Older pilots are more likely than their younger counterparts to be honest in their reporting to the U.S. Federal Aviation Administration (FAA) on the medications they use, according to a study by researchers from the FAA’s Civil Aerospace Medical Institute (CAMI).1
In addition, the study, which compared the medications found in post-accident toxicology tests with those that had been reported by the pilots in previous applications for FAA medical certificates, found that holders of special issuance (SI) medical certificates2 also were more likely to be truthful in reporting their medication use.
“[T]he probability of a pilot truthfully reporting medication use increases with age and an SI medical certificate,” the authors said in a report on the study, published in the July issue of Aerospace Medicine and Human Performance. In cases involving only cardiovascular drugs, age was the sole reliable predictor of truthful reporting, the report said.
Analysis of their findings determined that “for every additional year of age, the probability of a case being truthfully reported increased by 5 percent,” the report said, adding that calculations also indicated that a pilot with an SI “would be 3.12 times more likely to be truthful than a pilot without an SI.”
Considering only cardiovascular medications, “the odds of a case being truthful increases by 3 percent,” the report said.
“There are reasons to suggest why pilots with a SI tend to be more truthful when reporting medications than pilots without a SI,” the report said.
“Pilots who are more forthcoming about their health are more likely to come to the attention of the FAA when they report medical conditions and associated medications on their application for a medical certificate, resulting in the assignment of an SI to begin with,” the document added. “Once they have been granted an SI, the knowledge that details of their condition and treatment are routinely reported to the FAA provides an incentive to be truthful.”
The report said that the increase in truthfulness by older pilots might have to do with the fact that older pilots are more likely to have an SI, “due to the strong correlation of disqualifying medical conditions with age.”
Signs of Increased Drug Use
The report noted that previous studies have found that drugs of all categories are increasingly present in the bodies of pilots who have been involved in fatal accidents.
“Although mandatory testing in the transportation industry … is currently limited to opiates, marijuana, amphetamines, cocaine and phencyclidine, the increasing use of over-the-counter (OTC), prescription and illicit drugs in the U.S. population has raised concern about the possible safety implications of drug use in aviation, especially in air transport operations,” the report said.
FAA regulations prohibit the piloting of an aircraft by any person “while using any drug that affects the person’s faculties in any way contrary to safety.”
These drugs have the potential to “significantly impair alertness, judgment, reaction time and behavior, all of which could impair the ability to safely operate an aircraft and increase the likelihood of an accident,” the report said, singling out sedating antihistamines in general and those containing diphenhydramine3 in particular.
The report noted that, although the FAA does not specify which medications are prohibited and which are acceptable for use by pilots, the agency’s Guide for Aviation Medical Examiners (AMEs) includes a “do not use−do not fly” list. Most of the drugs named on the list can cause drowsiness.
The report noted previous research indicating that pilots do not report all of their medications to the FAA, including a 2012 study that compared their reported medications with those found in postmortem analyses and found that only 8 percent of pilots had accurately reported their medications to the FAA.
In a 2006 study, researchers found that of 223 pilots with post-accident findings that were positive for psychotropic drugs, 14 had reported to the FAA that they had a psychological condition and only one had reported using the psychotropic medication. That study also found that of 69 pilots who reported a cardiovascular disease, 29 reported using the cardiovascular medication that was identified in post-accident tests, and that of 15 pilots with positive post-accident testing for neurological medications, only one reported having a neurological condition and none reported using an associated neurological medication.
In this new study, researchers used CAMI data to compare the medications found in post-accident testing of pilots involved in fatal accidents from 2009 through 2014 with the medications that the pilots had reported to the FAA on their applications for medical certification.
Researchers examined all drug record findings associated with pilot fatalities but paid particular attention to medications used in treating cardiovascular, psychological or neurological conditions because “they are serious conditions and they have the potential to rapidly incapacitate a pilot in flight,” the report said.
“Further, medications used to treat such conditions are normally not started, discontinued or changed without good documentation,” the report said. “By comparison, drugs used to treat less serious medical conditions are often started, discontinued or replaced with other medications with little or no documentation, which can result in a clinically insignificant difference between reported medications and those found at the time of postmortem toxicological testing.”
The study did not examine use of alcohol or illegal drugs ─ items typically not reported to the FAA.
1,485 Pilots Killed
Data showed that 911,896 pilots obtained FAA medical certificates between 2009 and 2014 and that during that time, 1,485 pilots were killed in a total of 1,213 accidents. Most of the accidents (1,111) involved general aviation aircraft, but the study also included 39 air taxi accidents, 34 agricultural operations accidents, seven external load-helicopter accidents, three flight training accidents, three air carrier accidents and 16 accidents in which the type of operation was unspecified.
Of the 1,485 pilots who were killed in crashes, postmortem toxicology tests were performed on 1,377 (92.7 percent). The average age of these 1,377 pilots was 54.2 years. Nearly 97 percent were men.
Of the 1,377 pilots, 13.1 percent held first class medical certificates, 30 percent held second class certificates, and 54.2 percent held third class certificates. Of these, 7.9 percent were SI medical certificates. In addition to those holding valid medical certificates, 1.8 percent had been denied certification, and 0.9 percent were deferred ─ that is, the applications were still being reviewed.
Diphenhydramine was detected in 7.8 percent of the pilots, more frequently than any other medication, the report said; none of the pilots had told the FAA they were taking the drug.
Diphenhydramine is a sedating medication and one of the substances that the FAA considers “do not fly” medications; the report noted that the FAA guide for AMEs says pilots should wait 60 hours after taking diphenhydramine before they fly. Because the drug is sold over the counter and because it is used to treat a variety of symptoms, the report said that “it is understandable that it was frequently identified in postmortem toxicology but its use was not reported to the FAA.”
Conversely, aspirin was the most frequently reported medication ─ reported by 7.3 percent of the pilots but detected in the toxicology tests of only 3.5 percent.
The report said aspirin might have been frequently reported because the FAA places no restrictions on its use, and it might have been infrequently detected because it is eliminated from the body quickly and sometimes goes undetected in post-accident testing.
Other frequently detected medications were acetaminophen, detected in 5.7 pilots and reported to the FAA by 0.4 percent; ibuprofen, detected in 5 percent and reported by 1.2 percent; amlodipine, a blood pressure medication, detected in 3.5 percent and reported by 3.3 percent; and metoprolol, another blood pressure medication, detected in 3.5 percent and reported by 2.5 percent.
The two blood pressure medications were reported and detected in nearly equal numbers, probably because high blood pressure is a common condition that, when controlled, does not preclude issuance of a medical certificate, the report said.
That same reason presumably factors in pilots’ reporting of their use of the medication, the report said, noting that the study’s review found that 66 percent of pilots whose records were studied had reported their cardiovascular medications. Cardiovascular conditions only rarely prevent pilots from receiving medical certification, although in some cases, they receive an SI.
In comparison, 4 percent of accident pilots who took psychological medications and none of those who took neurological medications shared that information with the FAA, the report said.
The FAA began allowing pilots with mild to moderate depression to obtain an SI medical certificate if their depression is treated with one of four approved antidepressants.
“Pilots with more than moderate depression or those treated with unapproved antidepressants could be inclined not to report their medical condition or their medication use to the FAA since this might result in a denial of their application for medical certification,” the report said. “Likewise, pilots with a seizure disorder would likely not report their medical condition or their medication use since they would also not be eligible for a medical certificate.”
That reluctance may extend to pilots with Parkinson’s disease or other neurological conditions, who need an SI medical certificate to fly and who must use FAA-approved medications, the report said.
- DeJohn, Charles A.; Greenhaw, Richard; Lewis, Russell; Cliburn, Kacey. “Drug Use Reported by U.S. Pilots, 2009−2014.” Aerospace Medicine and Human Performance, Volume 91 (July 2020): 586−591.
- A special issuance medical certificate typically requires a pilot to produce more detailed medical information intended to demonstrate that he or she is capable of flying an aircraft despite an inability to meet a specific FAA medical requirement.
- Diphenhydramine is used to treat allergic symptoms such as nasal congestion, a runny nose and itching eyes. Side effects include dizziness and drowsiness, and, because of these side effects, the FAA and most other civil aviation authorities prohibit pilots from flying while using these medications.