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THERAPEUTIC USE EXEMPTION (TUE)

The WSF Therapeutic Use Exemption (TUE) Process is the means by which an athlete
competing in any WSF event can obtain approval to use a prohibited prescribed substance or method for the treatment of a legitimate medical condition. The World Anti-Doping Association (WADA) publishes a Prohibited List of substances and methods each year effective 1st January. It is important always to check the new list each year as there are often changes. For 2010, the changes to the Prohibited List have resulted in a change to the TUE process required for: The use of the inhaled beta-2-agonists salbutamol and salmeterol used in the The administration of platelet-derived preparations (e.g. platelet rich plasma or ‘blood spinning’) by non-intramuscular routes. Such preparations are sometimes used to aid healing of muscle, tendon or ligament injuries For these indications a Declaration of Use is required not a full TUE
The TUE Process
There are three types of exemption to apply for: 3. Standard TUE
1. DECLARATION OF USE

A Declaration of Use is required for the following substances:
Salbutamol and salmeterol by inhalation
ii) Glucocorticoids by inhalation
iii) Glucocorticoids administered by localized injection (intra-articular, periarticular,
peritendinous, epidural and intradermal) iv) Platelet-derived preparations (e.g. platelet rich plasma, ‘blood spinning’) by non-
i) There is a threshold urine level of 1000ng/ml for salbutamol and salmeterol. This
level can be exceeded if inhalers are not used as prescribed. The prescribed dose is up
to 1600mg/24hrs taken as no more than 2 puffs (400ug) every 6 hours. If this time
period is lessened with more than 2 puffs taken within a 6 hr period, the urinary threshold can be exceeded. If tested, this will result in an anti-doping violation. Declaring the Use does not mean freedom to use as much inhaler as an athlete wants. It permits the use of these inhalers as regularly prescribed. ii) The beta-2 agonists terbutaline and formoterol remain on the Prohibited List. A TUE
iii) Combination inhalers containing both a glucocorticoid and the beta-2 agonists
terbutaline or formoterol do not require a Declaration of Use. Instead, the athlete
must declare the use of the glucocorticoid with the beta-2 agonist substance make a TUE application iv) A TUE is still required for glucocorticoids administered by oral, intravenous,
v) The use of platelet-derived preparations by intramuscular routes is not permitted

How to make a Declaration of Use
Athletes in the WSF registered testing Pool (RTP) must make their declaration of use through ADAMS (Anti-Doping Administration & Management System) All other Athletes (not in WSF RTP) must make their declaration by writing to the WSF Anti- Doping Administrator [email protected] or by completing the online declaration www.worldsquash.me.uk/declaration_form.htm.
When to make a Declaration of Use

Athletes must make the Declaration of Use at the time the substance (inhaled salbutamol or
salmeterol; inhaled glucocorticoids; localised injected corticosteroids; platelet-derived preparations) use begins. A Declaration of Use is required:  Every time an injection is administered (glucocorticoids or platelet-derived  When a salbutamol or salmeterol and/or glucocorticoid inhaler is (1) used for the first time or (2) has not been previously declared
Who can make a Declaration of Use?

Athlete support personnel can make the Declaration on behalf of their athlete but it is always
the Athlete’s responsibility to ensure that the Declaration is made and is accurate. Where feasible the online Declaration www.worldsquash.me.uk/declaration_form.htm should be made in the presence of the prescribing physician.
Information required to make a Declaration of Use
Athletes are strongly advised to get their prescribing physician to complete the information listed below for them if the Declaration cannot be made in the presence of a physician. This is to enable the Athlete to complete the Declaration themselves accurately. (1) Athlete Name, Address, Telephone Number and E-mail Address (2) Name of National Federation (3) Date (5) Generic name of substance(s) being declared (6) Dosage, units and frequency of each substance (7) Medical Practitioner Name, Address and Telephone Number
Are there any requirements at Doping Control

In addition to declaring the use of inhaled salbuamol or salmeterol, inhaled glucocorticoids,
localized glucocorticoid injection or platelet-derived preparations through ADAMS or the WSF online form, Athletes must also declare the use of theses substances in answer to questions on the Doping Control Sample Collection Form. For further information contact the Doping Control Officer [email protected]. 2. ASTHMA TUE

The beta-2 agonists terbutaline and formoterol continue to need a TUE.
The WSF TUE Beta-2 Agonist Application form is required. This can be found on the WSF website www.worldsquash.me.uk/rul-doping.asp. Note that this requires: 1. A detailed medical history and clinical review 2. Bronchodilator or Bronchoprovocation test results
3. STANDARD TUE
For all other substances and methods used for valid medical reasons require a Standard TUE. The Standard TUE form is available on the WSF website www.worldsquash.me.uk/rul-doping.asp. The following medical evidence is required: 1. History of medical condition 2. Evidence of diagnosis (e.g. hospital review letters, test results) 3. Alternative permitted medications that have been tried
Where to send the TUE application:

Source: http://www.worldsquash.org/ws/wp-content/uploads/2010/05/ad-guidance.pdf