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FEATURE: REVISED TUE RULINGS EXPLAINED

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Lee Taylor 11 December 2008

• Abbreviated TUEs will no longer exist
• Additional medical evidence needed for beta-2 agonists inhalers to treat asthma
• All other Substances and Methods on Prohibited List still require TUE

In the last of our features on the changes the revised Code will bring in January, we look at how Therapeutic Use Exemptions (TUEs) will differ via the new International Standard for TUEs.

The TUE process allows athletes a means of obtaining approval to use a prescribed Prohibited Substance or Prohibited Method for the treatment of a legitimate medical condition.  Under the current system an athlete can apply for an Abbreviated TUE (ATUE) that covers mainly asthma applications and localized injections and a Standard TUE (STUE) that is used for all other applications.  However from 1 January 2009, this ATUE process ceases to exist. Athletes must also be aware that ATUEs that are due to expire in 2009 are still valid but that those due to expire after 2009 will cease to be valid as of January 2010.

As a result, athletes are no longer required to apply for an ATUE for non-systemic glucocorticosteroids, most commonly found in anti-inflammatory treatments, but must declare to UK Sport when glucocorticosteroid use begins, which they can do from 1 January by logging onto UK Sport’s online declaration form (https://declaration.uksport.gov.uk). Glucocorticosteroids administered by oral, intravenous, intramuscular or rectal routes will require a TUE, but ‘Topical preparations’, i.e. eye drops, nasal sprays, creams & ointments, containing a glucocorticosteroid are not prohibited and do not require either a TUE or a declaration of use.

In addition, athletes will be required to submit additional medical evidence to support their TUE application for the use of inhaled beta-2 agonists to treat asthma. These applications will be reviewed by UK Sport’s TUE Committee (TUEC) and if approved, exemptions will be provided for four years. Applications without evidence of asthma or its ‘clinical variants’, in other words exercise-induced asthma, exercise-induced bronchoconstriction, and other clinical respiratory diseases, will be returned without being reviewed. Therefore, TUE applications will be required for Formoterol, Salbutamol, Salmeterol and Terbutaline, which can all be used to treat such conditions. Two documents also require submission, those being a complete and legible beta-2 agonist application form, and lung function test results. Where athletes may currently have approval to use their inhaled medication, UK Sport are now unable to guarantee that approval will be given again unless they have fulfilled all of the necessary medical requirements.

The Acting Director for Drug-Free Sport at UK Sport, Andy Parkinson, once again stressed the importance of taking these changes on board.

“As with all the changes coming in, these are equally as important,” he said. “As I have continued to stress over the last couple of months we are working hard with the sports and their athletes to ensure they are aware of their responsibilities, and the new International Standard for TUEs is no different. We do not want any athlete to incur an anti-doping violation because they have failed to obtain the correct permissions, and we will do what we can to help prevent this from happening, but equally it is important that athletes are aware of their role in this process. The changes will also ensure that any athlete who is successful in their application for asthma medication has fully legitimate reasons and this is another example of how the revised Code is a step closer to the global harmonisation we desire.”

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