TUE case studies

Drug Free Sport NZ has experienced numerous cases in which athletes have returned a positive drug test because they were taking medication for a legitimate medical condition.

Below we’ve detailed some cases in which athletes have faced anti-doping rule violations (ADRVs) as a result of taking medication without the required Therapeutic Use Exemption.  These case studies highlight medications we most commonly encounter in ADRVs.  You’ll find cases involving:

As a medical professional, Drug Free Sport NZ advises you to check the status in sport of every medication before prescribing to an athlete.  Even if a medication may not seem performance enhancing, it could be prohibited in sport.

If a medication is prohibited then it’s likely you’ll need to make an application for a Therapeutic Use Exemption (TUE). You can find out more about this process here.

Prednisone  [probhibited in sport]

Case: Hockey player reprimanded in 2014

A young representative hockey player tested positive for the glucocorticosterioid, Prednisone, which is prohibited in sport.

She was diagnosed with kidney problems and the specialist concerned prescribed prednisone knowing she played representative hockey. The doctor did not believe prednisone was “in any way performance enhancing” and did not check its status in sport.

The athlete checked the prohibited list on the WADA website, but did not find any reference to Prednisone.  She did not contact Drug Free Sport NZ. .

The athlete faced an anti-doping rule violation and was subsequently reprimanded by the Sports Tribunal of New Zealand.

The Tribunal stated that athletes need to be “very explicit about their situation when consulting doctors.”  It also stressed the need for Drug Free Sport NZ to be the first port-of-call for queries about medications to be prescribed to New Zealand athletes. Read the full decision of the Sports Tribunal here.

Lesson:  Athletes need to ensure they advise medical professionals that they are competitive sports people who could be drug tested.  Medical professionals need to check the status of every medication before prescribing to an athlete, whether they believe it to be performance enhancing or not.

 

Probenecid  [Prohibited in sport]

Case 1:  Paralympian reprimanded in 2012

A Paralympian competing in athletic field events developed a serious infection in his arm. He visited an Accident and Medical clinic and was diagnosed with cellulitis.  He was prescribed Probenecid as part of his treatment.

The athlete, who was due to compete at the London Paralympic Games, advised the doctor at the A&M clinic that he was subject to drug testing and could not take any medication which was prohibited in sport.  The doctor advised that the medication was safe.

During subsequent follow-up checks with at least six different doctors, the athlete advised that he could be drug tested and none of the medical professionals advised him that Probenecid was a prohibited substance.

The Sports Tribunal reprimanded the athlete and stated that “the breach in this case arose out of a critical emergency where insufficient attention was given to the athlete being subject to the drug free regime.” You can read the full Sports Tribunal decision here.

Lesson:  Accident and medical doctors need to exercise extra caution.  They should check the status of all medications before prescribing to competitive athletes and make sure they are familiar with the Therapeutic Use Exemption process. 

Case 2: Professional rugby player banned for one week in 2011

A professional rugby player was diagnosed with cellulitis and treated by a ‘substitute’ team doctor.  He was prescribed intravenous antibiotics and Probenecid tablets.

The player did not remind the doctor that he was subject to drug testing in sport and the doctor did not specifically mention Probenecid by name to the athlete.

After treatment, the player subsequently asked the practice nurse if the medication was “alright for him to take”.  He received no further information on this matter.

He subsequently returned a positive drugs test and faced an anti-doping rule violation.  The Rugby Union’s Anti-Doping Tribunal banned him from sport for one week.

The Tribunal acknowledged that the player had chosen a team doctor who “he reasonably believed to be knowledgeable in terms of anti-doping matters” and whom he could trust to “prescribe only safe drugs”.

 It also said the doctor was at fault for not raising the issue of a Therapeutic Use Exemption. You can read the full decision of the tribunal here.

Lesson:  Athletes may rely on doctors who regularly treat sportspeople to have a greater knowledge of anti-doping rules and knowledge of prohibited substances. Team doctors, sports doctors or doctors who regularly treat sportspeople should be mindful to check every medication they prescribe to an athlete, whether they believe it to be performance enhancing or not. 

Case 3: Boxer reprimanded in 2010

A competitive boxer was treated for cellulitis at an Accident and Medical Clinic. As part of his treatment, he was prescribed Probenecid.

The boxer told the doctor he was a competitive athlete who could be drug tested, but the doctor wrongly assumed that Probenecid would not pose a problem should the athlete be drug tested.  The doctor did not check MIMS or any other source to determine the status of Probenecid in sport.

The boxer returned a positive drugs test and faced an anti-doping rule violation.  He was reprimanded by the Sports Tribunal of NZ.

The Tribunal noted that it had “sympathy for the position” of the athlete.  It said it is “understandable that he accepted the doctor’s assurance.”  The Tribunal said it was “regrettable that the doctor was prepared to give assurance without checking the matter.” The doctor appeared to be motivated by “the need to treat” the athlete and did not “consider the consequences” for him as a sportsman or alternative treatment. You can read the full decision of the Sports Tribunal here.

Lesson:  Accident and medical doctors need to exercise extra caution.  They should check the status of all medications before prescribing to competitive athletes and make sure they are familiar with the Therapeutic Use Exemption process. 

Case 4: Rower banned for two months in 2009

A competitive rower sustained a hand injury and attended an Accident and Medical clinic.  He was prescribed intravenous antibiotics and given Probenecid by a nurse at the clinic.  He was not told that what he was given was Probenecid.

The athlete told the doctor he was a competitive rower and at the time of the consultation was wearing a New Zealand rowing shirt, but did not specify that he was subject to drug testing in sport.

Neither the doctor, nor the athlete, consulted MIMs or Drug Free Sport NZ to check the status of Probenecid in sport.

The athlete subsequently returned a positive drug test and faced an anti-doping rule violation before the Sports Tribunal of New Zealand.  He was banned from all sport for two months.

The Tribunal found that the athlete needed to do more to alert the doctor to the fact he could potentially be drug tested in sport.  It stated, “An athlete who has not alerted a doctor of his obligations under the rules cannot hide behind a doctor’s actions.”  Read the full decision of the Sports Tribunal here.

Lesson: Athletes attending Accident and Medical clinics need to be proactive in stating that they could be drug tested in sport and insisting that doctors check the status of medications in sport.  
Accident and medical doctors should check the status of all medications before prescribing to competitive athletes and make sure they are familiar with the Therapeutic Use Exemption process. 

 

Canrenone (metabolite of spironolactone) [Prohibited in sport]

Case: Runner banned for three months in 2011

A runner competing at national level tested positive for the prohibited substance canrenone.  She was prescribed the medication to treat a medical condition, but did not tell her medical professional that she was running at a national level nor did she ask the doctor to check whether the medication was banned in sport.

The runner subsequently returned a positive drugs test and was then granted a Therapeutic Use Exemption.

The runner faced an anti-doping rule violation and was suspended from participating in sport for three months.  

The Sports Tribunal of New Zealand said, “an athlete cannot avoid personal responsibility by ‘leaving it’ to a doctor or other medical professional. The athlete is not a drugs cheat but she fell well short of addressing her responsibilities and in truth did not address them at all …” Read the full decision of the Sports Tribunal here.

Lesson:  Athletes need to ensure they advise medical professionals that they are competitive sports people who could be drug tested.  Medical professionals need to check the status of every medication before prescribing to an athlete, whether they believe it to be performance enhancing or not.

 

Furosemide [prohibited in sport]

Boxer banned from sport for five months in 2010

A competitive boxer was treated with Furosemide to help reduce pain and swelling.  She saw her regular doctor who was aware that she was a competitive athlete.  He advised her not to take the medication “close to” or “around” competition.

Neither the doctor nor the athlete checked the status of the medication in sport with Drug Free Sport NZ.  The athlete subsequently tested positive for a prohibited substance and faced an anti-doping rule violation.

The Sports Tribunal said that although the doctor had given her “mistaken advice about furosemide” the athlete had been “alerted that it should not be taken close to or around competition but did nothing to clarify what this meant.” Read the Sports Tribunal's full decision here.

Lesson: Athletes should always seek further clarification from medical professionals if they make statements about a medication not being taken around competition.  This should act as a prompt for athletes to check the status of the medication with Drug Free Sport NZ.  Medical practitioners should not simply advise athletes not to take medication around competition.  If a medication cannot be used in competition then a Therapeutic Use Exemption is likely to be needed.