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?

Use the Medical Exemption Wizard to determine your medical exemption requirements, and to download the application form if required.

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 certain conditions.

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?

Your health and safety come first. Any decision made regarding your treatment plan should be done 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.

What should I do if I have surgery?

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.

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: