Retroactive Therapeutic Use Exemption

You may be eligible for a planned Retroactive Therapeutic Use Exemption if:

• your sport is not listed
• you have not been notified of your inclusion in the Sport Integrity Australia Registered Testing Pool or National Testing Pool or Domestic Testing Pool
• you do not meet any of the criteria for an in-advance TUE.

If you are eligible you should take the following steps: 

1. Have a medical file prepared with the information needed for a Therapeutic Use Exemption in case an application is necessary.
2. Look at the summary of medical information needed, aimed at athletes.
3. Let your medical practitioner know they can find a more detailed document about the medical evidence needed for TUEs on the WADA website. 
4. ASDMAC cautions athletes to ensure that their supporting documentation is sufficient to meet the Therapeutic Use Exemption guidelines.
5. If you are tested, you should declare any medication you are taking on your doping control form.
6. If you are informed that your sample has returned an adverse analytical finding (positive doping control test), you should apply to the Australian Sports Drug Medical Advisory Committee (ASDMAC) for a retroactive Therapeutic Use Exemption.

ASDMAC will at all times, apply the criteria in the WADA International Standard for Therapeutic Use Exemptions. They will be guided by the advice to Therapeutic Use Exemption Committees about the granting of Therapeutic Use Exemptions for particular substances.

Note: there are very strict minimum evidence requirements for all conditions – learn more about medical evidence needed for a TUE.  

For any athlete retroactive applications may also be considered if:

• Emergency or urgent treatment of a medical condition was necessary.
• There was insufficient time, opportunity or other exceptional circumstances that prevented the athlete from submitting (or the TUEC to consider) an application for the TUE before sample collection.
• Due to national level prioritisation of certain sports, the athlete’s National Anti-Doping Organisation did not permit or require the athlete to apply for a prospective (in-advance TUE).
• If an Anti-Doping Organisation chooses to collect a sample from an athlete who is not an International-Level Athlete or National-Level Athlete, and that athlete is using a Prohibited Substance or Prohibited Method for Therapeutic reasons, the Anti-Doping Organisation must permit the athlete to apply for a retroactive TUE.
• The athlete used Out-of-Competition, for Therapeutic reasons, a Prohibited Substance that is only prohibited In-Competition.

In rare and exceptional circumstances and notwithstanding any other provision in the ISTUE, you may apply for and be granted retroactive approval for a therapeutic use of a prohibited substance or method, if considering the purpose of the Code, it would be manifestly unfair not to grant a retroactive TUE.

This unique retroactive TUE will only be granted with the prior approval of WADA (and WADA may in its absolute discretion agree with or reject ASDMAC's decision).

TUEs and medical emergencies

Your health is the most important consideration.

Emergency treatment should be carried out, as medically appropriate. 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. 

Read below for information on emergency treatments that involve WADA prohibited substances.

Pain relief medications 

Narcotics (for example 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 before competition but are detected in an 'in-competition' drug test the athlete will be able to apply for a retroactive Therapeutic Use Exemption.

Prednisolone, hydrocortisone 

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 before competition but are detected in an 'in-competition' drug test the athlete will be able to apply for a retroactive Therapeutic Use Exemption.

Adrenaline 

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.

Blood transfusions 

Any transfusion of blood, in or out of hospital requires a Therapeutic Use Exemption.

Ventolin (salbutamol) 

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. 

TUEs and 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 (for example, pethidine, morphine, fentanyl) are WADA prohibited but only during competition. A Therapeutic Use Exemption is only required if used during competition.

Post-operative and 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.