4582 Federal Register / Vol. 80, No. 18 / Wednesday, January 28, 2015 / Notices 

Dated: January 22, 2015. 

Carolyn Baum, 

Program Analyst, Office of Federal Advisory 

Committee Policy. 

[FR Doc. 2015–01486 Filed 1–27–15; 8:45 am] 

BILLING CODE 4140–01–P 

DEPARTMENT OF HOMELAND 

SECURITY 

Coast Guard 

[Docket No. USCG–2014–0720] 

Request for Public Comment on 

Waiver Revisions for Certain 

Medications and Suggestions for Risk 

Evaluation 

AGENCY: Coast Guard, DHS. 

ACTION: Notice of proposed policy 

clarification and request for comments. 

SUMMARY: The Coast Guard is seeking 

public comment on the policy 

clarification proposed in this Notice 

regarding the criteria for granting 

medical waivers to mariners who 

require the use of potentially impairing 

prescription medications. The Coast 

Guard is also seeking input regarding 

effective methods of risk evaluation of 

such mariners. Current Coast Guard 

guidance states that the ‘‘use of certain 

medications is considered disqualifying 

for the issuance of credentials,’’ and that 

‘‘the underlying cause or need for use of 

these medications and potential side 

effects may result in denial of a 

credential application or require a 

waiver.’’ Current guidance specifically 

identifies that use of benzodiazepine 

medications, opioid and opiate 

medications, non-benzodiazepine 

sedative hypnotic medications, and 

barbiturate medications require a 

waiver, but does not specify the factors 

that the Coast Guard will consider in 

making its determination on whether 

the risks associated with use of these 

medications are low enough to warrant 

consideration for a waiver. 

The Coast Guard is proposing 

additions to the current medication 

policy that will clarify the 

circumstances that the Coast Guard will 

consider when determining whether to 

grant a medical waiver for use of these 

medications. Additionally, the Coast 

Guard is proposing to include a safety 

warning to mariners advising them to 

refrain from use of impairing 

medications while operating under the 

authority of their credential. The Coast 

Guard is seeking comments from the 

public on whether the proposed policy 

adequately addresses safety concerns 

regarding merchant mariners whose 

medical conditions require the use of 

medications that have the potential to 

impair cognitive ability, judgment or 

reaction time. 

DATES: Comments and related material 

must either be submitted to our online 

docket via http://www.regulations.gov 

on or before March 30, 2015 or reach the 

Docket Management Facility by that 

date. 

ADDRESSES: You may submit comments 

identified by docket number USCG– 

2014–0720 using any one of the 

following methods: 

(1) Federal eRulemaking Portal: 

http://www.regulations.gov. 

(2) Fax: 202–493–2251. 

(3) Mail: Docket Management Facility 

(M–30), U.S. Department of 

Transportation, West Building Ground 

Floor, Room W12–140, 1200 New Jersey 

Avenue SE., Washington, DC 20590– 

0001. 

(4) Hand delivery: Same as mail 

address above, between 9 a.m. and 5 

p.m., Monday through Friday, except 

Federal holidays. The telephone number 

is 202–366–9329. 

To avoid duplication, please use only 

one of these four methods. See the 

‘‘Public Participation and Request for 

Comments’’ portion of the 

SUPPLEMENTARY INFORMATION section 

below for instructions on submitting 

comments. 

FOR FURTHER INFORMATION CONTACT: If 

you have questions about this notice, 

call or email Lieutenant Ashley Holm, 

Mariner Credentialing Program Policy 

Division (CG–CVC–4), U.S. Coast Guard, 

telephone 202–372–2357, email 

MMCPolicy@uscg.mil. If you have 

questions on viewing material in the 

docket, call Docket Operations at 202– 

366–9826. 

SUPPLEMENTARY INFORMATION: 

Public Participation 

You may submit comments and 

related material regarding whether the 

policy clarifications proposed in this 

Notice should be incorporated into a 

final policy on issuing medical waivers 

to mariners whose medical conditions 

require use of benzodiazepine 

medications, opioid and opiate 

medications, non-benzodiazepine 

sedative hypnotic medications, or 

barbiturate medications. All comments 

received will be posted, without change, 

to http://www.regulations.gov and will 

include any personal information you 

have provided. 

Submitting Comments 

If you submit a comment, please 

include the docket number for this 

notice (USCG–2014–0720) and provide 

a reason for each suggestion or 

recommendation. You may submit your 

comments and material online or by fax, 

mail or hand delivery, but please use 

only one of these means. We 

recommend that you include your name 

and a mailing address, an email address, 

or a telephone number in the body of 

your document so that we can contact 

you if we have questions regarding your 

submission. 

To submit your comment online, go to 

http://www.regulations.gov, type the 

docket number (USCG–2014–0720) in 

the ‘‘SEARCH’’ box and click 

‘‘SEARCH.’’ Click on ‘‘Submit a 

Comment’’ on the line associated with 

this notice. 

If you submit your comments by mail 

or hand delivery, submit them in an 

unbound format, no larger than 81⁄2 by 

11 inches, suitable for copying and 

electronic filing. If you submit them by 

mail and would like to know that they 

reached the Facility, please enclose a 

stamped, self-addressed postcard or 

envelope. We will consider all 

comments and material received during 

the comment period. 

Viewing the comments: To view 

comments, go to http://

www.regulations.gov, type the docket 

number (USCG–2014–0720) in the 

‘‘SEARCH’’ box and click ‘‘SEARCH.’’ 

Click on ‘‘Open Docket Folder’’ on the 

line associated with this rulemaking. 

You may also visit the Docket 

Management Facility in Room W12–140 

on the ground floor of the Department 

of Transportation West Building, 1200 

New Jersey Avenue SE., Washington, 

DC 20590, between 9 a.m. and 5 p.m., 

Monday through Friday, except Federal 

holidays. We have an agreement with 

the Department of Transportation to use 

their Docket Management Facility. 

Privacy Act: Anyone can search the 

electronic form of comments received 

into any of our dockets by the name of 

the individual submitting the comment 

(or signing the comment, if submitted 

on behalf of an association, business, 

labor union, etc.). You may review a 

Privacy Act system of records notice 

regarding our public dockets in the 

January 17, 2008, issue of the Federal 

Register (73 FR 3316). 

Background and Purpose 

Coast Guard regulations in 46 CFR 

10.302 contain the medical standards 

that merchant mariners must meet prior 

to being issued a merchant mariner 

credential (MMC). In cases where the 

mariner does not meet the medical 

standards in 46 CFR 10.302, waivers 

may be granted when extenuating 

circumstances exist that warrant special 

consideration. 46 CFR 10.303. 

Additionally, 46 CFR 10.304 specifies 

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Federal Register / Vol. 80, No. 18 / Wednesday, January 28, 2015 / Notices 4583 

1National Transportation Safety Board Safety 

Recommendation I–00–5, January 13, 2000. http:// 

www.ntsb.gov/doclib/recletters/2000/I00_5.pdf. 

the scope of the general medical exam 

required for receiving an MMC and 

directs that ‘‘this exam must also 

document any condition requiring 

medication that impairs cognitive 

ability, judgment, or reaction time.’’ 

On September 8, 2008, the Coast 

Guard issued Navigation and Vessel 

Inspection Circular (NVIC) 04–08, 

‘‘Medical and Physical Evaluation 

Guidelines for Merchant Mariner 

Credentials’’ (NVIC 04–08). In Enclosure 

(4) of NVIC 04–08, the Coast Guard 

identifies medications that may be 

disqualifying or may require a medical 

waiver. (NVIC 04–08 is available on the 

Internet at: http://www.uscg.mil/hq/cg5/ 

nvic/pdf/2008/NVIC%2004-08%20CH%

201%20with%20Enclosures%

2020130607.pdf.) 

The medications identified have a 

documented potential to impair 

cognitive ability, judgment and/or 

reaction time. In many instances, the 

medication labels also warn against 

driving or operating heavy machinery 

while under the influence of these 

medications. Because of the 

documented potential for impairment 

associated with these medications, the 

Coast Guard considers the use of these 

medications to be generally 

disqualifying. In some cases, waivers are 

granted to allow for limited use of the 

medication; while in other cases, the 

mariner is denied medical certification. 

When waivers are granted for use of 

these potentially impairing medications, 

the conditions of the waiver usually 

stipulate that the mariner must refrain 

from use of the medication for a 

specified time period, in order to 

decrease the likelihood that the mariner 

will be under the influence of the 

medication while working. However, 

such waiver stipulations cannot be 

applied to mariners who are medically 

required to take their potentially 

impairing medications prior to, and 

while working. As a result, mariners in 

this situation often have to change their 

medical treatment plan or risk denial of 

medical certification. 

Enclosure (4) to NVIC 04–08 lists 

benzodiazepine medications, opioid and 

opiate medications, non-benzodiazepine 

sedative hypnotic medications, and 

barbiturate medications as requiring a 

waiver. Since the issuance of NVIC 04– 

08, there have been several instances 

where mariners sought waivers for use 

of these specific medications. However, 

NVIC 04–08 does not provide any 

guidance on the circumstances that will 

warrant consideration for a medical 

waiver. Published guidance on the 

circumstances that will be considered in 

determining whether the use of these 

medications warrant consideration for a 

medical waiver will support Coast 

Guard efforts to consistently evaluate 

merchant mariners whose medical 

condition requires the use of these 

medications and to assess whether an 

applicant’s use of one of these 

medications warrants a medical waiver 

under 46 CFR 10.303. 

The proposed policy changes seek to 

clarify the extenuating circumstances 

related to use of potentially impairing 

medications that the Coast Guard 

weighs in evaluating risk to public and 

maritime safety and in determining 

suitability for a medical waiver. 

Additionally, the policy would allow for 

consideration of the treating physician’s 

formal assessment of impairment in 

determining whether the risk associated 

with the mariner’s medication use is 

acceptable for a safety sensitive 

position. 

The Coast Guard recognizes that there 

are instances when a mariner may take 

a medication or start a prescription for 

a medication outside of the timeframe of 

the MMC application process, and thus 

the medication use has not been 

included in the Coast Guard’s review of 

the mariner’s MMC application. Because 

a number of prescription medications 

and over-the-counter medications have 

effects that may impair cognitive ability, 

judgment and reaction time, it is critical 

that each mariner consider the effects of 

his or her medication before deciding to 

operate under the authority of his or her 

credential. Between 1987 and 2000, the 

National Transportation Safety Board 

investigated a significant number of 

accidents across all modes of passenger 

transportation that involved the use of 

potentially impairing prescription and 

over-the-counter medications, and their 

analysis determined that ‘‘prescription 

and over-the-counter medications 

continue to be factors in transportation 

accidents and incidents.’’ 1

The current Coast Guard guidance 

advises mariners that certain 

medications may be considered 

disqualifying for the issuance of 

credentials, but the policy does not 

provide guidance on whether it is 

appropriate to operate under the 

authority of the credential while under 

the effects of a potentially impairing 

medication. As such, one of the 

proposed changes to the medication 

policy includes a safety warning to 

mariners advising them to refrain from 

operating under the authority of the 

credential when they are under the 

influence of any medication that can 

cause drowsiness, or impair cognitive 

abilility, judgment or reaction time. The 

Coast Guard is proposing to include 

these policy changes in a replacement to 

Enclosure (4) to NVIC 04–08. 

In addition to seeking comments from 

the public about whether the proposed 

policy adequately addresses safety 

concerns regarding merchant mariners 

whose medical conditions require use of 

potentially impairing medication, the 

Coast Guard is also seeking public input 

on five specific questions relating to the 

medical waivers for the use of such 

medications. 

Questions for the Public 

1. What factors, if any, should the 

Coast Guard consider in determining 

whether to grant a waiver for mariners 

whose conditions require them to use 

(or be under the effects of) a potentially 

impairing medication while operating 

under the authority of the merchant 

mariner credential? 

2. What methods of objective 

evaluation are available to reliably 

assure that a mariner is free of any 

impairing medication effects, 

specifically effects that would interfere 

with the safe operation of the vessel? 

3. Should the treating physician’s 

opinion that the mariner has no 

medication impairment be considered 

sufficient to mitigate risk to public and 

maritime safety? 

4. Should formal neuropsychological/ 

neurocognitive evaluation be required of 

all mariners who require chronic use of 

potentially impairing medications, or 

use of potentially impairing medications 

while operating under the authority of 

the credential? If so, what functions 

should be measured/evaluated, and 

what would be the appropriate standard 

for a test’s outcome? 

5. Under what circumstances, if any, 

should the Coast Guard consider 

granting waivers for mariners whose 

conditions require use of opioid 

maintenance therapy (for example, 

methadone or buprenorphine)? 

The Proposed Policy 

The proposed replacement to 

Enclosure (4) to NVIC 04–08, provided 

below, outlines more specific guidance 

for each class of medication discussed 

above. Additionally, the guidance 

advises mariners to carefully consider 

manufacturers’ warnings for any 

medication(s) they may be taking, 

whether prescription or over-thecounter, before acting under the 

authority of the credential. The 

proposed replacement for Enclosure (4) 

to NVIC 04–08 follows: 

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4584 Federal Register / Vol. 80, No. 18 / Wednesday, January 28, 2015 / Notices 

Medications 

Definitions 

A. Acting under the authority of the 

credential. The definition of ‘‘acting under 

the authority of a credential’’ is found in 46 

CFR 5.57. It states that 

(a) A person employed in the service of a 

vessel is considered to be acting under the 

authority of a credential or endorsement 

when the holding of such credential or 

endorsement is: 

(1) Required by law or regulation; or 

(2) Required by an employer as a condition 

for employment. 

(b) A person is considered to be acting 

under the authority of the credential or 

endorsement while engaged in official 

matters regarding the credential or 

endorsement. This includes, but is not 

limited to, such acts as applying for renewal, 

taking examinations for raises of grade, 

requesting duplicate or replacement 

credentials, or when appearing at a hearing 

under this part. 

(c) A person does not cease to act under 

the authority of a credential or endorsement 

while on authorized or unauthorized shore 

leave from the vessel. 

B. Alcohol means any form or derivative of 

ethyl alcohol (ethanol). See 33 CFR 95.010. 

C. Controlled substance has the same 

meaning assigned by 21 U.S.C. 802 and 

includes all substances listed on Schedules I 

through V as they may be revised from time 

to time (21 CFR part 1308). See 33 CFR 

95.010. 

D. Dangerous drug means a narcotic drug, 

a controlled substance, or a controlledsubstance analog (as defined in section 102 

of the Comprehensive Drug Abuse and 

Control Act of 1970 (21 U.S.C. 802)). See 46 

CFR 16.105. 

E. Drug means any substance (other than 

alcohol) that has known mind or functionaltering effects on a person, specifically 

including any psychoactive substance, and 

including, but not limited to, controlled 

substances. See 33 CFR 95.010. 

F. Intoxicant means any form of alcohol, 

drug or combination thereof. See 33 CFR 

95.010. 

Prohibitions 

A. Illegal Substances: Use of illegal or 

illegally obtained substances, including all 

illegal or illegally obtained dangerous drugs 

(as defined in 46 CFR 16.105), is 

incompatible with maritime service and is 

not waiverable under any circumstances. 

B. Intoxicants: Operation of vessels while 

under the influence of drugs or alcohol is 

regulated under 33 CFR part 95. Issuance of 

a credential does not authorize a mariner to 

operate a vessel in contravention of 33 CFR 

part 95. See also 46 U.S.C. 2302. 

Important Safety Warning 

Certain medications, whether prescription 

or over-the-counter, have known impairing 

effects and their labels warn about risk of 

drowsiness and caution against use while 

driving or operating hazardous machinery. 

The nature of shipboard life and shipboard 

operations is such that mariners may be 

subject to unexpected or emergency response 

duties associated with vessel or crew safety, 

prevention of pollution, and maritime 

security at any time while aboard a vessel. 

In the interest of safety of life and property 

at sea, the Coast Guard views shipboard life 

and the attendant shipboard duties that can 

arise without warning, as safety sensitive 

duties that are analogous to operating 

hazardous machinery. As such: 

A. Mariners are advised to discuss all 

medication use with their treating providers 

and to inform them of the safety sensitive 

nature of their credential; and 

B. Mariners are cautioned against acting 

under the authority of their merchant 

mariner credential while under the influence 

of medications that: 

(a) Can cause drowsiness, or 

(b) can impair cognitive ability, judgment 

or reaction time, or 

(c) carry warnings that caution against 

driving or operating heavy machinery. 

C. Mariners are advised that they are 

considered to be acting under the authority 

of the credential anytime they are aboard a 

vessel in a situation to which 46 CFR 5.57(a) 

applies, even when off-watch or while 

asleep. 

Prescription and Over-the-Counter 

Medications 

Credential applicants who are required to 

complete a general medical exam should 

disclose on the Merchant Mariner Credential 

Medical Evaluation Report, CG–719K, all 

prescription and over the counter 

medications, filled or refilled and/or taken 

within 30 days prior to the date that the 

applicant submits the CG–719K to the Coast 

Guard. 46 CFR 10.302(a) and 10.304(a). 

In addition, credential applicants who are 

required to complete a general medical exam 

should disclose on the CG–719K all 

prescription medications and over-thecounter medications, including dietary 

supplements and vitamins, that were used for 

a period of 30 days or more within the 90 

days prior to the date the applicant submits 

the CG–719K to the Coast Guard. 46 CFR 

10.302(a) and 10.304(a). 

Medications which may impair cognitive 

ability, judgment or reaction time are 

considered disqualifying for issuance of 

credentials. Additionally, the underlying 

condition requiring use of the potentially 

impairing medication and/or the possible 

side-effects of these medications may result 

in denial of a credential application. 

Mariners who require the use of disqualifying 

medications may seek consideration for a 

waiver in accordance with 46 CFR 10.303. 

The following is a non-exhaustive list of 

medications that may be deemed 

disqualifying due to risk of impaired 

cognitive ability, judgment or reaction time. 

Mariners on these medications are subject to 

further medical review, in accordance with 

enclosure (6) of NVIC 04–08, to determine 

whether the applicant’s use of the medication 

is disqualifying. If the applicant’s medication 

use is deemed disqualifying by the Coast 

Guard, then the Coast Guard will determine 

whether the mariner qualifies for a waiver 

under 46 CFR 10.303. Please refer to the 

section on Medication Waivers that follows. 

A. Anti-Depressants: 

(1) Conditions which require Selective 

serotonin reuptake inhibitors (SSRI), 

serotonin and norepinephrine reuptake 

inhibitors (SNRIs), or Wellbutrin (bupropion) 

do not require a waiver unless the underlying 

condition is deemed disqualifying. 

(2) Conditions which require the use of 

other anti-depressants will be evaluated for 

stability of the underlying condition and the 

absence of impairing medication side-effects. 

(3) A waiver is not required when used as 

a smoking cessation aid and with 

Premenstrual Dysphoric Disorder (PMDD). 

B. Anti-Motion Sickness Agents: Use is 

approved and a waiver is not required when 

used in accordance with manufacturers’ 

warnings and directions. 

C. Anti-Psychotics: The medication and the 

underlying condition will be reviewed to 

determine whether the mariner qualifies for 

a waiver under 46 CFR 10.303. 

D. Anti-Convulsives: The medication and 

the underlying condition will be reviewed to 

determine whether the mariner qualifies for 

a waiver under 46 CFR 10.303. See enclosure 

(8) for guidance on evaluating waivers of 

underlying conditions that may require anticonvulsives. 

E. Anti-Histamines: 

(1) Non-sedating medications, such as 

loratadine (Claritin), fexofenadine (Allegra) 

and desloratadine (Clarinex), are acceptable 

when used in accordance with 

manufacturers’ warnings and directions. 

(2) Sedating medications—The medication 

and the underlying condition will be 

reviewed to determine whether the mariner 

qualifies for a waiver under 46 CFR 10.303. 

F. Barbiturate Medications: Due to the risk 

of impaired cognitive ability, judgment, and 

reaction time, use of barbiturate medications 

is disqualifying. The medication and the 

underlying condition will be reviewed to 

determine whether the mariner qualifies for 

a waiver under 46 CFR 10.303. Waivers for 

use within 48 hours prior to, or while acting 

under the authority of the credential will 

only be approved on a case-by-case basis if 

the Coast Guard determines that there are 

exceptional circumstances that mitigate risk 

to public safety. See medication waiver 

discussion below. 

G. Benzodiazepines: Due to the risk of 

impaired cognitive ability, judgment, and 

reaction time, use of benzodiazepine 

medications is disqualifying. The medication 

and the underlying condition will be 

reviewed to determine whether the mariner 

qualifies for a waiver under 46 CFR 10.303. 

Waivers for use within 48 hours prior to, or 

while acting under the authority of the 

credential will only be approved on a caseby-case basis if the Coast Guard determines 

that there are exceptional circumstances that 

mitigate risk to public safety. See Medication 

Waivers discussion below. 

H. Cough Preparations with 

Dextromethorphan, Codeine, or other 

Codeine-Related Analogs: 

(1) Use of over-the-counter medications is 

approved when used in accordance with 

manufacturers’ warnings and directions. 

(2) For prescription medications containing 

opioid or opiate ingredients, see section K, 

Legally Prescribed Controlled Substances. 

I. Diet Aids (e.g. Dexatrim, Metabolife, etc.) 

and Stimulants (e.g. modafinil, 

amphetamines, etc.): 

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Federal Register / Vol. 80, No. 18 / Wednesday, January 28, 2015 / Notices 4585 

2 Kay, GG and Logan BK, (2011). Drugged Driving 

Expert Panel report: A consensus protocol for 

assessing the potential of drugs to impair driving. 

(DOT HS 811 438). Washington, DC: National 

Highway Traffic Safety Administration. 

(1) Use of over-the-counter medications is 

approved when used in accordance with 

manufacturers’ warnings and directions. 

(2) Prescription medications—The 

medication and the underlying condition 

will be reviewed to determine whether the 

mariner qualifies for a waiver under 46 CFR 

10.303. 

J. Non-benzodiazepine Sedative Hypnotic 

Medications: Due to the risk of impaired 

cognitive ability, judgment, and reaction 

time, use of non-benzodiazepine sedative 

hypnotic medications is disqualifying. The 

medication and the underlying condition 

will be reviewed to determine whether the 

mariner qualifies for a waiver under 46 CFR 

10.303. Waivers for use within 12 hours prior 

to, or while acting under the authority of the 

credential will only be approved on a caseby-case basis if the Coast Guard determines 

that there are exceptional circumstances that 

mitigate risk to public safety. See medication 

waiver discussion below. 

K. Legally Prescribed Controlled 

Substances (including legally prescribed 

narcotics, opiates, opioids and legally 

prescribed medications which contain 

narcotics or opioids such as Tylenol with 

codeine): Due to the risk of impaired 

cognitive ability, judgment, and reaction 

time, use of legally prescribed controlled 

substances is disqualifying. The medication 

and the underlying condition will be 

reviewed to determine whether the mariner 

qualifies for a waiver under 46 CFR 10.303. 

Waivers for use within 12 hours prior to, or 

while acting under the authority of the 

credential will only be approved on a caseby-case basis if the Coast Guard determines 

that there are exceptional circumstances that 

mitigate risk to public safety. See medication 

waiver discussion below. 

L. Medical Use of Hallucinogens (e.g. 

medical marijuana, peyote or ecstasy): Even 

if legalized by a state, is disqualifying and 

not waiverable under any circumstances. 

M. Muscle Relaxants: Centrally acting (e.g. 

carisoprodol, meprobamate, cyclobenzaprine, 

methocarbamol, orphenadrine citrate, antimuscarinics and phenyltoloxamine, etc.): 

The medication and the underlying condition 

will be reviewed to determine whether the 

mariner qualifies for a waiver under 46 CFR 

10.303. Waivers for use within 12 hours prior 

to, or while acting under the authority of the 

credential will only be approved on a caseby-case basis if the Coast Guard determines 

that there are exceptional circumstances that 

mitigate risk to public safety. See medication 

waiver discussion below. 

Medication Waivers 

A. As stated previously, medications 

which may impair cognitive ability, 

judgment or reaction time are considered 

disqualifying for issuance of credentials. The 

underlying condition, as well as the effects 

of the medications, may lead to denial of a 

credential application or may result in 

issuance of a waiver. 

B. Due to the documented risks of impaired 

cognition, judgment and reaction time 

associated with the use of centrally acting 

opioid/opiate medications, benzodiazepine 

medications, non-benzodiazepine sedative 

hypnotic medications, and barbiturate 

medications, the Coast Guard has determined 

that use of these medications while acting 

under the authority of the credential is 

generally not waiverable. However, waivers 

may be considered, on a case-by-case basis, 

if the Coast Guard determines that there are 

exceptional circumstances that warrant 

consideration for a waiver. 

C. The Coast Guard retains final authority 

for the issuance of waivers. 

D. Waivers may include restrictions and/or 

limitations on the credential. 

E. Applicants seeking consideration for 

waivers for the use of medications that may 

impair cognitive ability, judgment, or 

reaction time should submit the additional 

information detailed below, for each 

medication: 

(1) A letter from the prescribing and/or 

treating physician that includes the 

following: 

a. Whether the physician has familiarized 

him/herself with the detailed guidelines on 

medical conditions and medications 

contained in Navigation and Vessel 

Inspection Circular 04–08. 

b. Whether the physician understands the 

public-safety sensitive nature of the merchant 

mariner credential. 

c. A detailed discussion of the condition 

which requires use of the potentially 

impairing medication. 

d. A description of any known 

complications experienced by the mariner 

from the use of a particular medication, level 

of current stability and prognosis of the 

underlying condition. The physician should 

also provide his or her professional opinion 

on whether the condition is suitable for 

safety-sensitive work. 

e. A description of the dosage and 

frequency of use of the medication (this 

description should be very specific; ‘‘as 

needed’’ is not sufficient information). The 

description should also reflect that the 

physician has reviewed the mariner’s 

pharmacy records for documentation of the 

number of pills dispensed for use each 

month and documentation of the length of 

time that mariner has been on the 

medication. 

f. A detailed statement about whether the 

mariner is taking the medication as directed 

and if there are any concerns of misuse or 

overuse of the medication. 

g. A statement about whether the mariner 

is compliant with therapy and follow-up 

appointments. 

h. A statement about whether the mariner 

requires use of this medication while at 

work, or while aboard the vessel. If the 

mariner requires use of the potentially 

impairing medication while at work or while 

aboard the vessel, the physician should 

provide a detailed explanation and rationale 

for the use. 

i. A statement about whether the physician 

has advised the mariner of the risks of 

impairment related to the medication. The 

physician should also discuss any risks 

advised, as well as any instructions 

discussed with the mariner for mitigating 

risk. 

j. A statement about whether the mariner’s 

other medications, medical conditions, and 

work/sleep conditions might compound the 

impairing effects of this medication. This 

discussion should reflect that the physician 

has knowledge of the specifics of the 

mariner’s medications, medical conditions 

and work/sleep schedule. 

k. A statement about whether the physician 

has formally evaluated the mariner for the 

presence of any impairing medication effects. 

This discussion should include a description 

of the method of evaluation utilized, as well 

as the findings. 

l. A medical opinion of whether the 

mariner has any medication effects that 

would impede safe operation of a vessel or 

interfere with work in a safety sensitive 

position. This discussion should include the 

rationale for the physician’s opinion. 

m. A statement whether the physician has 

advised the mariner that it is safe to operate 

a vessel, operate hazardous machinery and 

perform safety sensitive functions while 

under the influence of this medication. 

(2) When requested, additional amplifying 

information, to include formal 

neuropsychological/neurocognitive 

evaluation. 

a. In particular, mariners seeking waivers 

to use or be under the influence of 

potentially impairing opioid/opiate, 

benzodiazepine, sedative hypnotic, and/or 

barbiturate medications, while acting under 

the authority of the credential, may be asked 

to submit the results of a formal 

neuropsychological/neurocognitive 

evaluation. 

b. When formal neuropsychologic or 

neurocognitive evaluation is requested, the 

assessment should include objective 

evaluation of the following functions, at a 

minimum: 2

i. Alertness, arousal and vigilance 

ii. Attention (focused, shifting and 

divided), processing speed,and working 

memory 

iii. Reaction time (choice and complex), 

psychomotor function, upper motor speed 

and coordination 

iv. Sensory perceptual function 

v. Executive function: Mental flexibility, 

adaptive problem solving, abstract reasoning, 

impulse control, risk taking/risk assessment, 

organizational ability (including visual 

spatial organization), and planning 

Authority 

Ths notice is issued under the 

authority of 5 U.S.C. 552(a) and 46 

U.S.C. 7101 et seq. 

Dated: January, 16, 2015. 

J.C. Burton, 

Captain, U.S. Coast Guard, Director of 

Inspections & Compliance. 

[FR Doc. 2015–01623 Filed 1–27–15; 8:45 am] 

BILLING CODE 9110–04–P 

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