Australia National Standard for Health Assessment of Rail Safety Workers 2024 3.4.8: Drugs and rail safety work: under the Rail Safety National Law a worker must not perform rail safety work with any alcohol or prescribed drug (THC, methamphetamine, MDMA and others declared) in their system, even if lawfully prescribed, so no THC-containing medicinal cannabis is compatible with rail safety work, and it is an offence to work under the influence of alcohol or any drug; the health professional reviews all prescription and over-the-counter medicines recorded on the questionnaire, weighing indication and severity, the worker's insight and adherence, side effects such as sedation, slowed reaction, impaired motor skills, blurred vision, hypotension and dizziness, combinations including alcohol, sleep deprivation in shift work, dose changes, cumulative and intermittent use requiring a management plan, other conditions, misuse history and whether the medicine will show on a random test, with particular caution for benzodiazepines, sedating antidepressants and antipsychotics, opioids and their effect on night vision, psychedelics and ADHD stimulants, advising workers accordingly

What does 3.4.8 require?

Under section 128 of the Rail Safety National Law a rail safety worker must not carry out rail safety work with any alcohol or a prescribed drug (delta-9-tetrahydrocannabinol, methamphetamine, MDMA or any substance the national regulations declare) present in their system, even where the drug was lawfully prescribed, so no product containing THC, including medicinal cannabis, can be used by rail safety workers, and psychedelics remain prescribed drugs; it is also an offence to work under the influence of alcohol or any drug, and operators must ensure workers do not work while impaired by any drug, prescribed or otherwise. Operators and ONRSR may test workers. Any drug acting on the central nervous system may reduce vigilance, slow reaction time, impair decision-making or exaggerate risk-taking, so workers record all prescription and over-the-counter medicines on the Health Questionnaire and the Authorised Health Professional considers the indication, severity and individual response and the consequences of not treating; the worker's insight and likely adherence; side effects including sedation, impaired reaction time and motor skills, blurred vision, hypotension and dizziness; the added risk of combining drugs that affect cognition including intermittent alcohol, sleep deprivation in shift workers, changes of medicine or dose, cumulative effects and as-required medicines such as pain relief, which are incompatible with safety critical work unless use is regularly reviewed under a management plan; other conditions that compound the effect; a history of alcohol or drug misuse; and whether the medicine will give a positive or non-negative result on random testing, which benzodiazepines, opioids, THC and ADHD stimulants will. Benzodiazepines raise incident risk and shorter-acting hypnotics are preferred; sedating tricyclic antidepressants impair more than serotonin reuptake inhibitors while treatment can improve performance; most antipsychotics sedate, especially older agents, clozapine, olanzapine and quetiapine, and early in treatment or at higher doses; opioids suppress cognition early in treatment and persistently reduce peripheral vision at night; ADHD stimulants rarely impair unless abused. Where medicines bear on specific conditions the relevant chapters apply.