Chapter[ X. Review of the Major League Baseball Joint Drug Prevention and
Treatment Program ]
Section[ B. 4. c. Therapeutic Use Exemptions ]
c. Therapeutic Use Exemptions
Beginning in 2006, the program administrator received authority to issue
therapeutic use exemptions to players in circumstances where the player is able to produce a
medically appropriate prescription for an otherwise banned substance. If the prescribing
physician is not the club physician, the player or the outside physician must notify the club
physician of the use of the prohibited substance and the issuance of the prescription before any
sample is taken.
To be medically appropriate, a prescription must be based on a documented
medical need under standards accepted in the United States or Canada. The program
administrator may request a player who has tested positive, or the player’s physician, to provide
documentation of the player’s medical need for the prescribed substance. Upon review of the
documentation and possible consultation with an expert in the area covered by the prescription,
the program administrator reports to HPAC his determination of whether to deem the test result a
positive under the joint program.
Although the joint program did not explicitly authorize the grant of therapeutic
use exemptions before 2006, Rob Manfred told us that in 2004 and 2005 there was an exemption
that was essentially the same as the therapeutic use exemption provisions that exist today.
I asked for the number of therapeutic use exemptions granted each year for
performance enhancing substances (without identifying the players involved) because
therapeutic use exemptions have been a significant loophole in some drug testing programs.548
The Commissioner’s Office and the Players Association declined to provide that information on
the ground that it is considered confidential under the joint program.
548 See Robert Weiner and Cael Pulitzer, Loopholes in Olympic Drug Policy Big Enough
to Ski Through, Seattle Post-Intelligencer, Feb. 10, 2006, at B7.
274
WADA has developed specific standards for granting therapeutic use exemptions,
which the joint program does not expressly include.549 However, the program administrator, Dr.
Smith, advised us that he applies all of the WADA criteria in evaluating requests for therapeutic
use exemptions under the joint program other than the requirement that those requests be made
before a positive test result.
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