Drug & Alcohol ProgrammesOne Airlines Experience

Dr Fiona Rennie, Emirates Group Medical Services, Dubai

Disclosure Information

I work for Emirates Airline.

I have no financial relationships to disclose.

I will not discuss off-label use and/or investigational use in my presentation

Outline

History & Regulations of D&A Testing

Emirates Programme and Testing Procedure

Audit Results

Case Histories

Summary

History

• Emirates Random Alcohol and Drug Testing Programme implemented in 2006 for safety-critical roles.

• Commenced MRO reviews 2008.

• UAE GCAA mandated a drug and alcohol screening programme in 2011 based on:

• ICAO Annex 1 recommendation to ensure all license holders who engage in any kind of problematic use of substances are identified and removed from their safety-critical functions

CAAP 19

• No employee shall report for work within 12 hours of drinking alcohol or under the influence of any other psychoactive substance or medication that could affect the safe performance of duties.

• The employee must be removed from performing safety sensitive functions if: -initial drug screening test is positive -an alcohol test result of 0.02% or higher.

• Random testing encourages employees to remain drug and alcohol free

• Annual requirement to test 20% of employees undertaking safety related duties.

If entire UAE aviation industry positive rate for 2 consecutive calendar years is <1% the regulator may lower this rate to 10%. If >1% then testing rate increases to 50%.

Testing Requirements

Alcohol must be tested by• Evidential Breath Testing Device

(EBT)

Drugs by urine immunoassay • Cannabis (THC)• Cocaine (COC)• Opiates+ Morphine(OPI)• Amphetamines (AMP)• Barbiturates (BAR)• Benzodiazepines (BZD)• Methadone (MTD)• Phencyclidine (PCP).

Emirates Airline ProgrammeComplies with GCAA requirements.

• Random Testing (Drugs & Alcohol) using an external testing provider and randomiser software.

• Pre-Employment (Drugs only) Urine screening done at time of licensing medical.

• Reasonable Suspicion; Post-Accident; Age 60+ License Renewal (MCV,GGT,CDT)

Testing Process

1. EVIDENTIAL BREATH TEST First Test (Screening)

If negative: Continue with dutyIf positive: Re-test @ 20mins

Second Test If negative: Continue with dutyIf positive: Suspended from duty & MRO review

2. URINE SCREENING If negative – Continue with dutyIf positive- Suspended from duty and sample sent for Confirmatory testing

Drug TestingInitial immunoassay test is a Qualitative test and determines only the presence or absence of a substance.

Lacks sensitivity and specificity and not sufficient for legal purposes

Quantified by Gas Chromatography / Mass Spectrometry (GC/MS) assay.

Positive test requires MRO review and will be verified positive or verified negative

Verified Negative

Positive AmphetaminesOral PseudoephridrineWeight loss medications

Positive OpiatesPoppy Seeds (High morphine, low codeine)Breads, Indian foods, Sweetened milk, Apple StrudelCodeine usually combined with Paracetomol or in Cough syrups

Positive Benzodiazepines, Barbiturates Weight loss medications“Cold” MedicationsPhenobarbitone (10mg)

Verified Positive

Marijuana, Methadone, Cocaine and PCPNo medical reason for use in aviation

Random Testing Drug & Alcohol 2007-2012

(PILOTS+CC)

NUMBERTESTED

TOTAL CREW % CREW TESTED

VERIFED POSITIVE

% POSITIVE

2007 2479 10,581 23% 3 0.12%

2008 2145 13,054 16% 0 0

2009 2202 12,786 17% 2 0.09%

2010 2870 14,584 20% 9 0.31%

2011 3271 16,607 20% 10 0.30%

2012 4513 19,877 22% 11 0.29%

TOTAL 17,480 38 0.24%

Random Testing ALCOHOL 2010-2012

CABIN CREW

2010 2433 7 0.29

2011 3457 6 0.17

2012 3425 9 0.26

PILOTS NUMBER TESTED

ALCOHOL POSITIVE

% POSITIVE VS. NUMBER TESTED

2010 240 1 0.42

2011 1236 1 0.08

2012 1088 0 0.00

TOTALCC + PILOTS

11,879 24 0.2%

Random Testing DRUGS 2010-2012

TOTAL CC/ PILOTS

11,879 82 22 6 0.06%

CC

2010 2433 35 7 1 BZD 0.04

2011 3457 20 7 2 THC/BAR 0.06

2012 3425 19 6 2 THC/COC 0.08

PILOTS NUMBER TESTED

POSITIVESCREEN

POSITIVEGC/MS

VERIFIED POSITIVE

% POSITIVE

2010 240 2 0 0 02011 1236 3 1 1 BZD 0.082012 1088 3 1 BZD 0 0

Random Testing Drug Types per Year(Pilots and Cabin Crew)

Random Testing- Negative vs. Positive GC/MS(Pilots and Cabin Crew 2010-2012)

Pre-Employment Drug Testing 2010-2012

TOTALCC+PILOTS

10,544 78 16 6 0.06%

CABIN CREW

2010 2790 8 2 1 (THC) 0.04

2011 3149 11 3 3 (THC/BAR) 0.09

2012 (TO AUG) 2964 11 3 2 (THC) 0.06

PILOTS NO. TESTED

POSITIVESCREEN

POSITIVEGC/MS

VERIFIED POSITIVE

% POSITIVE

2010 475 0 0 0 0

2011 683 3 0 0 0

2012 (TO AUG) 436 1 0 0 0

Pre-employment Negative vs. Positive GC/MS(Pilots and Cabin Crew 2010-2012)

2010-2012 Summary

RANDOM DRUG

11,879 82 22 6 0.05%

PRE-EMPLOY DRUG

10,497 33 11 6 0.06%

RANDOMALCOHOL

11,879 24 POSITIVE 0.2%

CC + PILOTS NUMBER TESTED

POSITIVESCREEN

POS GC/MS

VERIFIEDPOSITIVE

% POSITIVE

25 year old Japanese Cabin Crew

Before reporting for work took medicine purchased in Japan for “bad cold”Randomly selected and declared medication for “Cold” , Panadol Night &

Vitamin CScreened positive for Opiates & Amphetamines

GC/MS ResultPositive for dihydrocodeine >1500ng/ml (cut off 300ng/ml)

MRO Review:CAKONAL COLD BLOCK UP TABLETS

Ibuprofen 40mg Chlorpheniramine 7.5mgCaffeine 75mgPseudoephridrine 135mgDihydrocodeine 24mg

VERIFIED NEGATIVEAdvised codeine illegal in UAE

Male Cabin Crew Age 22Employed by Emirates for 1 yearPre-employment testing negativeSelected for Random Testing Negative for Alcohol, Positive for THC

GC/MS Result Positive for cannabis metabolites 46ng/ml (15ng/ml)

MRO Review3/7 before test operated a flight to CopenhagenWent to a bar “thick with cannabis smoke” Came to interview with Hemp Protein PowderCannabis plant but after processing <0.3% THC remainsUnlikely to cause +ve drug screen (Marijuana 2-20% THC)Consumption of the powder after interview failed to produce a positive result

VERIFIED POSITIVE

Cabin Crew Pre-Employment TestingAge 30 Brazilian, no medications declaredScreened positive for benzodiazepines

GC/MS ResultPositive for oxazepamMRO Review

ProzacChloridiazepoxide (BZD)EpedrinumFenproporex (AMP)GlucophageThyroxineFlutiranSpiron Dulcolax

Denied Depression, Diabetes, Bulimia or any other medical conditionTaking “cocktail” to maintain weight loss (76kg now 54kg) Sent for Psychological assessment

VERIFIED NEGATIVE

B777 Pilot – Random TestDeclared Panadol, Positive for opiates – suspended

GC/MS ResultCodeine detected >1500ng/mlMorphine detected 1060ng/mlMRO Review

No explanation for the positive tests and was shocked at results12 hours before flight took 2 tabs of paracetomol + pseudoephidrine Last 2 tabs in a blister pack so could not produce packWife advised medication contained 15mg CODEINE PHOSPHATEMorphine levels low not consistent with regular useHad returned from vacation in Cyprus 3 days before testMother had made bread every day contained POPPY SEEDS =Morphine

VERIFIED NEGATIVE

Summary

Verified positive rate of drug and alcohol tests is very low Average 0.24% for past 3 years (drugs 0.05%, alcohol 0.2%).

Well within the GCAA requirement less than 1% and have requested permission to reduce to 10% and redirect budgeted funds to testing at layover destinations.

Positive drug screens are mostly Over the Counter (OTC) medications and have reduced following crew education.

Programme could be acting as a deterrent - No pilot positive alcohol tests in past two years. However ? increase in Marijuana positives and may not be detecting “ Designer Drugs”

Crew suspended 7-10 days pending GC/MS which leads to loss of productivity and income for Crew. 80% are subsequently negative

Questions