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:


  • Use the Medical Exemption Wizard to determine your medical exemption requirements, and to download the application form and medical criteria checklist.
  • Work with your physician to complete the TUE application form and provide documentation to support your medical history, which must satisfy certain conditions. Costs incurred for the completion of the TUE application form or additional investigations, examinations, or imaging studies are the athlete’s responsibility.
  • 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, contact the CCES.
  • Incomplete applications may be returned and may need to be resubmitted with additional information.
  • A complete TUE application can take between 21 to 30 days to review from the time of receipt.
  • The CCES will contact the athlete and/or their designate once a decision has been rendered on the application, or if more information has been deemed necessary.
  • Keep a copy of your application form and medical file for your records.

In most instances, a TUE application must be submitted 30 days BEFORE commencing treatment. Under the rules of the Canadian Anti-Doping Program (CADP), there is a limited set of circumstances where an athlete can apply AFTER starting their treatment. This is known as a retroactive TUE. 

These limited circumstances include situations where:

  • An emergency or urgent treatment of a medical condition was necessary.
  • There was insufficient time, opportunity or other exceptional circumstances that prevented you from submitting the TUE application, or having it evaluated, before sample collection.
  • Under the rules of the Canadian Anti-Doping Program (CADP), the CCES did not require you to apply for a TUE in advance of sample collection.
  • You are using a prohibited substance or method for therapeutic reasons, but you compete in sport at a level that is not considered to be international or national as defined by your international federation or under the CADP (e.g., athletes that ARE NOT in the CCES’ National Athlete Pool (NAP) who do not compete in international events).
  • You tested positive after using a substance out of competition that was only prohibited in competition (e.g., glucocorticoids).

If you are confronted with a situation that requires the submission of a retroactive TUE, the following timelines would apply:

  • Athletes that ARE a) in the CCES’ NAP, or b) competing in any international event, must ensure that their retroactive TUE application is submitted as soon as possible after the use of the substance has begun. 
  • Athletes who ARE NOT a) in the CCES’ NAP or b) competing in any international event, do not need to submit a retroactive TUE application until they have gone through doping control.

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.

Prior to surgery, ask your physician for a list of the medications that will be used. Use the Medical Exemption Wizard to determine your medical exemption requirements, and to download the application form if required.

A CCES TUE is granted in accordance with the TUE rules of the CADP and is valid only in Canada, unless otherwise stated in your international federation’s (IF) 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 your IF’s TUE requirements. Contact the CCES to determine whether your CCES TUE is valid for international competition.

If at any time you are added to the CCES RTP, the CCES NAP, your IF’s RTP, or you attend an international event, it is your responsibility to ensure you meet all additional TUE requirements imposed by the CCES or your IF. Knowing when you need to apply for a TUE and which organization you should to apply to can sometimes cause confusion. We strongly recommend that you use the Medical Exemption Wizard to determine your requirements.

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. Some exceptions to this maximum are described in the Medical Criteria Checklist related to your application. It is your responsibility to know when your TUE expires and to apply for renewal before this date if necessary.

Each TUE has a specific duration, after which it expires automatically. It is your responsibility to submit a new TUE application if you still need the prohibited substance or method. Each TUE approval letter sent by the CCES outlines the medical documentation required for subsequent applications. We strongly recommend that you submit a renewal application BEFORE your current TUE expires.

Under the rules of the CADP, you may appeal a denial decision. The decision letter provided by the CCES will include a written explanation of the reasons for the denial and outline your appeal options in detail.

We strongly recommend that you use the Medical Exemption Wizard to determine your requirements.

If you already know your requirements, you can access our TUE forms directly.