FAR 91.17 prohibits flying after the use of “any drug that affects the person’s faculties in any way contrary to safety.” Yet every year pilots crash, killing themselves and their passengers, often because the pilot is chemically compromised by over the counter medications.
That’s the big message from a recent study by the National Transportation Safety Board on the use of drugs in the pilot population and how it contributes to accidents. The study concluded that drug use of all types, including prescription medications, is on the rise and, therefore, the risk of impairment from drugs is also increasing.
The study analyzed toxicology results for 6,677 pilots who died in aircraft accidents between 1990 to 2012.
Over the 22 years studied, the proportion of pilots testing positive for drugs with impairment potential nearly doubled from about 11% to almost 23%, according to NTSB officials.
Illicit drug use was relatively uncommon, increasing from 2.4% of pilots who died in accidents in the 1990s to around 4% by 2012, largely due to increasing marijuana use.
“I think that the key take-away from this study for every pilot is to think twice about the medications you’re taking and how they might affect your flying,” said NTSB Acting Chairman Christopher A. Hart. “Many over-the-counter and prescription drugs have the potential to impair performance, so pilots must be vigilant to ensure that their abilities are in no way compromised before taking to the skies.”
Whenever there is a fatal accident, blood samples from the pilot undergo toxicological screening by the FAA’s Civil Aerospace Medical Institute in Oklahoma City.
This study looked at the results of those screenings, according to one of the study’s authors, Dr. Loren Groff.
“We found that over a 22-year-period there was a signifiant increase in the finding of all sorts of drugs, from acetaminophen and Tylenol all the way up to the illicit drugs,” he said.
“The study indicates a significant problem” with the OTC drug diphenhydramine, according to Dr. Mary Pat McKay, who also authored the study.
The FAA has been aware of the dangers of OTC medications for years, said McKay.
“The FAA’s Civil Aerospace Medical Institute regularly reports in its academic literature as to what they are finding, but whether or not the information is getting to the pilot population is hard to know. There are brochures available on the topic and there is information on the FAA’s website for both pilots and Aviation Medical Examiners.”
The FAA website is a wealth of information on OTC and prescription drugs. Among the information is the warning that “any drug that produces drowsiness or other central nervous system effects should not be taken prior to or during flight. Some of the most commonly used OTC drugs, antihistamines and decongestants, have the potential to cause some of the most noticeable adverse side effects — sedation and drowsiness. The symptoms associated with common upper respiratory infections, including the common cold, will often suppress a pilot’s desire to fly, and treating symptoms with a drug that causes side effects only compounds the problem.”
The FAA does not allow pilots to take narcotic analgesics, stimulants, sedatives, hypnotics, amphetamines, barbiturates, anti-anxiety drugs, muscle relaxants, tranquilizers, and antipsychotics. Pilots also are prohibited from taking experimental or investigational drugs, those that are in clinical trials or that have limited approval by the U.S. Food and Drug Administration
FAR 61.53 places the burden on the pilot to determine fitness to fly and, judging by the results of the NTSB study, many pilots elect to fly when they are chemically compromised, according to Groff and McKay.
The two researchers suggest that sometimes pilots do not read labels of follow dosing instructions. Also, a pilot may not realize how the OTC drugs are impacting their abilities because they don’t know how long the active chemical ingredients stay in their systems.
The Aircraft Owners and Pilots Association has attempted to educate pilots about drug use by publishing a webpage that lists common medications — both prescription and over the counter — along with a waiting periods similar to “eight hours bottle to throttle.” Benadryl, for example, one of the more common OTC medications for allergies, carries the warning “60 hour wait after last dosage” on the AOPA page.
The NTSB study also noted that the age of the pilot is a key factor in the types of drugs ingested, especially when it comes to prescription drugs.
“There was a linear relationship between the age of the pilots and the prevalence of drugs in their system. The older pilots had more positive findings for drugs,” said Groff.
“The study found that there was an increase in the use of drugs to address cardio vascular and cholesterol issues, things that go along with aging, in the older pilots,” said McKay. “The use of illicit drugs tended to be the younger pilots.”
The NTSB study is getting mixed reviews from the aviation committee. The Experimental Aircraft Association queried how the study might affect the movement for third-class medical reform. The National Business Aviation Association pointed out that the study of drug use in the pilot population focused on general aviation, which is not held to the strict drug testing mandated for Part 135 and Part 121 operators. AOPA called the study incomplete and inconclusive.
Groff responds that the study is an indication that the FAA “needs to do additional research in the relationship between drugs and impairment.”
The NTSB made several recommendations to the FAA as a result of the study:
- Develop educational information for pilots about potentially impairing drugs, and make pilots aware of less impairing alternatives if they are available;
- gather more information about the flying activity of pilots not subject to medical certification;
- study the prevalence of drug use among pilots who are not involved in accidents; and
- develop and distribute a clear policy regarding any marijuana use by pilots regardless of the type of flight operations.
Both Groff and McKay predict that the use of marijuana in the pilot population will likely come under more scrutiny ― just as it has in the general population because marijuana is now legal in several states.
“Marijuana use is really a complex issue,” said McKay, “in part because it is hard to determine if the pilot is impaired because the drugs can stay in the pilot’s system for weeks. There are a number of folks doing research right now to determine what accident risks there might be.”
Groff noted any regulations created as a result of the study will come from the FAA. “That is why the Civil Aerospace Medical Institute is there, to set the standards,” he said.
“Pilots have to self-assess before every flight,” said McKay. “And if you feel so unwell you need to take a cold or allergy medication, you are probably too unwell to fly your airplane as well. The bottom line is safety has to come first.”