Instrument No.78 of 1998
Determination
of
Statement of Principles
concerning
DRUG DEPENDENCE OR DRUG ABUSE
ICD-9-CM CODES: 304, 305.2 - 305.8
Veterans’ Entitlements Act 1986
1. This Statement of Principles is determined by the Repatriation Medical Authority under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (the Act).
Kind of injury, disease or death
2. (a) This Statement of Principles is about alcohol dependence or abusedrug dependence or drug abuse and death from drug dependence or drug abuse.
(b) For the purposes of this Statement of Principles,
“drug dependence” means the presence of a constellation of cognitive, behavioural and physiological symptoms indicating the use of a drug or drugs despite significant drug-related problems. The pattern of repeated self administration may result in tolerance, withdrawal and compulsive drug use behaviour.
The diagnostic criteria for drug dependence are those specified in DSM-IV, and are as follows:
A maladaptive pattern of drug use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:
(1) tolerance, as defined by either of the following:
(a) a need for markedly increased amounts of the drug to achieve intoxication or desired effect
(b) markedly diminished effect with continued use of the same amount of the drug
(2) withdrawal, as manifested by either of the following:
(a) the characteristic withdrawal syndrome for the drug
(b) the same (or closely related) drug is taken to relieve or avoid withdrawal symptoms
(3) the drug is often taken in larger amounts or over a longer period than was intended
(4) there is a persistent desire or unsuccessful efforts to cut down or control drug use
(5) a great deal of time is spent in activities necessary to obtain the drug, use the drug or recover from its effects
(6) important social, occupational or recreational activities are given up or reduced because of drug use
(7) drug use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the drug;
“drug abuse” means the presence of cognitive, behavioural or physiological symptoms indicating the use of a drug or drugs despite significant drug-related problems, however these symptoms have never met the criteria for drug dependence. Additionally, signs of tolerance or withdrawal are absent.
The diagnostic criteria for drug abuse are those specified in DSM-IV, and are as follows:
A. A maladaptive pattern of drug use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:
(1) recurrent drug use resulting in a failure to fulfil major role obligations at work, school, or home
(2) recurrent drug use in situations in which it is physically hazardous
(3) recurrent drug-related legal problems
(4) continued drug use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the drug
B. The symptoms have never met the criteria for drug dependence.
The definitions for drug dependence and drug abuse exclude acute drug intoxication in the absence of drug dependence or drug abuse.
Drug dependence or drug abuse attracts ICD-9-CM code 304 or an ICD-9-CM code in the range 305.2 to 305.8.
Basis for determining the factors
3. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that drug dependence or drug abuse and death from drug dependence or drug abuse can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces.
Factors that must be related to service
4. Subject to clause 6, at least one of the factors set out in clause 5 must be related to any relevant service rendered by the person.
Factors
5. The factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting drug dependence or drug abuse or death from drug dependence or drug abuse with the circumstances of a person’s relevant service are:
(a) suffering from a psychiatric disorder at the time of the clinical onset of drug dependence or drug abuse; or
(b) experiencing a severe stressor within the two years immediately before the clinical onset of drug dependence or drug abuse; or
(c) suffering from a medical, surgical or psychiatric condition for which a course of opioid, sedative, hypnotic, or anxiolytic medications was medically prescribed, at the time of the clinical onset of drug dependence or drug abuse; where the drug dependence or drug abuse involves one or more agents from the related pharmacological class of prescribed opioid, sedative, hypnotic, or anxiolytic medications; or
(d) suffering from a psychiatric disorder at the time of the clinical worsening of drug dependence or drug abuse; or
(e) experiencing a severe stressor within the two years immediately before the clinical worsening of drug dependence or drug abuse; or
(f) inability to obtain appropriate clinical management for drug dependence or drug abuse.
Factors that apply only to material contribution or aggravation
6. Paragraphs 5(d) to 5(f) apply only to material contribution to, or aggravation of, drug dependence or drug abuse where the person’s drug dependence or drug abuse was suffered or contracted before or during (but not arising out of) the person’s relevant service; paragraph 8(1)(e), 9(1)(e), 70(5)(d) or 70(5A)(d) of the Act refers.
Inclusion of Statements of Principles
7. In this Statement of Principles if a relevant factor applies and that factor includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles.
Other definitions
8. For the purposes of this Statement of Principles:
“death from drug dependence or drug abuse” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s drug dependence or drug abuse;
“drug” (as referred to in the definition of “drug dependence” or “drug abuse” and as derived from DSM-IV) means any of the following substances, alone or in combination:
(i) amphetamine and derivatives; or
(ii) cannabis and derivatives; or
(iii) cocaine and derivatives; or
(iv) hallucinogens; or
(v) hydrocarbon fume inhalation; or
(vi) opioids and their derivatives and synthetic opioids with morphine like effects; or
(vii) phencyclidine; or
(viii) sedatives, hypnotics and/or anxiolytics including barbiturates, nonbarbiturate sedatives and benzodiazepines, and tranquillisers with similar effect;
“DSM-IV” means the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders;
“experiencing a severe stressor” means, the person experienced, witnessed or was confronted with, an event or events that involved actual or threat of death or serious injury, or a threat to the person’s or other people’s physical integrity, which event or events might evoke intense fear, helplessness or horror.
In the setting of service in the Defence Forces, or other service where the Veterans’ Entitlements Act applies, events that qualify as severe stressors include:
(i) threat of serious injury or death; or
(ii) engagement with the enemy; or
(iii) witnessing casualties or participation in or observation of casualty clearance, atrocities or abusive violence;
“ICD-9-CM code” means a number assigned to a particular kind of injury or disease in the Australian Version of The International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM), effective date of 1 July 1996, copyrighted by the National Coding Centre, Faculty of Health Sciences, University of Sydney, NSW, and having ISBN 0 642 24447 2;
“medically prescribed” means prescribed by a registered medical practitioner;
“psychiatric disorder” means any Axis 1 or 2 disorder of mental health attracting a diagnosis under DSM IV;
“relevant service” means:
(a) operational service; or
(b) peacekeeping service; or
(c) hazardous service;
“terminal event” means the proximate or ultimate cause of death and includes:
a) pneumonia;
b) respiratory failure;
c) cardiac arrest;
d) circulatory failure; or
e) cessation of brain function.
Dated this First day of December 1998
The Common Seal of the )
Repatriation Medical Authority )
was affixed to this instrument )
in the presence of )
KEN DONALD
CHAIRMAN