Therapeutic Use Exemption (TUE) & Substances

THERAPEUTIC USE EXEMPTION (TUE)

A Therapeutic Use Exemption (TUE) is necessary before an athlete uses a prescribed prohibited substance or method for the treatment of a legitimate medical condition.

Athletes should advise all medical personnel of their obligation to abide by the anti-doping rules of their sport and that any medical treatment received must not violate these rules.

TUE PROCESS

• STEP 1: CHECK STATUS OF SUBSTANCE OR METHOD OF TREATMENT
  • Check online at list.wada-ama.org for WADA’s Prohibited List
  • Singapore “Check Medications” Online
  • Global Drug Reference Online
• STEP 2: SUBSTANCE OR METHOD OF TREATMENT IS PROHIBITED
  • Discuss with your doctor for permitted alternative medication or treatment.
  • If there are no alternative medication or treatment available, proceed to Step 3.
• STEP 3: APPLY FOR A TUE
  • Download a TUE Application Form from ADS website or obtain it from your National Sports Association or International Federation, where applicable.
• STEP 4: COMPLETE THE TUE APPLICATION FORM
  • Complete the form with your doctor.
  • Medical evidence to justify the use of a prohibited substance or method must be attached to the application form
• STEP 5: IS THE SUBSTANCE OR METHOD PROHIBITED BOTH IN- AND OUT-OF-COMPETITION?
  • Yes, proceed to Step 6.
  • No, only prohibited In-Competition. Proceed to Step 7.
• STEP 6: WHEN TO SUBMIT THE TUE APPLICATION FORM?
  • If Substance or Method is Prohibited Both In- and Out-of-Competition, submit TUE application as soon as the medical condition is diagnosed.
• STEP 7: WHEN TO SUBMIT THE TUE APPLICATION FORM?
  • If Substance or Method is Prohibited only In-Competition, submit TUE application at least 30 days prior to participating in an event.
• STEP 8: SUBMIT THE TUE APPLICATION FORM
  • Submit completed TUE application form with relevant justifying documents (eg. Evidence of the diagnosis, a comprehensive medical history and the results of all examinations, laboratory and investigations and imaging studies relevant to the application).
  • Submit to ADS for ADS Registered and Domestic Testing Pools and all other athletes not in any testing pool.
  • Submit to your International Federation for International-level athletes.
• STEP 9: APPROVAL OF TUE
  • Decisions of the TUE application will be conveyed to the athlete and/or relevant NSA within 30 days of receipt of the completed TUE application form and relevant justifying documents.

CRITERIA FOR GRANTING A TUE

A TUE will be granted only if the following criteria are fulfilled:

1. The athlete would experience a significant impairment to health if the prohibited substance or method were withheld for treating an acute or chronic medical condition.
2. The therapeutic Use of the Prohibited Substance or Prohibited Method would produce no additional enhancement of performance other than that which might be anticipated by a return to a state of normal health following the treatment of a legitimate medical condition.
3. There is no reasonable therapeutic alternative to the Use of the otherwise Prohibited Substance or Prohibited Method.
4. The necessity for the Use of the otherwise Prohibited Substance or Prohibited Method cannot be a consequence, wholly or in part, of prior non-therapeutic use of any substance from the Prohibited List.

WHEN TO APPLY FOR A TUE?

A valid TUE should be obtained before the start of the use of the prohibited substance or method. The TUE application should be made as soon as an athlete is prescribed a prohibited substance or method for a medical condition that is prohibited both In-Competition and Out-of-Competition. Where a substance or method is prohibited only In-Competition, the TUE application must be made at least 30 days before the athlete needs the valid TUE. Retroactive consideration for the application of a TUE will be considered only in exceptional circumstances as follows:

1. Emergency treatment or treatment of an acute medical condition was necessary, or
2. If, due to exceptional circumstances, there was insufficient time or opportunity for an applicant to submit, or a TUE Committee/Panel to consider, an application prior to doping control.
3. All other Singapore athletes who are not in the ADS RTP and ADS DTP, as well as those not carded under Sport Singapore’s spexCarding programme, will be allowed to submit a TUE retroactively if selected for testing by ADS or a NSA according to the ADS Anti-Doping Rules.

SUBMITTING A TUE APPLICATION

All athletes carded under the Sport Singapore’s spexCarding programme and athletes in the ADS Registered Testing Pool and ADS Domestic Testing Pool, Singapore athletes participating in a NSA National Championship for which a TUE granted pursuant to the ADS Anti-Doping Rules is required and any other Singapore athlete requiring a TUE for the use prohibited substances or methods shall submit the TUE application to ADS. A TUE application should be made on the ADS TUE Application Form that is completed with your Doctor. Athletes who are in their respective International Federation’s Registered Testing Pool shall submit the TUE application to their International Federation. The application to ADS should include the completed ADS TUE Application Form and medical evidence (for example, comprehensive medical history, results of all relevant examinations, laboratory investigations and imaging studies) to justify the use of a prohibited substance or method. A TUE application without medical evidence will not be reviewed by the ADS TUE Committee. For certain specific medical conditions, such as asthma, additional medical information is required to support the TUE application. Please click here for details of medical information required for specific medical conditions. The TUE application should be submitted to:

Anti-Doping Singapore
3 Stadium Drive
Singapore 397630
Fax: +65-64409205
Email: Sport_TUE_ADS@sport.gov.sg

Note: A TUE granted by the ADS TUE Committee may not be acknowledged by the International Federation. It is the athlete’s responsibility to be aware of the requirements of the International Federation or event organiser prior to competing. International Federation’s may have different TUE application and information requirements and forms.

For more details, please refer to the ADS TUE Policy.

PROHIBITED LIST

The List of Prohibited Substances and Methods, updated annually by the World Anti-Doping Agency (WADA), is the International Standard defining what is prohibited In-Competition and Out-of-Competition. The List also indicates whether particular substances are banned in particular sports. WADA reviews and updates the List annually and the most current edition of the List is posted on WADA’s website at: https://www.wada-ama.org/en/prohibited-list . The updated Prohibited List comes into effect on 1 January every year.

For easier access, the List is now available on the various mobile devices and platforms. Visit the Prohibited List mobile site or download the application for iPhones.

PRINCIPLE OF STRICT LIABILITY

Athletes should know that, under the Code, they are strictly liable whenever a prohibited substance is found in their urine or blood sample. This means that a violation occurs whether or not the athlete intentionally, knowingly or unknowingly, used a prohibited substance or was negligent or otherwise at fault. It is therefore very important for athletes to understand not only what is prohibited, but also what might potentially cause an inadvertent doping violation.

Athletes should always check with their International Federation or Anti-Doping Singapore (ADS) to find out what additional substances and methods are prohibited in their sport. Athletes should always make their doctor aware that they are athletes and check if the prescribed medications is in the Prohibited List. Those who are unsure of what a product contains should not take it until they are sure it is not prohibited. Ignorance is never an excuse.

MEDICAL CONDITIONS

Athletes, like anyone, may at times experience a medical condition that requires them to use particular medicines.  The substances that an athlete may be required to take to treat a condition could fall under the List. However, by applying and obtaining a Therapeutic Use Exemption (TUE) from your International Federation or ADS, an athlete may be allowed to take the necessary medicine!

Athletes who need to apply for a TUE should request more information about the TUE application process from their International Federation (for international-level athletes) or ADS (for national-level athletes).

Athletes, like anyone, may at times experience a medical condition that requires them to use particular medicines. The substances that an athlete may be required to take to treat a condition could fall under the List. However, by applying and obtaining a Therapeutic Use Exemption (TUE) from your International Federation or ADS, an athlete may be allowed to take the necessary medicine.

Athletes who need to apply for a TUE should request more information about the TUE application process from their International Federation (for international-level athletes) or ADS (for national-level athletes).

CHECKING MEDICATION

Athletes can check if the medication is a Prohibited Substance, or the method of treatment is a Prohibited Method under the List by one of the following ways:

1. Anti-Doping Singapore’s (ADS) Check Medications Database For list of medications registered in Singapore

1. Global Drug Reference Online
   For list of medications registered in Australia, Canada, Japan, the United Kingdom, the USA and Switzerland

3. Hong Kong Anti-Doping Committee’s Drug in Sport
For list of medications registered in Hong Kong

1. Irish Pharmacy’s Drug in Sport Database (endorsed by the Irish Sports Council)
   For list of medications registered in Ireland

TIPS FOR ATHLETES TRAVELLING ABROAD

Athletes planning to travel abroad are advised to:

• Take enough medication to continue any treatment for the duration of the trip
• Check the medication is permitted in the country of travel and whether it is permitted to bring through customs

Any products purchased overseas should be carefully checked. The ingredients in common medications can and do contain different substances to those available in Singapore.

Some countries have different customs laws that may prohibit the import of certain substances into a particular country. Athletes carrying a prohibited substance for a legitimate medical condition, should carry the following documents at all times:

• The prescription from the prescribing doctor including the name of the substance, the dose and the frequency of use
• The TUE Certificate to demonstrate that an authorised anti-doping organisation has permitted the use of a prohibited substance for medical purposes