THERAPEUTIC USED EXEMPTION
What is Therapeutic Use Exemptions (TUE) ?
A Therapeutic Use Exemptions (TUE) is a written authorization to use a prohibited substance or method for medical purposes. Athletes may have illnesses or conditions that require them to take medications or undergo procedures. If the medication or method an athlete is required to use to treat an illness or condition is prohibited as per the World Anti-Doping Agency’s (WADA) Prohibited List , a TUE may give that athlete the authorization to use that substance or method while competing without invoking an anti-doping rule violation (ADRV) and applicable sanction. Applications for TUEs are evaluated by a panel of physicians the TUE Committee (TUEC).
All of the 4 following criteria must be met (for more details, please refer to the WADA International Standard for Therapeutic Use Exemptions (ISTUE) Article 4.2):
- The athlete has a clear diagnosed medical condition, which requires treatment using a prohibited substance or method; – The therapeutic use of the substance will not, on the balance of probabilities, produce significant enhancement of performance beyond the athlete’s normal state of health;
- The prohibited substance or method is an indicated treatment for the medical condition, and there is no reasonable permitted therapeutic alternative; – The necessity to use that substance or method is not the consequence of the prior use (without a TUE), of a substance or method which was prohibited at the time of use.
Athletes who are subject to anti-doping rules would need a TUE to take a prohibited substance or use a prohibited method. You should verify with CADA to know to whom you need to apply and if you can apply retroactively.
First, check if the required medication or method you intend to take or use is prohibited as per the WADA Prohibited List. (Prohibited List , globaldro.com)
You have a responsibility to inform your physician(s) that you are an Athlete bound to anti-doping rules. You and your physician(s) should check the Prohibited List for whatever substance/method you are prescribed. If the substance/method is prohibited, discuss non-prohibited alternatives, if there are none, apply for a TUE. Remember athletes have the ultimate responsibility. Contact CADA if you are having difficulties. Then, contact Cambodia Anti-Doping Agency (CADA) to determine your competition level and TUE application requirements. If it is determined that you are a National-Level Athlete as described in CADA Rules, you must apply to CADA in advance, as soon as the need arises, unless there are emergency or exceptional circumstances. For substances prohibited in-competition only, you should apply for a TUE at least 30 days before your next competition.
If you are, or become an International-Level Athlete, or compete at Major Games, that TUE will not be valid unless it is recognized by the relevant International Federation (IF) or Major Event Organization (MEO). It is your responsibility to check if your CADA’s TUE is automatically recognized by such IF or MEO.
CADA can assist you in the determination of your level and TUE application requirements, and, should the need occur, assist you in presenting your CADA’s TUE to an IF or MEO for recognition. Please contact Cambodia Anti-Doping Agency , National Stadium, Sangkat Veal Vong, Khan 7Makara, Phnom Penh, Cambodia.
You may only apply retroactively for a TUE to CADA 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.
- As per our anti-doping rules you were not permitted or required to apply in advance for a TUE.
- You are a lower-level athlete who is not under the jurisdiction of an International Federation or National Anti-Doping Organization and were tested.
- You tested positive after using a substance Out-of-Competition that was 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.
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.
You must exclusively submit your TUE application, including the required medical file, via ADAMS. If you do not have an ADAMS account yet, please contact Cambodia Anti-Doping Agency , National Stadium, Sangkat Veal Vong, Khan 7Makara, Phnom Penh, to have your account set up.
Otherwise, please download the CADA’s TUE Application Form [https://www.cada.gov.kh/tueform], and once duly completed and signed, send it together with the required medical file to Cambodia Anti-Doping Agency , National Stadium, Sangkat Veal Vong, Khan 7Makara, Phnom Penh Your TUE application must be submitted in a legible form using capital letters or typing.
The medical file must include:
- A comprehensive medical history, including documentation from the original diagnosing physician(s) (where possible),
- The results of all examinations, laboratory investigations and imaging studies relevant to the application.
Any TUE application that is not complete or legible will not be dealt with and will be returned for completion and re-submission.
To assist you and your doctor in providing the correct medical documentation, we suggest consulting the WADA’s Checklists for TUE applications for guidance and support during the TUE application process, and TUE Physician Guidelines for guidance on specific common medical conditions, treatments, substances, etc.
Keep a complete copy of the TUE application form and all medical information submitted in support of your application, and proof that it has been sent.
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 shall 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 CADA, 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 ADO TUEC.
CADA’s TUEC’s must render a decision as soon as possible, and usually within 21 days from the date of receipt of the complete TUE application, including the required medical information.
A decision to deny a TUE application includes a written explanation of the reason(s) for the denial. If it is not clear to you, please contact CADA 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. Otherwise, you may appeal the denial decision by submitting all relevant document to the CADA. The CADA appeal panel begins review all documents and evaluates based on the information from original application and CADA will communicates decision to you accordingly
Should you need more information or assistance ,please contact Cambodia Anti-Doping Agency , National Stadium, Sangkat Veal Vong, Khan 7Makara, Phnom Penh, Cambodia.
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 process and in the DCAT’s TUE Application Form. 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 CADA’s TUEC to obtain the information related to your TUE request in accordance with the Athlete’s Declaration, your TUE application will be deemed withdrawn without approval being granted.
Your TUE request-related information will be retained by CADA 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.
For any further information and questions in relation to CADA’s personal information practices, and If you have a doubt as regards to which organization you should apply for a TUE, or as to the recognition process, or any other question concerning TUEs, please contact Cambodia Anti-Doping Agency , National Stadium, Sangkat Veal Vong, Khan 7Makara, Phnom Penh, Cambodia.
