When a pilot first reads or hears the words HIMS program in relation to himself or herself, it can be one of the most daunting, overwhelming and confusing moments in his or her life. Understanding the program is the essential first step toward gaining control of the situation.
The HIMS program was developed in the early 1970s as a joint effort between airlines and the medical community. The objective was to help pilots with substance dependence. Prior to its inception, any significant alcohol related event, such as a DUI, or diagnosis of substance dependence could easily result in withdrawal of a pilot’s medical certification with no chance of reinstatement. The airline would lose a pilot on whom they had spent a considerable amount of time and money training and the pilot would lose a career, so a solution to this lose-lose situation was welcomed.
The program was well received by both airlines and pilot’s unions. The specifics of the program have changed over the years, but the essence has remained the same. The program involves rehabilitation, treatment, abstinence with compliance monitoring, and eventual return to the cockpit as PIC with ongoing monitoring. Once a diagnosis of substance dependence has been established, subsequent medicals are provided on a special issuance basis, which means that the pilot has a condition that is disqualifying but because of the specific circumstances (in this case, participation in the HIMS program) the Federal Air Surgeon has seen fit to authorize issuance of a medical with certain restrictions and requirements (ongoing participation in the HIMS program).
Entering the HIMS program begins with the identification of a substance dependence problem. This is generally with the occurrence of an alcohol related event (such as a DUI), self-reporting by a pilot who recognizes that he or she has an issue, or referral by a chief pilot or peer. The airline’s HIMS coordinator will then initiate the process by having the pilot enter a treatment program. This generally takes the form of an in-patient phase followed by an intensive out-patient program (IOP). The pilot will also be referred to a HIMS AME for assessment. The HIMS AME will follow the pilot through the rest of the program and is responsible for not only performing their own evaluations but also gathering the data and documentation required for the special issuance and making an overall assessment and recommendation for or against the provision of the medical on a special issuance basis.
In the program a pilot will see the HIMS AME on a regular basis for monitoring, generally every three months initially (for the first two years at least). The HIMS AME will delve into all aspects of the pilot’s life during these interviews in an effort to know what is truly going on with the pilot and evaluate any stressors, and specifically to identify any “red flag” items that might indicate a risk of relapse. For a pilot who is doing well, these interviews can be fairly brief, basically confirming that nothing has changed.
There are many requirements laid out by the FAA, both for initial qualification for the HIMS program and to maintain the special issuance on the HIMS program. These include, typically, complete abstinence from alcohol and all other mood-altering drugs, psychiatry and neuropsychology evaluations, successful completion of a treatment program, attendance at AA, regular follow-up with the HIMS AME, and compliance monitoring by urine toxicology or SoberLink.
Substance dependence is considered to be a relapsing remitting condition and so some form of monitoring is continued for as long as the airman holds an FAA medical certificate. As long as the airman remains in good recovery, the follow-up and monitoring requirements are gradually reduced in a step-down fashion but even in the long-term maintenance phase medicals must be done by a HIMS AME.
For someone with any class of certificate who has demonstrated alcohol abuse, such as having a single DUI and with no other criteria suggesting alcohol dependence, many of the broader requirements do not apply. Every case is evaluated on an individual basis, but treatment and neuropsychological testing does not typically apply. There may be a requirement for a psychiatry or substance abuse professional evaluation to confirm that there is no evidence of dependence with no follow-up with those specialists necessary. Abstinence will be mandatory. The minimal monitoring would be follow-up with the HIMS AME and compliance monitoring by urine toxicology or SoberLink. In these cases, if all goes well, the special issuance is lifted after two to four years and thereafter regular issuance of the medical by any AME is possible. In fact, if an initial applicant has a history of a single DUI more than five years in the past with a blood alcohol level at the time of less than 0.15 any AME can complete a medical and issue a certificate without consulting the FAA as long as the AME has no other concerns. When the special issuance is lifted the FAA will send a letter warning the airman to not to have any future incidents and recommending lifetime abstinence.
The original focus of the HIMS program was to manage cases of substance dependence in commercial pilots. The program now includes cases of alcohol abuse and more recently includes airmen on one of four authorized SSRI antidepressants. Also, the program is open to pilots with a third class medical; technically this is a HIMS-like program but functionally it is very similar.
With respect to SSRI use, the FAA has authorized four medications for use in pilots. Again, the medical is provided on a special issuance basis after the airman is stable on the medication and providing favorable psychiatry and neuropsychology evaluations. Follow-up evaluations are required for commercial pilots every six months with the HIMS AME and psychiatry, and every year with neuropsychology; these times are one year and two years respectively for pilots with a third-class certificate. Because of the evaluation and monitoring requirements, these cases were integrated into the HIMS program.
Note that your medical is still valid for the same period of time, five years under the age of 40 and two years thereafter. First and second-class privileges have more limited time periods, but the medical itself is still valid. The medical certificate is a completely separate item and will have a specified expiry date which will not correspond to the expiry date of the medical. A HIMS AME can provide an interim certificate during the validity period of the special issuance without performing another medical as long as the airman has not relapsed and is in full compliance with the provisions of the special issuance.
There are many resources that may be accessed for further information, including the HIMS AME, HIMS coordinator, peer advisor, and chief pilot.
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