Therapeutic Use Exemption Applications

What is a TUE?
Squash athletes like others may have illnesses or conditions that require them to take a medication that is on the World Anti-Doping Agency (WADA) Prohibited List. A TUE may be granted to enable the athlete to take the required medication without committing an Anti-Doping Rule Violation. The granting of a TUE is not automatic. Athletes must follow the appropriate process in accordance with WADA’s International Standard for TUEs.

Do I need a TUE?
Athletes are solely responsible for all substances taken via all possible routes of administration, including all the medicines they take. It is therefore critical that all medication is checked for prohibited substances and methods, several resources exist such as: Global Drug Reference Online.

What are the criteria for granting a TUE?
An Athlete may be granted a TUE if (and only if) he/she can show, on the balance of probabilities, that each of the following conditions is met:

a) The Prohibited Substance or Prohibited Method in question is needed to treat a diagnosed medical condition supported by relevant clinical evidence.
b) The Therapeutic Use of the Prohibited Substance or Prohibited Method will not, on the balance of probabilities, produce any additional enhancement of performance beyond what might be anticipated by a return to the Athlete’s normal state of health following the treatment of the medical condition.
c) The Prohibited Substance or Prohibited Method is an indicated treatment for the medical condition, and there is no reasonable permitted Therapeutic alternative.
d) The necessity for the Use of the Prohibited Substance or Prohibited Method is not a consequence, wholly or in part, of the prior Use (without a TUE) of a substance or method which was prohibited at the time of such Use.
Full information detailed Article 4.2, 2021 International Standard for Therapeutic Use Exemptions

Who grants TUEs?
The ITA Therapeutic Use Exemption Committee (ITUEC), comprised of more than 15 physicians of different expertise and origin, is responsible for reviewing and deciding on all requests from International level athletes who wish to play in a squash event covered under the WSF Anti-Doping Programme.

How do I apply for a TUE?
WSF has delegated responsibility for all TUE applications to the International Testing Agency (ITA). This means that the ITA is now fully responsible for the TUE application process for all international-level athletes that fall under the WSF’s jurisdiction.
All TUE applications now need to be directed to the ITA. Athletes must obtain a TUE application form, have their physician fill out and sign the form and produce the required supporting documentation. Submit the TUE application in ADAMS or send it to the ITA at tue@ita.sport, which will then be reviewed by the ITUEC.
Applications that are not filled in correctly will be returned to the athlete and not considered until the errors and/or omissions are corrected.
Athletes should keep a copy of the application and a record of the transmission or acknowledgement of its receipt.

Where do I find the application form?
The ITA TUE application form may be downloaded here

How long does an application take to process?
The process follows the ISTUE timelines, providing a decision in less than 21 days, unless exceptional circumstances. Nevertheless it aims at providing such decisions in a shorter timeframe, particularly in emergency requests.

Can the decision of the TUEC be Appealed?
Any TUE decision by an International Federation (or by a National Anti-Doping Organization where it has agreed to consider the application on behalf of an International Federation) that is not reviewed by WADA, or that is reviewed by WADA but is not reversed upon review, may be appealed by the athlete and/or the Athlete’s National Anti-Doping Organization, exclusively to the Court of Arbitration for Sport (CAS) for a final decision.

When can I start using the medication and for how long?
TUEs are effective from the date specified on the Letter of Approval. Athletes should not assume that their application will be granted even for the renewal of an existing TUE.
Any athlete using a Prohibited Substance prior to approval does so entirely at their own risk.
All TUEs are granted for a specific period of time and so do expire. Before a TUE has expired a new application must be submitted for a renewal to permit continued use of the prohibited substance.

Can I get a backdated TUE?
An Athlete who needs to Use a Prohibited Substance or Prohibited Method for Therapeutic reasons must apply for and obtain a TUE prior to Using or Possessing the substance or method in question.
However, an Athlete may apply retroactively for a TUE if one of any of the following exceptions applies:
a) Emergency or urgent treatment of a medical condition was necessary;
b) There was insufficient time, opportunity or other exceptional circumstances that prevented the Athlete from submitting (or the TUEC to consider) an application for the TUE prior to Sample collection;
c) Due to national level prioritization of certain sports, the Athlete’s National Anti-Doping Organization did not permit or require the Athlete to apply for a prospective TUE;
d) If an Anti-Doping Organization chooses to collect a Sample from an Athlete who is not an International-Level Athlete or National-Level Athlete, and that Athlete is Using a Prohibited Substance or Prohibited Method for Therapeutic reasons, the Anti-Doping Organization must permit the Athlete to apply for a retroactive TUE; or
e) The Athlete Used Out-of-Competition, for Therapeutic reasons, a Prohibited Substance that is only prohibited In-Competition.
Full information detailed Article 4.1, 2021 International Standard for Therapeutic Use Exemptions

What happens if a Prohibited Substance is detected during a test analysis?
When a report is received from the laboratory, an initial review takes place to verify whether the athlete has a valid TUE for the prohibited substance and that the results of the analysis are consistent with the conditions of that TUE. If this is the case, the result of the test will be recorded as negative.

My TUE was approved by my National Anti-Doping Organisation (NADO), do I need to submit another TUE to the WSF?
Athletes who compete at the national level or below need only obtain a TUE from their NADO. When such an athlete wishes to compete at an event under the jurisdiction of the WSF Anti-Doping Programme a new TUE application would only be required if the NADO issued TUE had not been processed in accordance with the WADA International Standard for TUE (ISTUE).
It is important for athletes to check with the ITA that their NADO approved TUE is recognized before entering an International level competition.

Note: This is a summary of the TUE process and is not a substitute for a full review which can be found on the WADA website. Other information that you might find useful:

TUE Application Form
ADAMS TUE Quick Reference Guide
WSF Definition of an International Athlete
NADOs with automatic TUE Recognition
World Squash Anti-Doping Rules

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