Category Archives: TUEs

Understanding the Prohibited List

WADA has released details for the 2017 Prohibited List, which will come into effect on 1 January 2017. The Clean Sport Blog caught up with Hannah Gribble, UKAD’s Science Officer, to find out what the Prohibited List is and why it’s important.

The Prohibited List, also known as the List, identifies substances and methods that athletes are prohibited from using whilst competing in sport. These substances and methods are grouped into different categories based on the effect they have on the body and the type of drug they are. For example, there is a category for anabolic steroids and another one for stimulants.

Some substances are prohibited at all times whilst others are prohibited only during the competition period. In addition, alcohol and beta-blockers are prohibited only in certain sports; so for example, alcohol is prohibited in-competition in motorsports whilst beta-blockers are prohibited at all times in archery but neither are prohibited in cycling or football.

Ok, so how often is the list updated? And who is responsible for making the key changes?

In the main, the Prohibited List is updated yearly. In order for a substance to be included on the List, it must meet two of three criteria:

  1. It has the potential to enhance or enhances sport performance.
  2. It represents an actual or potential health risk to the athlete.
  3. It violates the spirit of sport.

WADA is responsible for the updates which are published on an annual basis in October. This gives athletes a chance to change any relevant medications or apply for a Therapeutic Use Exemption (TUE) before the new list comes into effect on 1 January.

The only exception is when WADA has reason to change the list mid-year. In this case there is a three month delay before the changes come into effect.

It seems that certain substances are only prohibited in-competition. How soon before a competition can an athlete take that substance?

When a substance is prohibited only in-competition an athlete must ensure that the substance has completely cleared from the body in time for the event or competition period. Therefore, the time-point at which the athlete must cease use depends on two factors:

  1. How quickly the substance is cleared from the body. This differs depending on the particular drug as well as various other physiological factors, such as body mass. An athlete should ask their doctor or a pharmacist for advice if necessary.
  2. The definition of the event or in-competition period. This may vary between different sports and between different events. As an example the in-competition period for the Olympics starts 12 hours before an athlete’s event and ends when the Doping Control process for that event has been completed. The rest of the period is therefore considered out-of-competition. Athletes need to ensure they check the anti-doping rules for any event in which they are competing so they are aware of the in-competition period.

It is the athlete’s responsibility to ensure that they stop using the substance at the appropriate time. Athletes who are close to competition and therapeutically need to use a medication that is only prohibited in-competition are encouraged to contact UKAD to find out if they need to apply for a TUE.

Alcohol and beta-blockers are only prohibited in particular sports. Do sports have a say in the List?

NGBs are able to provide their feedback and suggestions regarding the List to their International Federations. It is then the Federations that provide recommendations to WADA in regards to sport specific content. Recommendations must be supported with a rationale or evidence to support the specific viewpoint.

We’ve also heard about Specified Substances and Non-Specified Substances. What’s the difference?

There is a greater likelihood of there being a credible non-doping explanation for a specified substance being present in an athlete’s sample, such as a substance inadvertently entering the athlete’s body.

But this greater likelihood is simply not credible for certain substances, such as steroids and human growth hormone. This differentiation between Specified and Non-Specified Substances allows an arbitration panel more flexibility when making a sanctioning decision regarding the length of a ban.

Under the World Anti-Doping Code, an athlete can face a ban of up to two years if a Specified Substance is present in their sample. Whereas, they could face a maximum of four years for a Non-Specified Substance.

What are the easiest ways for an athlete to check whether or not a substance or medication is on the List?

Looking at the List itself can be confusing, as it outlines the substances and methods which are banned in sport but does not outline which medications these substances are found in.

Global DRO (Global Drug Reference Online) is a user-friendly online tool that can be used to search for medications or specific ingredients to see if they are prohibited or not, or if any conditions apply to the use of that substance. It gives athletes and support personnel the information which is relevant to them, based on the sport in which the athlete competes. We recommend that users save or print the results as evidence of their search. Global DRO cannot be used to check the status of supplements.

Additionally, athletes should remember that the List changes on 1 January each year so it is important to renew searches of regular or recurring medications.

Are there any circumstances where an athlete would be able to use a substance on the List and how would they go about gaining permission to do so? 

An athlete may be able to use a prohibited substance if they have an illness or medical condition that requires it. A common example of this is an athlete who suffers from diabetes and therefore requires the use of insulin.

To receive permission to use a specific substance, athletes must fill out a TUE form and provide medical evidence to demonstrate their therapeutic need. Depending on the level of the athlete, this should be submitted for review either to the International Federation (international level athletes) or to UKAD (national level athletes). More information can be found on this process via the UKAD website.

What changes have been made to the 2017 version of the Prohibited List? 

There have been a few changes in the 2017 List and a full summary of the 2017 Major Modifications and Explanatory Notes is available on the WADA website.

It is important that athletes and support personnel take time to read all of the information available and check any medications or supplements.

One of the key changes for many athletes will be the amendments made to two asthma medications – a summary can be seen below:

Salbutamol Inhalers (aka albuterol or marketed as Ventolin)

  • Previously, an inhaled dosage of no greater than 1600 micrograms was permitted over 24 hours However, it was never the intention that this meant that athletes could inhale 1600 micrograms in one go or over a few hours
  • Dosing parameters of inhaled salbutamol have been amended to reflect that athletes are allowed a maximum of 1600 micrograms over 24 hours, but not to exceed 800 micrograms every 12 hours
  • Salbutamol inhalers commonly dispense either 100 or 200 micrograms per puff/inhalation, this relates to an allowance of either 8 or 4 inhalations per 12-hour period
  • Dose per inhalation can vary between inhalers, therefore athletes should ask their doctor or check the patient information leaflet which accompanies their prescribed inhaler to establish the dose administered in each inhalation
  • If an athlete requires more than 800 micrograms in a 12-hour period, they should consult their doctor and contact UKAD to determine if they need to apply for a TUE

Salmeterol

  • It is usually administered via inhalation twice a day, in the morning and evening, about 12 hours apart
  • Under the 2017 List, the maximum allowable dosage of salmeterol has been defined for the first time as “200 micrograms over 24 hours”. This is consistent with manufacturers’ recommendations
  • In previous versions of the List, no dosage was provided and instead athletes were advised that inhaled salmeterol was permitted “in accordance with the manufactures’ recommended therapeutic regimen”
  • The dose administered per inhalation of an inhaler containing salmeterol can vary. Athletes are advised to check the patient information leaflet that accompanies their inhaler to establish the dose that is administered per inhalation
  • If an athlete requires more than 200 micrograms over 24 hours, they should consult their doctor and contact UKAD to determine if they need to apply for a TUE

Further information can also be found on the Prohibited List section of UKAD website or via our free 100% me Clean Sport App available to download via iTunes, Google Play or the Windows Store.

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