Answers for Pilots

Recognizing a drug's effect is the pilot's responsibility

An AOPA member in Rancocas, New Jersey, is a good example of an airman who is taking responsibility for his role as pilot in command. When prescribed the drug Etanercept for arthritis, he immediately contacted the aviation technical specialists at AOPA.

Because the Federal Aviation Regulations include no specific references to medication usage, it is up to the pilot to discover if the medication he is prescribed is accepted for use while flying. And since only 200 of the more than 13,000 controlled prescription drugs are listed by the FAA as "acceptable" - and this does not include over-the-counter drugs - it is even more important for pilots to do their own homework.

"It is a huge area of interest, and there are few places for pilots to go for information," said Gary Crump, director of medical certification for AOPA. "There is no published list of accepted drugs, and the FAA cannot be involved in managing a drug list, so the pilot is on his own to be aware of the regulations concerning drug use."

The member's first call - we are not naming him out of respect for his privacy - was to aviation technical specialist John Collins who then directed his call to the medical certification team, which includes Crump, Ruby Zecher, and Joann Wilson. It was determined that Etanercept is an accepted drug by the FAA.

The call was a wise one; FAR 91.17 prohibits "any drug that affects the person's faculties in any way contrary to safety." Language in the information on Etanercept did not indicate adverse side effects that could affect the member's ability to fly, but he had the responsibility to know whether the drug was accepted or might have side effects.

For example, most over-the-counter drugs have accompanying literature that lists potential side effects. Virtually all drugs have the potential to cause adverse side effects in some people. That's one reason why so many medications carry the generic warning to avoid operating heavy machinery or motor vehicles while using the drug. This warning obviously carries a greater significance for flying. While some individuals experience no side effects with a particular drug, others may be significantly affected. Since each person's response is different, the FAA has to consider the worst possible reaction to a drug when evaluating the decision to allow flight duties.

Also, drugs with no apparent side effects for a particular individual on the ground can be different in the air. Even for general aviation pilots flying at relatively low altitudes, the changes in concentrations of atmospheric gases - including oxygen and nitrogen - in the blood can enhance the effects of seemingly innocuous drugs and impair judgment, decision making, and performance. It is the pilot's responsibility to know the classification of the drug and its potential side effects.

FAR 91.17 - often called the "eight-hour bottle-to-throttle rule" - applies to medications also. No person is to act or attempt to act as a crewmember of a civil aircraft until eight hours after the medication has been taken. Many over-the-counter drugs for colds and allergy symptoms have a sedating effect that could impair a pilot's ability to fly safely. FAR 61.53 applies because a pilot would know that he has a potential medical deficiency - or increase in medical deficiency - that would make him unable to meet the requirements for his current medical certificate, i.e., no impairment. "FAR 61.53 puts the burden on the pilot," reiterated Crump.

Remember, too, that the prescription of medication is two-sided; medications are prescribed to treat a medical condition, and that condition itself may be disqualifying to the FAA. A bad head cold, for example, could be considered a medical deficiency under the regulations.

For more information on medication use, visit these Web pages on AOPA Online: www.aopa.org/members/files/medical/med_use.html and www.aopa.org/members/resources/medical.html.

As an AOPA member, you have access to the best resource anywhere for information and answers for pilots. AOPA Online (www.aopa.org) provides members with access to a wealth of information and resources 24 hours a day, seven days a week. The AOPA toll-free Pilot Information Center gives you direct access to specialists in every area of aviation. The center, 800/USA-AOPA (800/872-2672), is available to members from 8:30 a.m. to 6 p.m. Eastern time, Monday through Friday.