Australia National Standard for Health Assessment of Rail Safety Workers 2024 4.12: Substance misuse and dependence: assess Category 1 and 2 workers for misuse of any substance that impairs cognition, including chronic heavy alcohol use, misuse of prescription and over-the-counter medicines and unregulated intoxicants, and for dependence marked by tolerance, withdrawal, loss of control and continued use despite harm; use the AUDIT questionnaire and clinical and laboratory evidence, interface with the operator's drug and alcohol management program, and apply the criteria in Table 23, which generally require assessment Temporarily Unfit during active misuse and a period of demonstrated remission with treatment, specialist involvement and a monitoring regime before Fit for Duty Subject to Review

What does 4.12 require?

This chapter covers Category 1 and 2 Safety Critical Workers who have substance misuse or dependence involving any substance that can impair cognition. Misuse is a continuum from occasional to severe use and for the Standard means use of any legal or illegal substance that causes social, psychological, physical or legal problems through intoxication, binge use or dependence, including chronic heavy alcohol consumption, misuse of prescription and over-the-counter medicines and natural unregulated intoxicants. Dependence is marked by tolerance, withdrawal, use in larger amounts or for longer than intended, persistent desire or failed efforts to cut down, much time spent obtaining, using or recovering, giving up important activities, and continued use despite known harm. The chapter interfaces with the operator's drug and alcohol management program under the Rail Safety National Law, which handles testing, while the health assessment provides the minimum mechanism for managing workers with identified problems and may underpin an intensive individualised testing regime on return to work. Assessment draws on history, the Alcohol Use Disorders Identification Test, clinical signs, laboratory markers and specialist addiction medicine or psychiatric opinion. The fitness criteria in Table 23 generally make a worker with active misuse or dependence Temporarily Unfit for Duty, with Fit for Duty Subject to Review available after a period of demonstrated remission, engagement in treatment, specialist support and an agreed monitoring and testing regime, and Permanently Unfit where the condition cannot be controlled.