|ICAO Annex 1||184.108.40.206, 220.127.116.11, 18.104.22.168, 6.4.2, 6.5.2|
|Civil Aviation Act||s27B|
|CAR Part 67||Part 67.103 b, & e, 67.105 b, & e, 67.107 b, & e|
|General Directions||Timing of Routine Examinations [PDF 500 KB]|
|Examination Procedures [PDF 1.6 MB]|
|ICAO Medical Manual||Chapter 1: 1.2.35 – 1.2.37. 1.4 Definitions|
|9.12 Drug Use (Abuse and Dependence)|
Alcohol has the potential to interfere with aviation safety through reductions in functional capacity (e.g. impairment or intoxication), through increased likelihood of incapacitation, and through unsafe behaviour. Those adverse effects are not limited to periods of intoxication or ‘being under the influence’ but can, in some cases, be active for much longer periods of time.
The aviation implications of (AOD) on safety are not limited to the realms of hypothetical possibilities but take a very real toll in damage and lives lost. In 2015 the Transport Accident Investigation Commission (TAIC) recommended 'regulatory changes to strengthen the management of alcohol and drugs in the aviation, rail, and maritime transport modes'.1 This was in response to a number of transport safety investigations, including the 2012 Carterton Hot-air balloon accident.2 Similarly the first edition of TAIC’s safety monitoring publication, the Watch List, included, as one of its three highest priority transport safety issues: 'The issue of people in safety-critical roles being impaired as a result of using drugs or alcohol. The Ministry of Transport has stated its zero tolerance of operator impairment where members of the public are being transported by sea, rail, and air.'1
TAIC: 'The detrimental effects of drugs and alcohol on cognitive abilities are well documented. International research suggests the likelihood and severity of accidents increase if people responsible for performing safety-critical tasks use drugs or alcohol. In the New Zealand air, rail, and marine accidents investigated by the Transport Accident Investigation Commission, consumption of alcohol or use of other performance impairing substances recurs as a contributing factor or a potential impediment to survival. We believe more can be done in the transport sector to prevent people who are in safetycritical roles being under the influence of performance-impairing substances.'2
The Civil Aviation Authority’s medical certification system has an important role to play in preventing community losses due to the effects of alcohol and other drugs in the aviation industry. Medical Examiners are at the forefront of this system, being in a position to identify and investigate AOD-related safety concerns as well as being well placed to educate and assist at-risk aviation industry participants. This section of the CAA Medical Manual deals only with the aviation medical certification considerations of AOD use.
Alcohol is a recreational drug and psychoactive substance that is widely and legally available. Alcohol is used safely and in moderation by many, but still takes a huge toll of damage on our community. The New Zealand Health Promotion Agency’s published alcohol fact sheet4 includes advice that:
This Medical Manual section provides information and describes CAA’s requirements for the medical certification of pilots who have, or may be at risk of having, an unsafe relationship with alcohol. It is beyond the scope of this Medical manual to address the wider public health management of AOD problems within the general community or the aviation community.
For a wide range of reasons an individual’s alcohol consumption patterns are not always accurately reported to safety regulatory agencies. Because of these imperfect reporting patterns a range of collateral information often needs to be considered if a medical certification system aims to reduce the likelihood of harm caused by an individual’s unsafe relationship with alcohol.
In general terms the CAA’s approach to medical certification safety and alcohol:
Sometimes a Medical Examiner is confronted with information that suggests the possible presence of an unsafe relationship with alcohol but is not adequate to either confirm or refute that suggestion. This should not be surprising given the alcohol consumption patterns observed in our wider community.
It is important to remember that a medical certificate should not be issued unless satisfied that there is not a safety problem. This is the approach required by our legislation and is consistent with the general principle to offer the benefit of any doubt to public safety.
There are many observations that may, in isolation or in conjunction with other observations, reasonably suggest the possibility of an unsafe relationship with alcohol. The presence of any such red flags does not mean that an alcohol problem exists, but they do mean that further information should be sought before concluding that there is not an unsafe relationship with alcohol. The red flags most often seen by the CAA include:
When a pilot with a previously identified unsafe relationship with alcohol is returned to flying a range of ongoing medical surveillance is usually implemented. The role of that surveillance is to provide reassurance, over time, that no unsafe recurrence has occurred.
Generally those surveillance requirements are gradually stepped-back over time, usually by reducing their frequency, as safety confidence grows. Because of the wide range of individual circumstances many medical surveillance regimens are tailored for a particular applicant, usually via the detailed consideration of an Accredited Medical Conclusion (AMC).
Medical surveillance requirements are usually implemented by conditions placed upon a medical certificate. If the holder of a medical certificate fails to comply with any such condition they are not permitted to exercise the privileges associated with the medical certificate (See Civil Aviation Rule 61.35).
If an individual is subject to ongoing medical surveillance because of an alcohol problem and an abnormal result occurs (e.g. a rising CDT titre when it has been in the normal range for a long time) then that result should be weighted highly as suggesting the likelihood of a returned or relapsed unsafe relationship with alcohol.
Possible unsafe relationship with alcohol
When faced with the presence of any red flag, or others not listed above, the CAA’s approach is to gather additional information in an effort to adequately mitigate the red flag(s). The additional information sought, on top of the detailed history and examination findings of the Medical Examiner (ME), may include any of the following:
This situation most often occurs in the form of a single drink-drive offence in a first-time medical certificate applicant. If the ME interview and examination does not disclose any additional alcohol red flags some additional confirmatory information should be sought, but a medical certificate can be issued while that additional information is being gathered.
Typically the following would be sought as a minimum:
The particular suite of surveillance requirements is tailored on a case-by-case basis in recognition of the individual situation and circumstances. The alcohol-related surveillance obligations placed upon CAA medical certificate holders, include the following:
Typically such cases involve a drink drive conviction, new or in a first time applicant, and some other feature suggesting the possibility of potentially unsafe alcohol consumption patterns.
Typically the following would be sought:
Civil Aviation regulatory medical practitioners encounter a wide range of alcohol problems, from barely a problem at all through to a severe, chronic, relapsing condition with other associated medical problems. For this reason it is not possible to provide specific detailed guidelines that cover every situation likely to be encountered.
If the ME assesses a case that is not easily decided by considering this information then the ME should discuss the details with a CAA Medical Officer.
An ME should not issue a medical certificate until he / she is satisfied that no alcohol-related problem exists and that the applicant does not have an unsafe relationship with alcohol.
An ME should not issue a medical certificate on an assumption that if CAA sees a problem they will intercede. The ME’s primary and over-riding responsibility must be towards public safety.
If any of the information sought discloses additional red flags, such as additional drink drive convictions or potentially unsafe alcohol consumption patterns, then further information should be sought before concluding the applicant safe for the issue of a medical certificate.
Such cases should be handled by immediate liaison directly with CAA Medical Officers.
Typically this applies to an applicant who has previously been worked-up as outlined above, with red flag(s) having been identified and investigated.
In such a case the applicant may be considered as meeting the relevant medical standards only if:
Otherwise an ME should not assess the applicant as meeting the medical standards, should consider seeking further information (along the lines outlined above), and should consider seeking for the application to be processed via the statutory flexibility (AMC) process.
A wide range of recreational drugs, legal and illegal, are available and used within the wider community. For example the 2012 / 2013 Ministry of Health drug use survey identified over 10% of the adult population as self-reporting the use of cannabis during the previous 12-months, with 6% of those users reporting harmful effects on work, studies or employment opportunities, and 8% reporting mental health harm due to cannabis use.6 That same survey identified approximately 1% the adult population as self-reporting the use of amphetamines during the previous 12-months.7 The previous nationwide drug use survey,8 which did not consider synthetic cannabinoid use, identified approximately 15% of adults as using cannabis during the previous 12-months followed, respectively, by stimulants (including methamphetamine) 3.9%, ecstasy 2.6%, LSD and synthetic hallucinogens 1.3%, prescription sedatives 1%, injected drugs 0.3%, and opiates 0.1%. The rapid emergence of use of synthetic cannabinoids is of grave concern given their potency and difficulties in detecting them.
'It is totally unacceptable for anyone in a safety-critical transport role, such as a pilot, to be working while impaired by a substance, whether legal or not', Chief Commissioner John Marshall QC told a media briefing.
CAA considers the use of other recreational drugs to be totally unacceptable, even when abstaining at times of duty. This is because of the multiple pyscho-social consequences and circumstances usually associated with drug use.
On the first occasion that an applicant presents with a history of drug use.
1 New Zealand Transport Accident Investigation Commission Annual Report 2014 – 2015 (F.7 ANN)
2 New Zealand Transport Accident Investigation Commission Final report, Aviation inquiry 12-001 Hot-air balloon collision with power lines and in-flight fire, near Carterton, 7 January 2012.
3 New Zealand Transport Accident Investigation Commission Watch List ‘Substance use: regulatory environment for preventing performance impairment’ accessed online at Substance use: regulatory environment for preventing performance impairment(external link) on 16 February 2016.
4 New Zealand Health Protection Agency alcohol.org.nz ‘Alcohol Quick Facts’.
5 World Health Organization. WHO Expert Committee on Problems Related to Alcohol Consumption: Second report. Geneva: WHO. 2007.
Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, & Patra J. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. The Lancet, 373(9682), 2223 - 2233. 2009.
Business and Economic Research Limited (BERL) Report to: Ministry of Health and ACC, Costs of Harmful Alcohol and Other Drug Use. BERL ref #4577. July 2009.
Connor J, Kydd R, Shield K, & Rehm J. Alcohol-attributable burden of disease and injury in New Zealand: 2004 and 2007. Research Report commissioned by the Health Promotion Agency. Wellington: Health Promotion Agency. 2013.
Law Commission. Alcohol in our lives: an issues paper on the reform of New Zealand’s liquor laws. Wellington: Law Commission. 2099.
6 New Zealand Ministry of Health. 2015. Cannabis Use 2012/13: New Zealand Health Survey. Wellington: Ministry of Health.
7 New Zealand Ministry of Health. 2013. Amphetamine Use 2012/13: Key findings of the New Zealand Health Survey. Wellington: Ministry of Health.
8 New Zealand Ministry of Health. 2010. Drug Use in New Zealand: 2007/08 New Zealand Alcohol and Drug Use Survey. Wellington: Ministry of Health.