswith disabilities.
6.2 TUECs may seek whatever medical or scientific expertise they deem
appropriate in reviewing the circumstances of any application for a TUE.
6.3 The WADA TUEC shall be composed following the criteria set out in
Article 6.1. The WADA TUEC is established to review on its own initiative TUE
decisions granted by Anti-Doping Organizations. As specified in Article 4.4 of
the Code, the WADA TUEC, upon request by Athletes who have been denied
TUEs by an Anti-Doping Organization, will review such decisions with thepower to reverse them.

7.0 Therapeutic Use Exemption (TUE) Application
Process
7.1 A TUE will only be considered following the receipt of a completed
application form that must include all relevant documents (see Annex 2 –TUE form). The application process must be dealt with in accordance with theprinciples of strict medical confidentiality.

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7.2 The TUE application form(s), as set out in Annex 2, can be modified by
Anti-Doping Organizations to include additional requests for information, but
no sections or items shall be removed.
7.3 The TUE application form(s) may be translated into other language(s)by Anti-Doping Organizations, but English or French must remain on theapplication form(s).
7.4 An Athlete may not apply to more than one Anti-Doping Organization
for a TUE. The application must identify the Athlete’s sport and, whereappropriate, discipline and specific position or role.
7.5 The application must list any previous and/or current requests for
permission to use an otherwise Prohibited Substance or Prohibited Method,
the body to whom that request was made, and the decision of that body.
7.6 The application must include a comprehensive medical history and theresults of all examinations, laboratory investigations and imaging studies
relevant to the application. The arguments related to the diagnosis andtreatment, as well as duration of validity, should follow the WADA “Medical
Information to Support the Decisions of TUECs”. For asthma, the specificrequirement(s) set out in Annex 1 must be fulfilled.
7.7 Any additional relevant investigations, examinations or imaging studies
requested by the TUEC of the Anti-Doping Organization before approval will
be undertaken at the expense of the applicant or his/her national sport
governing body.
7.8 The application must include a statement by an appropriately qualified
physician attesting to the necessity of the otherwise Prohibited Substance or
Prohibited Method in the treatment of the Athlete and describing why analternative, permitted medication cannot, or could not, be used in thetreatment of this condition.
7.9 The dose, frequency, route and duration of administration of theotherwise Prohibited Substance or Prohibited Method in question must be
specified. In case of change, a new application should be submitted.
7.10 In normal circumstances, decisions of the TUEC should be completed
within thirty (30) days of receipt of all relevant documentation and will be
conveyed in writing to the Athlete by the relevant Anti-Doping Organization.
In case of a TUE application made in a reasonable time limit prior to an Event
the TUEC should use its best endeavors to complete the TUE process before
the start of the Event. Where a TUE has been granted to an Athlete in theAnti-Doping Organization Registered Testing Pool, the Athlete and WADA will
be provided promptly with an approval which includes information pertaining
to the duration of the exemption and any conditions associated with the TUE.
7.11 a. Upon receiving a request by an Athlete for review, the WADA TUEC
will, as specified in Article 4.4 of the Code, be able to reverse a decision on a
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TUE denied by an Anti-Doping Organization. The Athlete shall provide to the
WADA TUEC all the information for a TUE as submitted initially to the AntiDoping Organization accompanied by an application fee. Until the review
process has been completed, the original decision remains in effect. The
process should not take longer than thirty (30) days following receipt of all
the information by WADA.
b. WADA can, on its own initiative, undertake a review at any time.
7.12 If the decision regarding the granting of a TUE is reversed by WADA
upon review, the reversal shall not apply retroactively and shall not disqualify
the Athlete's results during the period that the TUE had been granted andshall take effect no later than fourteen (14) days following notification of thedecision to the Athlete.
7.13 The Use of inhaled Beta-2 Agonists:- The Use of inhaled formoterol, salbutamol, salmeterol, terbutalinereflects current clinical practice. The Use of these substances should be
declared on ADAMS where reasonably feasible and in accordance with
the Code as soon as the product is used and must as well be declaredon the Doping Control form at the time of Testing. Failure to declare
will be taken into account in the result management process inparticular in case of application for a Retroactive TUE.
- Athletes using the substances listed above by inhalation must have a
medical file justifying this Use and meeting the minimum requirements
outlined in Annex 1.
Depending upon the category of the Athlete, the medical file will
be evaluated as follows:- For all Athletes included in an International Federation Registered
Testing Pool a regular TUE approved before the Use of the substance.
- For Athletes participating in an International Event but who are notincluded in an International Federation Registered Testing Pool either a
TUE, or a Retroactive TUE in the case of an Adverse Analytical Finding,in accordance with the rule of the International Federation or of the
Major Event Organization.
- For national-level Athletes who are not included in an International
Federation Registered Testing Pool, whether or not they are part of anational Registered Testing Pool, either a TUE, or a Retroactive TUE inthe case of an Adverse Analytical Finding, in accordance with the rulesof the National Anti-Doping Organization.
- No Retroactive TUE will be granted if the requirements of Annex 1 are
not met meaning that any Adverse Analytical Finding reported by theInternational Standard for Therapeutic Use Exemptions
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laboratory in these circumstances will result in an anti-doping ruleviolation.
- Any Athlete may apply for a TUE at any time if they wish.
- Any Athlete who has applied for a TUE or a Retroactive TUE and who
was denied such TUE may not use the substance without the prior
granting of a TUE (no Retroactive TUE will be permitted).

8.0 Declaration of Use Process
8.1 It is acknowledged that some substances included on the List ofProhibited Substances are used to treat medical conditions frequently
encountered in the athlete population. For monitoring purposes, thesesubstances, for which the route of administration is not prohibited, will
require a simple declaration of use. These are strictly limited to :Glucocorticosteroids used by non systemic routes, namely intraarticular,
periarticular, peritendinous, epidural, intradermal injections and inhaledroute.
8.2 For the mentioned substances, the declaration of Use should be done
through ADAMS where reasonably feasible and in accordance with the Codeby the Athlete at the same time as the Use starts. This declaration should
mention the diagnosis, the name of the substance, the dose undertaken, thename and the contact details of the physician.
In addition, the Athlete must declare the Use of the substance in question on
the Doping Control form.

9.0 Clearinghouse
9.1 Anti-Doping Organisations are required to provide WADA with all TUEs
approved for Athletes who are part of a national or international Registered
Testing Pool, and all supporting documentation, in accordance with section 7.
9.2

The declarations of use should be available to WADA (ADAMS).

9.3

The clearinghouse shall guarantee strict confidentiality of all the
medical information.

10.0 Transitional provision
Abbreviated Therapeutic Use Exemptions (ATUEs) delivered priorDecember 31, 2008 shall remain governed by the 2005 TUE Standard.

toThese ATUEs shall remain valid after January 1, 2009 until the earliest of:International Standard for Therapeutic Use Exemptions
January 200918

(i) The date on which they are cancelled by the competent TUEC following
review in accordance with art. 8.6 of the 2005 TUE Standard ;(ii) Their expiry date as mentioned on the ATUE ;(iii) December 31, 2009.

International Standard for Therapeutic Use Exemptions
January 200919

ANNEX 1:
Minimal requirements for the medical file to be used for the
TUE process in the case of asthma and its clinical variants
The file must reflect current best medical practice to include:1)

A complete medical history

2)

A comprehensive report of the clinical examination with specific focus
on the respiratory system

3)

A report of spirometry with the measure of the Forced Expiratory
Volume in 1 second (FEV1)

4)

If airway obstruction is present, the spirometry will be repeated after
inhalation of a short acting Beta-2 Agonist to demonstrate thereversibility of bronchoconstriction

5)

In the absence of reversible airway obstruction, a bronchial
provocation test is required to establish the presence of airway hyperresponsiveness6)

Exact name, speciality, address (including telephone, e-mail, fax) of
examining physician.

International Standard for Therapeutic Use Exemptions
January 200920

ANNEX 2:
Therapeutic use exemption application form

Identification of Anti-Doping Organization
Application form

(Logo or Name of the ADO)

Therapeutic Use Exemptions
TUE
Please complete all sections in capital letters or typing
1. Athlete Information
Surname: .....................................
Female 

Male Given Names: ………………………………………….

Date of Birth(d/m/y)………………………………………

Address: …………………………………………………………………………………………
City: .................................. Country: ........................... Postcode: …………..
Tel.:………………………………….
……………… E-mail:…………………………………………………………………...
(with international code)

Sport:……… . Discipline/Position: ……………..
International or National Sport Organization:………………………………………………………………………..
If athlete with disability, indicate disability: ………………………………………….

International Standard for Therapeutic Use Exemptions
January 200921

2. Medical information
Diagnosis with sufficient medical information (see note 1):……………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………..
If a permitted medication can be used to treat the medical condition, provide clinicaljustification for the requested use of the prohibited medication……………………………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………………………..

3. Medication details
Prohibited substance(s):Generic name

Dose

Route

Frequency

1.

2.

3.

Intended duration oftreatment:(Please tick appropriate box)

once only emergency or duration (week/month): …………………………………

Have you submitted any previous TUE application:

yes 

no 

For which substance?
…………………………………………………………………………………………………………………
To
whom?…………………………………………………………………….When?………………………………………………
Decision:

Approved 

Not approved International Standard for Therapeutic Use Exemptions
January 200922

4. Medical practitioner’s declaration
I certify that the above-mentioned treatment is medically appropriate and that theuse of alternative medication not on the prohibited list would be unsatisfactory forthis condition.

Name:……………………………………………………................................................
Medical specialty: …………………………………………………………………………………
Address: …………………………………………………………………
Tel.: …………………………………………………………………….
Fax: ………………………………………………………………….…
E-mail: …………………………………………………………………
Signature of Medical Practitioner: ……………………………

Date: ……………….

5. Athlete’s declaration

I, …………………………………………………………………………………. certify that the information under 1. isaccurate and that I am requesting approval to use a Substance or Method from the WADA
Prohibited List. I authorize the release of personal medical information to the Anti-Doping
Organization (ADO) as well as to WADA staff, to the WADA TUEC (Therapeutic Use Exemption
Committee) and to other ADO under the provisions of the Code. I understand that if I everwish to revoke the right of these organizations to obtain my health information on my behalf,
I must notify my medical practitioner and my ADO in writing of that fact.
Athlete’s signature: ..........................................................

Date: …………….

Parent’s/Guardian’s signature: .........................................

Date: ……………..

(if the athlete is a minor or has a disability preventing him/her to sign this form, a parent or guardianshall sign together with or on behalf of the athlete)

International Standard for Therapeutic Use Exemptions
January 200923

6. Note:
Note 1

Diagnosis
Evidence confirming the diagnosis must be attached and forwarded with this application. The
medical evidence should include a comprehensive medical history and the results of all
relevant examinations, laboratory investigations and imaging studies. Copies of the originalreports or letters should be included when possible. Evidence should be as objective as
possible in the clinical circumstances and in the case of non-demonstrable conditions
independent supporting medical opinion will assist this application.

Incomplete Applications will be returned and will need to be
resubmitted.

Please submit the completed form to the ADO and keep a copy for yourrecords.

International Standard for Therapeutic Use Exemptions
January 200924