Medicines and sport: UK anti-doping rules and therapeutic use exemptions

Anti-doping rules are not limited to elite professionals. Amateur and club competitors in many sports can be tested, and the same responsibility applies. A parent, coach or doctor who is unfamiliar with sport may prescribe something sensible for a medical condition without knowing it appears on the list.

This page is general information. Rules are set by the World Anti-Doping Agency and applied in the UK by UK Anti-Doping, and the sport you play may add its own requirements.

UKAD describes three groups. Some substances are prohibited at all times, such as anabolic agents, peptide hormones, diuretics and masking agents. Others are prohibited only in competition, including cannabinoids, glucocorticoids, narcotics and stimulants. A third group applies only in particular sports.

The list works by class as well as by name: other substances with a similar chemical structure or biological effect are also prohibited even if not named. It is revised each year with effect from 1 January, and further changes need three months' notice.

The UKAD medicine hub sets out a three-step approach. First, search for the medicine by its name in Global DRO. Second, check the result against your sport, your level and whether it is in or out of competition. Third, if the medicine is prohibited and you need it, apply for a therapeutic use exemption.

Do this before a new prescription is started where possible, and tell the prescriber that you compete. Many conditions have a permitted alternative, and doctors can often choose it once they know. UKAD also offers a TUE wizard decision tool to help work out whether an exemption is needed.

• Show the prescriber the Global DRO result, or ask them to look it up.

• Record your medicines in the 100% me Clean Sport app so there is a reference if you are tested.

• Keep prescriptions and clinic letters in case you are asked for evidence.

UKAD explains that athletes in the National TUE Pool must obtain a TUE in advance of starting a prohibited medicine or method, and that international-level athletes apply to their international federation instead. Athletes outside both groups generally need an exemption only if they are drug tested, in which case a retroactive application is made; UKAD says the athlete has five working days after written notification to submit it.

Treatment may start without advance approval in an emergency, when an athlete moves up to a level that requires a TUE, or for a local glucocorticoid injection (retroactive only if there is a positive result). Before starting, the athlete should confirm with their doctor that the substance treats a diagnosed condition, is clinically supported and has no permitted alternative.

UKAD sets out how common inhalers are treated. Inhaled glucocorticoid preventers are permitted when taken by inhalation, with no exemption needed. Long-acting beta-2 agonists in combination inhalers are conditionally permitted below stated daily limits, and a TUE is needed only if prescribed doses exceed them. Salbutamol is conditionally permitted up to a stated daily maximum, with a retroactive TUE needed if it is exceeded. Terbutaline is prohibited at all times regardless of dose and needs advance approval.

The lesson applies beyond asthma: the same condition may be treated by medicines with very different status, so the name on the prescription matters.

UKAD stresses that athletes should assess the need, risk and consequences to their career before taking any supplement. It points to third-party batch-testing schemes such as Informed Sport, while still warning that no supplement can be guaranteed free of prohibited substances and that batches vary.

Cold and flu remedies, nasal decongestants, some cough products and weight-loss or "pre-workout" products are common routes to an accidental positive. Check every product, not just prescription items.