USADA Policy for Therapeutic Use Exemptions


1) General Principles

USADA’s Policy for Therapeutic Use Exemptions is based upon the relevant provisions of the World Anti-Doping Code (the “Code”) and the provisions of the World Anti-Doping Agency (“WADA”) International Standard for TUEs (“IS TUE”) which are incorporated herein as if fully set forth. This Policy is informed by the following general principles which provide the context for USADA’s Policy.

It is each Athlete’s personal duty to ensure that no Prohibited Substance enters his or her body. Athletes are responsible for any Prohibited Substance or its Metabolites or Markers found to be present in their Samples. Source: Code, Article 2.1.1.

Athletes with documented medical conditions requiring the use of a Prohibited Substance or a Prohibited Method must request a Therapeutic Use Exemption (“TUE”) from their International Federation (“IF”) or USADA. For certain major competitions such as the Olympic Games and the Pan American Games TUEs must be sought directly from the event organizer and a USADA TUE or TUE from an IF will not be sufficient. Source: Code, Article 4.4.

Athletes who are in there IF’s Testing Pool OR who intend to compete in an International Event may only obtain TUEs in accordance with the rules of their IF or the event organizer. Source: Code, Article 4.4.

Each IF shall publish a list of those International Events for which a TUE from the IF is required. Source: Code, Article 4.4.

All Athletes in the USADA National Testing Pool (“USADA NTP”) who require a TUE and who have not gotten a TUE from their IF must contact USADA. USADA will recognize a valid TUE obtained from an Athlete’s IF.
An application for a TUE will not be considered for retroactive approval except in cases where:

a. emergency treatment or treatment of an acute medical condition was necessary, or
b. due to exceptional circumstances, there was insufficient time or opportunity for an applicant to submit, or a therapeutic use exemption committee (“TUEC”) to consider, an application prior to doping control.

Specific national rules for TUEs may be established for non-international-level or non-national level competitors without being in conflict with the Code. Source: Code, Definition of “Athlete.” 

2) Definitions

A complete list of definitions from the Code and IS TUE which are relevant to this Policy can be found in Article 3 of the IS TUE. In addition, the following definitions have particular importance in applying this Policy:

a) Foreign Athlete: For purposes of this Policy, a “Foreign Athlete” is an Athlete who is not a resident of the United States and is not either an International Level Athlete or a National Level Athlete as defined below.
b) International Event: An Event where the International Olympic Committee, the International Paralympic Committee, an IF, a Major Event Organization, or another international sport organization is the ruling body for the Event or appoints the technical officials for the Event.
Note: Pursuant to Code Article 4.4, each IF is required to publish a list of those International Events for which a TUE from the IF is required.

c) International-Level Athlete: Athletes designated by one or more IFs as being within the Registered Testing Pool for an IF.

d) National Level Athlete: For purposes of this Policy a “National Level Athlete” is any Athlete in the USADA NTP who is not in the Registered Testing Pool of an IF.

e) Non-National Level Athlete: For purposes of this Policy a “Non-National Level Athlete” is any United States Athlete who is not an International-Level Athlete or an Athlete entered into an International Event and is not a National Level Athlete and over whom USADA has authority to conduct results management in relation to an Adverse Analytical Finding, an Atypical Finding or other potential anti-doping rules violation.

3) National Level Athletes


USADA will process TUE applications for National Level Athletes in accordance with the IS TUE.

a) A National Level Athlete may apply to USADA for a TUE for any substance at any time, however, such applications must be complete and received by USADA at least twenty-one (21) days in advance of any use prohibited in sport.

b) TUEs will only be considered for retroactive approval in accordance with the strict criteria set forth in the IS TUE.

WARNING: For substances which are prohibited only in-competition the athlete must ensure sufficient time for clearance from the body before the competition. Urine excretion rates for various substances vary between individuals and the Athlete must allow sufficient time to avoid anti-doping rules violation. Of course, discontinuance of a medication can also have adverse health consequences and should never be under taken without consultation with the Athlete’s physician and a full appreciation of the risks involved.The only completely safe method for an International-Level Athlete or a National Level Athlete to use a Prohibited Substance without risking an anti-doping rule violation is to obtain a TUE prior to using a Prohibited Substance or Prohibited Method.

4) International Level Athletes

USADA’s TUE Policy does not apply to International-Level Athletes. USADA will assist International-Level Athletes in the USADA RTP with forwarding applications for TUEs if such requests for USADA assistance are made at least 21 days in advance of the Athlete’s Use of the medication where prohibited in sport.

Some IFs have granted USADA authority to process TUEs for International-Level Athletes who are U.S. citizens; USADA will process their TUE applications in accordance with the rules of the IF and the IS TUE.
WARNING: If a National Level Athlete competes in an International Event they may be required to obtain a TUE in advance from the relevant IF. It is the responsibility of every Athlete to investigate the applicable TUE requirements before competing in an International Event.

5) Non-National Level Athletes

a) Non-National Level Athletes are required to obtain an advance TUE for prohibited substances with the exception of a first AAF caused by one or more of the:
i) substances prohibited only in-competition or prohibited by particular sports,

ii) the class of “Diuretics and Other Masking Agents”,

iii) Beta-2 agonists (except inhaled salbutamol / albuterol and salmeterol), and

iv) insulin where the athlete can demonstrate diagnosis of insulin-dependent diabetes.

TUEs will be obtained in the same manner as for National Level Athletes as set forth in Section 3 above.

b)Non-National Level Athletes who have a first AAF caused by the Use of a medication will not have committed an anti-doping rules violation for substances outlined in Section 5 a) i–iv above if the rules below are followed.
i) For substances listed in 5)a) above
(1) The Athlete has a medical condition which was well documented in his or her medical records prior to the date doping control was performed.

(2) The Athlete, at the Athlete’s expense, promptly undergoes any additional medical examination and testing requested by USADA, including, but not limited to, seeing particular physicians which may be designated by USADA.

(3) The facts and circumstances of the case put to rest any reasonable suspicion that the Athlete used the substance for the purpose of enhancing the Athlete’s performance. Completing the “Declaration of Use” section on the DCOR shall be considered strong proof that the use of the substance was not intended to enhance performance.

(4) If the Athlete intends to compete further in any Event or Competition that may be drug tested by USADA the Athlete must apply for a TUE for any prohibited substance in advance of any further Event or Competition.

Non-National Level Athletes who have once had an AAF caused by the use of any substance shall be liable for an anti-doping rules violation for any future positive drug test for any substance unless they have applied for and been granted a TUE for the substance in accordance with the IS TUE;

6) Effective Date

This USADA TUE Policy shall go into effect on January 1, 2011. This Policy shall not apply retrospectively to matters pending before January 1, 2011 except as provided in Article 25 of the Code.