Therapeutic Use Exemptions

What is a TUE?
Athletes, like all others, may have illnesses or conditions that require them to take medications. If the medication an athlete is required to take happens to fall under the World Anti-Doping Agency’s Prohibited List, a therapeutic use exemption (TUE) can give the athlete authorization to take the needed medicine.

Athletes are not automatically granted authorization and must ensure they follow the appropriate process for their sport and competition level.

Who should apply for a TUE?
All athletes who are subject to doping control must be aware of the TUE rules and requirements that apply to them. These rules and requirements will vary depending on the athlete and will determine when and to which organization an athlete must submit a TUE application. Check your requirements now.

Under what circumstances will a TUE application be approved?
A TUE application will be considered by the CCES under the following circumstances:

  • the substance or method is needed to treat an acute or chronic medical condition, such that the athlete would experience a significant impairment to health if the prohibited substance or method were to be withheld;
  • the use of the prohibited substance or 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; and
  • there are no reasonable therapeutic alternatives or other alternatives are ineffective.

Examples include:

  • Insulin for the treatment of Type 1 Diabetes Mellitus;
  • Beta-2 Agonist inhaler, such as terbutaline, for the treatment of asthma; or
  • Methylphenidate for the treatment of ADD or ADHD.

How do I apply for a TUE?
Step 1: Check to see if your medication, or its route of administration, is prohibited. If it is not prohibited, no further action is required. Verify through one of the following resources:

Step 2: Determine which organization is responsible for processing your TUE application:

  • International Federation (IF): Athletes in their IF’s Registered Testing Pool (RTP), or who compete at an international level (i.e., in IF-sanctioned events), must ensure that they comply with their IF’s TUE requirements. Contact the CCES if you need assistance obtaining information from your IF.

or

  • The CCES: Athletes in the CCES Registered Testing Pool (RTP) and/or National Athlete Pool (NAP) should submit an application to the CCES. International-level athletes who have been directed by their IF to submit an application to the CCES may also use this process.

Step 3: Determine when your TUE application should be submitted:

  • At the time the medication is prescribed by your physician for medications prohibited in- and out-of-competition;

or

  • No less than 30 days prior to participating in an event for medications prohibited only in-competition.

Step 4: Compile medical evidence confirming your diagnosis and prescription including:

  • A letter from your physician confirming you were seen within the last 12 months;
  • Comprehensive medical history related to the diagnosis;
  • The results of all relevant objective examinations, laboratory investigations and imaging studies;
  • Independent supporting medical opinion in the case of non-demonstrable conditions;
  • Relevant correspondence between physicians regarding the diagnosis and prescription; and
  • Additional requirements listed on the Therapeutic Use Exemption (TUE) Checklist and Application for specific diagnoses, if applicable.

Step 5: Complete the TUE application form:

  • The CCES will accept applications submitted on the CCES TUE application form or an IF TUE application form, provided all required information is included.
  • All information on the form must be legible (typed or block letters preferred).
  • All fields must be properly completed, and the form must be dated and signed by the athlete and the prescribing physician.
  • Illegible and/or incomplete forms will be returned to the athlete unprocessed.

Step 6: Send the completed application form and supporting documentation to the appropriate organization. In the case of applications to the CCES, please:

  • Fax: 613-521-3134;
  • Email: tue-aut@cces.ca; or
  • Mail: Attn: Athlete Services Officer, CCES, 350-955 Green Valley Cr, Ottawa, ON, K2C 3V4.

Step 7: If you are selected for doping control, be sure to verbally declare your medications to the doping control officer, including the following:

  • All prescribed medications (e.g., asthma medications and glucocorticoids); and
  • All non-prescribed medications and supplements taken in the last seven days.

TUE application timelines and information:

  • A complete TUE application can be reviewed within 21 days of receipt of a complete application.
  • The CCES will contact the athlete once a decision has been rendered on the application, or if more information has been deemed necessary.
  • Costs incurred for the completion of the TUE application form or additional investigations, examinations, or imaging studies are the responsibility of the athlete.
  • The CCES will confirm receipt of a TUE application by email within two business days. If you do not receive a confirmation of receipt within that time frame, please contact the CCES.
  • Incomplete applications will be returned and will need to be resubmitted with additional information.
  • Keep a copy of your application form and medical file for your records.

What is a retroactive TUE?

Athletes competing in national events but not included in the CCES Registered Testing Pool (RTP) or the CCES National Athlete Pool (NAP), are not required to have a TUE application approved prior to using a prohibited substance. Instead, they may go through a retroactive TUE application process to validate and permit the use of prescribed medications for therapeutic reasons.

The retroactive TUE application process is initiated by the CCES after an athlete goes through doping control and the sample analysis reveals the presence of a banned substance. The CCES would contact the athlete through their sport organization to determine whether or not the substance was used as part of a medical treatment plan. If so, the athlete would be asked to have their physician complete a TUE application form and provide documentation to support their medical history. The application is submitted to the CCES for review.

The TUE application provided to the CCES must include a medical file which satisfies all of the following conditions listed in Step 4: Compile Medical Evidence.

If at any time an athlete is added to the CCES RTP, the CCES NAP, their International Federation’s (IF) RTP, or the athlete attends an international event, it is their responsibility to ensure that they meet all additional TUE requirements imposed by the CCES or their IF.

What should I do in case of an emergency or acute treatment?

Step 1: Your health and safety come first. Any decision made regarding your treatment plan should be done in consultation with your physician. Proceed to Step 2 once your treatment is being managed.

Step 2: Check to see if your medication, or its route of administration, is prohibited. If it is not prohibited no further action is required. Verify using one of the following resources:

Step 3: : Determine if a TUE application should be submitted. A TUE application for emergency or acute treatment should be submitted only in the following cases:

I am in my IF’s RTP, and take medication that is prohibited both in and out of competition;
I am in my IF’s RTP, I take medication that is prohibited in competition only, and plan to compete in 30 days or less of having completed my treatment;
I am in the CCES NAP or RTP and take medication that is prohibited both in and out of competition;
I am in the CCES NAP or RTP, I take medication that is prohibited in competition only, and plan to compete in 30 days or less of having completed my treatment; or
I am not in a testing pool (IF RTP, CCES NAP or CCES RTP); however, I take medication that is prohibited in competition only and plan to compete at an IF - sanctioned event in 30 days or less of having completed my treatment. 

IF: International Federation; RTP: Registered Testing Pool; NAP: National Athlete Pool

Step 4: Determine which organization is responsible for processing your TUE application:

  • International Federation: Athletes in their IF’s RTP or who compete at an international level (i.e., in IF-sanctioned events), must ensure that they comply with their IF’s TUE requirements. Contact the CCES if you need assistance obtaining information from your IF.

or

  • The CCES: Athletes in the CCES RTP and/or NAP should submit their application to the CCES. International-level athletes who have been directed by their IF to submit their application to the CCES may also use this process.

Step 5: Compile medical evidence confirming your diagnosis and prescription including:

  • A letter from your physician confirming you were seen within the last 12 months;
  • Comprehensive medical history related to the diagnosis;
  • The results of all relevant objective examinations, laboratory investigations and imaging studies;
  • Independent supporting medical opinion in the case of non-demonstrable conditions;
  • Relevant correspondence between physicians regarding the diagnosis and prescription; and
  • Copies of all clinical notes relating to the treatment received during your emergency/acute intervention.

Step 6: Complete the TUE application form:

  • The CCES will accept applications submitted on the CCES TUE application form or an IF TUE application form, provided all required information is included.
  • All information on the form must be legible (typed or block letters preferred).
  • All fields must be properly completed, and the form must be dated and signed by the athlete and the prescribing physician.
  • Illegible and/or incomplete forms will be returned to the athlete unprocessed.

Step 7: Send the completed application form and supporting documentation to the CCES by:

  • Fax: 613-521-3134;
  • Email: tue-aut@cces.ca; or
  • Mail: Attn: Athlete Services Officer, CCES, 350-955 Green Valley Cr, Ottawa, ON, K2C 3V4.

What should I do if I have surgery?

Step 1: Prior to surgery, ask your physician for a list of the medications that will be used. Check to see if the medications, or their routes of administration, are prohibited. If not prohibited, no further action is required. Verify through one of the following resources:

Step 2: Determine if a TUE application should be submitted. A TUE application should be submitted in the following cases:

I am in my IF’s RTP, and take medication that is prohibited both in and out of competition;
I am in my IF’s RTP, I take medication that is prohibited in competition only, and plan to compete in 30 days or less of having completed my treatment;
I am in the CCES NAP or RTP and take medication that is prohibited both in and out of competition;
I am in the CCES NAP or RTP, I take medication that is prohibited in competition only, and plan to compete in 30 days or less of having completed my treatment; or
I am not in a testing pool (IF RTP, CCES NAP or CCES RTP); however, I take medication that is prohibited in competition only and plan to compete at an IF - sanctioned event in 30 days or less of having completed my treatment. 

 

Step 3: Determine which organization is responsible for processing your TUE application:

  • International Federation (IF): Athletes in their IF’s RTP, or who compete at an international level (i.e., in IF-sanctioned events), must ensure that they comply with their IF’s TUE requirements. Contact the CCES if you need assistance obtaining information from your IF.

or

  • The CCES: Athletes in the CCES RTP and/or NAP should submit their application to the CCES. International-level athletes who have been directed by their IF to submit their application to the CCES may also use this process.

Step 4: Compile medical evidence confirming your diagnosis and prescription including:

  • A letter from your physician confirming you were seen within the last 12 months;
  • Comprehensive medical history related to the diagnosis;
  • The results of all relevant objective examinations, laboratory investigations and imaging studies;
  • Independent supporting medical opinion in the case of non-demonstrable conditions;
  • Relevant correspondence between physicians regarding the diagnosis and prescription; and
  • Copies of all clinical and surgical notes relating to the treatment received during your surgery including preparation and recovery.

Step 5: Complete the TUE application form:

  • The CCES will accept applications submitted on the CCES TUE application form or an IF TUE application form, provided all required information is include.
  • All information on the form must be legible (typed or block letters preferred).
  • All fields must be properly completed, and the form must be dated and signed by the athlete and the prescribing physician.
  • Illegible and/or incomplete forms will be returned to the athlete unprocessed.

Step 6: Send the completed application form and supporting documentation to the CCES by:

  • Fax: 613-521-3134;
  • Email: tue-aut@cces.ca; or
  • Mail: Attn: Athlete Services Officer, CCES, 350-955 Green Valley Cr, Ottawa, ON, K2C 3V4.

How long is my TUE valid?

A TUE granted by the CCES is valid for the duration of the treatment as prescribed by the physician, up to a maximum of four years. It is your responsibility to know when your TUE expires and to apply for renewal before this date if necessary.

What should I do if my competition level changes?

A CCES TUE is granted in accordance with the TUE rules of the 2015 Canadian Anti-Doping Program and is valid only in Canada, unless otherwise stated in your International Federation’s anti-doping rules. If at any time you are included in your IF’s Registered Testing Pool (RTP) or compete at an international level, you must comply with their IF TUE requirements. You should contact the CCES to determine whether your CCES TUE is valid for international competition.

For more information about TUEs:
Try the Medical Exemption Wizard
Email: TUE-AUT@cces.ca
Call the toll-free InfoLine: 1-800-672-7775