UCI Therapeutic Use Exemptions

A TUE is special permission to use a prohibited substance or method for a legitimate medical condition.

Riders, like everyone else, may have illnesses or condition which requires them to take a particular medication. If a substance contained in your medication or the method used appears on the World Anti-Doping Agency’s (WADA) Prohibited List, you must apply for a TUE before starting the treatment.

Since the UCI delegated the management of the operational aspects of its anti-doping program to the International Testing Agency, applications for TUEs are evaluated by a panel of physicians established by the ITA, the International TUE Committee (ITUEC).

After the ITA’s ITUEC has reviewed your application, you may be given authorization to obtain treatment.

A. Riders included in the UCI Registered Testing Pool (RTP) or Testing Pool ( TP)

If you are included in the UCI RTP or TP, you must apply for a TUE, as soon as the need arises, directly to the ITA through ADAMS exclusively.

If you already had a TUE granted by your NADO at the time of your inclusion in the UCI RTP or TP, you must apply for the recognition of this TUE by the ITA’s TUEC through ADAMS exclusively. If that TUE meets the criteria set out in Section 4.0 of the UCI TUE Regulations, then the ITA’s TUEC shall recognize it.

B. Riders not included in the UCI RTP or TP but participating in an International Event

If you are not included in the UCI RTP or TP, you shall apply for a TUE to your National Anti-Doping Organisation (NADO) in accordance with the regulations of your NADO.

However, if you are not included in the UCI RTP or TP and wish to participate in an International Event (i.e. an event where the UCI is the ruling body), you must, prior to such participation, obtain recognition from the ITA’s TUEC of the TUE already granted by your NADO. If that TUE meets the criteria set out in Section 4.0 of the UCI TUE Regulations, then the ITA’s TUEC shall recognize it.

If the need for the TUE arises during the International Event Period, you shall apply directly for a TUE to the ITA’sTUEC.

Note: The list of International Events is published on the UCI website under each discipline.

C. Automatic Recognition

Please note that the UCI automatically recognizes TUEs decisions made by the following NADOs.

This means that if a rider’s TUE has been delivered by a NADO listed below, he/she does not need to apply to the ITA for recognition of that TUE, insofar as the TUE is still valid. The TUE is automatically recognised, without further action required by the Rider.

• NADO of the French Community of Belgium
• Canadian Centre for Ethics in Sport
• Agence Française de lutte contre le dopage
• Agencia Española de Protección de la Salud en el Deporte
• Antidoping Switzerland
• Antidoping Denmark
• NADO Vlaanderen
• National Anti-Doping Agency Austria
• Anti-Doping Norway
• UK Anti-Doping
• South African Institute for Drug-Free Sport
• United States Anti-Doping Agency
• Swedish Sports Confederation
• Nationale Anti Doping Agentur Deutschland
• International Paralympic Committee
• Australian Sports Anti-Doping Authority
• NADO Italia
• Sport Ireland
• Anti-Doping Autoriteit Nederland
• Anti-Doping Agency of Serbia
• Slovenian Anti-Doping Organisation
• Finnish Anti-Doping Agency
• Slovak Anti-Doping Agency
• China Anti-Doping Agency
• Drug Free Sport New-Zealand
• Monaco Anti-Doping Agency
• Autoridade Antidopagem de Portugal

A rider who needs a TUE should apply as soon as the need arises, unless exceptional circumstances or true emergencies exist.

For substances prohibited in-competition only, the rider should apply for a TUE at least 30 days before his/her next Competition, unless exceptional circumstances or true emergencies exist.

The rider should apply to the ITA, using the TUE application form available on ADAMS. Please refer to the section “How to apply for a TUE to the ITA” below for further information on the TUE application process.

According to Article 4.2 of the UCI Regulations for TUE, a Rider may be granted a TUE if (and only if) he/she can show, on the balance of probabilities, that  all of the four following conditions are met:

1. The Prohibited Substance or Prohibited Method in question is needed to treat a diagnosed medical condition supported by relevant clinical evidence.
2. The Therapeutic Use of the Prohibited Substance or Prohibited Method will not, on the balance of probabilities, produce any additional enhancement of performance beyond the rider’s normal state of health;
3. The Prohibited Substance or Prohibited Method is an indicated treatment for the medical condition, and there is no reasonable permitted Therapeutic alternative.
4. The necessity to Use of the Prohibited Substance or Prohibited Method is not a consequence of the prior Use (without a TUE) of a substance or method which was prohibited at the time of such Use.

A.   Glucocorticoids

According to the WADA Prohibited List, all glucocorticoids are prohibited when administered by oral, intravenous, intramuscular or rectal route.

Note: from 2022 onwards, all types of injections of glucocorticoids will be banned in-competition by the World Anti-Doping Agency (WADA).

Authorised routes of administration

The following routes of administration (i.e., how the medication is administered or taken) are authorised and hence do not require a TUE for the use of glucocorticoids:

• Dermatological – on the skin;
• Auricular – in or on the ear;
• Buccal – inside the mouth (without swallowing);
• Gingival – on the gums;
• Nasal – inside the nose, either by topical application or nasal spray;
• Ophthalmic – on or in the eye;
• Perianal – around the anus;
• Inhalation – through the mouth via an inhaler or “puffer”;
• Intradermal injection – into the skin;
• Epidural injection – into the spine;
• Intra-articular injection – into a joint capsule;
• Periarticular injection – around a joint;
• Peritendinous injection – around a tendon.

Prohibited routes of administration – systemic administration

You must complete a full TUE application before taking glucocorticoids by any of the following systemic routes:

• Orally – through the mouth, usually in the form of pills or tablets or syrup or drops;
• Intravenous injection – injection into a vein;
• Intramuscular injection – injection into a muscle;
• Rectally – into the rectum usually in the form of a suppository or rectal application of a cream.

Local injection of glucocorticoids – “8-days rest period”

In case of a local injection of glucocorticoids, which is subject also to the UCI Medical Rules, the rider must rest and is declared as medically unfit to compete for at least 8 days (article 13.3.055 of the UCI Medical Rules).

Therefore, any injection that falls within the scope of the injection ban policy must be immediately reported in writing, within a maximum of 24 hours, to the UCI Doctor (by e-mail: medical@uci.ch).

B. Beta-2 agonists for asthma

Whether or not you need to apply for a TUE before using a beta-2 agonist for the treatment of asthma depends on the medication. Please pay utmost attention to the substance which is included in your inhaler.

Salmeterol /Salbutamol/Formoterol/Vilanterol

Inhaled salbutamol (maximum 1600 micrograms over 24 hours in divided doses not to exceed 800 micrograms over 12 hours starting from any dose), inhaled formoterol (maximum delivered dose 54 micrograms over 24 hours), inhaled salmeterol (maximum delivered dose of 200 micrograms over 24 hours) and inhaled vilanterol (maximum 25 micrograms over 24 hours) are not prohibited and therefore do not require a TUE.

For inhaled salbutamol, you must obtain a TUE if you need to take more than 1600 micrograms over 24 hours in divided doses not to exceed 800 micrograms over 12 hours starting from any dose. This threshold is not valid if you are using any substances in the category of diuretics and masking agents. In this case, you must have a TUE for each substance.

You must obtain a TUE if you need to inhale more than 54 micrograms per day of formoterol. This threshold is not valid if you are using any substances in the category of diuretics and masking agents. In this case, you must have a TUE for each substance.

You must obtain a TUE if you need to inhale more than 200 micrograms per day of salmeterol.

You must obtain a TUE if you need to inhale more than inhaled 25 micrograms per day of vilanterol.

You must obtain a TUE if you take salmeterol, salbutamol and/or formoterol by any other routes of administration.

Terbutaline or other Beta-2 agonist

If you take terbutaline or any other beta-2 agonist not mentioned above for the treatment of asthma, you must submit a TUE request for asthma and your full medical file through ADAMS to confirm the diagnosis of asthma and/or its clinical variants.
The medical file should include:

• A detailed medical history and clinical review;
• Lung function test with spirometry;
• Bronchodilator response;
• Bronchial provocation tests.

To assist your doctor in completing the correct tests, and providing the correct medical information, we suggest that he or she consults the WADA Guidelines on Asthma.

C. Injections – “No Needle” Policy

We remind you that the use of injections to administer drugs or substances without a clear and recognised medical indication is prohibited under the UCI Medical Rules. This applies to any substance that is injected whether endogenous or exogenous, prohibited under the UCI Anti-Doping Rules (ADR) or not, and to any type of injection (article 13.3.052 of the UCI Medical Rules).

Accordingly, the injection that falls under the “No Needle Policy” must be reported immediately and in writing not later than 24 hours afterwards to the UCI Doctor (medical@uci.ch).

You may only apply retroactively for a TUE to UCI if:

• You required emergency or urgent treatment of a medical condition.
• There was insufficient time, opportunity or other exceptional circumstances that prevented you from submitting the TUE application, or having it evaluated, before getting tested.
• You are a lower level athlete who is not under the jurisdiction of UCI or NADO and were tested.
•  You tested positive after using a substance Out-of-Competition that is only prohibited In-Competition (for example glucocorticoids).

In rare and exceptional circumstances and notwithstanding any other provision in the ISTUE, you may apply for and be granted retroactive approval for a therapeutic use of a prohibited substance or method, if considering the purpose of the Code, it would be manifestly unfair not to grant a retroactive TUE.

This unique retroactive TUE will only be granted with the prior approval of WADA (and WADA may in its absolute discretion agree with or reject the UCI’s decision).

Important note:

Using a prohibited substance or method without a TUE could result in an Anti-Doping Rule Violation.

In case an application for a retroactive TUE is necessary following sample collection, you are strongly advised to have a medical file prepared and ready to submit for evaluation.

If you need to take any substance or method which is included in the Prohibited List or to have your TUE granted by your NADO recognised, you must apply for a TUE to the ITA, using exclusively the TUE application form available on ADAMS, or download here. The completed TUE application form (signed by the athlete and his/her physician) and a comprehensive medical file must be submitted to the ITA via ADAMS.

All TUE applications must be submitted in legible French or English. Written medical reports must also be submitted in legible French or English, although results of tests may be in the original language.

If you need a TUE, you should apply as soon as the need arises. For substances prohibited in-competition only, the rider should apply at least 30 days before his/her next competition, unless exceptional or true emergencies exist.
To assist your doctor in providing the correct medical documentation we suggest that you consult the WADA TUE Checklist to access the medical information required to support TUE application for treatments of several common medical conditions.

If you are a rider whose doctor has a medical ADAMS account, your team doctor can undertake this task on your behalf through ADAMS.

Each TUE has a specific duration, at the end of which it expires automatically. Should you need to continue to use the prohibited substance or method, it is your responsibility to submit a new application for a TUE with updated medical information ahead of the expiry date, so that there is sufficient time for a decision to be made prior to the expiry of the current TUE.

Important note:

The presence (following sample collection), use, possession or administration of the prohibited substance or method must be consistent with the terms of your TUE. Therefore, if you require a materially different dosage, frequency, route or duration of administration, you should contact the ITA, as you may be required to apply for a new TUE. Some substances and dosages, e.g. insulin, are often modified during treatment and these possible fluctuations should be mentioned by the treating physician in the TUE application and would usually be accepted by the TUEC.

A decision to deny a TUE application will include a written explanation of the reason(s) for the denial. If it is not clear to you, please contact the ITA to understand exactly why the TUE was denied. Sometimes, there may be a critical piece of information, diagnostic test, laboratory results missing, etc. In which case, you should re-apply to us.

You and/or your NADO may refer the matter to WADA for review no later than 21 days after notification of the ITA‘s TUEC decision. You should send the same information that you submitted to us, and on which the decision to deny the TUE was based on, via a secure online method or by registered mail at:

WADA Medical Department
World Anti-Doping Agency
Stock Exchange Tower
800 Place Victoria (Suite 1700)
P.O. Box 120
Montreal (Quebec) H4Z 1B7
Canada

The email address to enquire and/or send the request for review is: medical@wada-ama.org

It should be noted that WADA is not obliged to proceed with a request for a review. In that case, you and/or your NADO may appeal to the Court of Arbitration for Sport (CAS).

You and/or your NADO have 21 days from the date of decision to refer the matter to WADA for review. The email address to enquire and/or send the request for review is: medical@wada-ama.org.

Alternatively, you may send to:

WADA Medical Department
World Anti-Doping Agency
Stock Exchange Tower
800 Place Victoria (Suite 1700)
P.O. Box 120
Montreal (Quebec) H4Z 1B7
Canada

The same information that was provided to your NADO should be submitted to WADA. Please use a secure on-line method unless sending by registered mail.

Pending WADA’s decision, your NADO TUE remains valid for national-level competition and out-of-competition testing only.

If the matter is not referred to WADA for review, your NADO must determine whether the original TUE that was granted should remain valid for national-level Competition and Out-of-Competition Testing.

All the information contained in a TUE application, including the supporting medical information and any other information related to the evaluation of your TUE request is kept strictly confidential and treated in accordance with the Athlete’s Declaration contained in the ADAMS TUE and in the TUE Application Form which can be found here. All members of the TUEC and any other authorized recipients of your TUE request and related information (as described in the Athlete’s Declaration) are subject to a professional or contractual confidentiality obligation.

Please review the terms of the Athlete’s Declaration carefully. In particular, note that should you wish to revoke the right of the ITA’s TUEC to obtain the information related to your TUE in accordance with the Athlete’s Declaration, your TUE application will be deemed withdrawn without approval [or recognition] being granted.

Your TUE request-related information will be retained by ITA and any other authorized recipients for no longer than necessary for the purposes stated in the Athlete’s Declaration, in accordance with the International Standard for the Protection of Privacy and Personal Information (WADA ISPPPI).

For any further information and questions in relation to UCI’s personal information practices, please contact privacy@ita.sport.