Therapeutic Use Exemptions

Jennifer Morris, MD MBA

ABPN, ABOM, ABPM-add, ABSPP

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Therapeutic use exemptions, or TUE's, are exemptions granted when an athlete is sick or has a condition that requires treatment with a medicine on the World Anti Doping Agency (WADA)'s prohibited substance list. A TUE allows the athlete to use the medicine or method, as it ensures the athlete is able to compete in a proper state of health, but does not confer a competitive advantage. TUE's ensure athletes can be treated for medical conditions, even with prohibited substances or methods, without being sanctioned. (wada)

the list of prohibited items  includes nonapproved substances, anabolic agents, peptide hormones, growth factors, mimetics, beta-2 agonists, hormone and metabolic modulators, diuretics and masking agents, manipulation of blood and blood components, chemical and physical manipulation of samples, gene and cell doping, stimulants (in competition), narcotics (in competition), cannabinoids (in competition), glucocorticoids (in competition), and beta-blockers (in particular sports.) (wada-prohibited list)

The most common substances observed associated with TUEs at the 2016-2022 olympics were glucocorticoids, stimulants, and diuretics. 

While it might appear that TUEs are at very high risk of abuse, and that almost every professional athlete might have one, the prevelence of TUEs at the Olympic and Paralympic games was <1% and <3%, respectively, from 2016 to 2022. (Vernec) 

Athletes should rely upon their coaching and sports medical staff for up-to-date information on TUEs-whether one is required. The United States Anti-Doping Agency (USADA) has also created an online tool to inform and assist with this process. (USADA. ) Additionally, the site globaldro provides a searchable database of medicines and their status. (globaldro)

https://www.wada-ama.org/en/athletes-support-personnel/therapeutic-use-exemptions-tues. accessed 9/9/24. 

https://www.wada-ama.org/en/prohibited-list#search-anchor. Accessed 9/10/24. 

Vernec, Alan; David Healy, Tamar Banon, Andrea Petroczi. Prevalence of therapeutic use exemptions at the Olympic Games and Paralympic Games: an analysis of data from 2016 to 2022. Br J of Sports Med 2024 Sept 4;58(17):996-972. doi: 10.1136/bjsports-2024-108266. https://pubmed.ncbi.nlm.nih.gov/38981660/#:~:text=Conclusions%3A%20The%20number%20of%20athletes%20competing%20with%20valid,that%20TUEs%20are%20not%20widespread%20in%20elite%20sport.prevalence \ . Accessed 9/9/24. 

https://www.usada.org/athletes/testing/tue/determine/. Accessed 9/10/24. 

globaldro.com/home. Accessed 9/10/24.