WADA study confirms low prevalence of Therapeutic Use Exemptions among Olympic and Paralympic athletes

A recent study carried out by the World Anti-Doping Agency (WADA) has provided evidence that Therapeutic Use Exemptions (TUEs) are not widespread in elite sport. A TUE is a special exemption granted by Anti-Doping Organizations (ADOs) to an athlete with a medical condition allowing them to use a prohibited medication or method, if they fulfil the criteria as outlined in the International Standard for Therapeutic Use Exemptions (ISTUE). 

The study, which was recently published in the British Journal of Sports Medicine, concluded that the number of athletes competing with valid TUEs at the Olympic and Paralympic Games between 2016 and 2022 was less than 1% and less than 3%, respectively.   

WADA Medical Director, Dr. Alan Vernec said: “On the eve of the Paris 2024 Olympic and Paralympic Games, we welcome the results of yet another study demonstrating the low prevalence of TUEs in elite sport. Studies like these are important to the sporting community and may help inform future policy and education initiatives in sport and anti-doping.” 

For this cross-sectional observation study, researchers studied data from eight cohorts of athletes, including athletes with TUEs, who competed in the Olympic and Paralympic Games in Rio de Janeiro (2016), Pyeongchang (2018), Tokyo (2020) and Beijing (2022).  

Of the 28,583 athletes who competed in four editions of the Olympic Games, the total prevalence of athletes with TUEs was 0.90% among all competitors. At the four Paralympic Games, the total TUE prevalence among the 9,852 athletes was 2.76%. 

The study also found that the most frequently observed substances associated with TUEs at the Summer Olympics were glucocorticoids (0.50% in Rio de Janeiro) and stimulants (0.39% in Tokyo). At the Summer Paralympics, diuretics (0.79% in Rio de Janeiro) and stimulants (0.75% in Tokyo) were the most common. The Winter Games had somewhat similar trends, although TUE numbers were very low. 

Dr. Vernec added: “The TUE Program is a necessary part of sport, allowing athletes with legitimate medical conditions to receive appropriate treatment. It is widely accepted and globally used by athletes, physicians and sports authorities, and there are robust frameworks in place to avoid abuse of the system. The results of this study provide objective data to dispel some of the concerns and misconceptions surrounding TUEs that they are prone to misuse or serve as a means for ‘legitimized’ doping.”  

While assessing the general prevalence of TUEs presents a formidable challenge, namely due to variability and number of athletes competing, these results from the highest level of sport are consistent with previous findings, reaffirming that the TUE system is a fundamental tool in supporting athletes and protecting clean sport. 

Along with Dr. Vernec, the research team comprised: 

• Tamar Banon, WADA Medical Manager; 
• David Healy, WADA Senior Medical Manager; and 
• Dr. Andrea Petroczi, Professor at Kingston University and member of WADA’s Prevalence Working Group