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Trouble Medications for Pilots

by Darren Smith, CFII/MEI
General Aviation Human Factors, June, 2009
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Drug Series:  Pilot's Drug Test | Trouble Medications | False Positives

The NTSB's research indicates that abuse and misuse of prescriptions is more prevalent than "illicit" drug use.  Since 1990, there has been a dramatic increase in the use of medications for chronic pain, anxiety, attention deficit, and sleep disorders.  Inappropriate use of medications comes in the following forms:
  • Non-medical use is when use of the medication is not prescribed by a medical professional and is used for the experience or feeling it causes.
  • Misuse is the incorrect use of a medication by not following prescribed dosage levels, frequency of use, or use for a purpose other than for which it was prescribed.
  • Abuse is when the pattern of use leads to clinically significant impairment or distress that manifests itself in the individual’s behavior.
  • Physiological dependence is when the individual experiences increasing tolerance for a drug and experiences withdrawal when the medication is discontinued.
  • Psychological dependence ("addiction") is when the individual experiences an overall loss of control, seeks medication compulsively, and continues use of the medication in spite of negative consequences.
The problem with such medications is side effects such as:
Impaired judgment
Erratic performance
Muscle weakness
Visual disturbance
Impaired reflexes

Some medications are potentially medically disqualifying for pilots:
  • Insulin – all forms, unless given exemption
  • Seizure medication
  • Methadone—increasingly being prescribed for chronic pain
  • Modafinil—stimulant used to increase wakefulness, alertness
  • Antidepressants and Psychoactive Medication which relieve depression and other psychological conditions
  • Steroids which control bodily functions
Medical providers may not be aware of your status as a pilot and may not initially consider a medication alternative that does not have disqualifying side effects. 

Medications to be Wary Of

There are hundreds of new drugs on the market every year that have potential “impairing” effects.  Instead of trying to list the thousands of drugs that could cause undesireable side effects, I've listed here "classes" of drugs to be wary of. 

Pain medicines:
such as Codeine, Darvocet, Morphine, Vicodin, oxycontin.  This class of medications will cause Drowsiness, Slower reaction times, Mental confusion, Anxiety,  Agitation, Dizziness, and Blurred vision.

Tranquilizers and Sedatives: such as Ativan, Diazepam, Xanax, Halcion, and Valium. These drugs help relieve anxiety, stress, and insomnia.  This class of medications will cause Drowsiness, Amnesia,  Agitation, Dizziness, Weakness, Unsteadiness, and Disorientation.

Muscle relaxers: such as Flereril, Parafon Forte, Robaxin as this class of medications will cause Drowsiness, Fatigue, Nervousness, Confusion, Dizziness, and Visual disturbances.

Anti-motion sickness: such as Antivert, Dramimine, and Phenergan. This class of medications will cause Drowsiness, Restlessness, Hallucinations, and Blurred vision.

Antihistamines: such as Benadryl.
Antihistamines reduce allergy and cold symptoms and can also be used to treat insomnia. This class of medications will cause Drowsiness, Slowed reactions, & Impaired vision.

Stimulants: such as Sudafed, ephedrine, Aderall which cause the user to be more alert.
This class of medications will cause Jitteriness, Diminished concentration, False sense of alertness, Irritability, and Post-high fatigue

OTC Medications

It's not just prescribed medications, Over-the-Counter (OTC) medications can also have disqualifying effects.  Common OTC medications types include: Pain relief/fever reducers, Colds/Flu medications, Appetite suppressants, Bowel preparations, Sleeping aids, and Stimulants.   OTC drug products are those drugs that are available to consumers without a prescription.  There are more than 80 therapeutic categories of OTC drugs, ranging from acne drug products to weight control drug products.

Side effects from OTC medications include:  Agitation, Anxiety, Blurred vision, Breathing difficulty, Chest pain, Chest tightness, Confusion, Dizziness, Disorientation, Double vision, Drowsiness, Disorientation, Emotional instability, False sense of well being, Fatigue, Fever, Hallucinations, Severe Headache, Hyperventilation, Insomnia, Light headedness, Muscle cramps/spasms, Nausea/vomiting, Nervousness, Palpitations, Poor coordination, Rapid or irregular heart beat, Restlessness, Ringing in the ears, Sedation, Seizures, Severe diarrhea, Tremors, and Weakness.  This is not a complete list, this was obtained from browsing 2 isles of medications in my local drug store.

All OTC medications require the label to describe the active ingredients and potential side effects.  Read these labels carefully to ensure that you are medically qualified to perform safety sensitive duties. 

In the next article, we'll discuss how even OTC drugs can cause false positives on drug tests. 

NEXT: False Positives >>

"For us as pilots, the question is: What do I do with this? Go or no go?"
— Wolfgang Langewiesche, as quoted in Weather Flying, 1977 by Robert N. Buck

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