therapeutic use exemptions: principles and practice · therapeutic use exemptions: principles and...
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Therapeutic Use Exemptions: Principles and Practice WADA TUE Symposium, Paris 2014
Dr. Alan Vernec Medical Director, World Anti-Doping Agency
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Sport,
Anti-Doping
and the Prohibited List
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Some athletes have legitimate medical conditions requiring the use of prohibited medications or methods
Therapeutic Use Exemption (TUE)
Source: westchesterhealthandlife.com
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The TUE process was created to ensure that
athletes with medical conditions may compete in sport
It should not confer an advantage to the athlete
Concern that a TUE could be a “back-door” way
to cheat
The TUE and Fair Play
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“TUEs are a ripe area for people to
try to get around the rules and take
banned substances without testing
positive.”
“Athletes abusing doctor’s note system to benefit from banned drugs”
Travis Tygart, USADA
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Medical Exemption to Cheat?
“Medical Exemption”
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World Anti-Doping Code and International Standards
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4.1 of ISTUE:
a. The absence of treatment would cause a significant impairment to the athlete’s health
b. Treatment will produce no performance enhancing effect, other than the return to the athlete’s normal state of health
c. There is no reasonable permitted therapeutic alternative
/
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ISTUE 2015 ADO Jurisdiction and TUE Recognition
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• National Anti-Doping Organization • International Federation • Major Event Organizer
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Include sufficient information to support the diagnosis • Physician notes • Laboratory and/or test results • Imaging studies
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Quality TUEs Dr. John Landis;
446 Cunningham Rd; Hamilton, Ontario
December 18, 2013 Reference: Arthur Vandalay Mr. Vandalay is a 20 year old student at McMaster University. He is a high level athlete and has ADHD, a chronic medical condition. His symptoms are well managed with Adderall 10 mg. 3 times/ day. Mr. Vandalay needs his medication to function at school. J.R. Landis, M.D. FRCP; 84-432
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Dueling Perspectives?
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Treating Physician My patient has a medical condition and this is the medication that he needs
TUE-C Physician I must uphold the concept of fairness in sport. Convince me why this athlete should be exempted from the rules
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IFs and MEOs may recognize TUEs
TUE Recognition in ADAMS
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ADAMS and Automatic Recognition
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ADAMS: TUEs by Substance Class 2009
21% - Glucocorticoids
S6 - Stimulants 3%
68% - Beta-2 Agonists
S2 - Peptide Hormones, Growth Factors & Related
substances 4%
S5 - Diuretics & other masking agents
1% S9 - Glucocorticoids
S6 - Stimulants
S3 - Beta-2Agonists
S2 - Peptide Hormones, GrowthFactors & Related substancesS5 - Diuretics & other maskingagentsS7 - Narcotics
S1 - Anabolic agents
P2 - Beta-Blockers
S4 - Hormone & MetabolicModulatorsM2 - Chemical and PhysicalManipulationS8 - Cannabinoids
M1 - Manipulation of Blood &Blood Components
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ADAMS: TUEs by Substance Class 2013
Glucocorticosteroids; 36%
Stimulants; 21%
Beta-2 Agonist, 5%
Peptide Hormones, Growth Factors & Related substances;
4%
Diuretics & other masking agents, 8%
Narcotics,, 6%
S1. Anabolic Agents, 3%
Beta-Blockers, 1%
Hormone & Metabolic
Modulators 14%
Chemical & Physical
Manipulation, 1%
Cannabinoids, 1% Manipulation of Blood & Blood Components, 1 %
S9. Glucocorticosteroids
S6. Stimulants
S3. Beta-2 Agonists
S2. Peptide Hormones, Growth Factors & Relatedsubstances
S5. Diuretics & other masking agents
S7. Narcotics
S1. Anabolic Agents
P2. Beta-Blockers
S4. Hormone & Metabolic Modulators
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Resources: ISTUE TUE Guidelines TUE Physician
Guidelines
Engage
Quality TUEs
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Thank you! Merci!