The preliminary drug screening of the pilot-in-command of the Air India Phuket-Delhi flight that was involved in a sudden altitude-loss incident returned a “non-negative” result, after which the samples were sent for confirmatory testing and the results are awaited, the Ministry of Civil Aviation (MoCA) said on Sunday.The requirement of a confirmatory test suggests that the initial screening may have indicated the presence of a psychoactive substance in the sample. Confirmatory tests are required as certain foods and medications can throw up false positives in initial screenings. While the incident, which left 17 passengers and cabin crew members injured due to the sudden altitude loss of about 300 feet, is being investigated by the Aircraft Accident Investigation Bureau (AAIB), the initial non-negative drug test report has added another dimension to the probe. To be clear, the incident was initially attributed to severe turbulence, but sources now suggest that the Airbus A320 jet faced some snags with the aircraft’s hydraulic and control systems just before the incident, which will also be investigated by the AAIB.According to aviation safety regulator Directorate General of Civil Aviation (DGCA), the global spread of drug-abuse, the increase in general availability of psychoactive substances in different parts of the world, and the increasing number of addicted users is a serious concern to aviation safety. Their use causes behavioural, cognitive, and physiological changes, which could result in substance-dependence, major health-related issues and a negative effect on performance.Over four years ago, the DGCA established and implemented a stringent protocol for flight crew members — pilots — and other segments of the aviation workforce who test positive for psychoactive substances. These rules are designed to mitigate the safety risks in aviation. The implications in case of a confirmed case of psychoactive substance abuse can range from mandatory rehabilitation — for the first offence — to licence cancellation in the case of repeated instances of use of banned substances.Rules governing testing for drug consumption in aviationThe DGCA’s Civil Aviation Requirement (CAR) on testing aviation personnel for drug consumption was released in September 2021 and took effect on January 31, 2022. While pilots and air traffic controllers are seen as the primary focus segments of these rules, they also extend to the broader range of aviation personnel engaged in safety-sensitive functions, like aircraft maintenance engineers and certifying staff, trainee pilots, and instructors and examiners. Story continues below this adFlight crew and air traffic controllers are the only groups where a 10% annual random test is strictly mandated, while other groups are required to be tested at the time of hiring or after specific incidents. Apart from the routine random testing, these tests are also usually done after a safety-related incident, as is the case with the Air India Phuket-Delhi flight of August 4.Also Read | Mid-flight turbulence could get worse with climate change. Here’s what passengers need to knowAirlines and other organisations like flying schools, maintenance and repair organisations and air navigation services providers are also encouraged to extend the random testing to other segments of their workforce.The DGCA rules state that urine samples of the employees are to be tested for the presence of the six categories of psychoactive substances — amphetamine and amphetamine-type stimulants, opiates and metabolites, cannabis as tetrahydrocannabinol, cocaine, barbiturates and benzodiazepine.The testing protocolThe urine sample of the pilot, or any other employee covered under the rules, on whom the test is being conducted is to be split and stored in two separate containers. The testing process begins with a screening test on the sample in the first container, which is done immediately after the sample is collected. If this initial test is ‘non-negative’, which means it is indicative of the presence of psychoactive substances, the pilot is immediately taken off flying duty, pending the results of a confirmatory test.Story continues below this adThe sample in the second container is then sent for the confirmatory test at a designated laboratory using high-complexity instrumentation, involving using either gas chromatography/mass spectrometry (GC/MS) or liquid chromatography-mass spectrometry (LC-MS). “In case sample A is non-negative, then sample B with signatures of the sample collector, employee (donor) and medical personnel of the concerned Organization shall be forwarded to the appropriate laboratory for Confirmatory Test,” the CAR says.Also Read | 2 new CEOs, 2 very different challenges at IndiGo and Air IndiaIn case the confirmatory test is found positive, the medical in-charge of the concerned organisation is required to consult a medical review officer (MRO) to determine if the positive result was due to a legitimate therapeutic treatment or some other innocuous source, and not drug abuse. For instance, pain relief medication containing codeine may trigger a positive result for opiates. The MRO is defined as a doctor who has successfully completed a recognised MRO certification course, possesses knowledge and experience in psychoactive substance abuse disorders, and is responsible for reviewing and evaluating laboratory results of psychoactive substance testing programmes.According to an advisory issued by pilot body Airline Pilots’ Association of India (ALPA India), pilots should not self-medicate as common cold, cough, allergy, and sleep-aid formulations sold across pharmacies in India may contain ingredients from the six tested classes. It also urged pilots to consult the medical in-charge of their organisations before starting any new medication, declare all medications truthfully, and retain prescriptions and pharmacy receipts in case an MRO review is triggered after testing.Story continues below this ad“ALPA India reminds all members that several widely available, commonly used OTC (over-the-counter) medications in India contain active ingredients that can trigger a non‐negative screening result under the six substance classes tested…A screening non-negative is not proof of drug use — para 8.1 of the CAR requires immediate stand-down pending confirmatory GC-MS/LC-MS testing — but it nonetheless triggers removal from duty, stress, and reputational risk that is entirely avoidable,” the association said in its advisory issued on Monday.What happens if the positive result is confirmed as a case of drug use?If the MRO confirms the result is a positive case of drug use, there is an escalation ladder of disciplinary actions that comes into the picture. If it is the first occasion of a positive drug test, the employee is referred by his or her organisation to a specialist doctor, counsellor, or de-addiction centre for a rehabilitation program, in consultation with the MRO. To return to active duty, the employee must undergo new testing, receive a negative report, and obtain a fitness certificate from the organisation’s medical in-charge.If the employee who returned to duty after a first offence is found positive again, his or her licence is suspended for three years. A third positive test result leads to the cancellation of the person’s license.Story continues below this adThe DGCA treats a refusal to undergo testing with similar severity to a positive result. Upon the initial refusal, the employee is removed from duty and must clear a drug test within 48 hours. On failure to do so, the license is suspended for one year, and the employee must undergo rehabilitation before returning to the active duties.“In case a person refuses for the test on the second occasion or is tested positive after the first occasion of refusal for testing, the license shall be suspended for a period of three years and any subsequent violation shall lead to the cancellation of license,” the rules say.