Therapeutic Use Exemptions.

The introduction, in 2004, of the World Anti-Doping Code and a standardized "prohibited list" of substances and methods proscribed in sport represented a consistent, international response to the escalating challenge of drug misuse in contemporary sport. Simultaneously, it was recognized that athletes experiencing illness or injury might legitimately require the use of "prohibited" medications or procedures, and the concept of the "therapeutic use exemption" (TUE) was introduced. The mechanisms of the TUE process are carefully defined and described in a specific WADA "international standard" (IS). As a consequence, anti-doping organizations (ADOs) were empowered to establish "Therapeutic Use Exemption Committees" (TUECs) whose membership and responsibilities were clearly delineated in the IS, and to whom an athlete and treating physician(s) could make appropriate application for a TUE. A careful review of such an application by a TUEC panel of physicians might allow permission for an otherwise prohibited course of treatment, provided that appropriate criteria had been met. Sport physicians have a clear responsibility to ensure accurate and complete documentation of the clinical circumstances requiring a TUE when completing such applications. Typically, applications for consideration by TUECs are forwarded to a national ADO, but depending on an applicant's level of competition, it may become necessary to involve an international federation or major event organization (e.g., International Olympic Committee, or Commonwealth Games Federation). Such organizations may receive, review, and grant TUEs specific to the competitions over which they preside. Increasingly, there is recognition of TUEs granted by other ADOs. However, this is not always the case; in certain circumstances, the decisions of other TUECs to grant or deny an application may be appealed. The advent of the TUE process ensures that an athlete with a genuine medical condition that necessitates the use of a prohibited substance or procedure can apply for permission to use such treatments and is not denied access to competition or training.