Doping and Therapeutic Use Exemptions (TUE)

Doping is not just a positive test. The World Anti-Doping Code lists <strong>11 anti-doping rule violations (ADRVs)</strong>, including presence, use, whereabouts failures, tampering, possession, trafficking, <strong>administration</strong>, complicity and prohibited association.

Two principles for every doctor

Strict liability: the athlete answers for whatever is in their body, regardless of intent. “My doctor prescribed it” is no defence.
The doctor’s role: administering or prescribing a prohibited substance can itself be an ADRV. Check every drug given to a competing athlete.

Categories (WADA 2026 list)

Always prohibited: S0 non-approved substances, S1 anabolic agents, S2 peptide hormones, S3 beta-2 agonists, S4 hormone modulators, S5 diuretics and masking agents, M1 to M3 blood, chemical and gene manipulation
In-competition only: S6 stimulants, S7 narcotics, S8 cannabinoids, S9 glucocorticoids
Particular sports: P1 beta-blockers (archery, shooting)

Everyday prescribing traps

Drug or method	Rule
Ventolin (salbutamol) MDI	Inhaled up to 1600 µg/24 h (max 600 µg/8 h): no TUE. Formoterol 54 µg, salmeterol 200 µg per 24 h. Terbutaline, fenoterol, reproterol and higenamine are prohibited even inhaled.
Pseudoephedrine (Actifed, Sudafed)	Prohibited in-competition (urine above 150 µg/mL). A single dose can exceed it
Glucocorticoid injections	Prohibited in-competition by oral, rectal or injection routes. Inhaled, nasal, topical and eye routes are permitted. Washout: 3 days, 10 days for triamcinolone. Depot triamcinolone IM up to 60 days
IV fluids (M2)	Over 100 mL per 12 hours is prohibited, even plain saline. “Wellness” drips included. Hospital treatment excepted
Tramadol	Prohibited in-competition. Codeine, caffeine and PRP are not
Supplements	Largest source of inadvertent violations. Use batch-tested products

Cold alternatives

saline irrigation, intranasal corticosteroids, permitted antihistamines.

Where to refer (Malaysia)

ADAMAS (national anti-doping agency): TUEs for national-level athletes. International-level athletes apply through their International Federation.
WADA Prohibited List and Global DRO (globaldro.com) for medication status.
Athletes carry a doctor’s letter (ingredients, dose) and a valid TUE.

TUE: all four criteria required

Necessity: withholding it would cause significant health impairment
No reasonable permitted alternative
No performance enhancement beyond restoring normal health
No masking of another prohibited substance

Apply before use. Retroactive TUEs are for emergencies only.

Workflow

check status, prefer a permitted alternative, apply in advance, document diagnosis and rationale thoroughly (incomplete files are a common cause of rejection), respect washouts.

References

WADA Prohibited List 2026, wada-ama.org
ADAMAS Prohibited List 2026, adamas.gov.my
NADA 2026 changes, nada.de
Sports Med Open 2026, doi:10.1186/s40798-026-01014-z

Medical disclaimer: this article is general information, not personal medical advice. Always consult a qualified doctor about your own situation.