Chapter 8: Drug Abuse or Drug Addiction
A. Drug Abuse or Drug Addiction
Applicants who are found to be drug abusers or addicts are inadmissible.  See INA 212(a)(1)(A)(iv). Drug abuse and drug addiction are defined as the non-medical use of a controlled substance listed in Section 202 of the Controlled Substance Act.
In 2010, CDC changed the Technical Instructions on how a civil surgeon determines whether an applicant is a drug abuser or drug addict.  See CDC’s Technical Instructions for Physical or Mental Disorders with Associated Harmful Behaviors and Substance-Related Disorders, available at http://www.cdc.gov/immigrantrefugeehealth/exams/ti/civil/mental-civil-technical-instructions.html. The civil surgeon must now make this determination according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) as specified in the Technical Instructions.  The DSM is a publication of the American Psychiatric Association. Considerations that were relevant under previous Technical Instructions, such as a pattern of abuse or a history of experimental use of drugs, no longer play a direct role in the admissibility determination; they are now only considered as one of the elements under the DSM assessment. The assessment under the DSM is complicated. For more information, please see the Technical Instructions.
If the applicant is classified as a drug abuser or addict, the applicant can apply again for an immigration benefit if his or her drug abuse or addiction is in remission. Remission is now defined by DSM criteria, and no longer by a set timeframe as it was under previous Technical Instructions.  Under the pre-2010 Technical Instructions, an applicant’s substance abuse or addiction was in remission if the applicant had not engaged in non-medical use of a controlled substance within the past three years, or non-medical use of a non-controlled substance within the past two years. In order for an applicant’s drug abuse or addiction to be classified as in remission, the applicant must return to a civil surgeon for a new assessment.
If the officer has reason to question the completeness or accuracy of the medical examination report, the officer should ask CDC to review the medical report before sending a Request for Evidence (RFE).
Most applicants who are found to be drug abusers or addicts are ineligible for a waiver; the availability depends, however, on the immigration benefit the applicant seeks.  See Volume 9, Waivers, Part C, Waivers for Health-Related Grounds of Inadmissibility [9 USCIS-PM C] for more on waivers.
B. Part of Form I-693 Addressing Drug Abuse or Drug Addiction
The civil surgeon must check the appropriate findings box on the medical examination report. The civil surgeon should also either annotate the findings in the remarks section or attach a report, if the space provided is not sufficient. However, the officer should not RFE simply because the civil surgeon has omitted the remarks or failed to attach a report.
C. Request for CDC Advisory Opinion
If an officer has a case where there is a question concerning the diagnosis and/or classification made by the civil surgeon or panel physician, the officer may forward the pertinent documents to CDC and request an advisory opinion.
The request should include a cover letter indicating the request and reason(s) for the request.
The request should include the following documents:
A copy of the medical examination documentation (Form I-693 or Form DS-2053/DS-2054, and its related worksheets);
A copy of the provided medical report(s) detailing the medical condition for which the advisory opinion is being requested; and
Copies of all other relevant medical reports, laboratory results, and evaluations connected to the medical condition.
The documents should be mailed to the following address:
Centers for Disease Control and Prevention
Division of Global Migration and Quarantine
1600 Clifton Road, Mailstop E 03
Atlanta, GA 30333
Attention: Quality Assessment Program (QAP)/Advisory Opinion
If the officer determines that a waiver case warrants expeditious review by CDC, the case may be faxed to (404) 639-4441 or emailed to firstname.lastname@example.org, Attention: Quality Assessment Program (QAP)/Advisory Opinion, Urgent. If sent via email, the documents should be sent in password protected file(s). If sent via fax, the fax cover sheet should request that the case be reviewed expeditiously and that CDC’s response be sent via fax. The officer should also email CDC a email@example.com, advising that an expedited request was sent via fax.
Once the documents are received by CDC, the documents are reviewed and CDC will forward a response letter with results of the review to the requesting USCIS office. Only CDC’s response is provided to the requesting USCIS office.
CDC’s usual processing time for review and response back to the requesting USCIS office is approximately 4 weeks.
Upon receipt, the officer should review CDC’s response letter to determine next steps.