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Medications on the Mind: Flying (or Not) with Drugs: I

In 2011, the FAA reviewed the toxicology reports of 1,353 recent fatal General Aviation accidents. They found that 42 percent of all pilots involved had drugs in their blood stream that impaired performance. It's a stark reminder that the most common cause of aviation accidents is pilot error, and that a frequent contributor to those errors is drugs, legal or illegal. If you're using crack, ecstasy or heroine, you've got no business going near an aircraft, much less trying to fly it. Now, I'm not going to say anything more about illicit drugs. The thousands of legal drugs your physician might prescribe, your pharmacist recommend, or your Aunt Tilly says are good for you, pose a more complicated problem. So, how do you make the Go/No Go decision as to flying with drugs on board?

The first think to think about is, what is the underlying condition you are treating? Let's say you have a flu bug. You've got a fever and are sweating up a storm. You have a pounding headache and a dry cough. You take two ibuprophen tablets. You know you don't have any problems with that medicine. Forty minutes later you're feeling pretty good. Should you hop in the cockpit for a five hour cross-country? No! A good rule is not to fly if you must depend on a medication to fly safely. If the untreated condition is one that would prevent safe flying, you should not fly until the condition gets better, whether you are taking drugs or not.

A second thing to consider is flying after starting a new medication. There are two types of problems you can have with a medication: an idiosyncratic reaction, and a common side-effect. An idiosyncratic reaction is a unique reaction based on the individual's genetic make-up. These are usually uncommon and are generally unpredictable.

For example, isoniazid is a commonly used drug to prevent tuberculosis after exposure to an infected person. Most folks tolerate it very well. Rarely, however, it can be toxic to the liver, causing you to become jaundiced (looking yellow as a pumpkin), confused in thought pattern, and feeling generally awful. Will it happen to you? There's no way to predict. That's why the FAA strongly advises grounding yourself for at least forty-eight hours after starting any new medication.

OK, let's say you are not that one-in-ten-thousand guy who gets an idiosyncratic reaction to a drug. Are you home free? Not by a long shot! Virtually any drug made has a potential for side-effects. Let's say you have a sore knee and you take a pain pill. The medicine in that pill doesn't just travel down to that knee. It is distributed all over your body, and has the potential to react with every one of your organs. That includes your eyes, balance apparatus and brain-all pretty important equipment for flying.

So, you've got that sore knee. You need something. You have a box of pain pills with a package insert listing the side-effects. You can't call your doc or AME at 2:00 a.m. on a Sunday. What should you look for to find out if this pill is right for flying?

The FAA suggests you look for the key words "light-headedness, drowsiness, dizziness, visual disturbance." Also, look for the "do not operate motor vehicles or machinery" warning. If the package lists any of these, don't take it and then fly! Suppose you've had this medicine before and even though they warned you about side-effects, you didn't have any. Is it OK to take and fly? Nope! Side effects can occur at any time, so, even if you have taken the same drug in the past without having side-effects, that's no guarantee they won't occur in the future. Like everything else in life, your body changes and so do its reactions.

If it's not 2:00 a.m. on a Sunday, you do have resources to answer your medication questions. Your AME should be able to give a definitive answer. The FAA web site does list some drugs that are absolute no-no's. However, they steer away from specific lists of good and bad drugs, mostly for legal reasons. The AOPA website has a drug database that can be helpful:

Next month, we'll get into different types of medicines to avoid in flight, as well as why. After all we don't want any of you to be statistics!

Fly wisely. See you next month.

As always, comments, questions and suggestions are welcome:


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