Understanding TUEs: Who Should Apply And When?

The heightened focus on doping at the 2016 Rio Olympics has brought a lot of attention to the oft-misunderstood classification of therapeutic use exemptions (TUEs) – but what are they, and who should apply for them?

What is a TUE?

TUEs are legally-obtained exceptions to bans on certain substances that an athlete needs for medical treatment. For example, if a swimmer is prescribed an inhaler by a doctor to treat his or her asthma, that swimmer can apply for a TUE to be able to legally use his or her inhaler even if some of the contents appear on the World Anti-Doping Agency (WADA) banned substances list.

The rule verbatim from the WADA International Standards for granting TUEs:

4.4.1 The presence of a Prohibited Substance or its Metabolites or Markers, and/or the Use or Attempted Use, Possession or Administration or Attempted Administration of a Prohibited Substance or Prohibited Method shall not be considered an anti-doping rule violation if it is consistent with the provisions of a TUE granted in accordance with the International Standard for Therapeutic Use Exemptions

Recently, Russian hacking group Fancy Bear has begun to release documents detailing private, confidential medical information and TUE applications from Olympic athletes in a number of sports. On the heels of multiple allegations of a massive, state-sponsored illegal doping program in Russia, Fancy Bear alleges that other nations are also cheating the system through TUEs.

The difference, of course, is that TUEs are legally obtained through the rules set by WADA and disclosed to anti-doping authorities, while the reports critical of Russia allege the nation was systematically using banned substances without any sort of TUE paperwork and was purposefully hiding its doings from authorities.

WADA has published international standards for granting TUEs, and athletes apply for them through national anti-doping organizations (USADA in the United States, for example) and through international sporting federations (like FINA in the case of swimming).

TUEs granted by national organizations are only valid on the national level, meaning they would cover athletes at events like the U.S. Nationals or U.S. Open. For international-level events like the World Championships or Olympic Games, swimmers need to apply for TUEs through FINA.

Who should apply?

Say you’re a swimmer with asthma, or a parent of a child with ADD. Should you be applying for a therapeutic use exemption? For Americans, USADA lists the following checklist on its website, simplified some here:

Step 1: Is the medication in question banned in-competition, out-of-competition, both or neither?

Some substances are banned only during competition, meaning an athlete can fail a test administered at a competition, but if the substance appears in a test administered outside of a meet setting, the athlete is still legal. (More on that distinction in WADA’s Prohibited List for 2017)

• Banned in- and out-of-competition: TUE needed
• Banned in-competition, but not out-of-competition: Depends on level of competition (see step 2)
• Not banned in- or out-of-competition: No TUE needed (duh)

Step 2: What is the athlete’s level of competition?

Per the USADA website, that middle category of substances depends on whether the athlete competes at the international/national level or what it terms the “non-national” level. Swimmers at the international/national level must apply for a TUE for any substance banned in- or out-of-competition.

Here are some qualifications that could put an athlete in that class of swimmer:

• Is in an international federation’s registered testing pool or has been in the past. For swimmers, this would be FINA’s registered pool, which typically focuses on athletes with very high world ranks. We broke down that system some a few years ago in this post.
• Is planning to compete in any event sanctioned by an international federation (like FINA), the IOC, the IPC, the USOC or PASO.
• Is planning to compete in a competition which immediately results in National Team selection for an Olympic, Paralympic, Pan or Para-Pan Am Games or Youth Olympic Games. (For American swimmers, this would include Olympic Trials and most U.S. National Championship meets).
• Is in the USADA Registered Testing Pool or has been in the past (again, we break down this group in more detail here, but it comprises athletes with high world ranks along with U.S. National Team members)
• Receives USOC funding
• Has ever tested positive in an antidoping test
• Is planning to compete in an Elite-Level National Championship at the senior level (this would include U.S. Nationals, Winter Nationals and U.S. Open, but not age group events like Junior Nationals or the Winter Junior Championships)

Swimmers not at the international/national level are termed as “non-national” athletes. Swimmers at that level still have to apply for TUEs for substances banned in- and out-of-competition, but don’t need a TUE prior to competition for substances banned in-competition but not out. There are a handful of exceptions listed at the bottom of this USADA steplist as well, including insulin for diagnosed diabetics and inhaled beta-2 agonists, which would include most inhalers.

How To Apply

Again, a swimmer’s level of competition comes into play. For athletes swimming strictly on the national stage, a TUE filed with USADA would be enough. You can find the USADA application here.

Athletes who may compete internationally (including World Cups, Junior Pan Pacs, Junior World Championships and Youth Olympic Games, among others) will also need to file a TUE with FINA. You can find the FINA application here.

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