March 29 2020
Did Gambhir require a TUE to use corticosteroids?
30 May 2011

The media has been abuzz with reports in recent days about Test cricketer Gautam Gambhir not having sought a Therapeutic Use Exemption (TUE) for possible use of glucocorticosteroids for his shoulder injury and the chance of the player having exposed himself to an anti-doping rule violation charge.

Going by the observations made by Kolkata Knight Riders physio Andrew Leipus, Gambhir has not violated any of the applicable anti-doping rules. Even if he had been administered corticosteroid injections “into his shoulder” once or twice during the “last two years”, as had been reported, it would have been of little significance in the anti-doping domain.

Gambhir confirmed on Sunday that he had been administered an injection into his shoulder joint about one and a half years ago. He said he was guided then by the Indian team’s physio, who had been handling matters related to anti-doping regulations.

Familiar with rules

Gambhir told The Hindu he had undergone a few dope tests after that. He said he was fully familiar with the anti-doping rules then as well as now and pointed out that the formalities associated with  the use of corticosteroids through specified routes were no longer in place in the rules of the International Cricket Council (ICC) and the World Anti-Doping Agency (WADA).

Corticosteroids (e.g. cortisone, prednisone), though often described as “steroids”, should not be confused with anabolic steroids.  They are commonly used in orthopaedic injuries, among others, because of their excellent anti-inflammatory properties and the resultant pain-relieving capacity.

In the 2011 Prohibited List, glucocorticosteroids are listed as banned ‘in-competition' when “administered by oral, intravenous, intramuscular or rectal routes.”

Till 2009, the use of glucocorticosteroids through intraarticular, periarticular, peritendinous, epidural or intradermal injections and inhalation route required an Abbreviated Therapeutic Use Exemption (ATUE).

(Intraarticular means within a joint, periarticular means surrounding a joint, peritendinous injection is associated with ‘jumper's knee' and tendonitis, among other conditions; epidural injection is associated with treatment of pain in the lumbar region, among other conditions; intradermal means between layers of the skin).

In 2009, the WADA brought in “declaration of use”, in place of ATUE (a simpler form of TUE) if the above permissible routes were to be employed. The stipulation required a declaration by the athlete on the doping control form and, “when available”, intimation through ADAMS (the web-based Anti-Doping Administration and Management System).

Significantly, failure to declare the use either on the doping form or through the ADAMS was not to be considered as an anti-doping rule violation.

Change in rule

In the new Prohibited List released in January this year, the “declaration of use” was removed. In short, nothing was required to be intimated in advance if the administration of the drug was through the specified routes.

Though the WADA Prohibited List has removed any reference to the allowed routes of administration, the relevant ICC TUE rule says that a player would not require a TUE if glucocorticosteroids were to be used for therapeutic reasons and were being administered through the routes mentioned above.

The majority of sports injuries that require the administration of corticosteroids should be covered by the above routes, without the need for a TUE.

A PTI report last Thursday quoted Dr. P.S.M. Chandran, President of the Indian Federation of Sports Medicine, and the Director General of the National Anti-Doping Agency (NADA), Rahul Bhatnagar, to argue respectively that a TUE was required for using corticosteroids, and to confirm that the NADA had not issued a TUE to Gambhir for corticosteroids.

The report triggered speculation on the Internet and on television channels. “Now, Gambhir under dope scanner”, screamed many a web headline. Gambhir laughed it off on Sunday.

If Gambhir or any other cricketer needs a TUE, in order to use a banned substance for medical reasons, he can go to the ICC. There will be no point in approaching the NADA, especially if the player is an international cricketer, since the Board of Control for Cricket in India (BCCI) does not accept the NADA writ.



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