Athletes, like all people, may have illnesses or conditions that require them to take particular medications or undergo procedures. If the medication or method an athlete is required to take/use to treat an illness or condition is included in the World Anti-Doping Agency’s (WADA) Prohibited List, a Therapeutic Use Exemption (TUE) makes it possible for the athlete to take the treatment while remaining in compliance with the anti-doping rules.
Applications for TUEs are reviewed by a panel of experts, the FEI TUE Committee (TUEC), and will be approved if the conditions set by WADA’s International Standard for Therapeutic Use Exemptions (ISTUE) are satisfied.

As an athlete, if you intend to take a medical treatment you must check if your medication contains a prohibited substance or if your treatment is considered to be a prohibited method. Please note, as the Prohibited List (List) is updated annually, you should recheck the status of any treatment you continue to use before the start of each calendar year.

It's important to know that most categories on the List only include some common examples and are not exhaustive. Therefore fact that a substance is not on the Prohibited List does not mean that it is not prohibited. Athletes can use the search tool Global DRO to determine if their medication (brand or ingredient) is prohibited. This search is an anonymous process and does not gather any personal identifiers. Here's how to proceed:

1. Select your country of sport nationality. Read the "Terms and Conditions" carefully. Click "I accept these terms" to continue. If you choose to not accept the conditions, you will not be allowed to proceed to the search page.
2. Select your "User Type" (e.g., Athlete, Parent, Coach).
3. Select your "Sport" (Equestrian Sports).
4. Enter a minimum of four characters of the brand name, or the active ingredient.
5. Click [Search].
6. Click [View status] on the correct brand or ingredient from the list, checking that the name on the Global DRO matches that on the label. This must be an exact match.
7. Print, save or email the summary page to keep for your records (or at minimum record the unique reference number).

Global DRO provides information on products sold in Australia, Canada, Japan, New Zealand, Switzerland, the United Kingdom, and the United States. For other countries, please contact your National Anti-Doping Organization (NADO) or the FEI.

For a TUE to be granted, all of the four following criteria must be met (for more details, please refer to the WADA International Standard for Therapeutic Use Exemptions (ISTUE) Article 4.2:

• The prohibited substance or method in question is needed to treat a diagnosed medical condition supported by relevant clinical evidence.
• The therapeutic use of the prohibited substance or method will not produce any additional enhancement of performance beyond a return to the athlete’s normal state of health following the treatment.
• The prohibited substance or method is an indicated treatment for the medical condition, and there is no reasonable permitted therapeutic alternative.
• The necessity for the use of the prohibited substance or method is not a consequence of the use (without a TUE) of a substance or method which was prohibited at the time of use.

Follow these steps to find out if you need a TUE and where to apply for it:

Useful links:

• WADA Prohibited List  
• ‘Check your medication’ online tool: https://www.globaldro.com/Home (Note: please make sure to search using the correct spelling of the medication brand or substance name and the exact dosage and route of administration. Contact the FEI TUE team in case of doubt: tue@ita.sport.

You have the responsibility to inform your doctors that you are an athlete subject to doping control, and your doctors should check the Prohibited List whenever they prescribe a medication or method to you. If the substance/method is prohibited, check with your doctors if there are any alternative treatments that are not prohibited. If not, you have to apply for a TUE.

• If you are an FEI “International-Level Athlete” you must apply to the FEI in advance, as soon as the need arises, unless there are emergency or exceptional circumstances. The FEI Anti-Doping Rules for Human Athletes (ADRHA) define which athletes are considered as "International-Level Athlete" and there are two possible criteria for this:
  1. Rankings position.
  2. Inclusion in the FEI's Testing Pool or Registered Testing Pool.
  Please check this document to determine whether you hold the "International-Level Athlete" status in 2024.
   
• If you are NOT an "International-Level Athlete", you must apply to your NADO for a TUE.

(NB: If you have been tested by the FEI, are using a Prohibited Substance or Prohibited Method for therapeutic reasons, and were not required by your NADO’s rules to apply for a TUE (i.e., you are not a National-Level Athlete as defined by your NADO), the FEI will allow you to apply for a retroactive TUE. In this case, the application will be examined by the FEI and you should apply to the FEI as explained below).

CAN I GET A RETROACTIVE TUE?
If you are an athlete and have been prescribed a treatment involving prohibited substances/methods, you must obtain a TUE from the FEI or your NADO (National Anti-Doping Organization) before starting the treatment. You may apply retroactively to the FEI for a TUE only if your situation falls under the categories listed below (you will still meet the basic criteria for granting a TUE. To submit your application, please click here):

- Emergency or urgent treatment of a medical condition was necessary.
- There was insufficient time, opportunity or other exceptional circumstances that prevented you from submitting (or the FEI TUE Committee to consider) an application for the TUE prior to sample collection.
- You are not an FEI "International-Level Athlete" and due to national-level prioritisation of certain sports, your NADO did not permit or require that you apply for a prospective TUE.
- You were tested by the FEI, are not an International-Level Athlete or National-Level Athlete, and are using a prohibited substance or method for therapeutic reasons.
- You used out-of-competition, for therapeutic reasons, a substance that is only prohibited in-competition.
- In exceptional circumstances, the FEI may grant a retroactive TUE if it considers that it would be manifestly unfair not to grant it. For International-Level Athletes and National-Level Athletes, this decision will require the prior approval of WADA.  

For more details, please refer to WADA’s International Standard for Therapeutic Use Exemptions (ISTUE), articles 4.1 and 4.3.

Important note: using a prohibited substance or method before being granted a TUE could result in an Adverse Analytical Finding and a potential anti-doping rule violation. You are strongly advised to have a medical file prepared and ready to submit for evaluation in case an application for a retroactive TUE is necessary following sample collection.

HOW DO I APPLY TO THE FEI FOR A TUE?
To apply for a TUE, please click here and follow the instructions carefully.
NOTE:
Your TUE application must be submitted in legible English (or French) using capital letters or typing.
Your medical file must include:

• A comprehensive medical history, including documentation from the original diagnosing physician(s) (where possible).
• The results of all examinations, laboratory investigations and imaging studies relevant to the application.
• If the medical file is not in English or French, a summary explaining, in English or French, the key elements of the diagnosis, clinical examinations, medical tests and treatment plan must be provided.

Any TUE application that is not complete or legible will not be dealt with and will be returned for completion and re-submission. To assist you and your doctor in providing the correct medical documentation, please consult WADA’s Checklists for TUE applications for guidance and support, and the Medical Information to Support the Decisions of TUECs for guidance on specific common medical conditions, treatments, substances, etc.   Keep a complete copy of the TUE application form and all medical information submitted in support of your application, and proof that it has been sent.

WHEN WILL I RECEIVE A DECISION ON MY TUE APPLICATION? 
The decision of the FEI’s TUE Committee (TUEC) will be communicated in writing to you (unless exceptional circumstances apply) within 21 days from the date of receipt by the FEI of the complete TUE application, including the required medical information.

Each TUE has a specific duration, at the end of which it expires automatically. If you need to continue to use the prohibited substance or method, it is your responsibility to submit a new application for a TUE with updated medical information ahead of the expiry date, so that there is sufficient time for a decision to be made before your current TUE expires.

Important Note: The presence (following sample collection), use, possession or administration of the prohibited substance or method must be consistent with the terms of your TUE. Therefore, in the event that, after your TUE is granted, you require a materially different dosage, frequency, route or duration of administration, you must apply for a new TUE.

A decision to deny a TUE application includes an explanation of the reason(s) for the denial. If it is not clear to you, please contact the FEI to understand exactly why the TUE was denied. Sometimes, there may be a critical piece of information, diagnostic test, laboratory results missing, etc. Failing this, you and/or your NADO may refer the matter to WADA for review no later than 21 days after the decision was rendered by the FEI TUEC by sending the same information that you submitted to the FEI TUEC and on which they based their decision to deny the TUE via registered mail at:

WADA Medical Director
World Anti-Doping Agency
800 Square Victoria
Montreal, H4Z 1B7, QC
Canada

However, WADA is not obliged to proceed with such review. In that case, you and/or your NADO may appeal to the Court of Arbitration for Sport (CAS).

All the information contained in a TUE application, including the supporting medical information and any other information related to the evaluation of your TUE request is kept strictly confidential and treated in accordance with the Athlete’s Declaration contained in the ADAMS TUE process, and in the FEI’s TUE Application Form. All members of the FEI TUEC and any other authorised recipients of your TUE request and related information (as described in the Athlete’s Declaration) are subject to a professional or contractual confidentiality obligation.   Please review the terms of the Athlete’s Declaration carefully. In particular, please note that should you wish to revoke the right of the FEI’s TUEC to obtain the information related to your TUE request in accordance with the Athlete’s Declaration, your TUE application will be deemed withdrawn without approval being granted.   Your TUE request-related information will be retained by the FEI and any other authorised recipients for no longer than necessary for the purposes stated in the Athlete’s Declaration, in accordance with WADA’s International Standard for the Protection of Privacy and Personal Information (ISPPPI).

For questions in relation to the FEI’s personal information practices, please contact Catherine.Bollon@fei.org.
If you have a doubt as regards to which organisation you should apply for a TUE, or any other question with regard to TUEs, please contact: tue@ita.sport.