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Drugs and Alcohol A Manager's guide

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Warning: All rights reserved. Any unauthorised copying, hiring, lending, exhibition, diffusion, sale, public performance or other exploitation of this video and accompanying workbook training package is strictly prohibited and may result in prosecution. © Videotel MMXIII This video and accompanying workbook training package is intended to reflect the best available techniques and practices at the time of production. It is intended purely as comment. No responsibility is accepted by Videotel, or by any firm, corporation or organisation who or which has been in any way concerned with the production or authorised translation, supply or sale of this video and accompanying workbook training package for accuracy of any information given hereon or for any omission herefrom.

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DRUGS AND ALCOHOL A MANAGER’S GUIDE

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A VIDEOTEL PRODUCTION

The Producers would like to acknowledge the assistance of The Master, Officers and crew of MV Ruby Princess Alere Toxicology – Medscreen BP

International Maritime Organization (IMO)

International Seafarers’ Welfare & Assistance Network (ISWAN) Jo Tankers

Louis Dreyfus Armateurs SAS Princess Cruises

Security Association for the Maritime Industry (SAMI) SIGTTO SIRC

United States Coastguard V.Ships

PRINT AUTHOR: Sheila Brownlee WRITER/DIRECTOR: Ron Tanner PRODUCER: Amanda Gross

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Drugs and Alcohol, A Manager's Guide

Contents 1. INTRODUCTION

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2. ABOUT DRUGS AND ALCOHOL

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4. SUMMARY OF KEY POINTS

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3. DRUGS AND ALCOHOL ABUSE PREVENTION

5. CASE STUDIES

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6. APPENDIX

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7. FURTHER RESOURCES

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8. ASSESSMENT QUESTIONS

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9. ASSESSMENT ANSWERS

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1. INTRODUCTION About the programme DRUGS AND ALCOHOL, A MANAGER’S GUIDE shows how ship management can prevent and manage drugs and alcohol abuse on board ship.

Learning objectives

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DRUGS AND ALCOHOL, A MANAGER’S GUIDE will enable shore office managers and ships’ officers to: • understand the effects of drugs and alcohol on: àà seafarers’ health and work performance àà the safety of the ship and the marine environment

• be familiar with the latest regulations for drugs and alcohol • know how to implement a company drugs and alcohol abuse prevention programme • be aware of the treatment options available for seafarers with drugs or alcohol problems • understand the disciplinary consequences for anyone who breaches the policy

How to use the training in group sessions Preparation

Think about the group How familiar are your trainees with the topic of drug and alcohol abuse prevention?

What do they need to know? What kind of questions might they ask you? What do you want this session to achieve?

Watch the video It is important to familiarise yourself with the video in advance, so that you can anticipate possible questions from the group and research your answers.

Read the workbook This workbook expands on many of the points made in the video. It also contains information relevant to the two Videotel programmes on alcohol and drugs which are aimed at crew members: Alcohol Beware! A Seafarer’s Guide (Edition 3) and Drugs Way Off Course, A Seafarer’s Guide (Edition 3).

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Introduction

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Drugs and Alcohol, A Manager's Guide

Tips for running an effective training session Begin with an overview Tell the group what the objectives of the session are, what you are going to cover, what they will be able to do by the end of the session, and how long it will take.

Ask questions throughout It is a good idea to ask your trainees questions from the start, and to encourage them to take an active part in the session. You can use the questions and activities in this workbook to test understanding and reinforce the learning.

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Start discussions Encouraging discussions in a small group will help each individual to make a contribution to the session.

Sum up what the session has achieved At the end, briefly bring together everything you have covered. Make sure that you have asked for any other questions, and answered them. Ask the group what they found most useful about the session.

Afterwards When the session is over, spend a few minutes making notes about how it went, and how you might want to change it next time.

Definitions Although the term drugs normally covers anything from aspirins to amphetamines, in this programme it refers only to psychoactive drugs – controlled substances such as heroin, cocaine and cannabis that alter mood and behaviour.

Medication is the term we have used for the over-the-counter and prescription medicines that people may bring on board with them.

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Introduction

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1.1 Drugs and alcohol in the shipping industry The nature of life at sea, with its stress, isolation, and long periods away from home, can make seafarers more vulnerable to drinking too much and to using drugs.

Drug and alcohol abuse can have a serious impact on seafarers and their fellow crew members:

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• It may damage their health.

• It may make them more likely to make mistakes at work, which can seriously affect their own safety and that of their fellow crew members.

• Evidence that a seafarer has been abusing alcohol or drugs can ruin their career.

• Spills or groundings caused by personnel under the influence of drugs or alcohol can damage the marine environment.

Many shipping companies have a strict no-drugs, no-alcohol policy, or at least strict controls on alcohol use on board, but problems arise when seafarers go ashore and bring alcohol or drugs back on board with them, or when they use them ashore.

1.2 The drugs market

Different countries and different cultures have long used different drugs, usually because the regional climate affected what would grow. Europe has alcohol, South America has cocaine, Asia has opium and the Middle East has cannabis. Every continent has its range of hallucinogenic mushrooms and other plants such as the peyote cactus.

Drugs are generally available in bars in ports world-wide and in the so-called ‘coffee shops’ in the Netherlands. Buying drugs has also been facilitated through the growth of the internet which provides easy access to many types of drug, especially the new ‘legal highs’.

Drug pushers may be users themselves, selling drugs to finance their own habit, or they may be ‘business people’, ready with plausible reasons to tempt seafarers to buy their product. Shipping is a prime target for drug traffickers, who are not only looking for customers but also for someone to bribe or blackmail into helping transfer consignments of illegal drugs internationally. The trade in illegal drugs is the second largest business in the world, after armaments.

1.3 Drugs and alcohol tolerance and dependence People take drugs and alcohol because they enjoy the effects. But regular use of some drugs leads to tolerance, where the body becomes accustomed to them and ever larger quantities have to be taken to achieve the desired result.

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Introduction

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Drugs and Alcohol, A Manager's Guide A small number of people who take drugs become dependent on them. There are two parts to addiction. One is physical, where the person may have withdrawal symptoms and feel ill or irritable without the drug. The other is psychological, where they feel they cannot cope without the drug.

When someone is dependent on a drug, it becomes the most important thing in their life, and they may become desperate in their attempts to continue using it.

People who are dependent on drugs such as heroin, cocaine and alcohol have a serious problem which is recognised as an illness.

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1.4 Impairment caused by drugs or alcohol

People who misuse drugs or alcohol will find that their behaviour changes, that they cannot work properly and may be careless. Or they may not be aware of the change and may think that they are performing better than usual. This is dangerous not only for the user, but also for everyone on board.

It is not only drugs and alcohol that are a problem. Some medicines have side effects that could affect a seafarer’s work, and their impairment is likely to increase when these medicines are taken at the same time as alcohol.

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Introduction

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2. ABOUT DRUGS AND ALCOHOL 2.1 DRUGS How drugs work on the body Drugs affect the brain and central nervous system in different ways.

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1. Cannabis (also known as marijuana and hashish) The cannabis user becomes very relaxed and can seem to be in a world alone. This can lead to poor concentration, forgetfulness, slow reflexes and difficulty in making accurate assessments of space and distance. These effects may last for a long time and make cannabis a very dangerous drug for the workplace.

Someone who has ‘come down’ from a ‘high’ may not realise that their work performance can still be seriously impaired 24 hours later.

2. Depressants Depressants slow down the central nervous system. They are:

• alcohol • barbiturates such as amobarbital, pentobarbital and secobarbital. (Street names include barbs, downers, sleepers, ‘reds and blues’ and bluebirds.)

• benzodiazepines, which are often prescribed as sleeping pills or tranquillisers

A low dose of a depressant will relieve tension and anxiety and promote relaxation, but will also impair mental and physical functions and decrease self-control.

Higher doses may lead to ‘drunken’ behaviour, drowsiness, stupor or unconsciousness.

Using different depressant drugs together, such as alcohol and sleeping pills, can multiply the effects and be extremely dangerous, in the worst case leading to death.

This group also includes opioids: • • • •

opium morphine heroin synthetic opioids e.g. methadone

Opioids kill pain and are abused for the feelings of warmth, contentment and euphoria that they can create.

Injecting heroin intensifies these feelings into a short burst of sensation – a ‘rush’.

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About Drugs and Alcohol

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Drugs and Alcohol, A Manager's Guide 3. Stimulants Stimulants stimulate the central nervous system. They are: • cocaine • amphetamines (including methamphetamine which is also known as Crystal Meth, Ice, Tina and Glass) • ecstasy, the slang name for MDMA, MDEA and related compounds (also known as E, X and XTC) • khat (also known as Arabian Tea)

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A low dose will increase alertness, diminish fatigue and elevate the mood, but can also lead to over-confidence.

Higher doses can cause nervousness, anxiety, panic and temporary paranoid psychosis.

4. Hallucinogens Hallucinogens are:

• LSD • PCP (Angel Dust) • ecstasy (which is included in this category because it has hallucinogenic as well as stimulant properties) • ketamine (also known as K, Special K and Vitamin K) • naturally occurring examples such as mescaline and ‘magic’ mushrooms

The characteristics of hallucinogens are distorted perceptions, a feeling of unreality and a lack of coordination. The effects can be unpredictable and frightening to the user and to onlookers.

Ketamine use is now becoming linked to serious bladder problems.

5. New and emerging drugs • New drugs are becoming available all the time. Often misleadingly called ‘legal highs’, they are a deliberate attempt to keep ahead of legislation by changing the chemical composition of existing synthetic illegal drugs. Their ‘legal’ status is often only temporary.

The names of these drugs are changing all the time, but currently the main groups include: • synthetic cannabinoids (Annihilation, Black Mamba, Spice, Amsterdam Gold, Bombay Blue Extreme, X, Karma) • mephedrone (Miaow Miaow, Bubble, White Magic, MC, M-Cat, Bounce, 4-MMC) • 2-DPMP (Ivory Wave, Purple Wave, Vanilla Sky, D2PM) • APB (Benzo Fury)

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About Drugs and Alcohol

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These new psychoactive substances are sold on the internet as ‘research chemicals’, ‘smoking mixtures’, ‘plant mixtures’ or ‘bath salts’. They vary widely in terms of the compounds they contain, so should not be considered safe. Their side effects are unknown, both to the producers, who do not care, and to the users, who trust the expression ‘legal high’.

Be aware that some psychoactive substances may also be present in herbal medications.

2.2 Harmful effects of drugs on the user

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Health When used to excess, any drug can cause health problems. In the short term, users may suffer physical injury from accidents, and occasionally sudden death.

In the long term, they will be putting stress and strain on other functions of the body such as the sexual organs, the immune system and the kidneys.

The way the drug is taken can also cause illnesses unrelated to the effects of the drug itself. Injecting can cause sores and abscesses, while using contaminated equipment carries the risk of contracting hepatitis and HIV/AIDS. Snorting cocaine can damage the nose.

Expense Any drug habit costs money and if the drug use turns into drug dependency, then the person’s life becomes dedicated to supporting the habit at any price.

Work Short term impairment can cost seafarers their jobs as a result of poor performance.

In the case of stimulant drugs, work performance may appear to improve in the short term but the after effects will leave the user exhausted and irritable.

The use of other groups of drugs can leave the user lacking in energy, slow to react to sudden instructions, inattentive and careless, seemingly indifferent to the importance of routine safety tasks or even emergency duties.

Other crew members may also resent the extra workload placed on them when their colleagues who use drugs are unable to carry out their work satisfactorily.

Long term drug use can lead to erratic behaviour and increased sickness absence.

Finally, if drugs (or a drug user) are detected on board, this can cause delays and inconvenience to all crew members, and to the shipowner.

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About Drugs and Alcohol

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Drugs and Alcohol, A Manager's Guide Legal consequences Using illegal drugs runs the risk of discovery and the penalties in some countries can be severe.

Family Any of the possible consequences of drug use – erratic behaviour, ill health, financial worries, job loss and prison sentences – are likely to damage family relationships.

2.3 Recognising a problem drug user

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The different effects of drugs make describing a drug user difficult. Even in a small shipboard community, the signs of drug use may remain hidden.

Be aware of your colleagues’ behaviour but do not jump to conclusions. Personal problems may lead to use of drugs or alcohol and it can be difficult to know whether the misuse is the cause or consequence of the problems.

Be sympathetic, and if someone does admit to a problem with drugs, encourage them to seek help.

2.4 ALCOHOL

Alcohol on ships Studies have shown that heavy drinkers have three times the number of accidents as their colleagues.

Seafarers need to remain alert. They work on ships with small crews, where everyone has to do their share and nobody can be considered a liability in emergencies. It is also an environment dominated by technology, which demands a high level of concentration.

For both these reasons, alcohol consumption at sea is increasingly restricted and in some companies completely prohibited. More monitoring is taking place, with alcohol testing often used to enforce company rules.

2.5 Laws on alcohol

Alcohol use is subject to legislation, national and international.

National laws specify the blood alcohol content (BAC) limits for people operating heavy machinery and driving vehicles. BACs are normally expressed as a percentage per volume (milligrams of alcohol in millilitres of blood). The measurement is also known as ‘blood alcohol concentration’ and ‘blood alcohol level’.

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About Drugs and Alcohol

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In the STCW Code, as amended by the Manila Amendments (2010) which came into force on 1st January 2012, Regulation VIII/1 has set a BAC limit of 0.05% (i.e. 50mg of alcohol in 100ml of blood) and an alcohol in the breath limit of 0.25mg/l for Masters, officers and seafarers performing safety, security and marine environmental duties.

The United States Coast Guard (USCG) and OCIMF (Oil Companies International Marine Forum) have a BAC limit of 0.04% (i.e. 40mg of alcohol in 100ml of blood).

Note that individual flag States and port States may set different limits.

2.6 Effects on the body, mood and behaviour

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The reason alcohol is so strictly controlled on board ship is obviously the effect that it has on users’ behaviour, making them a hazard to themselves and their fellow crew members. The more the person drinks, the more their behaviour deteriorates.

The deteriorating effect of alcohol on behaviour

BAC

(mg of alcohol per 100ml of blood)

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Effects

The person may feel relaxed and cheerful, but less alert with slower reaction times than normal, though the user may think otherwise.

Twice as likely to have an injury or accident.

80

120

The person feels warm and confident.

Four times as likely to have an injury or accident.

Poor concentration, very slow reaction times, severe impairment of physical coordination and dexterity.

Five times as likely to have an injury or accident.

150

Ten times as likely to have an injury or accident.

>150

Coherent action is impossible and vital functions become more impaired.

>400

Death can occur.

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Speech slurred, appears drunk to observers.

About Drugs and Alcohol

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Drugs and Alcohol, A Manager's Guide

2.7 Measuring the amount of alcohol in a drink The alcohol content in drinks is measured in ‘units’ in many countries and in ‘drinks’ in the US. While a standard US drink is considered to contain 18ml alcohol, a unit of alcohol is usually 10ml of pure alcohol.

Drinks containers (bottles, cans) usually indicate the amount of alcohol they contain as a percentage e.g. ‘13% ABV’ (alcohol by volume). This percentage can be used to calculate the number of units a person is consuming.

These drinks contain the following number of units:

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• 330ml (half a pint) of beer (4% ABV) = 1.3 units. (The size of a small beer varies from country to country.)

• 750ml (standard bottle) of wine (13% ABV) = 9-10 units. (The size of wine glasses can vary from bar to bar, as well as from country to country.)

• 25ml (a shot) of spirits e.g. whisky (40% ABV) = 1 unit • A small bottle (275ml) of alcopops = 1.4 units

The health authorities in many countries recommend that:

• men should not regularly drink more than 3-4 units of alcohol a day • women should not regularly drink more than 2-3 units a day • everyone should have at least 1 day a week when they drink no alcohol

2.8 Units of alcohol and BAC

As a general rule, the average healthy male’s BAC will rise by 15mg/100ml for each unit of alcohol consumed, and a woman’s will rise more quickly, probably by about 20-30mg/100ml per unit consumed. It then takes one hour for each unit to be eliminated.

Some people may say that they can sober up more quickly by drinking coffee or eating a meal, but in fact nothing can speed up the process of alcohol elimination.

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About Drugs and Alcohol

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2.9 How alcohol affects the health Alcohol is not necessarily a harmful drug. In moderation, it can have beneficial effects.

But if a person regularly drinks too much they increase the risk of developing health problems. Often the damage is not noticed until it is well developed.

Risks of excessive drinking

Brain

Memory loss Depression

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Anxiety Aggressive, violent behaviour

Mouth and throat

Cancer

Upper body

Less resistance to infection Heart failure

Breast cancer

Cancer of the oesophagus

Liver cancer or other damage e.g. cirrhosis Stomach cancer or inflammation or ulcer Inflammation of the pancreas

Lower body

Impaired sexual performance (men)

Low birth weight or deformed babies (women)

Limbs

Trembling hands

Finger and toe numbness

Falls caused by impaired sensation

About 1 in 25 people become alcohol-dependent: drinking takes control of their lives.

Seafarers are particularly at risk of certain alcohol-related causes of death. Taking the UK as an example, the latest UK Decennial Supplement, which analysed UK mortality data for 1991-2000 by occupation, showed UK seafarers to have significantly higher death rates than average for cancer of the oral cavity, cancer of the pharynx, cancer of the liver, cancer of the larynx, cirrhosis and other alcohol related conditions.

Source: Table 8, Office of Public Sector Information: Decennial Supplement, published 2009.

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Drugs and Alcohol, A Manager's Guide

2.10 Binge drinking Recent years have seen a rise in the number of people who set out to get drunk quickly. This has been defined in the UK as consuming 8+ units in a single session and 6+ for women.

As well as being hazardous behaviour for the user and the people around them, binge drinking increases the risk of heart attack. People have also died after a binge drinking session by breathing in their own vomit and suffocating when they are semi- or totally unconscious.

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2.11 Combining alcohol with medication

Alcohol may interact badly with medications so it is important to check the leaflet that accompanies the medication. In the case of mixing drink with depressant drugs such as tranquillisers or sleeping pills, the risk is of becoming unconscious and stopping breathing.

2.12 Help with giving up alcohol

People who drink too much may need help to give up. If they have physical withdrawal symptoms such as shaking or sweating, or if they feel anxious without that first drink of the day, they have reached the point where they should go to the doctor.

It can be dangerous – even fatal – to give up too quickly without medical advice and support, as the person may suffer from serious symptoms such as hallucinations, seizures and/or severe agitation or confusion.

Self-assessment questionnaires

Simple ‘CAGE’ test for addiction to alcohol Answer yes or no to each question.

1.

2.

3.

4.

Have you ever felt you should cut down on your drinking?

Have people annoyed you by criticising your drinking?

Have you ever felt guilty or badly about your drinking?

Have you ever used drugs or alcohol first thing in the morning, to steady your nerves, or help with your hangover?

If the answer to only one question is yes, you are 80% on the way to being addicted to alcohol. If you answered yes to all four questions, you are 100% addicted.

You can also use the World Health Organization’s AUDIT (Alcohol Use Disorders Identification Test), which is widely available on the internet, to help you decide if you have an addiction.

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About Drugs and Alcohol

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2.13 What you can do If a person wants to stop, or reduce the amount they are drinking, they should: • decide on a reasonable daily target which includes 2-3 alcohol free days each week, and stick to it • give themselves a (non-alcoholic!) reward for meeting their targets • ask their friends, family or colleagues for support and understanding • not abandon the attempt if they have the occasional lapse You can help them too.

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• Covering up for colleagues is unwise. Instead, you should encourage them to seek help.

• If you are in the company of someone who is drunk, do take care of them.

They are not in a position to look after themselves.

• If someone says “No thanks” when offered a drink, respect their choice. They may be on the first steps back from their alcohol problem.

2.14 Chances of recovery

The International Labour Organization (ILO) have pointed out that if a person with alcohol problems seeks help while still in employment, there is an 80% chance of recovery. If the person loses their job, this chance is halved.

2.15 Drug and alcohol dependency – where to find help

Possible sources of support for people dependent on drugs or alcohol are:

• Maritime welfare agencies such as International Christian Maritime Association (ICMA) and International Seafarers’ Welfare and Assistance Network (ISWAN) • Specialist seafarer help accessed via unions, ITF (International Transport Workers’ Federation), port authorities or government consulates • Port chaplains • Specialist agencies such as Alcoholics Anonymous or Narcotics Anonymous

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Drugs and Alcohol, A Manager's Guide

3. DRUGS AND ALCOHOL ABUSE PREVENTION 3.1 Company drugs and alcohol policies Shipping companies’ drugs and alcohol policies vary from zero tolerance to allowing a specified daily allowance of alcohol. But although policies may differ, it is good practice to include certain basic elements in every policy:

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• a clearly written policy document, which should cover: àà rules on the use of alcohol on and off duty àà restrictions on consumption of alcohol before coming on duty àà alcohol and drug testing àà the use and/or possession and/or trafficking of illegal drugs àà the consequences of breaking the rules àà how the company will respond to crew members with drug and alcohol problems • • • • • •

education and training work environment improvements random and routine testing for drugs and alcohol (on the spot and laboratory) management of any crisis situation involving alcohol and/or drugs counselling, treatment and rehabilitation programme evaluation

3.2 Prevention

Prevention is the key to minimising the risk of people becoming drug or alcohol dependent, and there are several ways of doing this.

Improving working conditions Stress and anxiety can lead to increased use of drugs and alcohol. But this can be alleviated by improving recreational and social activities, and by providing education opportunities and regular contact with home.

One to one conversations with individual seafarers may also identify actions that might help their state of mind.

Testing Another way of taking preventative action is to carry out regular and random checks (see section 3.4 Monitoring and testing for more detail).

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Education and awareness When people clearly understand the risks involved in using drugs or alcohol, they are likely to be more cautious.

The Videotel programmes Alcohol Beware! A Seafarer’s Guide (Edition 3) and Drugs Way Off Course, A Seafarer’s Guide (Edition 3) contain valuable training material about drugs and alcohol and their effect on health, relationships and the safety of the crew and the ship.

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You may also wish to distribute self-assessment questionnaires (see section 2.12 Help with giving up alcohol) to help crew members identify whether their drug or alcohol use is becoming a problem.

Awareness also means understanding the legal consequences. Officers should ask their company agents or offices in countries that the ship will be visiting to supply information on national laws and regulations.

Recognising the signs of abuse Officers should be able to recognise drug and alcohol problems in themselves as well as others.

NCADD (National Council on Alcoholism and Drug Dependence) lists the following as signs of drug abuse: Physical and health warning signs of drug abuse • Eyes that are bloodshot or pupils that are smaller or larger than normal • Frequent nosebleeds – could be related to snorted drugs (meth or cocaine) • Changes in appetite or sleep patterns.

• Sudden weight loss or weight gain • Seizures without a history of epilepsy • Deterioration in personal grooming or physical appearance • Injuries/accidents and the person will not or cannot tell you how they got hurt • Unusual smells on breath, body, or clothes • Shakes, tremors, incoherent or slurred speech, impaired or unstable coordination Behavioural signs of drug abuse • Drop in attendance and performance at work; loss of interest in extracurricular activities; decreased motivation • Complaints from co-workers or supervisors • Unusual or unexplained need for money or financial problems • Silent, withdrawn, engaging in secretive or suspicious behaviours • Frequently getting into trouble (arguments, fights, accidents, illegal activities)

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Drugs and Alcohol, A Manager's Guide Psychological warning signs of drug abuse • Unexplained change in personality or attitude • Sudden mood changes, irritability, angry outbursts or laughing at nothing • Periods of unusual hyperactivity or agitation • Lack of motivation; inability to focus, appearing lethargic or ‘spaced out’ • Appearing fearful, withdrawn, anxious, or paranoid, with no apparent reason Warning signs of alcohol abuse These are some common signs that a person you know may be misusing alcohol: They cannot get through their day without drinking They often drink alone or try to cover up their drinking They get angry when someone mentions their drinking They become aggressive when they drink They forget what happened the night before, as a result of drinking Their hands tremble when they have not drunk alcohol for some hours

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• • • • • •

Alcohol withdrawal symptoms can range from not sleeping, agitation, anxiety, sweating and tremors, to vomiting, diarrhoea, hallucinations and seizures.

3.3 Setting the rules

The crew must be informed that they may be tested for alcohol/drugs at random.

Crew members and their cabins may also be searched for prohibited substances.

Remember that under STCW:

• anyone on board who performs safety, security and marine environmental duties must not have a BAC greater than 50 mg/100ml (= 0.05%) • no seafarer carrying out watchkeeping duties or any other safety related duty may consume any alcohol within four hours before beginning those duties The company may also have its own rules about limits on alcohol on board that all crew members must know.

3.4 Monitoring and testing

Shipping company policies may involve a blood, breath and/or urine test schedule which includes: • • • • •

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a pre-joining medical test and certificate random testing on board testing when there is reasonable cause testing after an incident routine testing: all crew breath-tested at least once every year

Drugs and Alcohol Abuse Prevention

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The ship should have alcohol screening devices (ASDs) to check for alcohol in the breath – these will provide an instant reading. In order to avoid potential disputes over accuracy, certificates should be kept on board to show that the ASDs have been duly calibrated ashore.

Types of sample Different types of sample are used to analyse different aspects of alcohol and drug use: breath – alcohol only urine – alcohol and drugs oral fluid – alcohol and drugs blood – blood tests are rarely used, because they require specialist personnel to collect the samples. Blood tests can analyse both alcohol and drugs, and may be used to diagnose long term alcohol problems • hair – long term use of drugs, and problem use of alcohol

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• • • •

Urine sample collection and the ‘Chain of Custody’ While the results of breath tests are instant, urine samples have to be sent away to a laboratory for testing. They have to be carefully controlled throughout the ‘Chain of Custody’, which starts at the point of collection, and continues through the laboratory, to its disposal after the results have been accepted.

Key features of the Chain of Custody are: • • • •

barcodes to link the sample and paperwork signed donor declaration of the sample tamper evident seals on the bottles tamper evident bags

An unbroken Chain of Custody will explicitly link the specimen to the donor (the individual giving the sample), and the result to the specimen.

The Chain of Custody procedures and the Chain of Custody form supplied with urine test kits may be required as legal evidence if the results are challenged.

Any discrepancies or omissions could be used to invalidate the test results.

The collection and testing process Typically, the collection facility on a ship is the medical room, which should have an adjoining bathroom/toilet.

The collecting officer identifies themselves to the Master or senior officer delegated to look after them, and this individual will be responsible for arranging for the crew members who are to be tested to come to the facility at the designated time, and for preparing the facility beforehand (sealing taps and liquid soap dispensers, removing

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Drugs and Alcohol, A Manager's Guide cleaning agents, checking for potential hiding places for ‘clean urine’ or other adulterants, etc.).

When the crew member arrives, the collecting officer will ask them for their photo ID and signature, and whether they are willing to be tested.

The specimen collection kit is designed to reassure the crew member that there is no risk of contamination. The collection bottle or cup is sealed, demonstrating that it is clean and unused, and the Chain of Custody bag is designed so that the pocket containing the bottles is completely sealed and leak-proof.

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The crew member provides the sample in the bathroom/toilet and the collecting officer records the temperature, to verify that it has been freshly produced. It is almost impossible to substitute another specimen within the prescribed temperature range of 32ºC to 38ºC without it being detected.

The sample will be split into two in clear view of the crew member, and the collecting officer will then close the bottles securely and apply the tamper evident seals.

The collecting officer will ask the crew member to read, sign and date the Chain of Custody form, and both bottles will be sent to the laboratory. Here, only one of them will be opened. The other one is for submission to a second laboratory in case the crew member should challenge the result.

When the samples arrive at the laboratory, they are checked against the Chain of Custody form and for evidence of any tampering, and are then given their initial testing. Positive results will be sent for medical review against any medications that the crew member has declared.

Test result certificates are made available for all results, whether positive or negative for the drug groups tested. They are normally sent as password protected PDF documents via email to the agreed address.

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US Coast Guard: Testing after a Serious Marine Incident (SMI) Since 2006, the USCG has required persons directly involved in a Serious Marine Incident (SMI) to be tested for alcohol and drugs within two hours of the incident.

This applies to all commercial vessels, regardless of flag of origin.

An SMI is defined under the Code of Federal Regulations 46 § 4.03–2 as: “(a) Any marine casualty or accident as defined in § 4.03–1 which is required by § 4.05–1 to be reported to the Coast Guard and which results in any of the following:

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1. One or more deaths; 2. An injury to a crewmember, passenger, or other person which requires professional medical treatment beyond first aid, and, in the case of a person employed on board a vessel in commercial service, which renders the individual unfit to perform routine vessel duties; 3. Damage to property, as defined in § 4.05–1(a)(7) of this part, in excess of $100,000; 4. Actual or constructive total loss of any vessel subject to inspection under 46 U.S.C. 3301; or 5. Actual or constructive total loss of any self-propelled vessel, not subject to inspection under 46 U.S.C. 3301, of 100 gross tons or more.

(b) A discharge of oil of 10,000 gallons or more into the navigable waters of the United States, as defined in 33 U.S.C. 1321, whether or not resulting from a marine casualty.

(c) A discharge of a reportable quantity of a hazardous substance into the navigable waters of the United States, or a release of a reportable quantity of a hazardous substance into the environment of the United States, whether or not resulting from a marine casualty.”

Ships should therefore keep on board saliva or breath testing devices for alcohol, and have the means to arrange for the collection of urine samples for drug testing ashore.

If your ship is involved in an SMI, you will also need the following paperwork: • • • •

Coast Guard 2692 and 2692b forms for the alcohol test Chain of Custody form for the drug test the applicable steps in how to use the testing device the regulation on SMI

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3.5 Searching for drugs on board The International Transport Workers’ Federation policy on drugs and alcohol recommends that if you suspect any person on board of abusing or smuggling drugs, you should immediately inform the Master or the company’s shore-based Marine Personnel Manager.

Many drugs are extremely dangerous and some can be absorbed through the skin. If you should discover a suspect substance:

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• Do not feel, handle or touch it without skin protection and a face mask • Do not inhale powders or fumes • Do not taste, eat or drink the suspected substance Forensic analysis is often required to establish the exact nature of any substance found.

Note: Individuals who need to use a prescribed drug for medical reasons should ensure that the Ship’s Medical Officer and the Master are informed so that unnecessary suspicion can be avoided.

3.6 What to do in a crisis

If a crisis should occur while the ship is at sea – for example, a crew member suffering from serious drugs or alcohol withdrawal symptoms – it is vital that ship’s officers have direct access to specialised medical personnel trained in dealing with drugs and alcohol issues. One option is to contact the emergency services provided by the International Radio Medical Centre in Rome.

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About the International Radio Medical Centre The International Radio Medical Centre (CIRM) provides round-the-clock free radio-medical assistance to patients on board ships flying any flag all over the world.

CIRM can also decide and coordinate, wherever possible, the evacuation of a patient from a ship by naval craft or helicopter, cooperating mainly with National Marine Rescue Coordination Centre (MRCC) and if necessary with other rescue organisations, e.g. the US Coast Guard.

All medical assistance provided by CIRM is completely free of charge.

Contact information (correct at the time of going to print):

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Telex Telephone Mobile GSM Telephone Fax E-mail

612068 C.I.R.M. I [+39 ] - 06.59290263 [+39 ] -348-3984229 [+39 ] - 06.5923333 telesoccorso@cirm.it

Italian Radio Coastal Stations Ask for CIRM

Requests via telex should be labelled MEDRAD or DH MEDICO to obtain priority of transmission.

When requesting radio-medical assistance you will need to communicate the following information: About the ship:

• name, international call sign • position, port of departure, destination, expected time of arrival • medicine chest available on board

About the patient:

• date of birth, nationality, rank • temperature, blood pressure, pulse and respiratory rates • onset of symptoms, accurate description of symptoms, location of pain, associated symptoms • any other medical problems, especially drug or other allergies, chronic illness and any treatment they have undergone • in case of accident, where and how it took place • treatment already administered to the patient

3.7 Counselling, treatment and rehabilitation Drug and alcohol dependence are treatable conditions, when the person cooperates fully.

Seafarers with drug or alcohol problems should have access to employee assistance programmes, offering telephone and face to face counselling, CBT (Cognitive ©Videotel MMXIII

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Drugs and Alcohol, A Manager's Guide Behavioural Therapy), relapse prevention therapy, and rehabilitation. This may be provided by the company through a separate, specialised unit.

A major incentive for the individual to seek help is the knowledge that their employment will not automatically be terminated if they voluntarily seek assistance.

When the seafarer has successfully completed a rehabilitation programme or taken part in a recognised continuing recovery programme, they should be entitled to re-employment in the maritime industry. However, because not all recovering individuals remain ‘clean and sober’, some countries prohibit their future employment in safety-sensitive positions.

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If the company has no formal employee assistance programme for people with drug and alcohol problems, you can contact flag State administration for assistance, or look in the International Seafarers’ Welfare and Assistance Network’s port directory of welfare provision information.

3.8 Programme evaluation

As with any set of procedures, the company’s drugs and alcohol abuse prevention programme will need regular review to determine whether it is working, so that adjustments can be made as required.

• Make sure the programme complies with national laws and regulations, as these may change frequently.

• Ask for feedback from Human Resources, medical and safety and health personnel, Masters/officers, seafarers and their representatives.

• Find out if there have been any advances in methods for testing, intervention, treatment and rehabilitation, and apply them as appropriate.

Companies with certified ISM Code or ISO 9000 based management systems will be familiar with evaluation and review procedures.

3.9 Discipline

All crew members should be clear about the consequences of using or trafficking drugs and of abusing alcohol.

Many companies have a single strike policy with regard to illegal drug use but may have a more tolerant attitude towards alcohol.

In almost all countries, drug trafficking is treated as a criminal activity and in view of the serious impact on the ship and company, any trafficking activity should be brought to the attention of the appropriate official within the company. For crew members caught trafficking in drugs, termination of employment and repatriation is the usual outcome.

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4. SUMMARY OF KEY POINTS Remember: • Alcohol and drugs can ruin people’s lives – not only the user’s life, but also that of their colleagues and family. Accidents caused by seafarers under the influence of drugs or alcohol can put everyone in danger and also damage the environment.

• Prevention, through education and awareness raising training, is the key to containing alcohol and drug use.

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• The company must have a clear, written policy.

• International legislation sets strict alcohol limits for seafarers who perform safety, security and marine environmental duties.

• There should be both regular and random on board testing.

• The ‘Chain of Custody’ for urine test specimens must be rigorously observed.

• Counselling is the first step for a seafarer dependent on alcohol or drugs.

• The company’s alcohol and drugs programme will need regular review and evaluation.

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5. CASE STUDIES 1 Death while rigging a gangway A seafarer aboard a car carrier died because he did not wear a fall arrester while arranging stanchions on a gangway. He fell 5.5 metres to the quay wall and was still conscious when an ambulance arrived, but died a few minutes later.

He had been drinking ashore and had a high blood-alcohol level. He returned to the vessel about two and a half hours before going on duty.

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2 Master guilty of operating ship under the influence of alcohol The Master of a freight vessel pleaded guilty to operating a commercial vessel under the influence of alcohol on a river in the US. He was sentenced to one year probation and a $500 fine. He was also prohibited from sailing in any capacity on waters subject to the jurisdiction of the United States for one year.

The Coast Guard and a pilot boarded to assist the ship in crossing a dangerous bar.

The Master was not present for the crossing and was instead found sleeping in his berth where there was a strong smell of alcohol. Coast Guard officials observed an almost empty bottle of scotch and the defendant appeared to be slurring his words. A breathalyser test indicated that the Master had a blood alcohol content way over the limit allowed in federal law.

3 Grounding of a container ship

A pilot from another ship went on board a container ship to investigate why numerous attempts to raise the ship had failed. They had failed because the Chief Officer and Master were both asleep and subsequently found to have extremely high blood alcohol content levels. Fatigue may also have increased the effects of alcohol.

There was no lookout on the bridge and the bridge navigational watch alarm system was off.

After several course changes were missed and the ship appeared to be Not Under Command, several attempts were made to communicate with it. A pilot boat tried to contact the ship by VHF channel 16 and 71 and by blasting the whistle. It circled around the ship while it tried to make contact. Shortly after the pilot boat approached the aft ship blasting the whistle almost continuously.

A rescue helicopter arrived, and from it, a person was observed sleeping on the bridge. No one else was to be seen. The helicopter observed that the ship was aground. A pilot then boarded the ship.

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Despite the foregoing, none of the crew, which included a 2nd officer, three able bodied seamen and two ordinary seamen, reacted or investigated the cause of the disturbance.

4 Man Overboard An experienced AB in his late fifties died when he fell from a ladder on a cargo ship while alongside. Analysis of post-mortem blood revealed that he had a BAC of almost 200mg/100ml.

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The Marine Accident Investigation Branch investigation identified that the AB almost certainly fell while climbing up to the port side platform of the straddle lift used to move the ship’s cargo hatch covers. It also found that: • the AB was working while under the influence of alcohol • the means of access to the straddle lift platforms used by the ship’s crew were unsafe • the opening and closing of the cargo hatch covers had not been identified as a key element within the on board procedures, and therefore the risks of accessing and operating the straddle lift had not been assessed • important personal protective equipment (PPE) was either not available on board, or was not fit for purpose. The AB’s boots and gloves had worn smooth, indicating that more frequent monitoring and, if necessary, replacement was required. However, his boots were also unsuitable for wear during cargo operations.

5 Grounding of a feeder container vessel

The vessel ran aground on the south Spanish coast, while on passage from Algeciras to Valencia. At the time of the grounding it was proceeding at full speed, and the bridge was unmanned.

The previous evening an engineer came onto the bridge shortly before midnight and he remained there, talking to the third officer. At around midnight, the second officer and two other officers came to the bridge. The second officer took over the watch from the third officer, but no lookout was posted and the watch alarm was not activated.

The officers on the bridge then began to drink, and over the next two hours proposed a series of ‘toasts’ to celebrate the third officer’s birthday. The second officer then announced that it was time for the party to break up as he needed to carry out his watch duties. Shortly after this, the other officers departed and the second officer was left alone on the bridge. At some point in the small hours, the second officer left the bridge and in an unscheduled departure from the passage plan, the vessel’s course was altered. No alarms sounded on the bridge during this alteration of course, and the ©Videotel MMXIII

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Drugs and Alcohol, A Manager's Guide bridge remained silent until the vessel grounded at nearly 6am on a gently shelving, sandy, shoreline.

The crew of a local fishing boat informed the Spanish coastguard that a merchant vessel appeared to have grounded and just after 6am, the Chief Officer entered the bridge and found it unmanned. At this time the vessel was hard aground with its controllable pitch propeller (CPP) still set to full ahead. The Chief Officer immediately telephoned the Master to advise him of the vessel’s predicament. The Master arrived on the bridge, put the CPP to zero pitch, called the Chief Engineer and instructed the Chief Officer to check the vessel for damage.

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As none of those involved were tested after the grounding for drug and alcohol consumption, it could not be stated as fact that alcohol was being consumed. Further, there were no independent witnesses to the party as there was no lookout posted.

However, from the VDR recording of the noise of the party and the conversations, including the regular ‘toasts’ and references to the collection of further supplies, it was considered reasonable to conclude that large quantities of alcohol were being consumed on the bridge that night.

6 Impaired performance

The Master of a general cargo ship lost his job after he was noticed having problems berthing the ship in Southampton. When breathalysed, he was found to have three times the legal limit of alcohol.

The Master pleaded guilty, was fined and remanded in custody.

7 Drunk in charge of hazardous cargo

A Master with 25% higher alcohol level than the UK legal limit for seafarers was jailed for two months and then deported from the UK. His ship had been carrying ammonium nitrate in liquid form and had a crew of 15 on board. When the pilot boarded, he reported to the Port Authority that the Master appeared drunk. Metropolitan Police officers boarded the vessel and administered a breath test which proved positive. He was dismissed from his job following his arrest.

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6. APPENDIX 6.1 Extracts from STCW (International Convention on Standards of Training, Certification and Watchkeeping for Seafarers), amended 3 August 2010 Standards regarding watchkeeping Section A-VIII/1

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Fitness for duty 10 Each Administration shall establish, for the purpose of preventing alcohol abuse, a limit of not greater than 0.05% blood alcohol level (BAC) or 0.25 mg/l alcohol in the breath or a quantity of alcohol leading to such alcohol concentration for masters, officers and other seafarers while performing designated safety, security and marine environmental duties.

Section B-VIII/1

Guidance regarding fitness for duty

Prevention of drug and alcohol abuse 6 Drug and alcohol abuse directly affect the fitness and ability of a seafarer to perform watchkeeping duties or duties that involve designated safety, prevention of pollution and security duties. Seafarers found to be under the influence of drugs or alcohol should not be permitted to perform watchkeeping duties or duties that involve designated safety, prevention of pollution and security duties, until they are no longer impaired in their ability to perform those duties.

7 Administrations should ensure that adequate measures are taken to prevent alcohol and drugs from impairing the ability of watchkeeping personnel and those whose duties involve designated safety, prevention of pollution and security duties, and should establish screeningprogrammes as necessary which: .1 identify drug and alcohol abuse;

.2 respect the dignity, privacy, confidentiality and fundamental legal rights of the individuals concerned; and .3 take into account relevant international guidelines.

8 Companies should consider the implementation of a clearly written policy of drug and alcohol abuse prevention, including prohibition to consume alcohol within four hours prior to serving as a member of a watch either by inclusion in the company’s quality-management system or by means of providing adequate information and education to the seafarers.

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Drugs and Alcohol, A Manager's Guide 9 Those involved in establishing drug and alcohol abuse prevention programmes should take into account the guidance contained in the ILO publication Drug and Alcohol Prevention Programmes in the Maritime Industry (A Manual for Planners), as may be amended.

6.2 Extracts from the Maritime Labour Convention, MLC 2006

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Guideline B4.3.1 - Provisions on occupational accidents, injuries and diseases 2. The competent authority should ensure that the national guidelines for the management of occupational safety and health address the following matters, in particular: …..(p) the effects of drug and alcohol dependency;

4. In addition, the competent authority should ensure that the implications for health and safety are taken into account, particularly in the following areas: ….. (b) the effects of drug and alcohol dependency

Guideline B4.3.10 - Safety and health education of young seafarers …..4. Education and training of young seafarers both ashore and on board ships should include guidance on the detrimental effects on their health and well-being of the abuse of alcohol and drugs and other potentially harmful substances, and the risk and concerns relating to HIV/AIDS and of other health risk related activities.

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7. FURTHER RESOURCES Regulations, guidelines and other publications STCW (International Convention on Standards of Training, Certification and Watchkeeping for Seafarers), as amended International Labour Organization (ILO): Maritime Labour Convention, MLC 2006, as amended International Labour Organization (ILO): Drug and Alcohol Abuse Prevention Programs in the Marine Industry

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ILO/WHO (World Health Organization): Guiding Principles on Drug and Alcohol Testing Procedures for Worldwide Application in the Maritime Industry WHO: The Alcoholic Use Disorder Identification Test [AUDIT]

MGN 448 (M) Medical Certification, Hours of Work and Alcohol Limits

ITF (International Transport Workers’ Federation) Policy on Drug and Alcohol Abuse INTERTANKO Guidelines for Tanker Companies’ Drug and Alcohol Policies OCIMF Guidelines for the Control of Drugs and Alcohol on Board Ship ISO 9001:2008 Quality management systems – Requirements

Useful organisations International Christian Maritime Association (ICMA) www.icma.as International Labour Organization (ILO) www.ilo.org

International Maritime Organization (IMO) www.imo.org International Radio Medical Centre (CIRM) www.cirm.it

International Seafarers’ Welfare and Assistance Network (ISWAN) www.seafarerswelfare.org

International Transport Workers’ Federation (ITF) www.itfglobal.org INTERTANKO www.intertanko.com

Mission to Seafarers www.missiontoseafarers.org

OCIMF www.ocimf.com

World Health Organization (WHO) www.who.int

Related Videotel programmes Alcohol Beware! A Seafarer’s Guide (Edition 3) (Code 1199)

Drugs - Way Off Course, A Seafarer’s Guide (Edition 3) (Code 1200) Fatigue and Stress at Sea (Code 656) Minimising Fatigue, Maximising Performance (Code 939)

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8. ASSESSMENT QUESTIONS 1. Drug tolerance is where you feel ill or irritable without the drug.

TRUE or FALSE?

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2. Sleeping pills and tranquillisers are: a) Depressants b) Stimulants c) Opioids d) Hallucinogenics 3. Cocaine is a/an: a) Depressant b) Opioid c) Stimulant d) Hallucinogenic

4. LSD is a/an: a) Depressant b) Stimulant c) Opioid d) Hallucinogenic

5. The new drugs such as mephedrone and APB (often called ‘legal highs’) can be considered safe.

TRUE or FALSE? 6. A person’s misuse of drugs or alcohol may be either the cause or consequence of their personal problems.

TRUE or FALSE?

7. What is the BAC (Blood Alcohol Content) limit for Masters, officers and seafarers performing safety, security and marine environmental duties under STCW? a) 5mg/100ml b) 50mg/100ml c) 500mg/100ml d) 5000mg/100ml

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8. At what BAC level can death occur? a) >4mg/100ml b) >400mg/100ml c) >40mg/100ml d) >4000mg/100ml

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9. If you should discover a substance among a crew member’s belongings that you suspect may be a drug, you should not feel, handle or touch it without skin protection and a face mask.

TRUE or FALSE? 10. What is the maximum number of alcohol units that many countries’ health authorities recommend that men drink per day? a) 1-2 b) 3-4 c) 5-6 d) 7-8

11. How can you sober up quickly after drinking alcohol? a) By drinking coffee b) By eating a meal c) By sleeping d) There is no way of speeding up the process of alcohol elimination

12. Mixing alcohol with depressant drugs such as tranquillisers or sleeping pills increases the risk of becoming unconscious and stopping breathing.

TRUE or FALSE? 13. Shaking and sweating are physical symptoms of alcohol withdrawal.

TRUE or FALSE?

14. What is the key to minimising the risk of people becoming alcohol or drug dependent? a) Discipline b) Legislation c) Self-assessment d) Prevention

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Drugs and Alcohol, A Manager's Guide 15. Under STCW, no seafarer carrying out watchkeeping or other safety related duties may consume alcohol within: a) 1 hour before beginning those duties b) 4 hours before beginning those duties c) 8 hours before beginning those duties d) 24 hours before beginning those duties 16. Officers should be able to recognise the signs of alcohol or drug problems.

TRUE or FALSE?

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17. Shipping company policies may involve a schedule which includes routine breath-testing: a) Once a year b) Once a month c) Once a week d) Once a voyage

18. An unbroken Chain of Custody will explicitly link the urine specimen to the donor, and the result to the specimen.

TRUE or FALSE? 19. If a person says “No thanks” to an alcoholic drink, what should you do? a) Report them to their senior officer b) Insist. One drink never did anyone any harm c) Respect their choice d) Ask what is wrong with them

20. US Coast Guard regulations require drug and alcohol testing to be carried out within: a) 30 minutes of a Serious Marine Incident b) 1 hour of a Serious Marine Incident c) 2 hours of a Serious Marine Incident d) 4 hours of a Serious Marine Incident

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9. ASSESSMENT ANSWERS Correct answer

Found in section.

1

False Feeling ill or irritable is a sign of drug dependence, not tolerance.

1.3

2

a

2.1

3

c

2.1

4

d

2.1

5

False ‘Legal highs’ should NOT be considered safe.

2.1

6

True

2.3

7

b

2.5

8

b

2.6

9

True

3.5

10

b

2.7

11

d

2.8

12

True

2.11

13

True

2.12

14

d

3.2

15

b

3.3

16

True

3.2

17

a

3.4

18

True

3.4

19

c

2.13

20

c

3.4

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NOTES

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84 NEWMAN STREET LONDON W1T 3EU, UK

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T : +44 (0) 20 7299 1800 F : +44 (0) 20 7299 1818 E : mail@videotel.com W : www.videotel.com 12/18/2013 4:33:50 PM