What is a therapeutic use exemption (TUE)?

Athletes may sometimes have conditions that require certain medications or undergoing medical procedures or surgeries. If the drug prescribed to the athlete is on the World Anti-Doping Agency (WADA) list of prohibited substances  Prohibited List, an athlete must apply for a therapeutic use exception to obtain permission to use the drug during competition without being considered a violator of the Anti-Doping rules. The therapeutic exception committee composed of experienced doctors evaluates the applications submitted by the athletes and makes the decision to grant the exemption according to the regulations and rules stipulated in the World Anti-Doping Code and Bahrain Anti-Doping Organization Rules.

What are the criteria for granting an exception for therapeutic use?

All four criteria listed below must be met:

• The athlete has a clearly diagnosed medical condition that requires treatment with a prohibited substance or method.
• Therapeutic use of the substance will not result in significant improvement in performance beyond the athlete’s normal state of health.
• There is no other therapeutic alternative to the use of the prohibited substance or method.
• The necessity of using that substance or method is not the result of prior use without (exception for therapeutic use) of a substance or method that was prohibited at the time of use.

Who should apply for therapeutic use exemption “TUE”? Where and when to apply?

1. check if the required medication or method you intend to take, or use is prohibited as per the WADA Prohibited List.You have a responsibility to inform your physician(s) that you are an Athlete bound to Anti-Doping rules. You and your physician(s) should check the Prohibited List for whatever substance/method you are prescribed. If the substance/method is prohibited, discuss non-prohibited alternatives if there are none, apply for a TUE.
2. Determine your competition level and TUE application requirements.International-Level Athlete: Athletes who compete in sport at the international level, as defined by each International Federation.National-Level Athlete: Athletes who compete in sport at the national level, as defined by each National Anti-Doping Organization. Athletes who were in the Registered Testing Pool (RTP) are also considered National-Level Athletes.

If it is determined that you are a National-Level Athlete, you must apply to BANDO in advance, as soon as the need arises, unless there are emergency or exceptional circumstances.

For substances prohibited in-competition only, you should apply for a TUE at least 30 days before your next competition. Please refer to the section “How to apply to BANDO for a TUE?” below.

If your level is lower than the “National-Level” as defined above, you are entitled to apply for a retroactive TUE after being tested by BANDO or any other Anti-Doping Organization.

Important note:

A TUE granted by BNADO is only valid at the national level. If you are, or become an International-Level Athlete, or compete at Major Games, that TUE will not be valid unless it is recognized by the relevant International Federation (IF) or Major Event Organization (MEO). It is your responsibility to check if your BNADO’s TUE is automatically recognized by such IF or MEO.

BNADO can assist you in the determination of your level, TUE application requirements and presenting your BANDO’s TUE to an IF or MEO for recognition. Please contact tue@b-nado.bh

Can I get a retroactive therapeutic use exemption?

You may only apply retroactively for a TUE to BANDO if:

• You required emergency or urgent treatment of a medical condition.
• There was insufficient time, opportunity or other exceptional circumstances that prevented you from submitting the TUE application, or having it evaluated, before getting tested.
• Due to national-level prioritization of certain sports, the athlete’s National Anti-Doping Organization did not permit or require the athlete to apply for a prospective TUE.
• You are a lower-level athlete who is not under the jurisdiction of an International Federation or National Anti-Doping Organization and were tested.
• You tested positive after using a substance Out-of-Competition that was only prohibited In-Competition (for example glucocorticoids).

This retroactive TUE will only be granted with the prior approval of WADA (and WADA may in its absolute discretion agree with or reject the BANDO’s decision).

Important note:

Using a prohibited substance or method without a TUE could result in an Anti-Doping Rule Violation.

In case an application for a retroactive TUE is necessary following sample collection, you are strongly advised to have a medical file prepared and ready to submit for evaluation.

How to apply to BNADO for a TUE?

Athlete can use one of following procedure to apply for a TUEs:

• only through ADAMS

You may submit your TUE application, including the required medical file, via ADAMS. If you do not have an ADAMS account yet, please contact Tue@b-nado.bh  to have your account set up.

• through electronic TUE form

To apply, please download the BANDO’s TUE Application Form, and once duly completed and signed, send it together with the required medical file to Tue@b-nado.bh .

Your TUE application must be submitted in legible form using capital letters or typing.

The medical file must include:

• A comprehensive medical history, including documentation from the original diagnosing physician(s),
• The results of all examinations, laboratory investigations and imaging studies relevant to the application.

The athlete is responsible for all costs related to the TUEs application, TUEs identification requests, and any supplemental information requested by the therapeutic use exemption committee.

Any TUE application that is not complete or legible will not be dealt with and will be returned for completion and re-submission.

To assist you and your doctor in providing the correct medical documentation, we suggest consulting the WADA’s Checklists for TUE applications for guidance and support during the TUE application process, and TUE Physician Guidelines for guidance on specific common medical conditions, treatments, substances, etc.

Keep a complete copy of the TUE application form and all medical information submitted in support of your application, and proof that it has been sent.

What happens at major events?

A Major Event Organization (MEO) requires athletes to apply for the recognition of their TUE if they wish to use a prohibited substance or method in connection with the Event.

If you have a TUE granted by BANDO and you will be competing at a Major Event e.g., the Olympic Games, you should contact the MEO for information on their recognition process.

When will I receive a decision on my TUE application?

BANDO’s TUEC’s must render a decision as soon as possible, and usually within 21 days from the date of receipt of the complete TUE application, including the required medical information.

What If I need to renew my TUEs?

Each TUEs has a specific duration, at the end of which it expires automatically. Should you need to continue to use the prohibited substance or method, it is your responsibility to submit a new application for a TUEs with updated medical information ahead of the expiry date, so that there is sufficient time for a decision to be made prior to the expiry of the current Tues.

Important note:

The presence (following sample collection), use, possession or administration of the prohibited substance or method shall be consistent with the terms of your TUE. Therefore, if you require a materially different dosage, frequency, route or duration of administration, you should contact BANDO, as you may be required to apply for a new TUE. Some substances and dosages, e.g., insulin, are often modified during treatment and these possible fluctuations should be mentioned by the treating physician in the TUE application and would usually be accepted by the BNADO TUEC.

What if my BNADO’s TUE application was denied?

A decision to deny a TUE application includes a written explanation of the reason(s) for the denial. If it is not clear to you, please contact BANDO to understand exactly why the TUE was denied. Sometimes, there may be a critical piece of information, diagnostic test, laboratory results missing, etc. In which case, you should re-apply to us. Otherwise, the athlete has the right to appeal the denial decision.

What if my BANDO’s TUE is not recognized by my international federation?

You or BANDO have 21 days to refer the matter to WADA for review after notification of the non-recognition. You should send the same information that you submitted to BANDO, and on which their TUEC based their decision.

WADA Medical Department

World Anti-Doping Agency
Stock Exchange Tower
800 Place Victoria (Suite 1700)
P.O. Box 120
Montreal (Quebec) H4Z 1B7
Canada

The email address to enquire and/or send the request for review is: medical@wada-ama.org

Pending WADA’s decision, BANDO’s TUE remains valid for national-level competition and out-of-competition testing only. If the matter is not referred to WADA for review, BANDO must determine whether the original TUE that was granted should remain valid for national-level Competition and Out-of-Competition Testing.

Will my medical information be treated in a confidential manner?

All the information contained in a TUE application including the supporting medical information, and any other information related to the evaluation of your TUE request is kept strictly confidential.

All members of the TUEC and any other authorized recipients of your TUE request and related information are subject to a professional or contractual confidentiality obligation.

Your TUE request-related information will be retained by BANDO and any other authorized recipients for no longer than necessary for any purposes, in accordance with the International Standard for the Protection of Privacy and Personal Information.

Contact Information

If you have a doubt as regards to which organization you should apply for a TUE, or as to the recognition process, or any other question concerning TUEs, please contact BNADO on the following:

17176702
tue@b-nado.bh

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