"4 Safety Issues
4.1 StudyFindings
This study identified the following findings:
 The percentage of study pilots with positive toxicology findings for all drugs, including potentially impairing drugs, drugs used to treat potentially impairing conditions, and controlled substances increased from just less than 10% of study pilots in 1990 to 40% in 2011.
 The percentages of study pilots with positive toxicology findings for multiple drugs, multiple potentially impairing drugs, and multiple controlled substances also increased during the study period.
 The patterns of increasing prevalence of drug use and use of multiple drugs identified in study pilots’ toxicology test results are consistent with observed trends of increasing drug use by the US population in general.
 Sedating antihistamines were the most commonly identified drug category in toxicology test results of study pilots.
 Diphenhydramine (an active ingredient in Benadryl and Unisom products) was the most commonly identified sedating antihistamine and the most commonly identified potentially impairing drug in this study.
 The percentage of study pilots testing positive for marijuana use increased over the study period, primarily in the last decade.
 The distribution of accident event types has been generally similar for study pilots with and without evidence of recent use of potentially impairing drugs.
 Study pilots who did not have a medical certificate or whose medical certificate had expired were more likely to have positive toxicology findings for all drugs, potentially impairing drugs, drugs used to treat potentially impairing conditions, controlled substances, and illicit drugs.
 The percentage of study pilots without a current medical certificate has been increasing since 2005, and the available pilot demographic data suggest that the increasing trend of pilots flying without medical certificates will continue.
5 Conclusions
1. Findings of increasing drug use and increasing use of multiple drugs by fatally injured study pilots are indicative of similar trends in drug use by the US pilot population in general.
2. The overall risk of drug-related pilot impairment is increasing due to the growing use of potentially impairing drugs.
3. An increasing number of pilots are flying without a medical certificate and will likely make decisions about their medical fitness to fly, including use of drugs while flying, without periodic interaction with an Aviation Medical Examiner.
4. The Federal Aviation Administration does not provide pilots with adequate information to make informed decisions about which drugs are safe or unsafe to use while flying.
5. Federal Aviation Administration medical certification requirements and US Department of Transportation mandatory drug and alcohol testing requirements for safety-sensitive aviation personnel have been associated with fewer toxicological findings of impairing drugs and conditions among accident pilots subject to those requirements.
6. Although this study found an association between fatally injured pilots flying without a medical certificate and increased evidence of such pilots using drugs with impairing effects, there has not been a corresponding increase in the proportion of accidents in which the National Transportation Safety Board determined that impairment contributed to the accident.
7. The accident risk for pilots flying without a medical certificate cannot be accurately determined because the Federal Aviation Administration does not collect information about the number of these pilots or their flight activity.
8. States’ guidelines for health care providers regarding prescribing controlled substances for pain provide an opportunity to highlight the importance of discussing risks in all transportation modes when prescribing these medications.
9. Current written and oral communications are not effectively informing patients about the risks their medical conditions and drug use may pose when operating a vehicle in any mode of transportation.
10. There is a gap in the Federal Aviation Administration’s policies regarding marijuana that may lead to confusion about the agency’s position on marijuana use by pilots not subject to mandatory US Department of Transportation drug and alcohol testing requirements.
11. Additional research is required to assess the complex relationship between pilots’ use of drugs and associated accident risk."
"Methamphetamine is a Schedule II, legally available but infrequently prescribed drug marketed under the brand name Desoxyn and used to treat obesity and attention deficit hyperactivity syndrome. This study differentiated licit versus illicit methamphetamine based on the fact that the methamphetamine molecule can be turned to the left or the right (left and right stereoisomers). Because the main form of legally available methamphetamine contains only the right hand form (the dextro-isomer) of the drug and no cases were found that included only that molecule, all of the cases involving both forms of methamphetamine were considered illicit for this study. However, the left hand form of methamphetamine is available topically in an OTC product intended to treat nasal congestion (Vick’s Vapor Inhaler). In two cases in this study, L-methamphetamine was found only in small amounts without association with other forms of methamphetamine. In these two cases, the finding was classified in the “nonsedating over-the-counter” category rather than the illicit category."
http://www.ntsb.gov/safety/safety-studies/Documents/SS1401.pdf
