Find answers to commonly asked questions about therapeutic use exemptions and the application process.
All US athletes are encouraged to submit their application directly to USADA, even though in some instances the international federation is the granting body for the TUE. USADA has special arrangements with the international federations such that we receive all TUE applications. USADA will interact with the national and international sporting bodies on behalf of the athlete.
To obtain a TUE, you should visit the Apply for a TUE page on the USADA Website. There you will find two documents to download: 1) an application form and 2) medical information required to justify the use of the prohibited substance. Read both documents so that you understand the requirements, and bring them with you to your doctor’s appointment. Your doctor should review the medical requirements for the TUE so that he or she can supply all of the relevant information. After completing the application, submit it to USADA by fax, mail, or email according to the instructions on the application form. We will notify you when we receive your application. If you don’t hear from us within three days, let us know – we may not have received your application.
The most important aspect of a TUE application is the medical file. The Therapeutic Use Exemption Committee (TUEC) will need to review any and all relevant medical details related to the application, including patient history, test results, how the disease/disorder/injury has been managed over time, and any and all attempts to use non-prohibited medications and methods. WADA has the right to review any TUE application at any time. It is in your best interest to make sure your TUE file is as complete as possible.
The TUEC is the group of doctors and medical experts that review your TUE application and recommend whether the TUE should be approved or denied based on the criteria in the WADA International Standard of TUEs. Each anti-doping agency and International Federation has its own TUEC. Your identity is never revealed to the TUEC.
Your doctor plays a crucial role in supplying the medical information necessary for the approval of a TUE. The Therapeutic Use Exemption Committee relies on the information supplied by your doctor to determine if your file meets the medical criteria set by the World Anti-Doping Agency.
USADA and the International Federations have authority to grant Therapeutic Use Exemptions. All applications from U.S. athletes should be submitted to USADA. Information about the application process can be found here: Apply for a TUE
Competition status refers to whether you compete in local, state, national, or international events, and whether you are a member of a testing pool (USADA National Testing Pool or international federation international testing pool). Your competition status is used to determine the granting authority for your TUE. USADA grants TUEs for all athletes competing at or below the national level. For athletes in an international testing pool, or for athletes competing in international events, the granting authority is the international federation. Regardless of the granting authority, all U.S. athletes should submit their TUE application to USADA.
A testing pool is a group of athletes identified as national or international caliber by USADA or an International Federation.
You will be formally notified if you are added to a testing pool. Athletes in testing pools are required to submit “whereabouts”, and take educational tutorials. If you don’t have to submit your whereabouts, and you have never received a letter or been required to take online tutorials then you are probably not part of a testing pool. However, you can contact Athlete Express to find out for sure by emailing AthleteExpress@usada.org.
A non-national level athlete is any athlete who meets ALL of the following criteria.
- Is NOT in any USADA or International Federation Testing Pool (now or in the past);
- Is NOT competing in an event sanctioned by an International Federation, the IOC, the IPC, the USOC or PASO (including events in the U.S.);
- Has never tested positive for any prohibited substance;
- Does not receive USOC funding; and
- Is not competing in the OPEN category of an ELITE-Level National Championship.
- Is not competing in a competition which immediately results in National Team selection for an Olympic, Paralympic, Pan or Para-Pan American Games, including Youth Olympic Games
You need a TUE to use some prohibited substances, but not for others. It is very important to know the Prohibited List category of the substance and your competition level (whether you are an international, national, or non-national level athlete). To learn more, go to the Determine if you need a TUE page of the USADA website.
A non-national level athlete is any athlete who does NOT meet any of the criteria for National or International level athletes. Click here to view the criteria for determining your competition level.
Most recreational and Masters level athletes are non-national level athletes, but not always! Visit the TUE page to confirm your competition level.
Start here and consult USADA’s policy on TUEs. You may need a TUE depending on the level at which you compete. If you compete at events sanctioned by an international sporting federation, then you need to obtain TUEs for prohibited substances along the same lines as an athlete in a testing pool of the international federation. If you compete at a national level or below, then the requirements for TUEs vary based upon the medication. Please note, sometimes “international events” are held in the United States, and not all events occurring in another country are considered “International Events” for the purposes of TUEs.
Not all international federations will recognize a TUE issued by USADA for an international event. For this reason, it is very important that you notify USADA if you intend to compete internationally. Please note, sometimes “International Events” are held in the United States, and not all events occurring in another country are considered “International Events” for the purposes of TUEs.
The event organizer can help you determine if an event is considered to be national or international level competition. This information is often on the event website or in the registration materials. National governing bodies and International Federations are required by WADA to post their “sanctioned” competitions on their websites so this is another very important place to look. Please note, sometimes “International Events” are held in the United States, and not all events occurring in another country are considered “International Events” (i.e. sanctioned by the International Federation).
If you compete at the national level or below, you only need to get a TUE from USADA. However, if you decide to compete in an International Event (i.e. an event sanctioned by the International Federation (IF) for your sport), then that makes you an international-level athlete for the purposes of TUEs.
It is extremely important that USADA knows about your competition plans. Some International Federations automatically recognize USADAs TUEs, but other IFs want to review and approve all of the TUEs for athletes in their sport. In this case, USADA can assist you in obtaining a TUE from your IF by forwarding the application you had submitted to USADA, or by guiding you through the TUE process for the IF. Either way, it is very important that you understand your competition level and the TUE requirements of the IF for your sport. If in doubt, please contact Athlete Express by email at AthleteExpress@USADA.org.
A TUE application can be returned to you without being reviewed by the TUE Committee because it is incomplete or it is not required. If your application has been returned to you because it is incomplete, you will receive instructions on what additional information is needed to make it a complete application.
If you are treated with a prohibited substance in an emergency, you should file an emergency TUE as soon as possible after the treatment has taken place. Make sure to write EMERGENCY TUE at the top of the form so that we know to expedite processing. It is understood that in some instances not all medical information can be obtained quickly. You should make your best effort to submit a medical file that is as complete as possible, and submit the TUE application as soon as possible.
Asthma inhalers may contain glucocortocoids, beta-2 agonists, or a combination. Inhaled glucocorticoids are not prohibited. However ALL INHALED beta-2 agonists are prohibited at all times except for albuterol, salmeterol, and formoterol which can be used only under a certain amount. Please make sure to read our detailed article on beta-2 agonists, and always check the status of your medications by searching GlobalDRO.com.
In the first instance, you should contact USADA to determine exactly why the TUE was denied if it is not made clear in the denial letter. Sometimes, there may be a critical piece of information that was overlooked or not provided, or new relevant information or test results may be available that would allow the TUE to be approved. You should investigate whether there is scope for resubmission of your application. Failing this, you may appeal the decision to the World Anti-Doping Agency. Information regarding the appeal process is available on the WADA website.
Predicting the time it takes for a medication to clear completely from your system is complicated, can vary greatly, and is unique between individuals and to each medication. For this reason, USADA cannot predict urine and/or blood clearance times for athletes. You will need to talk with your physician and/or pharmacist about the average time it takes the body to clear a particular medication, and whether there are any known factors that might affect how your body might process that medication. Once you have that information, you will need to decide for yourself whether the “clearance time” estimated by your physician or pharmacist is sufficient for you to compete. If you are not certain that the medication will have cleared by the time you compete, you are encouraged to apply for a TUE. Click here to learn more about clearance times of medications.
If you are planning a surgery, your first step is to look up all medications that you will be given during or after your surgery on www.GlobalDRO.com. For general anesthesia, it is common for more than one medication to be used. There may be cases when it is not possible to find out in advance of what medications you will receive (such as in an emergency) and sometimes the anesthesiologist will change his or her mind during the surgery about the most appropriate medication to use. In all cases, request a copy of the surgical notes in order to find out which medications were administered and submit an emergency TUE if necessary. You can use the USADA Surgery Checklist to help you.
The NCAA has different rules and regulations regarding medical exemptions than USADA. You need to contact the appropriate person at your education institution or NCAA to discuss your medication and if the medication is on the NCAA Banned Drug List. The USADA and NCAA application and review processes are completely separate.
USADA does not recognize NCAA medical exemptions. If you will also be competing in events sanctioned by the national governing body for the Olympic sport, then you will also need to submit a TUE to USADA.
The beta-2-agonists used for the treatment of asthma that have a limited dose or threshold set by WADA include:
- inhaled salbutamol (maximum 1600 micrograms over 24 hours),
- inhaled formoterol (maximum delivered dose 54 micrograms over 24 hours), and
- salmeterol when taken by inhalation in accordance with the manufacturers’ recommended therapeutic regimen. These include the isomers when available, such as levalbuterol (Xopenex®) and arformoterol (Brovana®). The threshold for the presence in urine of salbutamol is 1000 ng/mL and formoterol is 40 ng/mL.
When used as a nebulized treatment, the dose used is more than that listed for the inhalers. This is because a nebulizer device does not deliver that full amount into your lungs. Instead, only a fraction of that dose is inhaled. The amount you take per treatment is dependent on both the nebulizer device you use and the way in which that medical device nebulizes the specific drug. USADA does not maintain a list of all nebulizer devices or the percentage of drug each administers. As the athlete, you should contact the manufacturer of the nebulizer device and ask what percentage of the drug you are using is administered with each dose. If the amount inhaled is higher than the dose allowed by WADA, submit a Therapeutic Use Exemption for the use of your nebulizer and related inhalers.