The California State Athletic Commission is looking to regulate theraputic use expemptions

Ethan Miller

The California State Athletic Commission (CSAC) is looking to pass regulations on the allowance for therapeutic use exemptions (TUEs).

So it turns out that while the CSAC has some regulations on the books about drug use (spoiler alert: They don't like it), they had not yet gone so far as to create any official provisions for the potential necessity for an athlete to use a substance that might otherwise be considered banned. The more bigfoot milk we avoid as consumers, the better off all of our lives will be. Now, it looks like they're planning on addressing the issue with a new set of therapeutic use exemption regulations. The new rules should be up for voting on Monday, February 10th. Here's a look at the document, as it stands, via Fight Opinion.

CALIFORNIA STATE ATHLETIC COMMISSION
Adopt Sections 424, 425 of Article 8 of Division 13.2 of Title 4 of the California Code of Regulations to read as follows:
ARTICLE 14. THERAPEUTIC USE EXEMPTION
§424. Requirements for Therapeutic Use Exemption (TUE)
(a) It is each athlete's personal duty to ensure that no prohibited substance enters his or her body. Athletes are responsible for any Prohibited Substance or its Metabolites or Markers found to be present in their Samples. All athletes licensed by the commission may be required to submit to testing for prohibited substances at any time whether in or out of competition and whether or not they have a competition scheduled. Athletes with documented medical conditions requiring the use of a Prohibited Substance or a Prohibited Method in any event sanctioned by the commission or its authorized amateur sanctioning bodies shall request a Therapeutic Use Exemption (TUE) from the commission. The request shall be made by submitting to the commission an application for "Determination of Therapeutic Use Exemption" Form (form number) (New 12/2013).
(b) This Article shall apply equally to foreign and non-resident athletes who are licensed by the commission.
(c) "Prohibited substance" is defined as those substances specified in the Prohibited List of the World Anti-Doping Code, as promulgated by the World Anti-Doping Agency (WADA).
(d) The Prohibited List shall be the most current list of prohibited substances. A list of prohibited substances may be provided to an athlete with the application for a TUE.
(e) Athletes may apply to the commission for a TUE for any substance at any time. However, such applications must be complete and received by the commission at least twenty-one (21) days in advance of any use prohibited in sport. The time period required by this subdivision shall not apply to applicants applying for a retroactive approval.
(f) Applications for a TUE will not be considered for retroactive approval except in cases where:
(1) Emergency treatment or treatment of an acute medical condition was necessary, or
(2) Exceptional circumstances existed, sufficiency of which shall be determined at the sole discretion of the commission.
(g) Each of the following shall accompany the application for Determination of Therapeutic Use Exemption:
(1) Medical work-up, which shall include:
(a) Etiology based upon the treating physicians evaluation. For testosterone, the criteria established in the Therapeutic Use Exemption Guidelines, as promulgated by WADA, shall apply.
(b) An evaluation by a board-certified physician in the appropriate medical field.
(c) Patient medical history, which must be consistent with the standard of practice in the appropriate medical field relevant to the exemption requested. For testosterone, the endocrinologist must include all items listed in the current Therapeutic Use Exemption Guidelines, as published by WADA.
(d) A physical exam, which must be consistent with the standard of practice in the appropriate medical field relevant to the exemption requested. For testosterone, the endocrinologist must include all items listed in the current Therapeutic Use Exemption Guidelines, as published by WADA.
(e) A testing/laboratory evaluation, which must be consistent with the standard of practice in the appropriate medical field relevant to the exemption requested. For testosterone, the endocrinologist must include all items listed in the current Therapeutic Use Exemption Guidelines, as published by WADA.
(f) Pre Fight - Lab data for the therapeutic agent in question. For testosterone or its equivalent and sex hormone binding globulin (SHBG), lab data levels drawn during the past 6 months prior to a fight including one value within one month of the fight. Athletes should not have testosterone levels above the normal range or SHBG levels below normal. If a value is found to be out of the normal range, the athlete's provider should take action to correct the level by repeating the lab and/or adjusting medication appropriately, which should be documented in the records submitted to the commission. Repeat elevated testosterone levels (x2) during the 6 months prior to the fight will be grounds for disqualification evaluated on a case by case basis by the commission. The day prior to the fight, the athlete should submit the time, date, amount and method of the last dose of testosterone or other medication administered.
(g) Day of Fight - Lab data for the therapeutic agent in question. Agent specific levels shall be drawn on the day of Fight. For Testosterone its equivalent and SHBG level, will also be drawn on the day of Fight. Any level of testosterone above the normal range may subject the athlete to disciplinary action. Testosterone injections should be dosed appropriately to avoid peak levels above the normal range during testing.
(2) A copy of the medical records in which the applicant's medical condition is well documented, which must reflect that the condition existed prior to any test for a TUE was performed;
(3) Declaration under penalty of perjury of a board certified physician in the appropriate field of medicine, in good standing, attesting that he/she has read and understood the requirements for a Therapeutic Use Exemption and the most current Therapeutic Use Exemption Guidelines as published by WADA, examined the athlete, and the athlete qualifies for an exemption. The most current Therapeutic Use Exemption Guidelines, may be provided to an applicant with the application for TUE. An applicant for a TUE shall bear the sole responsibility of providing the guidelines to their evaluating physician.
(4) A copy of the medical records in which the applicant's medical condition is well documented, which must reflect that the condition existed prior to the date any test for a TUE was performed;
(5) Diagnosis;
(6) Name of the prohibited substance(s);
(7) Dose to be taken;
(8) Method of administration;
(9) Duration of treatment;
(10) Name and contact details of the applicant's treating physician.
(h) The applicant, at the applicant's expense, shall promptly undergo any additional medical examination and testing requested by the commission, including, but not limited to, being examined and/or tested by one or more physicians designated at the sole discretion of the commission.
(i) The commission shall determine based upon the facts and circumstances of the case there is no reasonable suspicion to the satisfaction of the commission the applicant used the substance for the purpose of enhancing his or her athletic performance.
(j) If the athlete intends to compete further in any event or competition that may subject the athlete to drug testing by the commission, the athlete must apply for a separate TUE for any prohibited substance in advance of such event or competition in accordance with the provisions of this section.

While it could be argued that creating provisions and processes for things like TRT create an easier gateway for athletes to use steroids legally, it should also be noted that it's almost impossibly to properly regulate something for which you have no rules set in place. The previous CSAC regulations surrounding drug use could essentially be summed up as "Don't do it." However, California originally started the process of creating a TUE allowance back in 2012, and it's apparently just taken this long to get it on the books. They then put a temporary ban on authorizing "new" TUE exemptions, last year, while they prepared to put more precise regulations in place. Essentially, while this may seem like a sudden shift in policy, it's the result of a several slow, deliberate steps that should serve to make exemptions less of a gray area for fights in California.

What do you think? Is this a step further in the wrong direction, towards making legal steroid use more acceptable? Or is more considered oversight required when it comes to managing complex medical issues in fight sports?

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