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    What should be done about TUEs when there is a medical emergency?

    Your health is the most important consideration.

    Medically necessary emergency treatment should be undertaken. Consideration of the need for a Therapeutic Use Exemption can be dealt with after the medical issue is stabilized. 

    There is a category of Therapeutic Use Exemptions for these situations called 'retroactive' where the application is made after the treatment has been given. 

    It is extremely important that you obtain and provide copies of the medical records of your care during any emergency medical care. They will be a key part of any retroactive TUE application.

     

    What are examples of emergency treatments that involve WADA Prohibited Substances?

    Pain relief medications

    Narcotics, including morphine, pethidine and fentanyl are not permitted in competition but may be used in an emergency for the management of severe acute pain, for example a significant fracture during play. If you have a medical emergency that requires the use of narcotics during competition you can apply for a retroactive TUE.

    Corticosteroids 

    Corticosteroids, including prednisolone, hydrocortisone and triamcinolone, may be given to treat severe allergy, anaphylaxis, asthma and other inflammatory conditions. When given orally, rectally or by any injectable route they are prohibited but only DURING competition. If you have a medical emergency that requires the use of corticosteroids during competition you can apply for a retroactive TUE.

    Adrenaline

    Adrenaline may be given for anaphylaxis. An epipen (which contains adrenaline) may be given to take home for any future events. It is WADA prohibited DURING competition. If you have a medical emergency that requires the use of adrenaline during competition you can apply for a retroactive TUE.

    Intravenous (IV) Fluids  

    No Therapeutic Use Exemption is required, regardless of the volume, if the IV fluid is given while the athlete is in hospital, including in the ward, in the emergency department, or during surgery. A TUE may be required if the substance is prohibited. If you have a medical emergency that requires the use of IV fluids greater than 100mls, at a place other than those listed above, you can apply for a retroactive TUE.

    For more information read Warning about IV infusions.

    Blood transfusions 

    If you have a medical emergency that requires a blood transfusion you can apply for a retroactive TUE.

    Beta 2 Agonists

    The Beta 2 agonists Ventolin (salbutamol), salmeterol, vilanterol and formoterol are used in the management of asthma and are permitted by WADA up to certain thresholds. You should familiarise yourself with the threshold doses for your asthma medication. 

    If you have a medical emergency that requires the use of salbutamol or one of these other drugs above the allowed thresholds you should apply for a retroactive TUE.

     

    Will I need a TUE for elective surgery?   

    There are a number of possible medications given during and after surgery that may need a Therapeutic Use Exemption. 

    Always check any medication you are given on Global DRO to check if they are on the WADA prohibited List. 

    Anaesthetic medications

    Narcotics (e.g. pethidine, morphine, fentanyl) are WADA prohibited but only DURING competition. A Therapeutic Use Exemption is only required if used during competition.

    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. A Therapeutic Use Exemption is required if the athlete takes these medications during competition.

     

    Do I need a TUE to use Tramadol? 

    As of January 1st, 2024, Tramadol is prohibited In-Competition.

    Athletes may be eligible to apply for an in advance Therapeutic Use Exemption (TUE) if they require Tramadol for a documented medical condition.

    Athletes and clinicians are reminded that if Tramadol is given within the 24 hours leading up to the In-Competition period (i.e. during the washout period), a sample collected In-Competition may result in an Adverse Analytical Finding (AAF).

    In this scenario, the athlete may be eligible to apply for a retroactive TUE.

    For more information visit:

    Can I donate blood?

    Donation of blood or blood components, including by apheresis (which can include, plasma, platelets and white cells), is permitted when performed in a registered/accredited collection centre (e.g. Lifeblood/Red Cross in Australia) of the country in which it operates.

    If an athlete donates blood or blood components, they should ensure they keep a medical record from the registered/accredited collection centre 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 whole blood or plasma 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 biological passport (ABP) and the athlete may be asked to explain these changes to anti-doping authorities.

    See more information about donating blood and plasma.

    Can I donate or receive plasma? 

    Donating plasma

    Donation of plasma is permitted for athletes when performed in a registered/accredited collection centre (e.g. Lifeblood/Red Cross in Australia) of the country in which it operates.

    If an athlete donates plasma, they should ensure they keep a medical record from the registered/accredited collection centre confirming the date, type and volume of the donation.

    This is because evidence of whole blood or plasma 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 biological 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.

    Receiving plasma

    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).

    See more information about donating blood and plasma.

    Do I need a TUE for an iron infusion? 

    Iron is not prohibited by WADA but if the amount of fluid used to give the infusion is greater than 100ml then a Therapeutic Use Exemption is required, unless the infusion is given in hospital where a TUE is not required, regardless of the volume. 

    If less than 100ml is used, then no Therapeutic Use Exemption is required. 

    For more information see the Iron infusions – fact sheet

     

    Can I get a TUE for Cannabis / Cannabinoids / THC / CBD? 

    Cannabis contains a range of substances known collectively as cannabinoids. One of these substances is cannabidiol (CBD) which is non psychoactive.

    As of 2018, WADA no longer lists CBD as a prohibited substance. Tetrahydrocannabinol (THC) and the other cannabinoids remain prohibited (banned) substances in competition. Many cannabinoid products contain a mix of THC and CBD. 

    There are also examples of THC contamination of products marketed as ‘pure’ CBD. Athletes prescribed CBD products by a Medical Practitioner for a documented medical condition, may be able to apply for a Therapeutic Use Exemption (TUE).

    Athletes prescribed medical cannabis products containing prohibited cannabinoids (including THC), by a medical practitioner, for a documented medical condition may apply for a Therapeutic Use Exemption (TUE).

    For more information:

    Athletes who choose to take an over the counter or internet purchased (non-prescribed) CBD product, even when marketed as ‘pure’ CBD oil are cautioned about the risk of contamination and advised to consider use akin to the risk of a supplement.

    Assessment of the risk of any supplement can be made through the Sport Integrity App and is free to download from Google Play or the App Store

    I'm a Gender Diverse Athlete – do I need a TUE to participate in sport? 

    It depends on the medication and level of competition:

    1. Check your medication/s on Global DRO to determine if your medication is prohibited by WADA and therefore needs a TUE
    2. If your medication is prohibited check your level of competition to determine whether you need a TUE in advance, or whether you can keep a medical file and apply retroactively (after the event) if needed. 

    Note:
    A TUE does not determine whether you are “eligible” to participate in a sport. A TUE is only about a medication exemption. Eligibility for sports participation based on criteria such as age and gender are determined by the sporting rules of the competition.

    Transgender male to female

    Transgender male to female athletes can apply for a TUE for prohibited substances, such as Spironolactone when there is a documented medical need.

    Note: WADA documentation states that a TUE for Testosterone should not be approved for females.

    Transgender female to male

    Transgender female to male athletes can apply for a TUE for prohibited substances, such as Testosterone at normal physiological levels.

    Non-binary athletes

     

    Acute Mountain Sickness 

    I'm traveling to altitude for a trekking holiday and have been prescribed Diamox (Acetazolamide), can I get a TUE?

    Acetazolamide is a prohibited substance in- and out-of-competition under the World Anti-Doping Code as a S5 diuretic and masking agent.

    A number of high-altitude medical management guidelines (WEJM 2019, UIAA Medical Commission 2014, CJSM 2014, BMJ 2018) recommend the use of Acetazolamide (Diamox) for the prevention of Acute Mountain Sickness (AMS) in travellers under certain conditions, such as in those with a past history of AMS, some pre-existing medical conditions or those who have a rapid ascent planned and are traveling to more than 2,500m.

    ASDMAC will consider a TUE application for the use of prophylactic (preventative) Acetazolamide for travellers to altitude, when the following information is received as part of the TUE application:

    1.  Evidence of the activity being undertaken such as tickets and the itinerary from the trekking company
    2. A supporting medical letter which includes any history of past AMS and other relevant medical condition.

    Athletes who become unwell at altitude with AMS, HAPE (high altitude pulmonary oedema) and HACE (high altitude cerebral oedema) are reminded of the importance of keeping medical records of any treatment received and if any substances prohibited under the WADA code are administered, athletes should apply for a retro-active TUE for 'emergency treatment or treatment of an acute medical condition'.

    More information:

     

    Can I vape? 

    Vaping, also called e-cigarettes or vapes, refers to inhalation of vapourised liquid directly into your lungs via an electronic device. Common ingredients include nicotine, propylene glycol, vegetable glycine, glycerol and other chemicals.

    The anti-doping risk associated with vaping is currently unknown. There is a risk that vapes may contain and deliver a prohibited substance (such as THC).  

    Additionally, vapes may contain unspecified and unlabelled ingredients especially when bought online or from overseas. Vaping should be viewed as a non-batch tested supplement in terms of anti-doping risk and should be avoided by athletes.

     

    Do I need a TUE for a Prohibited Substance as a support person working in sport? 

    (E.g. a coach, team manager or physiotherapist).

    As a support person, you DO NOT need a TUE to carry a prohibited substance for your own use.

    However, under the World Anti-Doping Code rules, possession of a prohibited substance or method by an athlete or a support person is considered an Anti-Doping Rule Violation (ADRV).

    Support personnel must have a legitimate reason (i.e. have a medical condition for which this medication is prescribed) to possess a prohibited substance whilst in the company of athletes or in the sporting environment. 

    In these circumstances you should always carry evidence to support this reason. This could include a copy of a doctor’s prescription and a medical letter from your doctor.

    • You should not carry prohibited substances for athletes
    • A team doctor is exempt from this, but they should have legitimate reasons for carrying these medications.

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