President’s Corner March 2021
Stirring the Pot – So To Speak
Cannabis Laws: Cannabis (or marijuana) use in the United States has increasingly become legalized for recreational use, “medicinal” use or decriminalized in a majority of states and US territories. For those states where it remains illegal, several are considering a relaxation of the current laws. Yet cannabis possession and use remain prohibited per the Controlled Substances Act of 1970 of Federal law. Cannabis is classified as a Schedule 1 substance under the Food and Drug Administration (FDA) because it has reportedly no accepted medical use and high potential for abuse.
Pilots operate aircraft under the Federal Aviation Regulations and thus under Federal law. They are restricted from the use of marijuana and such use invalidates their medical qualification. Under Department of Transportation drug testing regulations, a positive test for the psychoactive component of cannabis, delta-9-tetrahydrocannabinol (THC), is grounds for revocation of both any pilot certificates and ratings held and the airman’s medical certificate. It is not an acceptable excuse to state that the presence of THC was a result of legal use in the state or unknowing ingestion.
Currently, 16 states, 2 territories and the District of Columbia have legalized recreational cannabis use for adults. There are 20 additional states and 2 territories that allow cannabis use for “medicinal” purposes. The remainder of states have laws prohibiting the possession and use or severely limit access to medical marijuana products. However, some of these states are slowly moving to decriminalization policies.
Medical Use of Cannabis: The FDA has approved the use of several cannabis products for very specific purposes such as chemotherapy-induced nausea and vomiting, wasting syndromes with AIDS and childhood seizures. However, in states that allow “Medicinal” use of marijuana, the majority of prescriptions are for much more common conditions and very easy to obtain. Although many anecdotal reports exist describing great benefits from cannabis in a broad variety of conditions, rigorous scientific published papers are scarce. This may because as a Schedule 1 drug, it is difficult to obtain funds and authorization to conduct such studies.
Addictive Potential: Cannabis includes over 200 substances. The primary psychoactive component is delta-9-THC. This gives a euphoric sensation when consumed or smoked. According to the California Society of Addiction Medicine, 9% of first-time users will develop a marijuana use disorder (addiction). The number rises to 17% if the first use was as an adolescent. These are similar figures to alcohol use. Other substances such as opioids, cocaine, methamphetamines and tobacco have significantly higher rates of addiction after a single-use.
THC not only has a euphoric effect but it can slow reflexes, mental processing speed, impair working memory and other safety essential abilities. It also has a risk for psychotic episodes during use and long after use, particularly in adolescents. Importantly, the concentration of THC in various products has increased significantly in recent years, magnifying the effects and the levels detectable in testing. More disturbingly, THC may be consumed unknowingly as much of the general population views this as harmless and may use it in various food products given to friends. Unknowing ingestion, as mentioned above, is not a legitimate excuse for a positive DOT test.
Testing Challenges: The presence of drugs in a urine specimen or blood test does not measure impairment, unlike alcohol where various levels present in blood and breath specimens correlate well with impairment. Because of various differences in metabolism, genetics, body fat and other factors, different people ingesting or inhaling a specific amount of a drug may have completely different results in their specimens. Some may even have undetectable levels while others may have notable positive results. The detection of a drug in a test specimen simply indicates that that drug was consumed, knowingly or unknowingly, by the individual in the past.
Canada legalized cannabis in October 2018 nationwide. Drug testing of pilots is not allowed under the Canadian laws as testing does not measure impairment on the job. As a result, Canadian transportation authorities implemented a policy prohibiting flight crews and controllers from consuming cannabis for at least 28 days before being on duty. It has been called the 28-day “Toke to Yoke” policy in aviation circles. In most cases, this waiting period should eliminate cannabis from the body in detectable amounts. In chronic heavy users, particularly those with high body fat, there may be residual detectable THC after this abstinence period.
Recommendations for Pilots:
- As cannabis is increasingly legal in many US states, the temptation to use it briefly may be increased. For a pilot subject to DOT testing, this casual use could be career-ending. Pilots should also be careful when consuming food from unknown sources where high concentrations may be present.
- CBD- Oils, creams, foods and other products labeled as a CBD product should contain less than 0.3% THC and thus should not produce a positive test. However, there is little oversight on CBD products and there are incentives for manufactures to have higher THC content to make the product more appealing to the user. Again, unknowing ingestion or absorption of THC is not an acceptable excuse for a positive drug test. Buyer Beware is prudent advice when purchasing CBD products.
- Passive inhalation of marijuana smoke has been demonstrated in many studies NOT to cause a positive drug test, so do not fear a casual exposure to marijuana smoke. In some public areas, it is almost impossible to avoid. Positive tests are the result of individual use rather than secondhand exposure.
- If in the future, the US removes cannabis from the Schedule 1 category or legalizes it completely, pilots should wait at least 28 days after consumption before performing safety-sensitive duties. Better advice yet is to avoid using it at all and enjoy safe flying.
Be well and fly safely,