Airmen Medical Certification And Substance Dependence
As you may know, an airman who has an alcohol or substance dependence does not qualify for issuance of an unrestricted airman medical certificate under 14 C.F.R. §§ 67.307(a)(4), 67.207(a)(4), and 67.107(a)(4). However, the Federal Air Surgeon in the FAA’s Office of Aerospace Medicine may issue an Authorization for Special Issuance of Medical Certificate (“Special Issuance”) to an airman who does not qualify for an unrestricted medical certificate under 14 C.F.R. § 67.401.
The airman must convince the Federal Air Surgeon that he or she can perform the duties authorized by the applicable class of medical certificate without endangering public safety during the period in which the Special Issuance is in effect. Whether to issue a Special Issuance is at the sole discretion of the Federal Air Surgeon. And the Federal Air Surgeon’s decision whether to grant a Special Issuance is not subject to review by the National Transportation Safety Board.
So, how does an airman find him or herself in a position where the FAA may consider the airman disqualified due to a substance dependence condition? The most common reasons are
  • The airman is arrested for driving while intoxicated (“DWI”) or driving under the influence (“DUI”) and his or her blood alcohol concentration is 0.15 or greater. The FAA views the .15 level as an indicium of tolerance which shows an ongoing alcohol problem, rather than a one-time event;
  • The airman receives a second DWI/DUI; or
  • The airman refuses to take a breath or blood test, which the FAA assumes means the airman was, in essence, pleading guilty to DWI/DUI (the “guilty until proven innocent” approach, which also brings to mind the colloquial reference about what we do when we “assume”).
Once the FAA concludes that the airman has a substance dependence condition, then the airman is disqualified from being issued an unrestricted first, second, or third class medical certificate. However, the airman may still be able to qualify for a Special Issuance medical certificate, provided that the airman meets a multitude of conditions. This is where the HIMS program comes in.
The HIMS ProgramHimsProgram
The Human Intervention Motivation Study (“HIMS”) is a program specific to aviation that coordinates the identification, treatment and return to the cockpit of airmen who suffer from alcoholism and other chemical dependencies. The program is a balance between preserving the airmen’s careers while still ensuring air safety. The HIMS program provides a mechanism through which an airman with a disqualifying substance dependence condition may obtain a Special Issuance.
When an airman seeking a Special Issuance enters the HIMS program, he or she will be required to complete the following initial steps:
  • The airman must submit to a substance abuse assessment;
  • The airman must complete a 28-day (preferably in-patient) treatment program addressing his or her substance dependence;
  • The airman must establish peer and company sponsorship
  • Following the initial treatment program, the airman must complete 3 months of intensive outpatient follow up
  • The airman must regularly attend peer group meetings;
  • The airman must establish a regular aftercare regime; and
  • The airman must submit to psychiatric and neuropsychological evaluations by HIMS-trained addiction specialists.
Once the airman has completed the initial steps and he or she is established in recovery, then the airman can apply for a special issuance medical certificate. If the FAA is convinced the airman is, in fact, established in recovery, then the FAA may grant a Special Issuance of a limited duration (usually 12 months) that is conditioned upon the airman’s continuing compliance with certain “after care” requirements.
The airman bears the cost of his or her after care. While some airmen have insurance that may provide coverage for some, or maybe even all, of the after care requirements, many airmen do not. And unfortunately, the costs of complying with the ongoing after care requirements is expensive.
In the past, an airman who established and maintained recovery would eventually be eligible to receive an unrestricted first, second, or third class medical certificate. This meant the cost of complying with the Special Issuance after care requirements, including the monitoring, could eventually be eliminated. That is no longer the case.
The HIMS Step Down Plan
On August 17, 2020 when the Federal Air Surgeon released its “HIMS Step Down Plan” updating its after care requirements. Now, an airman who has obtained a special issuance medical certificate through the HIMS program is faced with lifetime monitoring by the FAA.
Under the new “HIMS Step Down Plan”, an airman with a history of substance dependence will be subject to the following after care requirements:
  • Permanent abstinence from mind and mood altering substances is expected for the duration of the flying career.
Initial Phase (Year 1, beginning with initial special issuance)
  • Aftercare weekly for 1 year;
  • HIMS psychiatrist/addictions specialist one visit at end of year 1;
  • Random testing 14 screens in 12 mos and/or mobile alcohol testing e.g. Soberlink;
  • Attendance at peer support group e.g. AA twice weekly;
  • Chief pilot/management assessment monthly;
  • Peer pilot assessment monthly; and
  • HIMS AME of record every 3 months (half the visits may be virtual).
Early Phase (Years 2-4)
  • Random testing 14 screens in 12 mos. and/or mobile alcohol testing e.g. Soberlink;
  • Attendance at peer support group e.g. AA twice weekly;
  • Chief pilot/management assessment monthly;
  • Peer pilot assessment monthly; and
  • HIMS AME of record every 3 months (half the visits may be virtual).
Advanced Phase (Years 5-7)
  • Random PEth testing (plus drug screens if indicated) 4 times in 12 months;
  • Attendance at peer support group e.g. AA weekly; and
  • HIMS AME of record every 6 months.
Maintenance Phase (Year 7 on)
  • HIMS AME of airman’s choice at each exam.
It is important to understand that each airman in the program is still evaluated on a case-by-case basis. Thus, the timing for progression through these phases may vary from airman to airman. Progression is not automatic.
Also, the testing frequencies are minimums. The airman’s HIMS AME may increase the frequency as needed, in the HIMS AME’s discretion.
Unfortunately, as is often the case, the FAA’s guidance is incomplete. It is not clear how or when the HIMS AME may exercise his or her discretion to increase the frequency of testing, and thereby increase the airman’s cost of compliance.
Equally unfortunate is the lifetime monitoring requirement. Airmen who have obtained a Special Issuance through the HIMS program are now stuck with the program for the rest of their flying careers. Although the HIMS program has certainly saved many airmen’s careers, for those in the program, and those who will enter the program in the future, the obligations and costs of participation are now are now a career-long commitment.

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