AOPA Pilot Magazine - January 2014 - 26

FLY WELL

Drug wars

BY DR. JONATHAN M. SACKIER

What's acceptable on board and what's not
SHOOTING APPROACHES at Brown Field Municipal
Airport (SDM) in San Diego, California, just north of
the Mexican border, might include interesting liaisons:
"Two-Tango-Alpha, traffic nine o'clock, same altitude,
one mile, northbound. Identify type and color, no radio
contact." Might that Cessna 172 be smuggling drugs?
Drugs can board small airplanes in other, equally
disturbing ways. In July 2013, Oklahoma's News 9
reported fatal aviation accidents involving pilots
using undeclared or illegal medications, including marijuana, cocaine, and amphetamines-as well
as mundane, over-the-counter (OTC) pharmaceuticals such as diphenhydramine, commonly included
in cold medications such as Benadryl, Advil PM, and
Robitussin Nighttime and Cold. Everyone understands

When medicating for a virus, allergies, or insomnia,
you are a hazard to safe aviation when the drug
is still in you.

DR. JONATHAN SACKIER

is an active
instrument-rated
pilot and teaches
at the University of
Virginia.

26 | AOPA PILOT January 2014

that drug abuse impacts the psyche; alters perception,
judgment, and behavior; diminishes reaction times;
and impairs coordination.
Many OTC medications may not be safe when flying.
Diphenhydramine and other ingredients cause drowsiness-beware products promising improved sleep or
reduced secretions; you might end up sleeping permanently, never worrying about secretions again. Frankly,
with colds or flu, you should not be flying anyway; pressure changes can seriously damage your eardrums, and
viral illnesses impair judgment and performance.
If you have used diphenhydramine to control symptoms of allergies, colds, flu, or as a sleep aid, be aware
that it has a variable but fairly long half-life, ranging
from eight to 17 hours. The FAA states that flying is prohibited for five times the half-life of the drug after using
any medication that may adversely affect flying. For
diphenhydramine this could be 85 hours-nearly four
days! Keep this in mind when medicating for a virus,
allergies, or insomnia, because you are a hazard to safe
aviation when the drug is still in you. Additionally, if
your sleep is disturbed, consider being evaluated for
sleep apnea, something the FAA is becoming increasingly concerned about.
There are safe drugs to take to address allergies,
and you should check the AOPA online database (www.

aopa.org/members/databases/medical/) and the FAA's
brochure on flying and medications (www.faa.gov/).
In fact, before a doctor prescribes any new medication for your use, check these sites or speak with your
AME; remember, you have to report all interactions
with doctors at your physical, and that is not the time
to discover you have been taking a nonapproved drug.
An oft-voiced complaint is why the FAA does not
allow certain newer medications, despite the fact that
they have been approved for human use by the FDA.
Simply put, to obtain market release, pharmaceutical
companies have to jump through a number of regulatory hoops, and impact on the ability to control an
aircraft is not one of them. That's why the FAA likes
some time to elapse from initial use to ensure that no
unexpected side effects, which might compromise safe
flight, are rearing their ugly heads. If a newly released
medicine is recommended to you, talk to your AME and
check with AOPA Pilot Protection Services for advice.
Selective Serotonin Reuptake Inhibitors (SSRIs)
are primarily used for mild to moderate depression and
in 2010, four were approved by the FAA for pilot use
(fluoxetine or Prozac, citalopram or Celexa, escitalopram or Lexapro, and sertraline or Zoloft).
Another area of concern is medications for chronic
pain. Previously, doctors used only pain relievers-
analgesics-although new drugs developed to treat
a range of disorders are being utilized, including
amitriptyline and gabapentin. Neither of these medications has an adverse-effect profile safe enough to
consider for use in aviation. If chronic pain is sadly in
your life, explore options with a pain specialist.
With medications for erectile dysfunction-Viagra
(sildenafil), Levitra (vardenafil), and Cialis (tadalafil)-
airmen should refrain from flight for six hours after
Viagra and 36 hours after the other drugs. Consider
evaluating what is causing this condition, as it might
presage underlying cardiovascular disease or diabetes.
Unlike that errant Cessna 172, do not cross the border between safe and unsafe flight, and treat drugs
with the respect they are due.
My thanks to Dr. Courtney D. Scott, manager of the
FAA's Aerospace Medical Certification Division, for
his help with this article and all he does for general
aviation.
AOPA
EMAIL jonathan.sackier@aopa.org

http://www.aopa.org/members/databases/medical/ http://www.faa.gov/ http://www.aopa.org/members/databases/medical/

AOPA Pilot Magazine - January 2014

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