FAQs Therapeutic Use Exemptions

• Justification of medical necessity
• Name of drug
• Dosage
• Route of administration
• Duration of treatment

Incomplete applications are returned to the applicant and any delay in approving the TUE will be the fault of the player. Any applications sent to The FA will be returned directly to the applicant and must be resubmitted to UK Sport. Again, any delay will be the fault of the player.

What is the difference between Standard and Abbreviated TUE forms?

Abbreviated

Abbreviated TUE application forms are designed for certain medical conditions frequently encountered by players. The prohibited substances and methods for which abbreviated applications must be submitted are:

• inhaled asthma medications (Formoterol, Salbutamol, Salmeterol and Terbutaline, and inhaled glucocorticosteroids)
• non-systemic preparations containing glucocorticosteroids, e.g. eye drops, local injections and inhalers.

TUEs are no longer required for the use of glucocorticosteroid ointments used for external dermatological conditions, such as eczema. The use of eye drops, ear drops, nasal sprays and oral gels still requires an ATUE

Approval for use of an Abbreviated TUE is effective on receipt by the appropriate organisation, of a fully completed abbreviated TUE form. Clubs should take measures to ensure that proof of delivery is retained (fax confirmation or recorded delivery is advised). Responsibility for delivery rests with the player and not UK Sport, UEFA or the Football Association.

Standard
For approval to use any other prohibited medication (than those requiring an Abbreviated TUE), applications must be made on a Standard TUE application form. Approval for use of a prohibited substance via a Standard application is only valid on receipt of a signed confirmation certificate which will be faxed to the player (sometimes via the prescribing physician). Any Standard TUE application must be supported by a clear justification of medical necessity for the treatment from the prescribing physician. Evidence confirming the diagnosis must be enclosed with the application, including results of all relevant examinations, laboratory investigations and imaging studies. Copies of original reports or letters should be included with the application where possible.

Medical practitioners should consult http://www.wada-ama.org/en/exemptions.ch2 for more information about requesting TUEs for the most commonly encountered medical conditions.

What are the criteria for granting a TUE?

TUEs will be granted according to the following criteria, adopted from the World Anti-Doping Agency International Standard for Therapeutic Use Exemptions:

• That the application must be completed in full with signatures of the athlete and prescribing physician and with all relevant medical information provided
• That the athlete would experience a significant impairment to health if the Prohibited Substance or Prohibited Method were to be withheld in the course of treating an acute or chronic medical condition.
• That the therapeutic use of a Prohibited Substance or Prohibited Method would produce no additional enhancement to 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. The use of any Prohibited Substance or Prohibited Method to increase "low-normal" levels of any endogenous hormone is not considered an acceptable therapeutic intervention.
• That there is no reasonable therapeutic alternative to the use of the otherwise Prohibited Substance or Prohibited Method.
• That the necessity for the use of the otherwise Prohibited Substance or Prohibited Method cannot be a consequence, wholly or in part, of prior non-therapeutic use of any prohibited substance.

When will I receive a response to my application?

Standard Applications –Standard TUE applications will be reviewed by a panel of independent physicians, known as a Therapeutic Use Exemption Committee (TUEC). Responses will be provided in accordance with the guidelines issued by each organisation (excepting cases where further medical or scientific information is required).

Abbreviated Applications – All abbreviated TUE applications are approved on receipt if (i) they are sent to the appropriate organisation, (ii) they are completed correctly, and (iii) if the application criteria outlined above has been met. Applicants should retain confirmation of delivery such as fax receipt or receipt of recorded postage, however confirmation will be provided by the organisation to whom the application has been made. This will include details of the expiry date.

Applications are only approved for the dosage and treatment duration as indicated on the original TUE application. If any changes are made to dosage or duration of treatment, or if a one-off treatment (eg. a corticosteroid injection) needs to be repeated, a new TUE application must be made.

Note that all Standard and Abbreviated TUE applications are open to review by UEFA, FIFA, WADA and UK Sport.

Are respiratory function tests needed to support applications for players using asthma medications?

No, currently this requirement is not included in the WADC International TUE Standard and therefore is not part of the FA, UEFA or FIFA TUE application process.

Which players in English football are required to submit TUEs?

Players in the following categories are required to submit TUEs in advance.

• Professional players and Scholars/Apprentices registered with Premiership, Championship, League 1 or League 2 clubs,
• First Team players registered with Women’s National Premier League clubs
• Any player under 16 years of age registered within the above leagues who trains with the senior or youth teams (male only) or is selected for a competitive senior or youth team fixture (male only).

All other players are not required to submit TUEs in advance of taking a banned medication, however who are tested under the FA Doping Control Programme will be given the opportunity to submit a retroactive TUE within a given timescale after the drug test is completed. However, there must be a clear medical need for the player to take the medication over a permitted alternative. In the event of a drug test, a TUE application must be made retroactively, within five days of the drug test. In this case, the player will be notified of the appropriate procedure at the time of the test.

Which organisation do I submit a TUE to?

If a player is applying for a new TUE, the follow guidelines should be followed:

What happens if I fail to submit a TUE?

The responsibility for providing a TUE rests ultimately with the player and therefore it is of paramount importance that TUE guidelines are adhered to at all times.

Players must be made aware that they are responsible for any substance present in their body, and if tested, any substance present in their urine. As such, players must notify their club doctor of any substance presribed whilst not under the supervision of club medical staff to ensure that a TUE application can be made.

What happens if a player needs emergency treatment and doesn’t have time to submit a TUE in advance?

If the prohibited substance or method requires an abbreviated TUE application, approval of a completed form is granted on receipt. Therefore, if proof of delivery to the appropriate authority is retained by the player (fax receipt or recorded delivery details), the TUE will be approved.

As standard TUE applications should only be submitted in emergency situations for certain conditions, players should not be competing immediately following the administration of a prohibited substance or method. Short term use of a prohibited substance or method to accelerate a player’s recovery from an acute condition in order to compete in a fixture would not be grounds for granting a TUE.

What happens when a TUE expires?

Players and physicians should check the expiry date of any TUE on receipt of an approval or TUE receipt. It is then the responsibility of the player to monitor expiry of the TUE approval and to re-apply if required prior to the date of expiry. Failure to do so, may result in a doping offence.

Does a TUE only become an issue if I get drug tested?

No. If it comes to the attention of the FA that a player is using a banned medication for which they do not have a valid TUE, the player will be committing the doping offence of ‘use’ of a prohibited substance, which carries the same minimum sanction as a positive drug test.

What happens if my TUE is refused?

If a TUE is refused, the player has the opportunity to appeal the decision to the organisation who reviewed the application. The appeals process for applications made to UK Sport is detailed in Schedule 5 of FA Doping Control Regulations. The UEFA appeals process is available on the UEFA website.

My club has been knocked out of European Competition and I have already submitted a TUE to UEFA. Do I also need to submit the same TUE to UK Sport?

No. Applications should only ever be made to one organisation and remain valid in all competitions until the expiry date has passed. UEFA, will notify UK Sport of all applications made by players at English clubs, so the application does not need to be made again if the club are knocked out of UEFA competition. If a new application needs to be made after the club have been knocked out of the UEFA tournament, this should be made to UK Sport.

I have a valid TUE and I’m about to compete in an international match/tournament. What do I need to do to make sure that I’m covered?

If the player is representing England at any level, all valid TUEs held by the player must be declared in the appropriate section of the FA pre-international tournament medical declaration form. The FA will then notify the appropriate organisation (FIFA or UEFA) of the presence of the player’s TUEs. Failure to declare a TUE to The FA may result in the TUE not being notified to the appropriate authority prior to the fixture, and this could result in the player facing a suspension if drug tested at the match/tournament.

For players representing countries other than England at international level, the procedures of the relevant national association will apply in regards to declaration of existing TUEs.

What happens if a player is administered a prohibited substance or method by a team doctor whilst on international duty?

Applications for Therapeutic Use Exemptions should always be completed by the prescribing physician and club doctors should avoid completing applications where the information provided may be inaccurate or second-hand as this may invalidate the approval.

According to FIFA requirements, the player’s international doctor should provide a TUE for the treatment to FIFA, however as the player may then be competing in Football Association competition, players and clubs should attempt to obtain written confirmation from the international doctor that a TUE has been submitted and copies of the approval certificate. Should this prove difficult to obtain, players and clubs should contact FIFA to ascertain whether the TUE application has been received.

A TUE approved by FIFA whilst on international duty, will remain valid in all competitions until the expiry date. If the TUE is then to be renewed, a new application should be made to UK Sport or UEFA as applicable.