Athlete's Therapeutic Use Exemption
When seeing a doctor, an athlete must remember to tell that he or she is subject to doping control. The doctor (together with the athlete) can then, before prescribing medication, check that the medication in question is not prohibited in sports. If there exists no permitted alternative for the treatment of the medical condition in question or, for some other reason, it is absolutely necessary to apply a prohibited medication or prohibited method, a TUE may be granted in order to allow the use of an otherwise prohibited treatment.
Criteria for granting a TUE
A TUE may be granted for any form of therapy mentioned in WADA's Prohibited List if the athlete can prove that all of the following criteria are met:
a. The use of the prohibited substance or method is necessary for the treatment of the athlete, and the athlete would experience a significant impairment to health if the treatment were to be withheld.
b. The therapeutic use of the prohibited substance or method must not give the athlete an extra advantage compared to healthy athletes. The treatment must not enhance the athlete's performance to a higher level than where it would normally be without the detrimental effect of the disease on the performance. The use of a prohibited substance or prohibited method to elevate naturally low levels of endogenous hormones is not considered an acceptable therapeutic intervention.
c. There is no reasonable therapeutic alternative to the use of the otherwise prohibited substance or prohibited method.
d. The necessity for the use of the prohibited substance or prohibited method must not be due to prior use (without a TUE) of a substance or method that was prohibited at the time of such use.
WADA documents titled "Medical Information to Support the Decisions of TUECs", available on WADA's website, assist in applying these criteria to particular medical conditions.
An application for a TUE will not be considered for retroactive approval except in cases where:
a. Emergency treatment or treatment of an acute medical condition was necessary.
b. Due to exceptional and unforeseen circumstances, there was insufficient time or opportunity for an athlete to submit, or the TUEC to consider, an application prior to doping control.
c. An athlete not covered by FINCIS's discipline-specific level determination and not competing at the international level is retroactively (after a doping test) applying for a TUE to prove that the use of a prohibited substance or prohibited method was medically justifiable in accordance with TUE requirements.
d. It is agreed, by WADA and by the Anti-Doping Organisation to whom the application for a retroactive TUE is or would be made, that fairness requires the grant of a retroactive TUE.
National-level athletes and national sporting events
FINCIS's Therapeutic Use Exemption Committee (TUEC) may, upon written application by an athlete, grant a TUE for a specified time for the use of a prohibited substance or prohibited method in accordance with the International Standard for Therapeutic Use Exemptions approved by WADA. FINCIS's TUE decisions concern only national-level athletes and national-level competitions in Finland. TUE matters concerning international-level athletes and athletes participating in international sporting events are handled by International Federations (see the tab ‘International TUE processes').
Effect of FINCIS's discipline-specific level determination on TUE application
Regardless of their age, athletes covered by FINCIS's discipline-specific level determination must apply for the TUEs they need in advance in accordance with the International Standard of Therapeutic Use Exemptions and FINCIS's guidelines.
Athletes not covered by FINCIS's discipline-specific level determination are not required to apply for a TUE in advance. However, after a doping test, they must retroactively apply for a TUE to prove that the use of a prohibited substance or method was medically justifiable in accordance with TUE requirements.
Athletes who are not covered by FINCIS's discipline-specific level determination but who have to use, for the treatment of a medical condition, a substance or method prohibited in sports, are advised to have a medical file prepared and ready to demonstrate their satisfaction of the TUE conditions.
TUE search engine ERKKA
Athletes can use the ERKKA engine to determine whether they should apply for a TUE in advance or retroactively. ERKKA helps also to determine whether they should submit their TUE application to FINCIS or the International Federation.
Applying to FINCIS for a Therapeutic Use Exemption
The TUE application should be submitted as soon as possible, once the athlete knows that he or she will need the medication and/or a TUE. For substances prohibited in-competition only, the application for a TUE should be submitted, if possible, at least 30 days before the competition for which the TUE is needed. Athletes covered by FINCIS's discipline-specific level determination should not start medication or treatment prohibited in sports before a TUE has been granted for it, except in an emergency requiring urgent treatment. In emergencies requiring urgent treatment, the TUE is applied for retroactively as soon as it is possible.
A TUE is applied for by submitting to FINCIS a TUE application form, downloadable on FINCIS's website. It is advisable to use English when filling out the form. The physician completes the sections relating to medical information and medication (2 and 3) as well as the declaration section (4). Both the physician and athlete (and, if necessary, the athlete's guardian) sign the application.
The application form must be accompanied by a comprehensive medical history, including documentation from the original diagnosing physician(s) and the results of all examinations, laboratory investigations and imaging studies relevant to the application. The medical documentation must include a valid medical justification as to why the prohibited substance or method is needed, and why it cannot be replaced by any alternatives permitted in sports. FINCIS's TUEC may, if necessary, request the athlete to provide additional information or undergo further examinations for assessing the necessity of the treatment.
The completed TUE application form shall be sent to FINCIS's office either by post (Finnish Center for Integrity in Sports FINCIS, Valimotie 10, 00380 Helsinki) or by fax (+358 (0)9 148 5195). The athlete should keep a copy of the application form and the accompanying documents for his or her own records. NB! FINCIS's TUEC will not review incomplete applications or applications without required attachments but will return these to the athlete for completion.
Validity and renewal of TUE
If the athlete is granted a TUE, he or she will receive a written TUE certificate which he or she shall present in doping control.
All TUEs are granted for a specified time, and each TUE is assigned a period of validity at the discretion of the TUEC. The permission to use the prohibited substance or method enters into force on the date defined by the FINCIS TUE Committee, in general immediately after the favourable decision by the TUE Committee and the writing of the TUE certificate. The period of validity is indicated on the TUE certificate.
The TUE expires automatically when the period of validity comes to an end. In certain cases the TUEC may revoke its decision prior to expiry if the athlete does not promptly comply with any requirements or conditions imposed by the TUEC granting the TUE. WADA may also review any TUE decisions at any time and reverse them if they do not meet the criteria specified in the International Standard for Therapeutic Use Exemptions.
If the athlete needs to continue to use the prohibited substance or prohibited method after the expiry date, he or she must submit an application for a new TUE well in advance of that expiry date, so that there is sufficient time for a decision to be made on the application before the expiry date. The athlete himself or herself is responsible for the renewal of the TUE.
Appealing a TUE decision made by FINCIS
FINCIS will always send the athlete a written notification of a denial to grant a TUE, with reasons. The athlete may appeal the decision made by FINCIS's Therapeutic Use Exemption Committee to the Supervisory Board and a decision made by the latter to the Finnish Sports Arbitration Board. (TUE decisions made by FINCIS on behalf/at the request of an International Federation can be appealed by submitting the decision for review by WADA and/or appealing to the Court of Arbitration for Sport (CAS).)
A checklist for applying a Therapeutic Use Exemption:
- Determine if you are covered by FINCIS's discipline-specific level determination or if you should apply for a TUE through your International Federation.
- If you are covered by FINCIS's discipline-specific level determination, do not start a prohibited medication or treatment before a TUE has been granted for it. NB! This does not apply to an emergency requiring urgent treatment!
- First, find out together with your doctor if there exists any permitted alternative to the prohibited medication or treatment.
- Print out the TUE application form available on FINCIS's website
- Fill out the application form (in English) together with your doctor.
- The application must be signed by both the physician and the athlete (and, if necessary, the athlete's guardian)!
- Attach to the application medical documentation corroborating the diagnosis, including:
- full medical history related to the medical condition in question
- results of medical examinations
- medical justification of why the treatment is necessary
- medical reasons of why the prohibited medication or treatment cannot be replaced by alternatives permitted in sports.
- Before sending, make a copy of the application form and its attachments for your records!
- Send the application form with its attachments to FINCIS:
- by post: Valimotie 10, 00380 Helsinki, or
- by fax: +358 (0)9 148 5195