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A Therapeutic Use Exemption (TUE) is special permission to use a prohibited substance for medical reasons based on substantial medical documentation. The USADA TUE process is consistent with the UFC TUE Policy and designed to protect the rights of clean athletes.

Start here. In general, a TUE is required for all prohibited substances and methods (see UFC’s Prohibited List), however the requirements vary depending on your competition status. For UFC athletes, a TUE is required for all prohibited substances or methods. You must obtain a TUE in advance of using any prohibited substance or method. Failure to do so may results in an anti-doping rule violation. For more information, review the UFC TUE Policy.

All UFC athletes should submit their application directly to USADA by email to tue@usada.org or by fax to 719-785-2029.

To obtain a TUE, you should visit the Apply for a TUE page on the UFC Anti-Doping Website. There you will find two documents to download: 1) an application form and 2) medical information required to justify the use of the prohibited substance. Read both documents so that you understand the requirements, and bring them with you to your doctor’s appointment. Your doctor should review the medical requirements for the TUE so that he or she can supply all of the relevant information. After completing the application, submit it to USADA by fax, mail, or email according to the instructions on the application form. We will notify you when we receive your application. If you don’t hear from us within three days, let us know – we may not have received your application.

The most important aspect of a TUE application is the medical file. The Therapeutic Use Exemption Committee will need to review any and all relevant medical details related to the application, including patient history, test results, how the disease/disorder/injury has been managed over time, and any and all attempts to use non-prohibited medications and methods. Read the application form and the medical information requirements closely and urge your doctor to do the same. The medical file should be as complete as possible.

The TUEC is the group of doctors and medical experts that review your TUE application with a focus on your medical file, and provides the recommendation for approving or denying your TUE application. The TUEC takes into account your entire medical file, the anti-doping rules outlined in the UFC TUE Policy and the UFC Anti-Doping Policy, and the current opinion for best medical practice. Your identity is never revealed to the TUEC.

Your doctor plays a crucial role in supplying the medical information necessary for the approval of a TUE. The Therapeutic Use Exemption Committee relies on the information supplied by your doctor to determine if your file meets the medical criteria set by the UFC TUE Policy.

USADA has the authority to grant TUEs for UFC athletes.

In some instances, a TUE application is returned to the athlete without being reviewed by the TUEC. Applications are often returned because they are not complete, or because a TUE is not required. A returned application should not be interpreted as a denial of your TUE. If your application is formally denied by the TUEC you will receive specific notification of this. If your application has been returned to you because it is incomplete, you are encouraged to resubmit it with new information.

If you are prescribed a prohibited substance for an emergency, you should file an emergency TUE. The process is essentially the same – you should download the relevant forms from the TUE application page and submit them as a matter of urgency. Make sure to write EMERGENCY TUE at the top of the form so that we know to expedite processing. It is understood that in some instances not all medical information can be obtained quickly. You should make your best effort to submit a medical file that is as complete as possible, and submit the TUE application as soon as practicable.

In the first instance, you should contact USADA to determine exactly why the TUE was denied if it is not made clear in the denial letter. Sometimes, there may be a critical piece of information that was overlooked or not provided, or new relevant information or test results may be available that would allow the TUE to be approved. You should investigate whether there is scope for resubmission of your application. Failing this, you may appeal the decision pursuant to the Hearing Protocol outlined in the UFC Anti-Doping Policy.

Predicting the time it takes for a medication to clear completely from your system is complicated, can vary greatly, and is unique between individuals and to each medication. For this reason, USADA cannot predict urine and/or blood clearance times for athletes. You will need to talk with your physician and/or pharmacist about the average time it takes the body to clear a particular medication, and whether there are any known factors that might affect how your body might process that medication. Once you have that information, you will need to decide for yourself whether the “clearance time” estimated by your physician or pharmacist is sufficient for you to compete. If you are not certain that the medication will have cleared by the time you compete, you are encouraged to apply for a TUE.

If you are planning a surgery, your first step is to look up all medications that you will be given (or that will be administered) during or after your surgery on UFC.GlobalDRO.com. For general anesthesia, it is common for more than one medication to be used. There may be cases when it is not possible to find out in advance of what medications you will receive (such as in an emergency) and sometimes the anesthesiologist will change his or her mind during the surgery about the most appropriate medication to use. In all cases, request a copy of the surgical notes in order to find out which medications were administered and submit an emergency TUE if necessary. Please review the UFC Surgery Checklist before a planned visit or emergency visit to the hospital.

If you are using a medication that is prohibited only in-competition[1], such as a stimulant (e.g. Ritalin, Modafinil, Concerta, Daytrana, Vyvanse), narcotic (e.g. oxycodone, pethidine, methadone and others), cannabinoid (e.g. Marinol and others), or glucocorticoid (e.g dexamethasone, prednisolone and others)[2], you might wonder how long before a competition you need to stop taking your medication to avoid testing positive. The good news is that you can apply for a Therapeutic Use Exemption (TUE) that, if approved, gives you the permission to use your medication in sport so that you do not have to stop taking it.

If you have applied and your TUE was denied, or you don’t have time to get a TUE, then you will have to work with your doctor to weigh your options of switching medications to a non-prohibited alternative, ceasing your medication, or opting not to compete. Please remember that if you choose to stop taking your medication just before a competition, you do so at your own risk.

If you do choose to stop taking your medication, a natural follow-up question is, “How long before a competition do I need to stop taking my medication to avoid testing positive?”

Unfortunately, USADA cannot predict how long before a competition you will need to stop your medication to avoid testing positive. It depends on many factors like the form of the medication (rapid release, extended release, injection, pill, cream etc.), your general health, your weight, your individual metabolic processes, liver function, other conditions you may have, and other medications you may be taking.

You can ask your doctor or pharmacist to help you, but you should be aware that doctors primarily rely on the drug’s half-life to make proper treatment recommendations.  While the half-life gives an estimate of how long the drug “works,” it DOES NOT tell you how long the parent compound or the metabolites (break-down products) are present in the urine. The WADA-accredited anti-doping laboratories look for the presence of those parent compounds and metabolites. So even though some drugs have a very short half-life, their metabolites are detectable for a long time in the urine. Marijuana, which is prohibited in-competition, is an example of a drug that is excreted in the urine over a prolonged period that could take weeks or months. Aspirin on the other hand, is an example of a rapidly excreted drug, and could clear completely from an athletes’ urine within hours.

The best scenario is to have an approved TUE in place before competing. If you choose to stop taking your medication just before a competition, please keep in mind that you do so at your own risk.

[1] In-Competition refers to the period commencing at noon on the day prior to the scheduled start of the Fight Card on which a Bout is contested and ending upon the completion of the post-Bout Sample or Specimen collection. If a post-Bout Sample or Specimen collection is not initiated by USADA within a reasonable time, which will not exceed one hour following an Athlete’s post-Bout medical clearance, then the In-Competition period shall expire at that time.

[2] See the UFC Wallet Card or check UFC Global DRO for more examples of medications that are prohibited in-competition.

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