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 only required if they are taken during competition. If they are taken prior to competition but are detected in a “in-competition” drug test the athlete will be able to apply for a retroactive Therapeutic Use Exemption.
Prednisolone, hydrocortisone may be given to treat severe allergy, anaphylaxis, asthma and other inflammatory conditions. When given orally or by any injectable route they are prohibited but only DURING competition. A Therapeutic Use Exemption is only required if the medication is taken during competition. If they are taken prior to competition but are detected in a “in-competition” drug test the athlete will be able to apply for a retroactive Therapeutic Use Exemption.
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 during competition.
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. 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 6 “puffs” in a 8 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 6 puffs in 8 hours are given.
Narcotics (e.g. pethidine, morphine, fentanyl) are WADA prohibited but only DURING competition. A Therapeutic Use Exemption is only required if used during competition.
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. A Therapeutic Use Exemption is required if the athlete takes these medications during 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).
Donation of plasma is permitted for athletes from the 1st of January 2024 providing it is performed in a registered collection centre. If an athlete donates plasma, 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 Registered Testing Pool and if their testing involves the Athlete Biological Passport (ABP). This is because evidence of plasma loss (whether intentional as part of a doping regimen or through an accident, illness or blood donation) may result in changes to an 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.
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.
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.
It depends on the medication and level of competition.
Check your medication/s on Global DRO to determine if your medication is prohibited by WADA and therefore needs a TUE.
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. 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.
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 where a supporting medical letter outlines any previous episodes of AMS, relevant medical conditions and includes an itinerary for flights and trekking or other activity at altitude.
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”.
Vaping, also called e-cigerettes 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.
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.
For more information, please see the ‘Medications and Supplements in Sport’ section in our resources hub.
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.
More information for athletes, athlete support personnel, clinicians and medical professionals can be found in the below factsheets created by the World Anti-Doping Agency (WADA):