Emergency treatment should be carried out, as medically appropriate, and considerations of the need for a Therapeutic Use Exemption can be dealt with after the medical issue is stabilised. There is a category of Therapeutic Use Exemptions for these situations called “retroactive” where the application is made after the treatment has been given.
Narcotics (e.g. morphine, pethidine, fentanyl) are on the WADA Prohibited List. They are only prohibited DURING competition. The clearance of these drugs from the body is relatively rapid but they can remain in the system for a few days. A Therapeutic Use Exemption is therefore required if the athlete is competing within 5 days of taking this medication.
Prednisolone, hydrocortisone may be given to treat severe allergy, anaphylaxis, asthma and other inflammatory conditions. When given systemically (i.e. Intravenous, intramuscularly, orally) these medications are WADA prohibited but only DURING competition. The clearance of these medications from the body is usually fairly rapid but can be variable and will remain in the system for a few days. A Therapeutic Use Exemption is therefore required if the athlete is competing within 5 days of taking this medication.
Adrenaline may be given for anaphylaxis and an epipen may be given to take home for any future events. It is WADA prohibited DURING competition. These substances both require a Therapeutic Use Exemption if used within 5 days of competition. If an athlete needs to carry an epipen a Therapeutic Use Exemption is required at all times.
Intra-venous (IV) fluids
No Therapeutic Use Exemption is required, regardless of the volume, if the IV fluid is given while the athlete is in hospital, either the ward, emergency department, in surgery or on the way to hospital in an ambulance. If it is given at a doctor’s rooms or any place other than those listed above and the volume is >100ml then a Therapeutic Use Exemption is required.
Any transfusion of blood, in or out of hospital requires a Therapeutic Use Exemption.
During an acute asthma attack you may be given salbutamol via an inhaler (and possibly a spacer) or nebuliser. Inhaled salbutamol is permitted by WADA but only up to 8 “puffs” in a 12 hour period. Salbutamol via a nebuliser will exceed this threshold so a retroactive Therapeutic Use Exemption should be applied for if a nebuliser or more than 8 puffs in 12 hours are given.
Narcotics (e.g. pethidine, morphine, fentanyl) are WADA prohibited but only DURING competition. As the clearance of these drugs from the body is rapid there is no need for a Therapeutic Use Exemption unless the athlete competes within 5 days of receiving these drugs.
IV fluids are usually given during surgery and the WADA rules state that NO Therapeutic Use Exemption is required for IV fluids given whilst in hospital.
Post-Operative/take home medication
There may be prescribed medication to take home after surgery. This is usually pain relief and some of these may be narcotics in tablet form (e.g. endone or oxycodone) which are prohibited DURING competition. This means a Therapeutic Use Exemption is required if the athlete takes these medications within 5 days of competition.
Donation of whole blood is not prohibited by the WADA rules.
However, if an athlete donates whole blood they should ensure they keep a medical record from the blood bank confirming the date, type and volume of the donation. This is particularly important if the athlete is in a drug testing pool and if their testing involves the athlete biological passport (ABP).
This is because evidence of blood loss (whether intentional as part of a blood doping regimen or through an accident, illness or blood donation) may result in changes to an athlete's haematological passport (ABP) and the athlete may be asked to explain these changes to anti-doping authorities. A record of donation would assist the athlete in these circumstances.
All blood transfusions (received in or out of hospital) require a Therapeutic Use Exemption. It does not need to be done before the treatment is performed if it is an emergency situation. In an emergency situation, appropriate treatment should be carried out first. A Therapeutic Use Exemption should be applied for after the medical situation is stabilised/resolved (i.e. a retroactive Therapeutic Use Exemption).
Athletes should avoid the donation of plasma or platelets both in and out of competition due to the WADA code restrictions on the infusion of fluid and the re-infusion of red blood cells during the plasma donation process, which is typically completed outside a hospital facility. Athletes who would like to understand more about the doping implications of plasma donation are encouraged to discuss this directly with the ASDMAC Secretariat by calling (02) 6222 4283.
This process is usually required for serious medical conditions so it is rare for elite athletes to still be competing with such significant illnesses. However if they are, as only plasma is infused (i.e. no red blood cells) and usually it is done in a hospital setting then no TUE is required (if given outside a hospital and >100ml is given then a TUE would be required).
Iron is not prohibited by WADA but if the amount of fluid used to give the infusion is >100ml then a Therapeutic Use Exemption required. If less than 100ml is used then no Therapeutic Use Exemption is required.
While cannabis has been legalised for medical use in a small number of conditions in Australia, it remains prohibited in competition under the World Anti-Doping Agency (WADA)’s Prohibited List. This can be verified via Global DRO.
Cannabidiol (CBD) is a non-psychoactive derivative of cannabis. As of 2018, WADA no longer lists CBD as a prohibited substance.
ASDMAC reminds athletes that CBD oil often still contains some concentration of the banned substance tetrahydrocannabinol (THC). Therefore, the use of CBD oil is at an athlete’s own risk and could be considered akin to the use of a supplement. Assessment of the risk of any supplement can be made through the Sport Integrity Australia app.
Remember, athletes are strictly liable for any prohibited substance found in their sample.