Medical Exceptions and TUE Procedures: What You Need to Know

"My prescription is a banned substance! Now what?"

It’s that time of year when athletes are returning to campus, the season is starting, and the banned drug list is hanging over everyone’s head. It’s also the time of year that Drug Free Sport receives many phone calls, emails, and online inquiries regarding banned medications and medical exception procedures.

If you are an athlete or parent reading this, please note that it is inherently important to report all medications and supplements to the sports medicine staff at your organization or school. 

Prescription and Over-the-Counter medications can be checked using the Drug Free Sport AXIS™ (formerly the Resource Exchange Center/REC) medication database at drugfreesport.com/axis. By entering the brand or generic name of the medication, you can view the status of the medication as “banned” or “not banned” by your sports organization. 

If the medication registers the response “Drug Class Unassigned,” the medication is not yet categorized in our database. To check the status of this medication, navigate to the Dietary Supplement Inquiry page in the TOOLS menu bar and submit the medication to our AXIS team. A response will be provided within 24-48 hours and the medication will be added to the database. [Images below detail the process of of checking medications in the database and submitting an "unassigned" medication via the Dietary Supplement Inquiry form.]

From the Homepage, select the quick link box on the bottom right (shown above) titled 

"Prescription & Over-the- Counter Medication Database" to begin. 

In the database, simply start typing the name of the medication in the search bar. Once the medication 

appears in the auto-generated drop down menu, click and view the Medication Status in the gray box on the right. 

In this example, Adderall is Banned under the Stimulants drug class. 

If the Medication Status comes back as "Drug Class Unassigned," use the TOOLS menu bar 

shown with the arrow above to select "Dietary Supplement Inquiry" to send it to our team. 

To send the medication to the AXIS team, "Start a new inquiry" and type the name of the medication in the search bar. For example, "Acxion" as shown above. Select the green bar that reads "Don't see your supplement listed? Click here." and enter the medication information in the Supplement Name box. Add to inquiry and click "SEND" to receive a confirmation email that your inquiry has been received by our team.

Commonly, medications (such as those used to treat ADHD) come back as “banned” in the database. Sport organizations understand that some banned substances are warranted for treating specific medical conditions. In this case, each organization has a medical exception or Therapeutic Use Exemption (TUE) process that athletes and sports medicine personnel can follow to clear an athlete for competition. Before pursuing a medical exception or TUE, prescribing physicians should always consider alternative medications that do not contain banned substances, when appropriate for certain treatment plans.

Below are links for more information about the medical exception or TUE process for differing organizations. We have also shared additional insights and notes regarding the NCAA medical exception process specifically as you read on. 

NCAA

USATF

LPGA

PGA Tour: Page 36

World Surf League

For NCAA athletes, preapproval from the NCAA is only required if the medication or treatment plan aligns with the Peptide Hormones and Analogues or Anabolic Agents drug classes. Medical exceptions are NOT granted for any substances within the “Street Drugs” class, regardless of the possession of a medical prescription. All other banned drug classes do NOT require preapproval, but it is recommended to have all documentation in place prior to competition.

For medications that are banned under the Diuretics & Masking Agents, Beta-2 Agonists, and Alcohol/Beta Blockers (banned for rifle only) drug classes, the athletic department will maintain appropriate documentation in the student-athlete’s medical record in the event that the athlete tests positive for the prescribed substance. This documentation includes: the current diagnosis, medical history, course of treatment, and a current prescription/dosage for the medication.

Note: Many asthma medications are Beta-2 Agonists that appear as banned substances. However, the NCAA Banned Drug List states that “Beta-2 Agonists [are] permitted only by prescription and inhalation.” By this account, prescription inhalers such as albuterol are permitted with a current prescription documented in the student-athletes medical record.

For medications banned under the Stimulants drug class (such as those used to treat ADHD), the institution will need to maintain the same documentation as for the other drug classes, in addition to the ADHD Reporting Form that can be found here.  Again, this form and all other documentation do not need to be sent to the NCAA until the student-athlete tests positive on a NCAA drug test, at which time the institution may request an exception.

For additional questions about medical exceptions procedures for your institution or sport organization, please use the links provided above or email our Education Department at axis@drugfreesport.com.