Therapeutic use exemptions (TUEs) are being recognised only by National Anti-Doping Organisations (NADOs) in western, English-speaking nations, analysis of figures from the World Anti-Doping Agency’s (WADA) 2013 Anti-Doping Rule Violation (ADRV) report appear to suggest. NADOs in Switzerland, the USA and Sweden reported high numbers of TUE explanation for AAFs, while just one African and three Asian countries reported a TUE explanation for an AAF finding.

Switzerland’s NADO reported 10 TUEs from 26 ADRVs; the US reported 23 TUEs from 64 AAFs and Sweden reported 22 TUEs from 72 AAFs. Conversely, the Russian Anti-Doping Agency (RUSADA), which reported a high number of samples analysed (14,582) and ADRVs (225), reported just four TUEs. Many countries that reported high numbers of ADRVs, such as Turkey, reported no TUE explanations for AAFs at all, as our table below shows.

Under WADA Guidelines on TUEs, athletes must hold a TUE prior to being tested (Article 3.0 of the TUE Guidelines), and must apply to the ‘appropriate ADO’ (Article 3.1). A NADO may issue a TUE for national events (Article 8.1.1), however international-level athletes must apply to an international federation or major event organiser (Article 8.1.2). Article 4.4.4.2 of the World Anti-Doping Code requires ADOs to recognise TUEs granted by ADOs that meet the requirements set out in WADA’s International Standard for Therapeutic Use Exemptions (ISTUE).

Comment

If ADOs are required to recognise TUEs that meet WADA’s standards, then the figures either suggest that athletes in some countries are not applying to their NADO for a TUE, that some NADOs are not granting TUEs, or that some NADOs have no athletes that need TUEs. Article 3.2 of the TUE Guidelines requires athletes to submit their application via WADA’s Anti-Doping Administration & Management System (ADAMS), which requires a translation into English or French for both national and international events. This could hinder non-English speaking countries from making TUE applications. Article 3.8 also stipulates that athletes are responsible for all costs relating to the TUE application, which could hinder athletes from less wealthy nations from making TUE applications, and their NADO from supporting such an application.

Culture could also play a part. In some countries, certain conditions are recognised, documented and treated whilst in other countries, they are not. An athlete from a state or sponsor funded programme in a developed country with the support of experienced medical practitioners is more likely to apply for a TUE for prednisone than a runner from a remote Kenyan mountain village.