SUE STANNARD, TIM CARTER
E.13.1 Acute and Long Term Harm
Seafarers may use alcohol and drugs that impair their ability to work and these may also have serious acute and long term effects on their health. They may present to medical staff ashore or to colleagues on board whilst under the influence of such substances or suffering withdrawal from them. Withdrawal symptoms are usually seen when a seafarer first joins a ship after a period of leave when they have used a substance regularly and frequently.
The acute and long term health effects of ingestion depend upon the substance that is taken, as do the effects of withdrawal. Of particular concern on board a ship is delirium tremens in the withdrawal from alcohol.
The use of tobacco may not have acute harmful effects but will have negative health effects in the long term.
Abuse of a substance or substance use disorder is defined by the American Psychiatric Association[1] as ‘a complex condition in which there is uncontrolled use of a substance despite harmful consequences.’ This may result in a change of behaviour that is dangerous on board a ship, including issues with judgement, decision making, learning, memory, and behavioral control.
Drugs that are abused include:
- Alcohol
- Marijuana
- Hallucinogens such as LSD
- Inhalants such as paint thinner or glue
- Opioid pain killers such as codeine and heroin
- Sedatives and anxiolytics such as diazepam
- Stimulants such as cocaine and methamphetamine
- Tobacco
In addition to the negative health effects, use of a substance may also lead to legal proceedings and loss of employment, for example if the company has a zero tolerance policy for alcohol and drugs and/or an accident occurs at sea whilst the seafarer is under the influence of a substance.
E.13.2 Risk assessment
The use of alcohol, drugs and tobacco should be identified on the self-declaration form used in a pre-employment medical assessment, such as that included in the ‘Guidelines for the Medical Examination of Seafarers.’[2] Additional questions may be asked as part of the history taken by the medical professional and certain behaviours indicating abuse of a substance may be identified.
Other medical conditions, both physical and psychological that may be associated with the use of certain substances should also be identified and an individualized risk assessment carried out.
Testing for the presence of alcohol and drugs during a medical examination does not form part of the international Guidelines[3]. Where it is performed, as a requirement of national authorities or employers, the procedures used should follow national, if available, or international good practice guidelines. These should provide adequate procedural and ethical safeguards for the seafarer. Consideration should be given to the Guiding Principles on Drug and Alcohol Testing Procedures for Worldwide Application in the Maritime Industry, adopted by the Joint ILO–WHO Committee on the Health of Seafarers (Geneva, 10 –14 May 1993), and any subsequent revisions.
E.13.3 Risk management
Appropriate risk assessment at PEME should identify those seafarers with possible alcohol or drug abuse problems. Such seafarers require careful, multi-disciplinary management to be given a medical certificate to work at sea.
All seafarers should be encouraged to stop smoking, limit their alcohol intake, and avoid the use of illicit drugs or the incorrect use of prescription drugs.
Action to stop the use of tobacco, alcohol or drugs should take place when the seafarer is at home with access to appropriate medication and support.
[1] https://www.psychiatry.org/patients-families/addiction/what-is-addiction. Accessed January 27th 2022
[2]https://www.ilo.org/sector/Resources/codes-of-practice-and-guidelines/WCMS_174794/lang--en/index.htm Accessed 27 January 2022
[3] https://www.ilo.org/sector/Resources/codes-of-practice-and-guidelines/WCMS_174794/lang--en/index.htm Accessed 27 January 2022