Why a Prescription Is Not the Same as Anti-Doping Permission

By Dr Mert Eray Onen

Estimated reading time: 6 minutes

A prescription authorises medical treatment; it does not, by itself, authorise the use of a prohibited substance or method under anti-doping rules. An athlete may need a Therapeutic Use Exemption (TUE), issued through the appropriate anti-doping process. Athletes and support personnel should not stop or alter prescribed treatment on their own; non-urgent questions should be coordinated promptly with the prescribing clinician and the relevant anti-doping organisation, and emergency care should never be delayed. This distinction connects medical care with the athlete’s sporting obligations. (UKAD, n.d.-a; WADA, n.d.-b)

For coaches, personal trainers and other support personnel, the essential skill is recognising where their role ends. They can prompt a medication check and help an athlete find the correct organisation. They cannot grant an exemption, replace the prescribing clinician or promise that a medicine is permitted.

Two decisions that answer different questions

The clinician asks what care the patient needs. The anti-doping process asks whether the athlete’s use of a prohibited treatment meets the applicable exemption requirements. These decisions interact, but one does not replace the other.

Under the ordinary TUE criteria, the athlete needs clinical evidence of a diagnosed condition requiring the prohibited treatment. The treatment should not add a performance benefit beyond a return to normal health, there should be no reasonable permitted therapeutic alternative, and the need should not result from earlier prohibited use without a TUE. These are assessed by the relevant TUE committee—not by a gym or course provider. (WADA, 2023)

A TUE is therefore neither a general licence to use medicines nor a shortcut around the rules. WADA’s athlete guidance describes an application supported by medical information and a decision that may carry specific conditions. (WADA, n.d.-b)

In March 2026, the International Testing Agency launched a public, anonymised TUE dashboard to improve understanding of the system. Its explanation addresses an important misconception: exemptions exist to enable legitimate medical care within sport’s rules, not to confer an unrestricted competitive advantage. (ITA, 2026)

What should happen when a medicine is mentioned?

Imagine an athlete tells a trainer, “My doctor prescribed it, so the anti-doping side must be sorted.” The trainer does not need to inspect the athlete’s full medical history to respond constructively.

A useful answer is: “Your treatment is a medical decision. Have you also checked the medicine’s anti-doping status and whether your governing organisation requires a TUE?” This separates the issues without casting doubt on the clinician or encouraging the athlete to change treatment.

UKAD advises checking prescribed and over-the-counter medicines. For supported countries, Global DRO provides a medicine-checking route. The exact product and country matter; a familiar brand name abroad is not enough. A missing search result is not evidence that a medicine is permitted. Save the search reference and resolve uncertainty with the appropriate anti-doping organisation. (UKAD, n.d.-a)

The check must be current. The Prohibited List changes, and classifications can depend on whether a substance is prohibited at all times, only in competition or in particular sports. A screenshot from a previous season should not be treated as permanent permission. (WADA, 2026; UKAD, n.d.-c)

Use a two-record handover, not a coach’s medical dossier

EFWA proposes the following educational handover aid. It is not an official application form or a validated compliance system. Its purpose is to keep responsibility visible while avoiding unnecessary circulation of sensitive information.

The care record belongs with the healthcare team

The athlete and treating clinician assemble the relevant diagnosis, clinical history, investigations and treatment rationale for the application. UKAD explains that sufficient medical evidence is needed; a short prescription entry is not a substitute for the supporting clinical record. The clinician can explain why a treatment is indicated and address permitted alternatives where relevant. (UKAD, n.d.-b)

The coach’s contribution can remain limited: help the athlete identify a contact, make time for an appointment or remember an administrative follow-up. EFWA’s position is that coaches should not routinely gather detailed medical documents just to demonstrate that they have been helpful.

The eligibility record belongs with the athlete and anti-doping process

The athlete should know which organisation handles the application, whether a decision is still pending and what any granted exemption actually covers. WADA distinguishes national-level applications to a national anti-doping organisation from international-level applications to the relevant international federation. The organisation’s definition of athlete level matters. (WADA, n.d.-b)

For teaching purposes, ask learners to complete three sentences in a fictional case:

• “The organisation we need to contact is ___.”
• “The point that is still unconfirmed is ___.”
• “The person responsible for the next action is ___.”

Do not fill those blanks with assumptions. “The coach has seen the prescription” is not an answer to any of them.

Why moving between competition levels needs attention

A domestic exemption should not simply be assumed to cover every international event. Recognition arrangements exist, but the athlete may need to take an additional step with an international federation or major event organiser. Some recognition is automatic; some requires a request. Check the applicable arrangements before relying on an existing decision. (WADA, 2023)

Likewise, not every athlete follows the same application timetable. UKAD distinguishes athletes required to obtain advance approval from situations in which a retroactive application may be available. Eligibility for that route must be checked; it is not a universal promise that paperwork can wait until after a test. (UKAD, n.d.-b)

A coach should not turn either distinction into a rule of thumb such as “amateurs do not need to worry” or “national approval covers everything”. The better habit is to name the responsible organisation and verify the athlete’s actual circumstances.

Urgent care is not an administrative negotiation

If an athlete needs emergency treatment, obtaining care takes priority. UKAD explicitly advises that checking medication should not delay treatment. The athlete should then contact the relevant anti-doping organisation about the documentation and any TUE process required. The possibility of a retroactive application is not a guarantee of its approval. (UKAD, n.d.-a; WADA, 2023)

Support personnel must not tell an athlete to stop, substitute or reschedule prescribed treatment to manage an anti-doping concern. Decisions about treatment belong with the treating clinician, informed by the relevant sporting requirements. For medicine-related health concerns, MHRA directs people to a doctor or pharmacist and to the patient information leaflet supplied with the medicine. That leaflet informs medical care; it is not an exemption decision. (MHRA, n.d.)

Current rules, limitations and professional scope

This article was checked on 15 September 2026 against the 2026 Prohibited List and the 2023 International Standard for Therapeutic Use Exemptions, which remains in force. WADA has published a 2027 standard, but its effective date is 1 January 2027; it should not be substituted for today’s rules. (WADA, 2026; WADA, n.d.-a)

This is an educational overview, not an individual eligibility decision, medical recommendation or legal opinion. Rules and recognition requirements must be verified with the responsible organisation.

For a different but related risk, see EFWA’s guide to supplements and positive doping tests. Explore the Anti-Doping & Sport Integrity collection for further education. A medication check, a supplement-risk assessment and a TUE decision are distinct tasks; completing one does not complete the others.

References

• International Testing Agency. (2026, March 17). Behind the numbers: ITA publishes TUE dashboard to strengthen transparency in the global fight against doping in sport. https://ita.sport/news/behind-the-numbers-ita-publishes-tue-dashboard-to-strengthen-transparency-in-the-global-fight-against-doping-in-sport/
• Medicines and Healthcare products Regulatory Agency. (n.d.). Yellow Card. Retrieved September 15, 2026, from https://yellowcard.mhra.gov.uk/
• UK Anti-Doping. (n.d.-a). Checking your medication. Retrieved September 15, 2026, from https://www.ukad.org.uk/checking-medications
• UK Anti-Doping. (n.d.-b). How to apply for a TUE. Retrieved September 15, 2026, from https://www.ukad.org.uk/tue-application
• UK Anti-Doping. (n.d.-c). What’s banned in sport—the Prohibited List. Retrieved September 15, 2026, from https://www.ukad.org.uk/athletes/whats-banned-sport-prohibited-list
• World Anti-Doping Agency. (2023). International standard for therapeutic use exemptions. https://www.wada-ama.org/sites/default/files/2022-09/international_standard_for_therapeutic_use_exemptions_istue_2023.pdf
• World Anti-Doping Agency. (2026). The 2026 prohibited list. https://www.wada-ama.org/sites/default/files/2025-09/2026list_en_final_clean_september_2025.pdf
• World Anti-Doping Agency. (n.d.-a). International standard for therapeutic use exemptions (ISTUE). Retrieved September 15, 2026, from https://www.wada-ama.org/en/resources/world-anti-doping-code-and-international-standards/international-standard-therapeutic-use
• World Anti-Doping Agency. (n.d.-b). Therapeutic use exemptions (TUEs). Retrieved September 15, 2026, from https://www.wada-ama.org/en/athletes-support-personnel/therapeutic-use-exemptions-tues

About the author

Dr Mert Eray Onen is EFWA’s Founder and Academic Director. His educational work includes exercise physiology, training science and anti-doping education. This article does not represent WADA or UKAD advice to an individual athlete. Author profile · ORCID: 0000-0001-8510-7293