Your health is the most important consideration.
Emergency treatment should be carried out, as medically appropriate, and considerations of the need for a TUE can be dealt with after the medical issue is stabilised. There is a category of TUEs for these situations called “retroactive” where the application is made after the treatment has been given.
Examples of Emergency treatments that involve WADA prohibited substances
Pain relief medications – Narcotics (e.g. morphine, pethidine, fentanyl) are on the WADA Prohibited List. They are only prohibited DURING competition. The clearance of these drugs from the body is relatively rapid but they can remain in the system for a few days. A TUE is therefore required if the athlete is competing within 5 days of taking this medication.
Prednisolone, hydrocortisone – May be given to treat severe allergy, anaphylaxis, asthma and other inflammatory conditions. When given systemically (i.e. Intravenous, intramuscularly, orally) these medications are WADA prohibited but only DURING competition. The clearance of these medications from the body is usually fairly rapid but can be variable and will remain in the system for a few days. A TUE is therefore required if the athlete is competing within 5 days of taking this medication.
Adrenaline – may be given for anaphylaxis and an epipen may be given to take home for any future events. It is WADA prohibited DURING competition. These substances both require a TUE if used within 5 days of competition. If an athlete needs to carry an epipen a TUE is required at all times.
Intra-venous (IV) fluids – no TUE is required, regardless of the volume, if the IV fluid is given while the athlete is in hospital, either the ward, emergency department, in surgery or en route to hospital in an ambulance. If it is given at a doctor’s rooms or any place other than those listed above and the volume is >100ml then a TUE is required.
Blood transfusions - Any transfusion of blood, in or out of hospital requires a TUE.
Ventolin (Salbutamol) - during an acute asthma attack you may be given salbutamol via an inhaler (and possibly a spacer) or nebuliser. Inhaled salbutamol is permitted by WADA but only up to 8 “puffs” in a 12 hour period. Salbutamol via a nebuliser will exceed this threshold so a retroactive TUE should be applied for if a nebuliser or more than 8 puffs in 12 hours are given.
There are a number of possible medications given during and after surgery that may need a TUE. Always check any medication you are given on GlobalDRO to check if they are on the WADA prohibited List.
- Anaesthetic medications –narcotics (e.g. pethidine, morphine, fentanyl) are WADA prohibited but only DURING competition. As the clearance of these drugs from the body is rapid there is no need for a TUE unless the athlete competes within 5 days of receiving these drugs.
- IV fluids- are usually given during surgery and the WADA rules state that NO TUE is required for IV fluids given whilst in hospital.
- Post-Operative/take home medication – There may be prescribed medication to take home after surgery. This is usually pain relief and some of these may be narcotics in tablet form (e.g. endone or oxycodone) which are prohibited DURING competition. This means a TUE is required if the athlete takes these medications within 5 days of competition.
Donation of whole blood is not prohibited by the WADA rules.
However, if an athlete donates whole blood they should ensure they keep a medical record from the blood bank confirming the date, type and volume of the donation. This is particularly important if the athlete is in a drug testing pool and if their testing involves the athlete biological passport (ABP).
This is because evidence of blood loss (whether intentional as part of a blood doping regimen or through an accident, illness or blood donation) may result in changes to an athlete's haematological passport (ABP) and the athlete may be asked to explain these changes to anti-doping authorities. A record of donation would assist the athlete in these circumstances.
All blood transfusions (received in or out of hospital) require a TUE. It does not need to be done before the treatment is performed if it is an emergency situation. In an emergency situation, appropriate treatment should be carried out first. A TUE should be applied for after the medical situation is stabilised/resolved (i.e. a retroactive TUE).
i) Donating Plasma: This process has some potential concerns under the WADA rules as the donation involves taking whole blood from the donor and then separating out the plasma from the red blood cells and returning the red blood cells (and usually some fluid) to the donor. In some donation centres a Plasmaphoresis machine is used which is a “closed circuit” (i.e. the blood is taken, the plasma extracted and the remaining blood is reinfused all in the one process and whilst connected to the donor).
Both the infusion of fluid and the re-infusion of red blood cells technically breaches the WADA code however this may be less of an issue with the closed circuit process. As with donating whole blood, there may be some changes to the haematological passport (ABP).
Athletes, who are part of a drug testing program, are therefore advised that the donation of plasma/platelets should be avoided whilst they are elite athletes (there is no difference whether the donation occurs in or out of a competition phase).
ii) Receiving Plasma: this process is usually required for serious medical conditions so it is rare for elite athletes to still be competing with such significant illnesses. However if they are, as only plasma is infused (i.e. no red blood cells) and usually it is done in a hospital setting then no TUE is required (if given outside a hospital and >100ml is given then a TUE would be required).
Iron is not prohibited by WADA but if the amount of fluid used to give the infusion is >100ml then a TUE required. If less than 100ml is used then no TUE is required.
While cannabis has been legalised for medical use in a small number of conditions in Australia, it remains prohibited in competition under the World Anti-Doping Agency (WADA)’s Prohibited List. This can be verified via Global DRO.
Athletes who have been prescribed Cannabis or who are considering use of medical Cannabis should determine if they require an in-advance TUE.
If the athlete is eligible for a retro-active TUE the following medical documents should be compiled to support a TUE application.
Further information for Doctors who may prescribe medical cannabis is provided by WADA.
What about CBD oil?
Cannabidiol (CBD) is a non-psychoactive derivative of cannabis. As of 2018, WADA no longer lists CBD as a prohibited substance.
ASDMAC reminds athletes that CBD oil often still contains some concentration of the banned substance tetrahydrocannabinol (THC). Therefore, the use of CBD oil is at an athlete’s own risk and could be considered akin to the use of a supplement. Assessment of the risk of any supplement can be made through the ASADA app.
Remember, athletes are strictly liable for any prohibited substance found in their sample.