Emergency treatment should be carried out as medically appropriate and considerations of the need for a TUE can be done after the medical issue is dealt with.
There is a category of TUEs for these situations called “retroactive” where the application is made after the treatment is started.
Examples of situations that may arise
- Anaesthetic drugs –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 48 hours of receiving these drugs.
- IV fluids- are usually given during surgery and the WADA rules state that NO Therapeutic Use Exemption is required for IV fluids given whilst in hospital
- Post-Operative/take home medication – sometime you may be prescribed medication to take home after surgery. This is usually pain relief and some are narcotics (i.e. endone or oxycodone) which are prohibited in competition. This means a TUE is required if you are taking these medications and are competing. If you stop taking them at least one week prior to competition then no TUE is required
- Pain relief medications – either oral or via injection. Those that are on the WADA prohibited list are narcotics (ie morphine, pethidine, fentanyl). See above
- IV fluids – no TUE is required if the IV fluid is given while you are 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 then a TUE is required
- Take home medication – see above
Any transfusion of blood or blood products, in or out of hospital requires a TUE. It does not need to be done before the treatment is performed if it is an emergency situation. In those situations a retroactive TUE can be applied for. If the athlete has a chronic condition that requires regular transfusions then a TUE covering these transfusions over a 12 month period is suggested and can be applied for in advance.
Donating blood is permitted. No TUE is required except if you are given an IV infusion to replace fluid after the donation.
- Donor – as plasma is removed and red cells are returned to the donor with fluid (often in a community setting) then a TUE is required
- Recipient – as only plasma is infused and usually in a hospital setting then no TUE is required
In general, most drugs given in relation to a hospital admission do not require a TUE however ASDMAC advises that athletes should keep a copy of their hospital paperwork should there ever be a query about the drugs they received.