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Substance use

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Definition

This protocol refers to suspected or confirmed “problematic use” of a substance such as:

• Positive workplace test
• Positive screening test by doctor / DAME
• DAME opinion
• A drug related conviction 10 years of application
• Self-reported use and confirmatory tests (e.g. Urine test, hair tests)

Aeromedical Implications

Effect of aviation on condition

• Hypoxia - increase cognitive decrement caused by substances

Effect of condition on aviation

• Subtle incapacitation - impaired alertness / reaction / decision-making
• Loss of situational awareness & vertigo
• Distraction due to impaired concentration.

Approach to medical certification

Based on the condition

• As per CASR 67.150 Table 67.150.1.5 and 1.6.
  • demonstrated abstinence from problematic use
• no sequelae from problematic use
• Normalisation of tests

Based on Treatment

• As per CASR 67.150 Table 67.150.1.5 and 1.6, 2.5 and 2.6, 3.5 and 3.6. - currently undertaking or completion of appropriate course of therapy
• no safety-relevant medications (methadone etc)  

Demonstrated Stability

• Abstinence or harm minimisation as per risk stratification
• Blood parameters and breath testing
• Sponsor reports
• Surveillance plan from applicant and/or employer detailing intended abstinence from substance use and monitoring by doctor, laboratory and sponsors

Risk assessment protocol - Information required

New cases

• Fellow of the Australasian Chapter of Addiction Medicine specialist [FAChAM] for an assessment in regards to:
  • diagnosis
  • past and present drug and alcohol consumption
  • current clinical status
  • physical and psychological sequelae/co-morbidities
  • Drug tests, LFTS, MCV and carbohydrate deficient transferrin (CDT)
  • treatment, response to treatment and side effects
  • prognosis
  • ongoing management plan
• FAChAM follow-up report, where applicable following treatment intervention, demonstrating
  • abstinence from problematic use of alcohol and other substances.
  • freedom from the ill-effects of substance misuse
  • recent blood tests (LFT’s, MCV and CDT)
  • recent urine tests (Urine/hair)
• Consider Police report

Renewal

• Fellow of the Australasian Chapter of Addiction Medicine specialist FAChAM for an assessment in regards to:
  • diagnosis
  • alcohol /substance consumption
  • review of physical and psychological sequelae/co-morbidities
  • current clinical status and compliance with established goals and requirements
  • review of LFTS, MCV and carbohydrate deficient transferrin (CDT)  and recent urine tests (Urine/hair)
  • review of sponsor reports and tests as listed below
  • treatment, response to treatment and side effects
  • prognosis
  • ongoing management and surveillance plan

(Note: In certain circumstances, reports may be accepted from psychiatrists or other alcohol or addiction medical specialists. Prior agreement must be sought to avoid unnecessary expense and delays.)

• monthly drug tests and 3 monthly LFT’s MCV and CDT, 
• Random substance testing
• Sponsor / peer / employer reports (as appropriate)

Indicative outcomes

The onus is on the applicant to demonstrate fulfilment of the regulatory requirements. Careful attention to the conditions requiring testing or reports by a particular date, is essential to give confidence that aviation safety is being maintained. Failure to submit tests and reports on time will be treated as indicators of possible relapse.

Favourable

• Demonstrated absence of problematic use for a pre-defined period. This is usually a minimum of 12 months, and includes sponsor and clinical reports
• Ongoing normal urine,  blood and breath-alcohol tests

Unfavourable

• Problematic use
• 2 relapses following diagnosis
• Alcohol-related convictions: 3 or more
• Substance related convictions in last 10 years
• Positive substance tests,  blood or breath-alcohol tests
• Complications of substance or alcohol-use e.g. psychiatric, portal hypertension, varices, clotting etc.

Pilot and Controller Information

• The hazardous and problematic use of substances has been associated with aviation accidents
• For pilots and controllers who have problematic use of substances, the most successful treatment has resulted from abstinence from all substances and alcohol use. For this reason, certification may be possible when pilots and controllers demonstrate abstinence
• The best way to demonstrate abstinence is through objective evidence of abstinence and careful attention to monitoring
• Problematic use of substances is associated with serious medical problems quite apart from the hazard to aviation activities.

Disclaimer

The Clinical Practice Guideline is provided by way of guidance only and subject to the Clinical practice guidelines disclaimer