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This work was accomplished under the approved task AM-B-98-TOX-202. AbstractThe use of drugs and alcohol in aviation is closely monitored by the FAA Office of Aviation Medicine's (OAM's) Civil Aeromedical Institute (CAMI) through the toxicological analysis of specimens from pilots who have died in aviation accidents. This information on the use of drugs in aviation is helpful to the FAA in developing programs to reduce the usage of dangerous drugs and identify potentially incapacitating medical conditions that may cause an accident. Data collected from this research can be used to evaluate the effectiveness of the FAA drug testing program. The toxicology reports prepared by the CAMI Forensic Toxicology Research Section are used by the FAA and the National Transportation Safety Board to determine the cause of aviation accidents. Specimens (blood, urine, liver, kidney, vitreous fluid, and other bodily specimens) were collected by pathologists near the accident and placed in evidence containers provided by CAMI. These samples were refrigerated and shipped by overnight air. Upon receipt, the specimens were inventoried and accessioned for the analysis of drugs, alcohol, carbon monoxide, and cyanide. All data collected by the laboratory were entered into a computer database for future analysis. The database was searched using a Microsoft Access TM program developed by a local contractor. The database was sorted based on the class of drug, controlled dangerous substance schedules I and II, controlled dangerous substance schedules III-V, prescription drugs, over-the-counter drugs, and alcohol. The Toxicology and Accident Research Laboratory received specimens from 1683 pilots for postmortem toxicology analysis between 1994 to 1998. Controlled dangerous substances, CDS, (schedules I and II) were found in 89 of the pilots analyzed. Controlled dangerous substances (schedules III -V) were found in 49 of the pilots tested. Prescription drugs were found in 240 of the pilots analyzed. Over-the-counter drugs were found in 301 of the pilots analyzed. Alcohol at or above the legal limit of 0.04% was found in 124 pilots. The number of positive drug cases has doubled over the past 5 years. Over-the-counter medications are the most frequendy found drugs in fatal aviation accidents and many of these drugs, or the medical conditions for which they are being used, could impair a pilot's ability to safely fly an aircraft. The increased number of positive cases found in this research is most likely the result of improved methods of analysis, rather than an increase in the use of drugs. The low incidence of CDS III-V drugs found in fatal aviation accidents may be a result of the difficulty in finding and identifying the new benzodiazepines commonly prescribed in this class.

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