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What Athletes Need to Know About the Dangers of Stopping Prescription Medication Before Competition

A variety of prescription medication bottles and a pill organizer.Under the World Anti-Doping Agency (WADA) Prohibited List, there are substances prohibited at all times, in-competition only, and in certain sports. The Therapeutic Use Exemption (TUE) process is designed to ensure that athletes who meet strict criteria can continue using necessary medications while they compete in sport.

However, USADA has recently observed a disturbing trend where athletes who are using a substance or medication that’s only prohibited in-competition are tempted to skip the TUE process and hope that they can briefly or permanently discontinue using a substance or medication instead. This can be risky from both an anti-doping perspective and a health perspective.

Here are some key points to keep in mind:

1. Athletes should apply for TUEs for medications prohibited only in-competition

Athletes are subject to both urine and blood testing 365 days a year and tests can occur at any time and any place. For substances that are prohibited at all times (such as hormones, anabolic agents, diuretics, and, for some sports, beta-blockers), athletes are required to have a valid TUE to use prohibited medications in sport regardless of whether they are competing.

But for substances prohibited only in-competition (stimulants, glucocorticoids, narcotics, cannabinoids, and, for some sports, beta-blockers) some athletes choose to stop taking a necessary medication just before competition instead of applying for a TUE. An athlete may choose not to apply for a TUE because they believe their TUE application will be denied, the application process is too long or complicated, or they don’t even realize that they can get a TUE for their medication. While the TUE process is rigorous to ensure that athletes don’t abuse the process to obtain an unfair advantage, it’s also designed to be fair in recognition that athletes often have a legitimate medical need to use a prohibited substance or method. USADA is here to help throughout the TUE process!

2. There are both serious anti-doping and health risks from stopping medications

In most (if not all) cases, stopping a medication just prior to competition is not a reliable way to prevent a positive test. If you are tested in-competition and return a positive test, you will be liable even if the substance was taken before the in-competition period began.

Moreover, stopping a medication could harm the health of the athlete by causing a condition or illness to go untreated or by causing other adverse effects from sudden withdrawal of the medication. For example, most ADHD medication is commonly prescribed to be taken daily, so missing a few days during a competition could have detrimental consequences to physical and mental health.

It is also important to understand that predicting the amount of time needed for a medication to clear completely from an individual’s system is complicated and unique to an individual based upon the medication and various other factors. For this reason, USADA cannot advise on clearance times for athletes. WADA has provided some guidance around glucocorticoids by publishing estimated withdrawal times associated with specific routes of administration, but there are no established clearance times for stimulants (except pseudoephedrine), narcotics, cannabinoids, or beta-blockers. 

3. The safest choice is to apply for a TUE as soon as possible

Given the above information, USADA encourages all athletes to apply for a TUE (or in the case of recreational or non-competitive athletes, submit a TUE Pre-Check Form) in advance of using a prohibited substance, even if it’s only prohibited in-competition. The TUE process is available to any athlete that wants to apply, even for recreational level athletes. Athletes and support personnel can contact TUE@USADA.org to receive personal guidance on TUE requirements based on the level of competition, substance, and other relevant circumstances. Keep in mind that, while some athletes can receive a retroactive TUE if they test positive and don’t have a TUE, the documentation and criteria used to grant a retroactive TUE is just as rigorous as the advance TUE process.

More questions?

For questions about specific products, substances, and methods, contact USADA’s Drug Reference Line at drugreference@USADA.org or call (719) 785-2000, option 2. There is also a TUE Pre-Check Form that athletes can submit to get a quick response on whether a TUE is necessary.

More education?

In addition to educating athletes and offering real-time support, USADA offers resources and tutorials for athlete support personnel, including health professionals and coaches.

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