Therapeutic use exemptions

Athletes may have illnesses or conditions that require essential medications or undergo vital medical procedures.

If that medication or method is banned by the World Anti-Doping Agency’s Prohibited List, a therapeutic use exemption may give the athlete authorisation to use it without breaking anti-doping rules. Therapeutic use exemptions are issued to a specific athlete, for a specific substance or procedure and for its specific use.

Applications for exemptions are evaluated by a panel of doctors known as the therapeutic use exemption committee.

Detailed information on therapeutic use exemptions, the application and renewal process, and contact information for exemption experts can be found on the website of the International Testing Agency. The information on this page is provided as a guide only.

Can I apply for an exemption?

The following four criteria, which are defined in more detail in the International Standard for Therapeutic Use Exemptions, must be met for an exemption to be granted.

1) Diagnosed condition. An athlete must have a clearly diagnosed medical condition that requires treatment using a prohibited substance or method.

2) No performance boost. Use of the substance will not produce a significant enhancement beyond the athlete’s normal state of health.

3) No alternative. The prohibited substance is normally used to treat the condition and there are no reasonable alternatives that do not fall on the banned list.

4) Continued use. Use of the prohibited substance is not a consequence of prior use, without an exemption, of a substance that was prohibited at the time it was used.

Who can apply for an exemption?

International athletes, including those who are in the registered testing pool, compete at world championships or attend other international events as a member of a national team, should apply to the International Testing Agency for a therapeutic use exemption. International athletes must apply for an exemption in advance, at least 30 days prior, of a major competition, unless there is an emergency.

National athletes, including those who compete within their own countries, should contact their National Anti-Doping Organisation to enquire about a therapeutic use exemption.

Therapeutic use exemptions issued nationally must be recognised by the International Testing Agency for use internationally.

Athletes have a responsibility to inform their doctor that they are bound by anti-doping rules. Both athlete and doctor should check the Prohibited List for any substance or method that is prescribed and discuss alternatives if that substance is banned, only applying for an exemption if there are no viable alternatives.

Can I apply for a retroactive exemption?

An athlete can only apply for a retroactive exemption if they required emergency or urgent treatment using a banned substance, there was not enough time or exceptional circumstances that prevented an application from being submitted in advance, or if a positive test was recorded out-of-competition for a substance that is only banned in-competition.

In rare circumstances, a retroactive exemption may be granted if it is manifestly unfair not to do so. Anti-doping organisations can grant exemptions like this with the express approval of the World Anti-Doping Agency, which makes the decision at its absolute discretion.

How do I apply for an exemption?

International athletes can apply for a new therapeutic use exemption through ADAMS, which is the online anti-doping management system run by the World Anti-Doping Agency. An athlete needs a personal account to use ADAMS and can contact the International Testing Agency to set one up.

Alternatively, an application form can be found on the International Testing Agency’s website.

Each application must be accompanied by a supporting medical file that includes a comprehensive medical history, including documentation from the doctor that made the original diagnosis, and the results of all examinations, laboratory investigations and imaging studies that are relevant.

Applications must be complete – and legible, if submitted on the paper form – and will be rejected if unfinished. Athletes must cover all costs in making an application and are advised to keep a complete copy, including the supporting medical file, along with proof that it was submitted.

An athlete that already has a national exemption can apply for international recognition by contacting the International Testing Agency and quoting the exemption’s reference number in ADAMS.

Major multisport events may have other rules surrounding exemptions. In the lead-up to the Olympic Games, for example, athletes should follow the normal process however once the event is in progress, athletes must contact the International Testing Agency office, which is located in the polyclinic in the Olympic village.

All information submitted with an application is kept strictly confidential and its terms of use are detailed in the accompanying athlete’s declaration.

When will I receive a decision?

The committee issues a decision as soon as possible and usually within 21 days of the complete application being received.

If an application is accepted, the athlete will receive a certificate that details the substance, the conditions and the length of the exemption, which always has an expiry date.

If an application is denied, the athlete will receive a written explanation of the reasons for rejection. (The International Testing Agency can be contacted for clarification.) The following two avenues are then available to pursue the application further.

• If the application was missing critical supporting information, reapply with the application complete.
• If the application was rejected on medical reasoning, refer the matter to the World Anti-Doping Agency for review within 21 days of notification of the decision.

The full application should be sent to the World Anti-Doping Agency by registered mail and it is recommended to contact the organisation in advance of submission. A review costs 500 USD, if accepted. The World Anti-Doping Agency’s decision can be appealed to the Court of Arbirtration for Sport.

This appeal process applies to both new exemptions and the international recognition of national exemptions.

How do I renew or change my exemption?

Therapeutic use exemptions always have a specific duration and expire automatically at their end date. Should an athlete need to continue using the prohibited substance or method, it is their responsibility to submit a new application with updated information before the expiry date.

(At least 30 days prior is recommended so that there is sufficient time to make a decision.)

The presence, use, possession and administration of the substance or method must always be consistent with the terms of an exemption. If an athlete requires a different dosage, frequency, route or duration of administration, it is their responsibility to check whether they need to apply for a new exemption.

Some substances and dosages, like those for insulin, are often modified during treatment and these possible fluctuations, if they are detailed by the doctor in the initial application, are usually accepted and would be defined within the terms of an exemption.