Athletes may have illnesses or conditions that require them to take medications. If the medication is on the World Anti-Doping Agency’s (WADA) Prohibited List, the therapeutic use exemption (TUE) process is available to validate and permit the use of prescribed medications for therapeutic reasons.

Who should apply for a TUE?

This is the million-dollar question. Rules and requirements vary depending on the athlete’s sport and competition level. The Medical Exemption Wizard is the best way to understand if, when and to which organization an athlete must submit a TUE application.

Athletes who are subject to doping control must be aware of the TUE requirements that apply to them. They are responsible for informing their physician that they are an athlete bound by anti-doping rules, and working with them to:

  • Verify the status of the prescribed medication on Global DRO.
  • If the substance or method is prohibited, discuss non-prohibited alternatives.
  • If there are no non-prohibited alternatives that are suitable for the specific athlete, apply for a TUE (see “How do I apply for a TUE?” below).

Under what circumstances will a TUE application be approved?

Athletes are not automatically granted authorization. A TUE application will be considered by the CCES if all three of the following are true:

  • 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 non-prohibited therapeutic alternatives or the 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; and
  • Methylphenidate for the treatment of ADD or ADHD.

For more information about TUEs:

FAQ

What happens if I’m already taking a prohibited medication?

First – don’t panic! This is a very common experience. Often, athletes will start a course of treatment for long before they need to apply for a TUE (e.g., when added to the NAP or meet the IF’s definition of an international-level athlete). 

Submit an application as soon as possible once you are required to do so. Use the Medical Exemption Wizard to determine your medical exemption requirements. 

What does it mean if my application is denied?

If your TUE application is denied, it means that your application doesn’t currently meet the criteria outlined in the ISTUE, not necessarily that your treatment isn’t considered valid.

The decision letter provided by the CCES will explain why it was denied and which criteria were not met. The letter will also list which elements were missing and could be submitted in a new application to be reconsidered by the TUE Committee (TUEC). Under the rules of the CADP, you may appeal a denial decision.

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

Your health and safety come first. Decisions regarding your treatment plan should be made in consultation with your physician. Once your treatment is being managed, use the Medical Exemption Wizard to determine your medical exemption requirements, and to download the application form if required.

Your health and safety come first. With the advisement of your medical team, get the medical help you need, and after your treatment has been managed, consult the Medical Exemption page to determine whether you need a medical exemption. 

If the application is for emergency or acute treatment, or for a surgery requires you to apply for a TUE, you might be eligible for the Retroactive TUE process.

What should I do if my level of competition level changes?

Your medical exemption requirements may change when your level of competition changes. An approved CCES TUE is valid only in Canada, so if you’re going to compete internationally, consult your international federation’s (IF) anti-doping rules. 

If you are added to your IF’s RTP or compete at an international level (e.g., a world cup, world championships, major games), you may be required to have your TUE recognized by your IF before this competition. Contact the CCES or the IF to determine if and how you should seek recognition for your TUE at the international level. 

How long is my TUE valid, once approved?

The duration of your TUE is determined by the CCES TUEC and varies from case to case. The duration and expiry date will be clearly stated on your TUE certificate. 

How do I renew my TUE before it expires?

Your TUE will expire after the date indicated on the TUE certificate. It is your responsibility to know when your TUE certificate expires, and to submit another application in advance of the expiry date if you are still using the prohibited medication.

The CCES’s TUE approval letter will outline the medical documentation required for subsequent applications. We strongly recommend that you submit a renewal application within three months of the expiry date (e.g., if your TUE expires on April 1, 2026, submit a new application by January 1, 2026). 

Do I need separate TUEs if I use multiple prohibited substances?

If you are taking prohibited medications for more than one diagnosis or condition, then you must submit a separate application for each condition. For example, if you use medications to treat ADHD and diabetes, you will submit one TUE application for the diabetes treatment, and a second one for the ADHD treatment. List all prohibited medication(s) that you are using for treating your condition on the TUE application form. 

Do I need a new TUE if I get switched from a brand-name medication to generic?

If the substance name (i.e., the active ingredient in your medication) listed on the TUE certificate is the same, then you do not require a new TUE. 

If you are switched from one prohibited medication to a different one, with a different active ingredient, you would need to apply for a new TUE.

What should I do if my dosage changes while my TUE is still valid?

If the type of medication and/or dosage changes before your TUE expires, you must contact the CCES to request a new TUE, because a TUE is only valid for the specific substance(s), dosage, route of administration, frequency, and duration. If you have been issued a TUE by the CCES, the letter of approval will highlight what elements should be submitted in the event your medication and/or dosage changes. 

Why is the TUE application process so thorough? It feels like athletes are being punished for needing medical treatment.

The TUE process is very rigorous, and some athletes may go through multiple rounds of submitting additional information or seeing specialists to get appropriate documentation before their application is considered complete. It can be a long, challenging process. 

The goals of the TUE are twofold: first, to ensure that athletes have access to the medical treatments they need, even if those treatments are prohibited, without being punished with a positive test. And second, to make absolutely sure that the system is not being used to cover for doping. 

The TUE process is thorough, but it’s thorough with good reason – to demonstrate beyond a shadow of a doubt that the athlete is competing clean.