Keywords: therapeutic use exemption, athlete, anti-doping

This blog summarises a recent study published in the BJSM (1).     

The World Anti-Doping Agency (WADA) leads the international movement for doping-free sport by coordinating rules and policies across all sports and countries. Each year, WADA publishes the List of Prohibited Substances and Methods (List), which has continued to expand over the years and contains many commonly used medications. 

An athlete can apply for a therapeutic use exemption (TUE) if they are prescribed a prohibited substance or method, or if they become subject to anti-doping rules. The TUE process safeguards the integrity of sport by ensuring that athletes can compete on a level playing field while promoting fairness and inclusion.

As the number of athletes potentially subject to anti-doping rules varies globally, it is difficult to assess the overall TUE prevalence., This study aimed to: 

1. a) describe the prevalence of TUE’s among athletes competing in four Olympic and four Paralympic games,
2. b) present the prohibited substance and methods classes associated with TUEs.

Why is this study important?

There are misconceptions that the TUE system is abused by athletes to gain an unfair advantage in sport. This could lead athletes to avoid necessary medical treatments due to fear of being labeled cheaters and can undermine the integrity of the World Anti-Doping Program. Therefore, continuing research on the prevalence of TUEs is crucial to disprove these misunderstandings and to protect athletes’ health. Additionally, this was the first study to assess the prevalence of TUEs among Paralympic athletes, which gives researchers and public readers novel information on that specific group of competitors.

How did the study go about this?

In this study, Olympic and Paralympic athletes competing at the games in Rio 2016, Pyeongchang 2018, Tokyo 2020, and Beijing 2022 were included in each cohort (1). Data from WADA’s Anti-Doping Administration and Management System were used to evaluate the prevalence of TUEs in those cohorts and the proportion of prohibited substances and methods. 

What did the study find?

Of the athletes who competed in four editions of the Olympic Games, the total prevalence of athletes with TUEs was 0.90%. At the four Paralympic Games, the total TUE prevalence was 2.76%. These findings are similar to a previous study’s results, which highlighted that the prevalence of TUEs was less than 1% among athletes competing in individual Olympic sports between 2010 and 2018 (2). Concerning prohibited substances, at the summer Olympics, the highest proportion was glucocorticoids in Rio (0.5%) and stimulants in Tokyo (0.4%). At summer Paralympics, the most common substances were diuretics in Rio (0.8%) and stimulants in Tokyo (0.8%). 

What are the key take-home points?

The proportion of athletes with TUEs is low; less than 1% at the Olympics and less than 3% at the Paralympics between 2016 and 2022. These findings align with previous research reaffirming that TUEs are not prevalent in elite sport.

Study conducted by Dr. Alan Vernec, WADA Medical Director; David Healy, WADA Senior Medical Manager; Tamar Banon, WADA Medical Manager; and Dr. Andrea Petroczi, Professor at Kingston University and member of WADA’s Prevalence Working Group.

Blog Authors: Alan Vernec, David Healy & Tamar Banon

References:

1. Vernec A, Healy D, Banon T, et al Prevalence of therapeutic use exemptions at the Olympic Games and Paralympic Games: an analysis of data from 2016 to 2022 British Journal of Sports Medicine 2024;58:966-972.

2. Vernec A, Healy D Prevalence of therapeutic use exemptions at the Olympic Games and association with medals: an analysis of data from 2010 to 2018 British Journal of Sports Medicine 2020;54:920-924.