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.

Amphetamine Misuse For Academic Gain: How Effective Are They?

Contributed by Anna Filardo, Education Program Manager at Drug Free Sport, Inc.

More NCAA student-athletes report using ADHD medications without a prescription compared to those with a prescription and medical diagnosis, according to the 2014 NCAA Substance Abuse Survey. Especially around this time of year, students may misuse or abuse prescription amphetamines such as Adderall, Ritalin, and Concerta to enhance memory and academic performance.

This is of concern to a number of sports organizations as not only are amphetamines banned/prohibited, but also potentially harmful to the athlete’s health. And ultimately, if the athlete does not have attention deficit/hyperactivity disorder (ADHD), does the non-medical use of these prescription stimulants actually lead to improved academic outcomes? We decided to investigate. 

Results from the NCAA Substance Abuse Survey.

First, let’s get a few knowledge points out of the way.

Amphetamines are:

• Occasionally called “speed” or “uppers," are synthetic, psychoactive drugs that are central nervous system (CNS) stimulants. 
• Prescribed to treat narcolepsy, obesity, and attention deficit/hypertension disorder (ADHD). 
• Considered performance-enhancing drugs (PEDs) that delay the onset of (or mitigate) fatigue. 
• Banned/prohibited stimulants by most, if not all, sports organizations. 
• Commonly found in dietary supplements, namely those marketed as “pre-workouts," but also hidden in other types of supplements. 
• Listed on product labels under different names or chemical formulas, causing uncertainty for consumers. (See Box 1 for examples popular ingredients of concern.) 
• Associated with negative health effects when misused/abused. (See Box 2.)

But, are they effective for improved academic performance?

In 2015, researchers from the University of Pennsylvania found that ADHD medications provide little to no benefit to those without medical need. In fact, the medication caused a decrease in motivation, and an increase in omission errors when compared to a control group. Amphetamine-users also perceived themselves as having poorer study habits and lower motivation than their non-user counterparts.

The University of Maryland School of Public Health conducted a literature review on non-medical amphetamine use among college-aged students. Their research revealed that non-medical use of amphetamines was also associated with the following characteristics in college-aged students:

• Excessive drinking and other drug use 
• Lower GPA 
• Low perceived harmfulness of using prescription stimulants non-medically 
• Greater attention difficulties 
• Psychiatric distress or depressed mood 
• More likely to skip class 
• Affiliation with a Greek (fraternity/sorority) organization 

For the full University of Maryland report click here: Nonmedical Use of Prescription Stimulants.

Medical Exceptions for ADHD Medications

The NCAA and World Anti-Doping Association (WADA) do have medical exception processes that athletes may complete should prescription amphetamines be required for a diagnosed medical need. NCAA and WADA athletes will need to fill out the ADHD Medical Exception Reporting Form or the Therapeutic Use Exemptions (TUE) form, respectively. The use of amphetamines will cause a positive drug test—and without a current prescription and medical exception, appropriate sanctions will follow.

Amphetamines are more dangerous than perceived and should only be used under the direction of a medical doctor. Prescription amphetamines are Schedule II drugs with considerable potential for abuse and addiction. According to the Drug Enforcement Agency, distributing Schedule II stimulants illegally (e.g., sharing or selling pills) is a felony.

If you or a student-athlete have a questions regarding amphetamine use (dietary supplement or medication), please visit www.dfsrec.com or call Drug Free Sport at 877-202-0769.



References:
Center for Substance Abuse Research. (2013, Oct. 29). Amphetamines Retrieved from http://www.cesar.umd.edu/cesar/drugs/amphetamines.asp
Center on Young Adult Heath and Development, University of Maryland School of Public Health. Retrieved from http://medicineabuseproject.org/assets/documents/NPSFactSheet.pdf
Illeva, I.P., & Farrah, M.J. (2015). Attention, motivation, and study habits in users of unprescribed ADHD medication. Journal of Attention Disorders, 1-13. doi: 10.1177/1087054715591849
Lakhan, S.E., & Kirchgessner, A. (2012). Prescription stimulants in individuals with and without attention deficit hyperactivity disorder: misuse, cognitive impact, and adverse effects. Brain and Behavior
National Collegiate Athletic Association. (2013). [Graph illustration from NCAA substance use survey]. NCAA National Study of Substance Use Habits of College Student-Athletes. Retrieved from https://www.ncaa.org/sites/default/files/Substance%20Use%20Final%20Report_FINAL.pdf
Rosenbloom, C.A., & Coleman, E.J. (2012). Sports Nutrition: A practice manual for professionals. United States of America: Academy of Nutrition and Dietetics.