The NCAA list of banned drug classes (NCAA Division I Bylaw 18.4.1.4.6 and NCAA Division II and III Bylaw 31.2.3.1) is composed of substances that are generally purported to be performance enhancing and/or potentially harmful to the health and safety of the student-athlete.

The NCAA recognizes that some banned substances are used for legitimate medical purposes. Accordingly, the NCAA allows exception to be made for those student-athletes with a documented medical history demonstrating the need for treatment with certain banned medications. Medical exceptions may be granted for substances in the following banned drug classes: anabolic agents*, stimulants, beta blockers, diuretics and masking agents, hormone and metabolic modulators*, beta-2 agonists, peptide hormones*, growth factors or related substances and mimetics*, and narcotics (see subpart 2 below). Per NCAA Division I Bylaw 18.4.1.4.8 and Division II and III Bylaw 31.2.3.2, a medical exception is not permitted for a substance in the class of cannabinoids.

*Note: The use of an anabolic agent, hormone and metabolic modulator, peptide hormone, growth factors, related substances and mimetics must be approved by the NCAA before the student-athlete is allowed to participate in competition while taking these medications.

Medical Exception Procedures and Considerations:

1. Consider non-banned medications. Alternative non-banned medications for the treatment of various conditions may exist and should be considered before a medical exception is pursued.
   • If the student-athlete and the physician (in coordination with sports-medicine staff at the student-athlete's school) agree that no appropriate alternative medication to the use of the banned substance is available, the decision may be made to use a medication that falls under an NCAA banned drug class.
      
2. When to Request a Medical Exception.
   • For an anabolic agent, hormone and metabolic modulator, peptide hormone, growth factors, related substances and mimetics, a school must request a medical exception before a student-athlete competes while taking these medications.
   • For stimulant medication used to treat ADHD, beta blockers or beta-2 agonists, diuretics and narcotics, a school may request a medical exception following a positive drug-test. See more in No. 6 below.
      
3. Required Documentation. The student-athlete’s school should maintain documentation that supports use of the banned medication in the student-athlete's medical record on campus. The documentation can be a letter or copies of medical notes from the prescribing physician that documents how the diagnosis was reached, and that the student-athlete has a medical history demonstrating the need for treatment with the banned medication. The letter should contain information as to the diagnosis (including appropriate verification of the diagnosis), medical history and dosage information.
    
   • Medical Exception for ADHD. In addition to the required documentation above, the NCAA requires the NCAA Medical Exception Documentation Reporting Form to be submitted with any request for a medical exception for stimulant medication used to treat ADHD
   • When to Send Documentation. A student-athlete's medical records or physicians' letters should not be sent to the NCAA unless requested by the NCAA or when a school is requesting pre-approval for the medical use of an anabolic agent, hormone and metabolic modulator, peptide hormone, growth factors, related substances and mimetics. In addition, the use of any substance should not be reported to the drug-testing collection crew during an NCAA drug test.
      
4. Requesting a Medical Exception after a Positive Test. If a student-athlete is drug tested by the NCAA and tests positive for a substance for which the school desires an exception, normal reporting procedures for positive test results will be followed (See Section 8.0 of the NCAA Drug-Testing Program Protocol). The school may request a medical exception at the time of notification of the positive drug test (“A” sample) by submitting documentation to Drug Free Sport International. If the school fails to provide medical documentation to Drug Free Sport International before the "B" sample is reported as positive to the school, the student-athlete will be withheld from competition until the documentation is received, reviewed and the medical exception granted. (contact mdorsey@drugfreesport.com)
    
5. Review of Medical Exceptions. Requests for medical exceptions will be reviewed by the medical panel of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports.
    
6. Communicating Decisions. The NCAA will inform the director of athletics or their designee regarding the outcome of the medical exception request. If the medical exception is not granted, the institution may appeal this action according to Section 8.0 of the NCAA Drug-Testing Program Protocol.

If you have questions about medical exception procedures for the NCAA Drug Testing Program, please contact ssi@ncaa.org.