Why not just get rid of the stupid 1 time medical while we’re at it. That make more sense and would further relieve the FAA of needless involvement in basic med operations.
I don't mind that I had to have held the medical, though I agree the value is questionable. The apparent disconnect between the regulatory requirements as published vs. FAA's internal policies is frustrating. The foundation of BM being that once you've been certified under Part 67 without suspension or revocation, etc. you can then work with your PCP regarding your fitness to fly. The tradeoffs being: 1. There are certain specified limitations on your pilot privileges/flight ops and 2. There are certain specified conditions for which a
clinical diagnosis or medical history would require an SI. (Obviously substance dependence being one of them.)
Regarding mental health conditions (of which substance dependence is a subset), 68.9c says:
"(c) Special rule for mental health conditions.
(1) In the case of an individual with a clinically diagnosed mental health condition, the ability to operate an aircraft under § 61.113(i) of this chapter shall not apply if—
(i) In the judgment of the individual's State-licensed medical specialist, the condition—
(A) Renders the individual unable to safely perform the duties or exercise the airman privileges required to operate an aircraft under § 61.113(i) of this chapter; or
(B) May reasonably be expected to make the individual unable to perform the duties or exercise the privileges required to operate an aircraft under § 61.113(i) of this chapter; or
(ii) The individual's driver's license is revoked by the issuing agency as a result of a clinically diagnosed mental health condition.
(2) Subject to paragraph (c)(1) of this section, an individual clinically diagnosed with a mental health condition shall certify every 2 years, in conjunction with the certification under § 68.3(b)(3), that the individual is under the care of a State-licensed medical specialist for that mental health condition."
So you'd think it's up to your state-licensed PCP who reviews your CMEC if you have a diagnosis that falls under this. And if that diagnosis is substance dependence, then you need to undergo treatment and eventually see your HIMS AME to initiate the SI process.
But as my attorney put it, DUI is "the sexy crime." Authorities treat it specially. In the case of the FAA, an NDR hit and OKC now steps in. And as we've read many times on this forum, they have their own internal policies, definitions, etc. that they apply. In the case of substance dependence, at least partially at odds with the licensed medical community's standards and criteria (or application thereof).
Yet if I have chest pains (example), my wife calls an ambulance and I go to the ER. There's no CFR section that compels me to report the incident directly to FAA within 60 days (vis a vis 61.15). That ER trip may or may not result in a cardiovascular diagnosis. That's up to the ER doc, my PCP, and associated specialists. And if that diagnosis falls within 68.9, then my PCP won't sign off my CMEC and I'll be contacting my AME to initiate an SI.
That's how it's supposed to work, anyway. But DUI's are special. Therefore, know the process before pushing the "button." (IMHO)
Happy Holidays.