President’s Corner 2Q17 “Will Your Medications Kill You?”

The FAA Monthly safety topic for General Aviation in July 2017 was “Pilots and Medication” https://www.faa.gov/news/safety_briefing/2017/media/SE_Topic_17_07.pdf . It points out that a study by the FAA’s Civil Aviation Medical Institute Toxicology Lab found that 42% of pilots in fatal aviation mishaps had medication found on autopsy. The Safety Topic points out that there are two major areas of concern.

First is potential adverse effects on judgment and decision making from the medications. The second area of concern is: what is the effect of the underlying condition on safe operations of an aircraft? The NTSB published a study in 2014 also looking at fatal accidents and found a steady increase in the rate of impairing medications, illicit drugs and potentially impairing conditions in pilots. Most recently, 40% of pilots in fatal accidents fell into one of these categories. Some pilots not in these categories were using medications for conditions that neither was potentially incapacitating. The study did not include alcohol found in autopsies.

I have written previously about the opioid epidemic in the US, the role of alcohol and other impairing substance and the role of depression and other psychological stressors in aviation decision making. They are all common factors, but even more common are the use of prescribed and over-the-counter medications and temporary medical conditions. A few examples will be helpful.
Many pilots will occasionally be affected by back pain. The pain itself may or may not limit the pilot’s ability to perform all routine and emergency flight duties. Turbulence can exacerbate back pain and sciatica could hinder pushing on a rudder pedal due to nerve impingement and muscle weakness. Many medications for back pain are disqualifying for a period of time. Besides the obvious adverse impact of narcotic medications, muscle spasm relievers may disqualify a pilot for up to 8 days following the last dose. Steroid injections are disqualifying for at least 24 hours and use of Valium may be disqualifying for 2 weeks after the last dose. Non-steroidal medications and acetaminophen are allowed if the underlying back pain does not hamper safe operations.

Another frequent situation is a cold or allergies causing nasal and sinus congestion. Any pilot who has experienced an ear or sinus block will not forget the incapacitating pain on descent from altitude. Medications to alleviate symptoms may also be disqualifying. Many OTC medications to treat allergies and colds contain an antihistamine, commonly diphenhydramine. This is also found in many “night-time” formulas to help users sleep. The FAA considers use of this medication disqualifying for 60 hours after last use because of its prolonged sedating properties. The OTC medications Allegra and Claritin are allowed by the FAA for allergies as are inhaled nasal steroids, after a ground test period that shows no adverse side effects. Decongesting nasal sprays are grounding for 24 hours after use.

In general, the FAA requires 5 dosing intervals after use of a potentially sedating medication before returning to fly. This means if the medication is used one every six hours, the pilot must wait 30 hours 5 times 6 hours) before flying. This assumes the underlying condition has improved enough to safely operate and aircraft.

To obtain further information on FAA medication policy and flying, the FAA Guide to Aviation medical Examiners has some limited information and mentions a few specific medications and wait times. The FAA also has a “Medications – Do Not Issue – Do Not Fly” list in the AME Guide and linked to in the above safety brief.

Aviation Medicine Advisory service maintains a listing of over 750 medications with the FAA policy on flying and required wait times after use on our web site. Search the link on the top right of our web site at https://www.aviationmedicine.com/medication-database/ . It is updated regularly as obtain new information on FAA policies and medications. Of course, the underlying condition eh medication is being used for is equally important in making a safe “Go – No Go” decision to fly. The FAA emphasizes the Aeronautical Decision Making guide (PAVE) to include “Pilot” and references the AIM Chapter 8 for the “I’M SAFE” preflight personal checklist. AMAS physicians are always available to answer your questions regarding you medical conditions, medications and FAA policy.

Fly Safely, Stay healthy,
Quay Snyder