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Drug Use Trends in Aviation: Assessing the Risk of Pilot Impairment

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Drug Use Trends in Aviation: Assessing the Risk of Pilot Impairment Drug Use Trends in Aviation: Assessing the Risk of Pilot Impairment Safety Study NTSB/SS-14/01 National PB2014-108827 Transportation Safety Board NTSB/SS-14/01 PB2014-108827 Notation 8565A Adopted September 9, 2014 Safety Study Drug Use Trends in Aviation: Assessing the Risk of Pilot Impairment National Transportation Safety Board 490 L’Enfant Plaza, S.W. Washington, D.C. 20594 National Transportation Safety Board. 2014. Drug Use Trends in Aviation: Assessing the Risk of Pilot Impairment. Safety Study NTSB/SS-14/01. Washington, DC. Abstract: This safety study examined trends in the prevalence of over-the-counter, prescription, and illicit drugs identified by toxicology testing of fatally injured pilots between 1990 and 2012. Safety issue areas identified during the study include (1) enhancing the precautionary information about potentially impairing drugs and conditions provided to pilots; (2) improving information about active pilots without medical certificates; (3) enhancing communication among prescribers, pharmacists, and patients about the transportation safety risks associated with some drugs and medical conditions; (4) developing and publicizing additional Federal Aviation Administration policy regarding marijuana use; and (5) researching the relationship between drug use and accident risk. As a result of this safety study, the National Transportation Safety Board makes recommendations to the Federal Aviation Administration and the 50 states, the District of Columbia, and the Commonwealth of Puerto Rico. The National Transportation Safety Board (NTSB) is an independent federal agency dedicated to promoting aviation, railroad, highway, marine, and pipeline safety. Established in 1967, the agency is mandated by Congress through the Independent Safety Board Act of 1974 to investigate transportation accidents, determine the probable causes of the accidents, issue safety recommendations, study transportation safety issues, and evaluate the safety effectiveness of government agencies involved in transportation. The NTSB makes public its actions and decisions through accident reports, safety studies, special investigation reports, safety recommendations, and statistical reviews. The NTSB does not assign fault or blame for an accident or incident; rather, as specified by NTSB regulation, “accident/incident investigations are fact-finding proceedings with no formal issues and no adverse parties … and are not conducted for the purpose of determining the rights or liabilities of any person.” 49 C.F.R. § 831.4. Assignment of fault or legal liability is not relevant to the NTSB’s statutory mission to improve transportation safety by investigating accidents and incidents and issuing safety recommendations. In addition, statutory language prohibits the admission into evidence or use of any part of an NTSB report related to an accident in a civil action for damages resulting from a matter mentioned in the report. 49 U.S.C. § 1154(b). For more detailed background information on this report, visit http://www.ntsb.gov/investigations/dms.html and search for NTSB accident ID DCA14SS003. Recent publications are available in their entirety on the Internet at http://www.ntsb.gov. Other information about available publications also may be obtained from the website or by contacting: National Transportation Safety Board Records Management Division, CIO-40 490 L’Enfant Plaza, SW Washington, DC 20594 (800) 877-6799 or (202) 314-6551 NTSB publications may be purchased from the National Technical Information Service. To purchase this publication, order product number PB2014-108827 from: National Technical Information Service 5301 Shawnee Rd. Alexandria, VA 22312 (800) 553-6847 or (703) 605-6000 http://www.ntis.gov/ NTSB Safety Study Contents Figures .............................................................................................................................................v Table .............................................................................................................................................. vi Acronyms and Abbreviations .................................................................................................... vii Executive Summary ................................................................................................................... viii 1 Introduction ..............................................................................................................................1 1.1 Study Goals ..............................................................................................................................1 1.2 Pilot Drug Use ..........................................................................................................................1 1.3 Drugs and the Risk of a Transportation Accident ....................................................................2 1.4 Drug Categories and Definitions ..............................................................................................2 1.5 Societal Trends in Drug Use ....................................................................................................3 1.6 DOT and FAA Efforts to Reduce Accidents Due to Impairment ............................................4 1.6.1 Pilot Medical Requirements ...........................................................................................4 1.6.2 Information for Pilots and AMEs ..................................................................................6 1.6.3 Federal Drug Testing Rules in Transportation...............................................................6 1.7 NTSB Research and Efforts to Reduce Transportation Accidents Due to Impairment ...........7 2 Methodology .............................................................................................................................8 2.1 Toxicology Data .......................................................................................................................8 2.2 Accident Data ...........................................................................................................................8 2.3 Study Dataset and Special Considerations ...............................................................................8 2.3.1 Drugs and Metabolites ...................................................................................................9 2.3.2 Specimen Types .............................................................................................................9 2.3.3 Ethanol and Its Production in the Body After Death .....................................................9 2.3.4 Postaccident Medical Treatment ..................................................................................10 2.4 Drug Categorization ...............................................................................................................10 3 Results .....................................................................................................................................13 3.1 Interpreting Results ................................................................................................................13 3.2 Study Pilots .............................................................................................................................13 3.3 Drug Prevalence .....................................................................................................................16 3.4 Drug Categories ......................................................................................................................17 3.5 Potentially Impairing Drugs and Conditions ..........................................................................20 3.6 Accident Characteristics .........................................................................................................21 3.7 Pilot Characteristics ................................................................................................................23 3.8 Medical Certification ..............................................................................................................26 4 Safety Issues ............................................................................................................................29 4.1 Study Findings ........................................................................................................................29 4.2 Safety Issue Areas ..................................................................................................................29 iii NTSB Safety Study 4.2.1 Providing Pilots More Information about Potentially Impairing Drugs ......................30 4.2.2 Assessing the Safety of Pilots Without Medical Certificates ......................................33 4.2.3 Guidelines for Prescribing Controlled Substances for Pain .........................................35 4.2.4 Communicating the Transportation Safety Risks of Potentially Impairing Drugs and Medical Conditions ...............................................................................................36 4.2.5 Statement on Marijuana Policy ....................................................................................37 4.2.6 Future Research Needs ................................................................................................38 5 Conclusions .............................................................................................................................39 6 Recommendations ..................................................................................................................40
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