Therapeutic use exemptions

To take into account the case of athletes who, due to a particular illness or state of health, may have to take medication or undergo treatments which appear on the List of prohibitions of the World Anti-Doping Agency (WADA), an International Standard for Therapeutic Use Exemptions (ISTUE) was created.

This standard, regularly updated, is inseparable from the World Anti-Doping Code and is mandatory.

A TUE is a document authorizing an athlete for proven medical reasons to use a normally prohibited substance or method listed on the prohibited list maintained and published by the World Anti-Doping Agency.

Except in the cases covered by article 4.1 or 4.3 of the International Standard for Therapeutic Use Exemptions, any athlete who is not an international-level athlete must contact the Monegasque Anti-Doping Committee (CMA) as soon as as possible in order to obtain a TUE.

Except in an emergency, the request must be made as soon as possible after being prescribed the medical substance or the route of administration. If the substance is prohibited only in competition the athlete must make sure to submit his request at least 30 days before the competition.

It is sent to the Monegasque Anti-Doping Committee by registered letter with acknowledgment of receipt or electronically.

It is examined by the Commission for Therapeutic Use Authorizations (CAUT), which is responsible for examining it independently. This Commission is made up of three doctors competent in the field of sports medicine and practical clinical medicine, appointed by the President of the Monegasque Anti-Doping Committee. All members of this Commission have signed a confidentiality agreement. It may, if necessary, seek the opinion of other medical or scientific experts.

If the request is deemed incomplete, the CMA will request the missing or additional documents. The response time is then suspended until receipt of the requested documents or the expiry of the time allowed to the interested party to send these documents. The CAUT will notify its decision to the athlete concerned as well as to his attending physician within 21 working days of receipt of the request or confirmation of its completeness.

If an athlete takes part in sporting events organized by his International Federation, both in Monaco and abroad, and he already has a TUE issued by the CMA's CAUT, he must then apply for recognition of that TUE. here with its International Federation.

An athlete who is not an international-level athlete must contact the CMA.

An athlete who is an international level athlete or participant in an international level competition must contact his international federation.

A Major Event Organization may require Athletes to apply to them for a TUE if they wish to Use a Prohibited Substance or Prohibited Method in connection with that Event.

The request is made by the athlete or his legal representative. It consists of specific form duly informed legibly with the assistance of the prescribing doctor and accompanied by supporting medical documents (elements confirming the diagnosis, the complete medical history, the results of any relevant examination, laboratory and imaging analyses, copies of the original reports or letters, etc.) . The information contained in the requests is confidential and covered by medical secrecy.

If in doubt, the Athlete may submit the TUE application to the CMA, who will assist the Athlete in determining which TUE authority is appropriate in their case.

Authorization is granted only according to the following criteria:

•  the Athlete would suffer significant health harm if the Prohibited Substance or Prohibited Method were not administered in the treatment of a diagnosed medical condition supported by relevant clinical evidence;
• the therapeutic use of the substance or method must not produce any improvement in performance other than that attributable to the return to a normal state of health, after treatment of the medical condition for which it was prescribed. The use of any prohibited substances or methods to increase physiologically depressed levels of endogenous hormones cannot be considered an acceptable therapeutic intervention;
• the Prohibited Substance or Prohibited Method is an indicated treatment for the Medical Condition and there must be no authorized and reasonable alternative treatment to substitute the Prohibited Substance or Prohibited Method;
• the need to use the prohibited substance or method must not be a partial or total consequence of the prior non-therapeutic use of substances which were then on the list of prohibited substances and methods.

A retroactive TUE may be requested by the athlete in the following limited cases:

• the need justified by the urgency or by the implementation of an urgent treatment of a medical condition;
• the justified existence of particular constraints or exceptional circumstances preventing the Athlete from submitting a request or the TUEC from examining this request before the Sample collection;
• when due to national priorities established in certain sports, the Monegasque Anti-Doping Committee does not allow the athlete to request a prospective TUE or does not require it;
• where an Anti-Doping Organization has elected to collect a Sample from an Athlete who is not an International-Level Athlete or a National-Level Athlete and that Athlete is Using a Prohibited Substance or Prohibited Method to therapeutic reasons;
• when the athlete has made use out of competition for therapeutic reasons of a substance which is only prohibited in competition;
• when justified by exceptional circumstances;
• where, in view of the objective of the World Anti-Doping Code, it would be manifestly unfair not to grant the Athlete a retroactive TUE.
  

The Athlete will receive authorization to use the requested substance or method under certain conditions.

The favorable decision will be sent to the athlete by registered mail and to his doctor (simple mail). If the CAUT secretariat is aware of the athlete's e-mail address, a copy of the decision will also be sent to them by e-mail.

If the Monegasque Anti-Doping Committee refuses a TUE request, the athlete can appeal exclusively to the Court of First Instance.

Additional information can be obtained on the WADA website: www.wada-ama.org