**3.6 Illicit Drug Use:**

D efinition of illicit drug

Description of the most common illicit drugs

Pharmacological effects of the most common illicit drugs

Symptoms, signs and performance effects of the most common illicit drugs

FAA drug testing program for aviation personnel

FAA regulations concerning the use of illicit drugs

Rehabilitation of the drug abuser/dependent pilot

[DEFINITION OF AN ILLICIT DRUG:]{.underline} An illicit drug is one that
is unlawful, illegal or prohibited.

[DESCRIPTION: MOST COMMON ILLICIT DRUGS:]{.underline} There are several
categories of drugs that may be used illicitly. They are categorized as
follows:

Amphetamines

Anabolic steroids

Cannabis (Marijuana)

Cocaine

Gamma Hydroxy Butyrate (GHB)

Hallucinogens

Heroin

Inhalants

Ketamine

MDMA (Ecstacy)

Rohypnol

Methylphenidate (Ritalin)

**[Methamphetamine & Amphetamines]{.underline}**

**General:** Street terms for methamphetamine: Meth, poor man\'s
cocaine, crystal meth, ice, glass, speed, Amphetamine,
dextroamphetamine, methamphetamine, and their various salts are
collectively referred to as amphetamines. In fact, their chemical
properties and actions are so similar that even experienced users have
difficulty knowing which drug they have taken.

**Methamphetamine is the most commonly abused.** Methamphetamine is
typically a white, odorless powder that dissolves easily in water.
Another form is clear, chunky crystals called crystal meth, or "ice". It
can also be found in brightly colored tablets and referred to as their
Thai name, "Yaba". It is taken by injection, snorting, smoking and
orally.

**Signs and Symptoms:** The effects include addiction, psychotic
behavior, and brain damage. Withdrawal symptoms include depression,
anxiety, fatigue, paranoia, aggression, and intense cravings. Chronic
use can cause violent behavior, anxiety, confusion, insomnia, auditory
hallucinations, mood disturbances, delusions, and **paranoia.** Damage
to the brain caused by meth usage is similar to Alzheimer\'s disease,
stroke, and epilepsy.

**[ANABOLIC STEROIDS]{.underline}:**

**General:** Commonly abused steroids: Anadrol, Oxandrin, Dianobol,
Winstrol, Durabolin, Depo-Testosterone, and Equipoise. There are more
than 100 types of anabolic steroids, and each requires a prescription.

Most common method of usage is via oral ingestion, injection or
topically rubbed on the skin as a cream or gel.

Steroids are used is primarily in young adults and high school students.
Use is much more prevalent among males than females. In a 2000 survey
among 19-22 year olds, 18.9% reported that they had a friend who was
using steroids.

Side effects and complications include:

Acne and breast development in men, increased irritability and
aggression, and increased incidence of liver cancer, heart attacks, and
high cholesterol.

Withdrawal symptoms include mood swings, fatigue, restlessness, loss of
appetite, insomnia, reduced sex drive, and depression.

Depression can lead to suicide attempts and, if left untreated, this
depression can persist for a year or more after the abuser stops taking
the drug.

[MARIJUANA]{.underline}

General: [Marijuana is the most commonly used illicit drug in the United
States.]{.underline} It is usually smoked as a cigarette (joint, nail),
or in a pipe (bong). It is also smoked in blunts, which are cigars that
have been emptied of tobacco and refilled with marijuana, often in
combination with another drug. Use also might include mixing marijuana
in food or brewing it as a tea. As a more concentrated, resinous form it
is called hashish and, as a sticky black liquid, hash oil. Marijuana
smoke has a pungent and distinctive, usually sweet-and-sour odor. There
are countless street terms for marijuana, including pot, herb, weed,
grass, widow, ganja, and hash.

The main active chemical in marijuana is THC
(delta-9-tetrahydrocannabinol). The membranes of certain nerve cells in
the brain contain protein receptors that bind to THC. Once securely in
place, THC kicks off a series of cellular reactions that ultimately lead
to the high that users experience when they smoke marijuana.

In 2001, over 12 million Americans age 12 and older used marijuana at
least once in the month prior to being surveyed. Data for drug-related
hospital emergency department visits in the continental United States
recently showed a 15 percent increase in the number of visits to an
emergency room that were induced by or related to the use of marijuana
(referred to as *mentions*), from 96,426 in 2000 to 110,512 in 2001.
**The 12 to 34 age range** was involved most frequently in these
mentions. For emergency room patients in the 12 to 17 age range, the
rate of marijuana mentions increased 23 percent between 1999 and 2001
(from 55 to 68 per 100,000 population) and 126 percent (from 30 to 68
per 100,000 population) since 1994.\
\
Effects on the Brain:

A great deal has been learned about how THC acts in the brain to produce
its many effects. When someone smokes marijuana, THC rapidly passes from
the lungs into the bloodstream, which carries the chemical to organs
throughout the body, including the brain. In the brain, THC connects to
specific sites called cannabinoid receptors on nerve cells and
influences the activity of those cells. Some brain areas have many
cannabinoid receptors; others have few or none. Many cannabinoid
receptors are found in the parts of the brain that influence pleasure,
memory, thought, concentration, sensory and time perception, and
coordinated movement.

**Signs and symptoms:**

The short-term effects of marijuana use can include problems with memory
and learning, distorted perception, difficulty in thinking and problem
solving, loss of coordination, and increased heart rate. Research
findings for long-term marijuana use indicate some changes in the brain
similar to those seen after long-term use of other major drugs of abuse.
For example, cannabinoid (THC or synthetic forms of THC) withdrawal in
chronically exposed animals leads to an increase in the activation of
the stress-response system and changes in the activity of nerve cells
containing dopamine. Dopamine neurons are involved in the regulation of
motivation and reward, and are directly or indirectly affected by all
drugs of abuse.\
\
**Cardiac effects:** One study has indicated that a user's risk of heart
attack more than quadruples in the first hour after smoking marijuana.
The researchers suggest that such an effect might occur from marijuana's
effects on blood pressure and heart rate and reduced oxygen-carrying
capacity of blood.\
\
**Effects on the Lungs** A study of 450 individuals found that people
who smoke marijuana frequently, but do not smoke tobacco, have more
health problems and miss more days of work than nonsmokers. Many of the
extra sick days among the marijuana smokers in the study were for
respiratory illnesses.\
\
Even infrequent use can cause burning and stinging of the mouth and
throat, often accompanied by a heavy cough. Someone who smokes marijuana
regularly may have many of the same respiratory problems that tobacco
smokers do, such as daily cough and phlegm production, more frequent
acute chest illness, a heightened risk of lung infections, and a greater
tendency to obstructed airways.\
\
Cancer of the respiratory tract and lungs may also be promoted by
marijuana smoke. A study comparing 173 cancer patients and 176 healthy
individuals produced strong evidence that smoking marijuana increases
the likelihood of developing cancer of the head or neck, and the more
marijuana smoked the greater the increase. A statistical analysis of the
data suggested that marijuana smoking doubled or tripled the risk of
these cancers.\
\
Marijuana use has the potential to promote cancer of the lungs and other
parts of the respiratory tract because it contains irritants and
carcinogens. In fact, marijuana smoke contains 50 to 70 percent more
carcinogenic hydrocarbons than does tobacco smoker. It also produces
high levels of an enzyme that converts certain hydrocarbons into their
carcinogenic form---levels that may accelerate the changes that
ultimately produce malignant cells. Marijuana users usually inhale more
deeply and **hold their breath longer** than tobacco smokers, which
increases the lungs' exposure to carcinogenic smoke. These facts suggest
that, puff for puff, smoking marijuana may increase the risk of cancer
more than smoking tobacco.\
\
**Other Health Effects** Some of marijuana\'s adverse health effects may
occur because THC impairs the immune system's ability to fight off
infectious diseases and cancer. In laboratory experiments that exposed
animal and human cells to THC or other marijuana ingredients, the normal
disease-preventing reactions of many of the key types of immune cells
were inhibited. In other studies, mice exposed to THC or related
substances were more likely than unexposed mice to develop bacterial
infections and tumors.\
\
**Effects of Heavy Marijuana Use on Learning and Social Behavior**
Depression, anxiety, and personality disturbances are all associated
with marijuana use. Research clearly demonstrates that marijuana use has
the potential to cause problems in daily life or make a person's
existing problems worse. Moreover, research has shown that marijuana's
adverse impact on memory and learning can last for days or weeks after
acute effects of the drug wear off because marijuana compromises the
ability to learn and remember. The more a person uses marijuana the more
he or she is likely to fall behind in accumulating intellectual, job, or
social skills.

Students who smoke marijuana get lower grades and are less likely to
graduate from high school, compared to their non-marijuana smoking
peers. In one study, researchers compared marijuana-smoking and
non-marijuana smoking 12th-graders' scores on standardized tests of
verbal and mathematical skills. Although all of the students had scored
equally well in 4th grade, the marijuana smokers' scores were
significantly lower in 12th grade).\
\
A study of 129 college students found that, for heavy users of marijuana
(those who smoked the drug at least 27 of the preceding 30 days),
critical skills related to attention, memory, and learning were
significantly impaired, even after they had not used the drug for at
least 24 hours. The heavy marijuana users in the study had more trouble
sustaining and shifting their attention and in registering, organizing,
and using information than did the study participants who had used
marijuana no more than 3 of the previous 30 days. Thus, someone who
smokes marijuana once daily may be functioning at a reduced intellectual
level all of the time.\
\
More recently, the same researchers showed that the ability of a group
of long-term heavy marijuana users to recall words from a list remained
impaired for a week after quitting, but returned to normal within 4
weeks. An implication of this finding is that some cognitive abilities
may be restored in individuals who quit smoking marijuana, even after
long-term heavy use.\
\
Workers who smoke marijuana are more likely than their coworkers to have
problems on the job. Several studies associate workers\' marijuana
smoking with increased absences, tardiness, accidents, workers\'
compensation claims, and job turnover. A study of municipal workers
found that those who used marijuana on or off the job reported more
\"withdrawal behaviors\"---such as leaving work without permission,
daydreaming, spending work time on personal matters, and shirking
tasks---that adversely affect productivity and morale.\
\
**Addictive Potential:** Long-term marijuana use can lead to addiction
for some people; that is, they use the drug compulsively even though it
often interferes with family, school, work, and recreational activities.
Drug craving and withdrawal symptoms can make it hard for long-term
marijuana smokers to stop using the drug. People trying to quit report
irritability, sleeplessness, and anxiety. They also display increased
aggression on psychological tests, peaking approximately one week after
the last use of the drug.

**Genetic Vulnerability:** Scientists have found that whether an
individual has positive or negative sensations after smoking marijuana
can be influenced by heredity. A 1997 study demonstrated that identical
male twins were more likely than non-identical male twins to report
similar responses to marijuana use, indicating a genetic basis for their
response to the drug. (Identical twins share all of their genes.)\
\
It was also discovered that the twins\' shared or family environment
before age 18 had no detectable influence on their response to
marijuana. Certain environmental factors, however, such as the
availability of marijuana, expectations about how the drug would affect
them, the influence of friends and social contacts, and other factors
that differentiate experiences of identical twins, were found to have an
important effect.\
\
Although no medications are currently available for treating marijuana
abuse, recent discoveries about the workings of the THC receptors have
raised the possibility of eventually developing a medication that will
block the intoxicating effects of THC. Such a medication might be used
to prevent relapse to marijuana abuse by lessening or eliminating its
appeal.

**[COCAINE]{.underline}**

**General:** Cocaine is a powerful central nervous system (CNS)
stimulant that heightens alertness, inhibits appetite and the need for
sleep, and provides intense feelings of pleasure. It is prepared from
the leaf of the Erythroxylon coca bush, which grows primarily in Peru
and Bolivia.

The initial resurgence of cocaine use, in the 1960s, was largely
confined to the affluent, for at that time it was quite expensive. Part
of the drug\'s mystique was its association with celebrities in the
music, sports, and show business worlds. Today, people from all walks of
life use cocaine, with young single people the most frequent users (male
users outnumbering female users two to one). There are no clear
connections between cocaine use and education, occupation, or
socioeconomic status.

Cocaine abuse and addiction continues to be a problem that plagues our
nation. In 1997, for example, an estimated 1.5 million Americans age 12
and older were chronic cocaine users. Although this is an improvement
over the 1985 estimate of 5.7 million users, there are substantial
efforts being made, in attempting to reduce the use of this addictive
stimulant. More is understood about where and how cocaine acts in the
brain, including how the drug produces its pleasurable effects and why
it is so addictive.

**Signs and symptoms:** There are enormous medical complications
associated with cocaine use. Some of the most frequent complications are
cardiovascular effects, including disturbances in heart rhythm and heart
attacks; such respiratory effects as chest pain and respiratory failure;
neurological effects, including strokes, seizure, and headaches; and
gastrointestinal complications, including abdominal pain and nausea.

Cocaine use has been linked to many types of heart disease. Cocaine has
been found to trigger chaotic heart rhythms, called ventricular
fibrillation; accelerate heartbeat and breathing; and increase blood
pressure and body temperature. Physical symptoms may include chest pain,
nausea, blurred vision, fever, muscle spasms, convulsions and coma.\
\
Research has revealed a potentially dangerous interaction between
cocaine and alcohol. Taken in combination, the two drugs are converted
by the body to cocaethylene. Cocaethylene has a longer duration of
action in the brain and is more toxic than either drug alone. While more
research needs to be done, it is noteworthy that the mixture of cocaine
and alcohol is the most common two-drug combination that results in
drug-related death.

Different routes of cocaine administration can produce different adverse
effects. Regularly snorting cocaine, for example, can lead to loss of
sense of smell, nosebleeds, problems with swallowing, hoarseness, and an
overall irritation of the nasal septum, which can lead to a chronically
inflamed, runny nose. Ingested cocaine can cause severe bowel gangrene,
due to reduced blood flow. Persons who inject cocaine have puncture
marks and \"tracks,\" most commonly in their forearms. Intravenous
cocaine users may also experience an allergic reaction, either to the
drug, or to some additive in street cocaine, which can result, in severe
cases, in death. Because cocaine has a tendency to decrease food intake,
many chronic cocaine users lose their appetites and can experience
significant weight loss and malnourishment.

**[GHB]{.underline} (gamma hydroxybutyric acid)**

**General:** Street Names: Liquid Ecstasy, Scoop, Easy Lay, Georgia Home
Boy, Grievous Bodily Harm, Liquid X, and Goop. There are primarily two
forms of GHB, an odorless, colorless liquid form and a white powder. It
is usually ingested as a liquid, **often mixed with alcohol.** It has
become quite popular with teens and young adults at dance clubs and
"raves." Some body builders use GHB for its alleged anabolic steroid
effects.

**Signs and Symptoms:** In lower doses, GHB causes drowsiness,
dizziness, nausea, and visual disturbances. At higher dosages,
unconsciousness, seizures, severe respiratory depression, and coma can
occur. Overdoses usually require emergency room treatment, including
intensive care for respiratory depression and coma. As of November 2000,
DEA documented 71 GHB-related deaths. GHB has been used in the
commission of sexual assaults because it renders the victim incapable of
resisting, and may cause memory problems that could complicate case
prosecution.

**HALLUCINOGENS**

**General:** Hallucinogens are among the oldest known group of drugs
used for their ability to alter human perception and mood. For
centuries, many of the naturally occurring hallucinogens found in plants
and fungi have been used for a variety of shamanistic practices. In more
recent years, a number of synthetic hallucinogens have been produced,
some of which are much more potent than their naturally occurring
counterparts.

The biochemical, pharmacological, and physiological basis for
hallucinogenic activity is not well understood. Even the name for this
class of drugs is not ideal, since hallucinogens do not always produce
hallucinations.

**Signs and Symptoms:** Taken in non-toxic dosages, these substances
produce changes in perception, thought, and mood. Physiological effects
include elevated heart rate, increased blood pressure, and dilated
pupils. Sensory effects include perceptual distortions that vary with
dose, setting, and mood. Psychic effects include disorders of thought
associated with time and space. Time may appear to stand still and forms
and colors seem to change and take on new significance. This experience
may be either pleasurable or extremely frightening. It needs to be
stressed that the effects of hallucinogens are unpredictable each time
they are used.

Weeks or even months after some hallucinogens have been taken, the user
may experience **flashbacks,** fragmentary recurrences of certain
aspects of the drug experience, in the absence of actually taking the
drug. The occurrence of a flashback is unpredictable, but is more likely
to occur during times of stress and seem to occur more frequently in
younger individuals. With time, these episodes diminish and become less
intense.

There is a considerable body of literature that links the use of some of
the hallucinogenic substances to neuronal damage in animals, and recent
data support that some hallucinogens are neurotoxic to humans. However,
the most common danger of hallucinogen use is impaired judgment that
often leads to rash decisions and accidents.

**Heroin**

**General:** Street terms for heroin: smack, thunder, hell dust, big H,
nose drops. Pure heroin is a white powder with a bitter taste. Most
illicit heroin varies in color from white to dark brown. \"Black tar\"
heroin is sticky, like roofing tar, or hard like coal, and its color may
vary from dark brown to black. It is used by injecting, smoking or
snorting.

**Signs and Symptoms:** One of the most significant effects of heroin
use is addiction. Once tolerance happens, higher doses become necessary
to achieve the desired effect, and physical dependence develops. Chronic
use may cause collapsed veins, infection of the heart lining and valves,
abscesses, liver disease, pulmonary complications, and various types of
pneumonia. It may cause depression of the central nervous system, cloudy
mental functioning, and slowed breathing to the point of respiratory
failure. Heroin overdose may cause slow and shallow breathing,
convulsions, coma, and possibly death. In addition, users put themselves
at risk for contracting HIV, hepatitis B and C, and other viruses.

**Inhalants**

**General:** Inhalants are a diverse group of substances that include
volatile solvents, gases, and nitrites that are sniffed, snorted,
huffed, or bagged to produce intoxicating effects similar to alcohol.
These substances are found in common household products like glues,
lighter fluid, cleaning fluids, and paint products. Some of these
products also include nail polish remover, gasoline, paint and paint
thinner, rubber glue, waxes, and varnishes. Inhalant abuse is the
deliberate inhaling or sniffing of these substances to get high, and it
is estimated that about 1,000 substances are misused in this manner.

The easy accessibility, low cost, legal status, and ease of transport
and concealment make inhalants one of the first substances abused by
children. Survey data indicates that about fifteen to twenty percent of
junior and senior high school students have tried inhalants with about
two to six percent reporting current use. The highest incidence of use
is among ten to twelve year old children with rates of use declining
with age. Parents worry about alcohol, tobacco, and drug use but may be
unaware of the hazards associated with products found throughout their
homes. Knowing what these products are, how they might be harmful, and
recognizing the signs and symptoms of their use as inhalants, can help a
parent prevent inhalant abuse.

Chemicals found in these products include toluene, benzene, methanol,
methylene chloride, acetone, methyl ethyl ketone, methyl butyl ketone,
trichloroethylene, and trichlorethane. The gas used as a propellant in
canned whipped cream and in small lavender metallic containers called
\"whippets\" (used to make whipped cream) is nitrous oxide or \"laughing
gas\", the same gas used by dentists for anesthesia. Tiny cloth-covered
ampules, called poppers or snappers by abusers, contain amyl nitrite, a
medication used to dilate blood vessels. Butyl nitrite, sold as tape
head cleaner and referred to as \"rush,\" \"locker room,\" or
\"climax,\" is often sniffed or huffed to get high.

Inhalants may be sniffed directly from an open container or huffed from
a rag soaked in the substance and held to the face. Alternatively, the
open container or soaked rag can be placed in a bag where the vapors can
concentrate before being inhaled. Some chemicals are painted on the
hands or fingernails or placed on shirt sleeves or wrist bands to enable
an abuser to continually inhale the fumes without being detected by a
teacher or other adult. Although inhalant abusers may prefer one
particular substance because of taste or odor, a variety of substances
may be used because of similar effects, availability, and cost. Once
inhaled, the extensive capillary surface of the lungs allows rapid
absorption of the substance and blood levels peak rapidly. Entry into
the brain is fast and the intoxicating effects are intense but short
lived.

**Signs and Symptoms:** Inhalants depress the central nervous system,
producing decreased respiration and blood pressure. Users report
distortion in perceptions of time and space. Many users experience
headaches, nausea, slurred speech, and loss of motor coordination.
Mental effects may include fear, anxiety, or depression. A rash around
the nose and mouth may be seen, and the abuser may start wheezing. An
odor of paint or organic solvents on clothes, skin, and breath is
sometimes a sign of inhalant abuse. Other indicators of inhalant abuse
include slurred speech or staggering gait, red, glassy, watery eyes, and
excitability or unpredictable behavior.

The chronic use of inhalants has been associated with a number of
serious health problems. Glue and paint thinner sniffing produce kidney
abnormalities while the solvents toluene and trichloroethylene cause
liver damage. Memory impairment, attention deficits, and diminished
non-verbal intelligence have been related to the abuse of inhalants.
Deaths resulting from heart failure, asphyxiation, or aspiration have
occurred.

**[Ketamine]{.underline}**

**General:** Street terms for Ketamine: jet, super acid, Special \"K\",
green, K, cat
Valium[^.^](http://www.dea.gov/concern/ketamine_factsheet.html#1) It's
appearance is clear liquid and a white or off-white powder form.

Ketamine is a tranquilizer most commonly used on animals. The liquid
form can be injected, consumed in drinks, or added to smokable
materials. The powder form can be used for injection when dissolved. In
certain areas,

Ketamine is being injected intramuscularly. Ketamine, along with the
other \"club drugs,\" has become popular among teens and young adults at
dance clubs and \"raves.\"

**Signs and Symptoms:** Higher doses produce an effect referred to as
\"K-Hole,\" an \"out of body,\" or \"near-death\" experience. Use of the
drug can cause delirium, amnesia, depression, and long-term memory and
cognitive difficulties. Due to its dissociative effect, it is reportedly
used as a date-rape drug.

**MDMA (Ecstasy)**

**General:** Street terms for MDMA/Ecstasy: XTC, go, X, Adam, hug drug
because of its use years ago by psychiatrists/marriage counselors. It
may appear in a form such as individual tablets often imprinted with
graphic designs or commercial logos, and typically containing 100 mg of
MDMA.

Ecstasy is usually ingested in tablet form, but can also be crushed and
snorted, injected, or used in suppository form. In the year 2000, more
than 6.4 million people, age 12 and older reported that they have used
Ecstasy at least once in their lives. Ecstasy is popular among
middle-class adolescents and young adults and is sold primarily at
legitimate nightclubs and bars, at underground nightclubs sometimes
called \"acid houses,\" or at all-night parties known as \"raves.\"

**Signs and symptoms:** In addition to chemical stimulation, the drug
reportedly suppresses the need to eat, drink, or sleep. When taken at
raves, where all-night dancing usually occurs, the drug often leads to
severe dehydration and heat stroke in the user, since it has the effect
of \"short-circuiting\" the body\'s temperature signals to the brain.

An Ecstasy overdose is characterized by a rapid heartbeat, high blood
pressure, faintness, muscle cramping, panic attacks, and, in more severe
cases, loss of consciousness or seizures. One of the side effects of the
drug is jaw muscle tension and teeth grinding. As a consequence, Ecstasy
users will often suck on pacifiers to help relieve the tension.

Ecstasy may cause hyperthermia, muscle breakdown, seizures, stroke,
kidney and cardiovascular system failure, and possible permanent damage
to sections of brain critical to thought and memory, and death.

ROHYPNOL: (FLUNITRAZEPAM) "roofies\"

**General**: Flunitrazepam is a benzodiazepine that is used in the
short-term treatment of insomnia and as a sedative hypnotic and
preanesthetic medication. It has physiological effects similar to
diazepam (commonly known by its trade name, Valium®), although
flunitrazepam is approximately 10 times more potent. Flunitrazepam
neither is manufactured nor sold legally in the United States. It is
produced and sold legally by prescription in Europe and Latin America.

**Signs and Symptoms:** Flunitrazepam is ingested orally, frequently in
conjunction with alcohol or other drugs, including heroin. The drug's
effects begin within 30 minutes, peak within 2 hours, and may persist
for up to 8 hours or more, depending upon the dosage. Adverse effects
associated with the use of flunitrazepam include decreased blood
pressure, memory impairment, drowsiness, visual disturbances, dizziness,
confusion, gastrointestinal disturbances, and urinary retention.
Paradoxically, although the drug is classified as a depressant,
flunitrazepam can induce excitability or aggressive behavior in some
users.\
\
Flunitrazepam use causes dependence in humans. Once dependence has
developed, abstention induces withdrawal symptoms, including headache,
muscle pain, extreme anxiety, tension, restlessness, confusion, and
irritability. Numbness and tingling of the extremities, loss of
identity, hallucinations, delirium, convulsions, shock, and
cardiovascular collapse also may occur. Withdrawal seizures can occur a
week or more after cessation of use. As with other benzodiazepines,
treatment for flunitrazepam dependence must be gradual, with use
tapering off.\
\
Flunitrazepam is touted as an effective "parachute" or remedy for the
depression that follows a stimulant high. Two common misperceptions
about flunitrazepam may explain the drug's popularity among young
people: first, many erroneously believe that the drug is
unadulterated---and therefore "safe"---because it comes in presealed
bubble packs; second, many mistakenly think its use cannot be detected
by urinalysis testing.

**Methylphenidate (Ritalin)**

**General:** Methylphenidate, a Schedule II substance, has a high
potential for abuse and produces many of the same effects as cocaine or
the amphetamines. The abuse of this substance has been documented among
narcotic addicts who dissolve the tablets in water and inject the
mixture. Complications arising from this practice are common, due to the
insoluble fillers used in the tablets. When injected, these materials
block small blood vessels, causing serious damage to the lungs and
retina of the eye. Binge use, psychotic episodes, cardiovascular
complications, and severe psychological addiction have all been
associated with methylphenidate abuse.

Methylphenidate is used legitimately in the treatment of excessive
daytime sleepiness associated with narcolepsy, as is the newly marketed
Schedule IV stimulant, modafinil (Provigil®). The primary legitimate
medical use of methylphenidate (Ritalin®, Methylin®, Concerta®) is to
treat attention deficit hyperactivity disorder (ADHD) in children. The
increased use of this substance for the treatment of ADHD has paralleled
an increase in its abuse among adolescents and young adults who crush
these tablets and snort the powder to get high. Youngsters have little
difficulty obtaining methylphenidate from classmates or friends for whom
it has been prescribed. Greater efforts to safeguard this medication at
home and school are needed.

**[FAA DRUG TESTING PROGRAMS]{.underline}**

There are many toxicological labs that screen for general categories of
drugs. For more gas chromatography, mass-spectrometry (GCMS) which is
considerably more sensitive and specific, is used definitive
confirmation.

**If there is a verified positive drug test result acquired under an
anti-drug program or internal program of the U. S. DOT or any other
Administration within the U. S. DOT or misuse of a substance that the
Federal Air Surgeon, based on case history and appropriate, qualified
medical judgment relating to the substance involved finds that:**

**Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or may
reasonably be expected, for the maximum duration of the airman medical
certificate applied for or held, to make the person unable to perform
those duties or exercise the privileges.**

**Use of a substance in which use was physically hazardous (e.g.
DUI/DWI) if there has been any other time an instance of the use of the
substance also in a situation in which the use was physically
hazardous.**

**No substance abuse within the preceding [two years]{.underline}
defined as: use of a substance in which that use was physically
hazardous, if there had been any other time an instance of the use of
the substance also in a situation which that use was physically
hazardous.**

**"Substance dependence" means a condition in which a person is
dependent on a substance, other than tobacco or ordinary
xanthine-containing (e.g. caffeine) beverages as evidenced by:**

**Increased tolerance**

**Manifestation of withdrawal syndrome**

**Impaired control of use or**

**Continued use despite damage to physical health or impairment of
social, personal or occupational functioning**

In November, 1988, the FAA published the Anti-Drug Program Rules for
Personnel engaged in Specific Activities. These rules require operators
under CFR's, Parts 121 and 135 to establish antidrug programs for
employees, including pilots, who perform safety related functions. Over
a half million aviation employees are affected by this rule. This
requires testing for five commonly abused drugs: Marijuana, Cocaine,
Opiates,

Amphetamines, Phencyclidine (PCP).

Most companies have their own alcohol and drug policies, and these
matters are the subject of national legislation and international
regulation. Alcohol policies are mainly concentrated on regulating
against alcohol consumption during flight and within a given time period
relative to flight. Relatively few airlines employ screening procedures
designed to detect alcohol or drug misuse in aircrews. Serious alcohol
or drug related accidents are rare in commercial passenger operations.

Use of psychoactive agents is a complex problem, because it is hard to
quantify the degree to which a problem may exist. In many instances,
denial or minimization of substance use by an airman cannot be proved or
disproved. Often it is difficult, though necessary to quantify the
nature and degree of the alleged substance use/abuse.

Obviously, there is quite a difference between an individual who has
used a narcotic medication on a short-term basis for a legitimate
medical problem versus someone who has abused amphetamines or LSD. The
effects of psychoactive agents can be experienced long after the period
of use, e.g., flashbacks. Alcohol, amphetamines, cannabinoids, cocaine,
LSD, mescaline, and PCP can all cause flashbacks or psychosis, whereas
the opiates generally do not. There has also been some evidence that
heavy alcohol abuse, or use of amphetamines, PCP,

LSD, and ecstasy can produce a psychosis similar to that seen in
schizophrenia. The addictive characteristics of various drugs do not
equate with long-term psychiatric sequelae. An individual can be
addicted to pain-killers for low-back pain for a lengthy period of time
and not be at the same level of risk as someone who heavily abused
amphetamines or LSD. Some drugs, such as ecstasy, are potent neurotoxins
that can cause permanent brain damage. This is especially critical since
some of these drugs are known to damage dopaminergic or serotonergic
neural pathways that are vital to normal sleep, mood, memory, and
cognitive functioning.

When an applicant discloses the use of a psychoactive agent, or it is
discovered in the course of screening, it raises a host of issue:
Relating to sobriety, overall mental health, and long-term psychiatric
stability. Also, a stressful event can provoke a recurrence of symptoms,
such as paranoid psychosis in former amphetamine users. Therefore, it is
necessary to closely monitor these individuals through ongoing
psychiatric evaluations to verify their functional level.

Substance use, or abuse, does exist among Class I and II airmen. Random
drug testing continues to play an important role in the enforcement of a
drug-free status for commercial pilots, but it does not help to identify
airmen with alcohol abuse problems. In the case of Class III airmen,
there is no comparable way of testing and enforcing a drug- and
alcohol-free status other than through the AME or through a reportable
incident. For the most part, the integrity of a drug/alcohol-free
aviation environment relies largely on self-reported airman information.
Consequently, it is important to stress the importance of maintaining a
drug-free status and the use of common sense with regard to alcohol
consumption. 

[**FAA** **REGULATIONS CONCERNING DRUG USE**]{.underline}

**ALL DRUGS REFERRED TO IN THE GUIDE FOR AVIATION MEDICAL EXAMINERS**

(TABLE I)

  ----------------------- ----------------------- ------------------------
  **[NONPRESCRIPTION      **[PRESCRIPTION         **[ILLICIT
  DRUG]{.underline}**     DRUG]{.underline}**     DRUG]{.underline}**

  ----------------------- ----------------------- ------------------------

  ----------------------- ----------------------- -----------------------
  **Antacids**                                    

                          **Amphetamines**        **Amphetamines**

                          **Anticoagulants**      

                          **Antidepressants**     

  **Antihistaminic**      **Antihistaminic**      

                          **Antihypertensive**    

                          **Antiviral**           

                          **Anxiolytics**         

                          **Barbiturate**         

  **Aspirin**             **Aspirin**             

                                                  **Cocaine**

                          **Contraceptives**      

                          **Cyclic hormones**     

                          **Desensitization       
                          injections**            

                                                  **Hallucinogens**

                          **Hypnotics**           

                          **Hypoglycemic drugs**  

  **Ibuprofen**           **Ibuprofen**           

                          **Insulin**             

                                                  **Marijuana**

                          **Mood ameliorating**   

  **Motion sickness**     **Motion sickness**     

                          **Mydriatic**           

                          **Naproxen**            

                          **Narcotics**           

  **Opioids**             **Opioids**             

                          **Oral hypoglycemic**   

  **Phenylephrine**       **Phenylephrine**       

                          **Psychoactive**        

                          **Sedative**            

                          **Steroid**             

  **Stimulant**           **Stimulant**           

                          **Sucralfates**         

                          **Tranquilizers**       

                          **Warfarin**            

                                                  

                                                  
  ----------------------- ----------------------- -----------------------

**The drugs/medications are those listed in the Guide for Aviation
Medical Examiners. Each category will be discussed in the appropriate
section. Below.**

**Below, is a summary table of illicit, prescribed and over the counter
drugs and the relationship to FAA regulations. These drugs/substances
are those specifically referred to in [THE GUIDE FOR AVIATION MEDICAL
EXAMINERS ]{.underline}**

(TABLE II)

  ----------------------- ----------------------- -----------------------
  **NAME OF DRUG**        **FAA GUIDE FOR         **PAGE CITATION: AME
                          AVIATION MEDICAL        GUIDE**
                          EXAMINER**              

  **Antacids**            ND                      51

  **Amphetamines**        DIS                     28, 66, 71

  **Anticoagulants**      MPC/ DFR                22, 27, 49

  **Antidepressants**     DIS                     70

  **Antihistaminic**      MPC see footnote        22
                          below\*                 

  **Antihypertensive**    MPC see footnote        22, 27, 95
                          below\*\*               

  **Antiviral**           MPC/ DFR                22

  **Anxiolytics**         DIS                     22, 28, 86, 70, 71

  **Aspirin**             ND see footnote re:     27, 58
                          dipyramidole            

  **Barbiturate**         DIS or DFR              22

  **Cocaine**             DIS                     28, 66, 71

  **Contraceptives**      ND                      55

  **Cyclic hormones**     ND                      55

  **Desensitization       ND                      25
  injections**                                    

  **Experimental drugs**  DFR                     22

  **Hallucinogens**       DIS                     28, 66, 70, 71

  **Hypnotics**           DIS                     28, 66

  **Hypoglycemic**        MPC/ DFR                3\. 22, 28, 72, 75, 98

  **Ibuprofen**           Tolerated? No side      58
                          effects?                

  **Illegal substances**  DIS                     28

  **Insulin**             DIS                     3, 28, 72, 75, 98

  **Investigational**     DFR                     22

  **Marijuana**           DIS                     28, 71

  **Mood ameliorating**   DIS, DFR                22

  **Motion sickness**     DFR                     22, 29

  **Mydriatic**           EX Not recommended for  40, 92
                          exam                    

  **Naproxen**            Tolerated? No side      58
                          effects?                

  **Narcotics**           DIS                     22

  **Opioids**             DIS                     28, 66, 71

  **Oral Hypoglycemic**   MPC/ DFR                3, 74

  **Phenylephrine HCl**   EX: May be used in ENT  36
                          exam                    

  **Psychoactive**        DIS                     28,66, 71

  **Psychotropic**        DIS                     68, 70

  **Sedative**            DIS                     28, 66, 70, 71

  **Steroid**             MPC/DFR                 22

  **Stimulant**           DIS                     66

  **Sucralfates**         ND Tolerated? No side   51
                          effects?                

  **Substance,            DIS                     3, 28, 30, 31, 66, 67,
  abuse/depend**                                  71, 72,

  **Tranquilizers**       DIS                     22, 70

  **Warfarin**            MPC/ DFR                49
  ----------------------- ----------------------- -----------------------

DIS=DISQUALIFYING

ND=NOT-DISQUALIFYING (Medication well tolerated? No side effects?)

DFR=DEFER TO FAA

EX=USED IN EXAMINATION

MPC/DFR=MAY PRECLUDE CERTIFICATION (DEFER)

ANTIHYPERTENSIVES: Diuretics, α-adrenergic blocking agents, β-adrenergic
blocking agents, Calcium channel blocking agents, ACE inhibitors, direct
vasodilators. This assumes the medicine is well tolerated and does not
produce side effects.

\*\*ANTIHISTAMINES: Loratidine, Astemizole or Fexofenadine not
disqualifying assuming that the medication is well tolerated and does
not product side effects.

\*\*\*ASPRIN (Dipyridamole, a coronary vasodilator and platelet
aggregate inhibitor, may not be disqualifying)

**REHABILITATION OF THE DRUG ABUSER/DEPENDENT**

The aviation industry operates in a safety sensitive environment, in
which there has been Appropriate concern regarding the formation of
alcohol and drug policies*.*

Aviation alcohol and drug policy is determined at three levels:
international, national and by each airline/air force The International
Civil Aviation Organization (ICAO) determines common international
requirements to which all member states subscribe (International Civil
Aviation Organization, 1995). ICAO licensing requirements for aircraft
maintenance personnel, air traffic controllers, flight operations
officers, and aeronautical station operators, as well as flight crew,
specify that **a license applicant shall have no established history or
clinical diagnosis of alcoholism or drug dependence.** Periodic medical
assessments, specified in the regulations, provide an opportunity for
the detection of alcohol or drug problems arising in existing license
holders. Finally, the regulations prohibit pilots and other flight crew
from flying while their performance is impaired by alcohol or other
drugs.

Various national bodies, such as the Federal Aviation Administration
(FAA) and the Civil Aviation Authority (CAA) in the United Kingdom
determine national policy, which is usually enshrined in legislation
(Federal Aviation Administration, 1986). Individual airlines and
military air forces also have their own policies that impose additional
restrictions over and above national and international legislation.

In most cases, drug policies are not as well defined as alcohol policies
and, for reasons stated in the previous section, alcohol rehabilitation
is considerably more successful.

In recent surveys, some companies only gave indication of a disciplinary
response, which sometimes included dismissal. Others indicated that
counseling and rehabilitation would he necessary, and in some cases, was
to be at company expense. In other cases, the company might give only
one opportunity for rehabilitation and dismissal would follow any
relapse. Where rehabilitation is an available option, some sort of
arrangement can be provided for careful monitoring and follow-up to
ensure a good outcome for the employee, and safety in the aviation
environment. It should be noted that according to some study surveys,
**suspension from flying duties was invariably mandated during the
process of rehabilitation.**

It is extremely important that the pilot\'s cognitive functioning not be
impaired, and substance abuse in an aviation setting is not to be taken
lightly. The use of psychoactive substances by aviators can have
potentially serious consequences, as evidenced by the toxicological
results of general aviation fatalities. **In a noteworthy number of
cases (approximately 10%), alcohol and/or controlled substances have
been present in the blood and tissues of general aviation pilots.**
Fortunately, the situation does not exist to this degree in a commercial
aviation setting; however, that does not necessarily translate to
off-duty time.

***THE ABOVE MATERIAL HAS BEEN TAKEN FROM SEVERAL PRIVATE AND
GOVERNMENTAL SOURCES. PRIMARILY THE DEA (DRUG ENFORCEMENT AGENCY)
REFERENCES HAVE [NOT]{.underline} BEEN INCLUDED.***