Substance Use Disorders

sec_arr Appendix F

Selected Other Agency Medical Guidelines

Canadian Railway Medical Rules Handbook:
The Canadian Railway Medical Rules Handbook has very comprehensive guidelines for return to safety-critical work following a diagnosis of a substance use disorder.17 Chapter 4.8 of this Handbook deals with substance use disorders.

Federal Motor Carrier Safety Administration (FMCSA)/Department of Transportation (DOT):

See Conference on Neurological Disorders and Commercial Drivers and Conference on Psychiatric Disorders and Commercial Drivers at: (

“Alcoholism §391.41(b)(13) A person is physically qualified to drive a commercial motor vehicle if that person: Has no current clinical diagnosis of alcoholism. The term ‘current clinical diagnosis of’ is specifically designed to encompass a current alcoholic illness or those instances where the individual’s physical condition has not fully stabilized, regardless of the time element. If an individual shows signs of having an alcohol-use problem, he or she should be referred to a specialist. After counseling and/or treatment, he or she may be considered for certification.”

Federal Aviation Administration:
Guide for Aviation Medical Examiners18:

An applicant with a history of substances of dependence/abuse (drugs or alcohol) must submit the following if consideration for medical certification is desired:

  • A current status report from a physician certified in addictive disorders and familiar with aviation standards
  • A personal statement attesting to the substance and amount, and date last used
  • If attended a rehabilitation clinic/center, provide dates and copies of treatment plan

NOTE: The applicant may be required to submit additional information before medical disposition can be rendered.