DOT/FAA/AM-00/21

Dennis V. Canfield1

Jerry Hordinsky1

David P. Millett2

Boyd Endecott1

Dudley Smith1

1

Civil Aeromedical Institute

Federal Aviation Administration

Oklahoma City, Oklahoma 73125

2

Southern Region Medical Division

Federal Aviation Administration

Atlanta, Georgia 30320

June 2000

Final Report

This document is available to the public

through the National Technical Information

Service, Springfield, Virginia 22161.

Prevalence of Drugs and

Alcohol in Fatal Civil

Aviation Accidents Between

1994 and 1998

Office of Aviation Medicine

Washington, D.C. 20591

U.S. Department

of Transportation

Federal Aviation

Administration
NOTICE

This document is disseminated under the sponsorship of

the U.S. Department of Transportation in the interest of

information exchange. The United States Government

assumes no liability for the contents thereof.
i

Technical Report Documentation Page

1. Report No. 2. Government Accession No. 3. Recipient's Catalog No.

DOT/FAA/AM-00/21

4. Title and Subtitle 5. Report Date

Prevalence of Drugs and Alcohol in Fatal Civil Aviation Accidents June 2000

Between 1994 and 1998 6. Performing Organization Code

7. Author(s) 8. Performing Organization Report No.

Canfield, D.1, Hordinsky, J.1, Millett, D.2, Endecott, B.1, and Smith, R.1

9. Performing Organization Name and Address 10. Work Unit No. (TRAIS)

1

FAA Civil Aeromedical Institute

P.O. Box 25082

Oklahoma City, Oklahoma 73125 11. Contract or Grant No.

2

FAA Southern Region Medical Div.

P.O. Box 30557

Atlanta, Georgia 30320

12. Sponsoring Agency name and Address 13. Type of Report and Period Covered

Office of Aviation Medicine

Federal Aviation Administration

800 Independence Ave., S.W.

Washington, D.C. 20591 14. Sponsoring Agency Code

15. Supplemental Notes

This work was accomplished under the approved task AM-B-98-TOX-202.

16. Abstract

The 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 frequently

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.

17. Key Words 18. Distribution Statement

Forensic Science, Toxicology, Drugs, Document is available to the public through the

Prevalence, Aviation National Technical Information Service

Springfield, Virginia 22161

19. Security Classif. (of this report) 20. Security Classif. (of this page) 21. No. of Pages 22. Price

Unclassified Unclassified 9

Form DOT F 1700.7 (8-72) Reproduction of completed page authorized

1

PREVALENCE OF DRUGS AND ALCOHOL IN FATAL CIVIL

AVIATION ACCIDENTS BETWEEN 1994 AND 1998

INTRODUCTION

The Federal Aviation Administration's Office of

Aviation Medicine is tasked with determining the

fitness of pilots to fly. The use of certain drugs and

specific medical conditions are strictly controlled to

assure the safety of the pilot and the general public.

Part of this responsibility includes enforcement of

alcohol and drug use regulations (1). The Civil Aeromedical Institute (CAMI), Office of Aviation Medicine (OAM), Federal Aviation Administration (FAA),

is required under Public Law 100-591[H.R.4686]

(2) to help assess the role of potential medical or drug

related pilot impairment in aviation accidents. The

Department of Transportation (DOT) Order 8020.11

(3) requires CAMI to “conduct toxicological analyses

on specimens from, and special pathologic studies

on, aircraft accident fatalities” (5). This includes the

identification of abused drugs such as cocaine, amphetamines, and benzodiazepines; or prescription

drugs such as cardiovascular and neurological

medications. This research reports the findings of

these tests.

Under the cooperative efforts of the FAA and

NTSB, specimens from the pilots who were fatally

injured in aviation accidents were analyzed for drugs

and alcohol as part of the investigation into the cause

of the accidents. Analysis for the presence of drugs in

body fluids and tissues of pilots in these fatal accidents was used to assist in the determination of

accident causation, and whether impairment from

drug use or a medical condition caused or contributed to the accident.

MATERIALS AND METHODS

Specimens (blood, urine, liver, kidney, vitreous

fluid, and other body specimens) from fatal aviation

accidents were collected and placed in specially designed evidence containers provided by CAMI. These

samples were refrigerated and shipped by overnight

air. Specimens prepared according to the instructions

were maintained at approximately 4° to 6° C for 48

hours. Upon receipt at CAMI, the specimens were

inventoried and accessioned for the analysis of drugs,

alcohol, carbon monoxide, and cyanide. Specimens

were screened for drugs of abuse by immunoassay and

any positives were confirmed by gas chromatography

(GC)/mass spectroscopy (MS). Specimens were

screened for prescription and over-the-counter medications using a variety of analytical procedures including: immunoassay, high performance liquid

chromatography (HPLC), and GC/MS. Confirmation of positives in these classes was done by GC/MS,

GC/FTIR, HPLC/MSn

 or by a different analytical

procedure than that used in the initial screening. The

total number of drugs reported in this research does

not include caffeine or nicotine. Alcohol was identified and quantitated in blood, vitreous fluid, urine

and tissues using headspace gas chromatography. All

positive alcohols in blood, vitreous fluid, and urine at

or above 20mg/dL were confirmed using fluorescence polarization immunoassay (FPIA). Only cases

with ethanol at or above 0.04% were reported in this

study due to the FAA regulations forbidding the

operation of an aircraft by a pilot with a blood

ethanol reading at or above 0.04% (40mg/dL). All

data collected by the laboratory were electronically

entered into a computer database for future analysis.

The results of these tests can be seen in Tables 1

through 6

RESULTS AND DISCUSSION

Data from 1994 to 1998 was compared with an

earlier 5-year study for the years 1989 to 1993 (4) to

determine changes in the incidents of drug use in

pilots. The Toxicology and Accident Research Laboratory received specimens from 1683 fatally injured

pilots for postmortem toxicology analysis from 1994

to 1998 (Table 1), which is less than the 1845 (Table

2) cases reported for 1989 to 1993 (4). This is a 9%

reduction in the number of fatal aviation accidents

received by the laboratory between the two 5-year
2

Table 1. Fatal Aviation Accidents with Drugs and Alcohol

Y 1 ear C % C 3 1 C % C x 3 R % R T x O % O l T A %A l l Fata

1 3 994 2 0 7 60 . 2 4 . 3 0 1 0 0. 6 0 1 4 7. 2 0 7 6 . 34

1 6 995 1 0 5 6 . 1 0 5 3 . 5 0 1 8 5. 6 0 1 4 9. 1 0 4 0 . 35

1 8 996 1 0 5 2 . 1 0 4 1 . 5 0 1 9 5. 5 0 1 7 8. 2 0 8 4 . 33

1 1 997 2 0 7 0 . 1 0 3 0 . 5 0 1 4 5. 6 0 2 9 0. 2 0 9 3 . 32

1 1 998 1 0 3 50 . 2 2 . 5 0 1 0 6. 5 0 1 0 5. 3 0 9 0 . 33

T 9 otal 8 0 5 9 . 4 0 3 0 . 2 0 4 1 1 4. 3 0 0 1 4 8. 1 0 2 7 3 . 168

C1 = Controlled Dangerous Substance Schedules I and II

Marihuana, Cocaine, etc.

C3 = Controlled Dangerous Substance Schedules III-V

Diazepam, Phentermine, etc.

Rx = Prescription Drugs

Amitriptyline, Imipramine, etc.

OT = Over-the Counter-Medications

Pseudoephedrine, Acetaminophen, etc.

Al = Alcohol levels equal to or greater than 0.04% (40.0mg/dL)

The values included in this tabulation incorporate cases in which the source of the alcohol is both

known and unknown.

Fatal = Fatal pilots only

Table 2. Fatal Aviation Accidents With Drugs and Alcohol

Y 1 ear C % C 3 1 C % C x 3 R % R T x O % O l T A %A l l Fata

1 83 989 2 70 . 2 70 . 2 4 . 2 9 6 8 . 2 0 8 9 . 34

1 4 990 1 8 3 54 . 1 4 . 2 5 6 2 . 3 7 8 9 . 2 9 7 7 . 36

1 2 991 2 7 5 38 . 0 4 . 2 2 6 2 . 4 8 1 0 0. 3 7 7 9 . 38

1 7 992 1 3 4 38 . 0 4 . 2 0 6 2 . 5 0 1 9 3. 2 3 7 0 . 40

1 3 993 1 8 3 0 . 1 9 2 1 . 3 1 9 7 . 5 8 1 0 6. 3 8 8 0 . 34

T 4 otal 7 0 4 8 . 2 5 1 0 . 1 0 1 6 7 . 2 2 0 1 6 1. 1 9 4 7 5 . 184

C1 = Controlled Dangerous Substance Schedules I and II

Marihuana, Cocaine, etc.

C3 = Controlled Dangerous Substance Schedules III-V

Diazepam, Phentermine, etc.

Rx = Prescription Drugs

Amitriptyline, Imipramine, etc.

OT = Over-the Counter-Medications

Pseudoephedrine, Acetaminophen, etc.

Al = Alcohol levels equal to or greater than 0.04% (40.0mg/dL)

The values include in this tabulation incorporate cases in which the source of the alcohol is both

known and unknown.

Fatal = Fatal pilots only
3

periods. For 1994-1998 controlled dangerous substances (CDS, schedules I and II) were found in 89

(5%) of the pilots analyzed, which is a 25 % increase

over the cases received between 1989 and 1993. The

present procedure used to screen and confirm CDS

I and II drugs is the same procedure used from 1989

to 1993 and this 25% increase does appear to be a real

increase in the use of CDS I and II drugs. Controlled

dangerous substances (schedules III - V) were found

in 49 (3%) of the pilots tested, an increase of 48%

over the earlier study (4). New screening methods

were adopted in 1994 to detect CDS III-V drugs

using HPLC/UV/FL and this could be the cause of

the increased number of positive CDS III-V drugs

detected. Prescription drugs were found in 240 (14%)

of the pilots analyzed. This constitutes an increase of

58% for prescription drugs over the original 5-year

study (4). Methods have been implemented that did

not exist between 1989 and 1993 to detect prescription drugs. This could account for the increased

number of prescription drugs found between 1994

and 1998. Over-the-counter (OTC) drugs were found

in 301 (18%) of the pilots analyzed which constitutes an increase of 37% from the OTC drugs detected between 1989 to 1993. The methods used to

screen and confirm OTC drugs have not changed

over the past 10 years and the increased number of

positives could be the result of an increased use of

these drugs by pilots. Alcohol at or above the upper

limit of 0.04% for pilots was found in 124 (7%)

cases. No change was observed in the positive rate for

alcohol between 1994 and 1998, compared with the

positive cases found between 1989 and 1993. The

reported positive alcohol increase does not differentiate between ingested and postmortem alcohol (5).

In 1995 the number of positive alcohols dropped

from the normal 8% positive alcohols to 4%. This

low positive rate only lasted for 1 year and returned

to the normal 8% in 1996. There is no clear-cut

explanation for the drop in 1995. One possible

explanation could be the implementation of the

DUI/DWI rule, which required the FAA to check for

DUI/DWI convictions of pilots and to take action to

suspend medical certificates where necessary. This

rule was enacted in 1991, but full implementation

did not occur until about 1993.

The actual drugs identified in this study are listed

in Table 3. Some drugs, such as antihistamines,

included in a given category may also be available in

another category. Multiple drug positives were found

in several of the cases. It should be noted that drugs

in Table 3 are classified based on the pure drug, and

that some of these drugs may be classified differently,

depending on the formulation of the drug.

Most airline transport and commercial pilots are

subject to drug testing for the presence of marihuana,

amphetamine/methamphetamine, morphine/codeine, cocaine, and phencyclidine (PCP). This study

examined the positive drug rate based on the medical

classification (Class 1, Class 2, or Class 3) of the pilot

and the type of pilot certificate (A – Airline Transport, C – Commercial, O – Other). The percentage

of pilots with positive CDS I-II drugs in a given

medical class is within 1% of each other (Table 4).

Controlled Dangerous Substances I-II were found in

9 (4%) of the 244 class 1 pilots compared with the 5%

in Class 2 pilots and 6% in Class 3 pilots.

A Class 1 commercial pilot flying under CFR Part

91 (general aviation) was found to be taking cocaine;

however, the 0.034 ug/mL found in urine is below

the 0.150 ug/mL in urine cut off set under 49 CFR

Part 40.29 (e). This pilot would have been classified

as negative for cocaine under the FAA drug-testing

program. The cause of the accident was reported by

the NTSB to be pilot error.

Marihuana was found in 3 Class 1 commercial

pilots, 1 Class 2 air transport pilot, and 10 Class 2

commercial pilots. The Class 2 airline transport pilot

was flying under CFR Part 135 (air taxi and commercial) at the time of the crash. Marihuana is by far the

most abused CDS drug found in commercial aviation. Morphine/Codeine was found in 1 Class 1

airline transport pilot, 3 Class 1 commercial pilots, 1

Class 2 airline transport pilot, and 3 Class 2 commercial pilots. The morphine detected in the Class 1

airline transport pilot is most likely from emergency

medical treatment because other drugs, such as

lidocaine, were also found that are typically used by

emergency medical staff. The 0.140 ug/mL of morphine found in the urine of a Class 1 commercial

pilot is below the cut-off for the FAA drug-testing

program and would have been reported as negative.
4

DRUG

SCHEDULE Drug PILOTS

CLASS 1

PILOTS

CLASS 2

PILOTS

CLASS 3

TOTAL

PILOTS

CI and CII Amphetamine/Methamphetamine 0 3 6 11

Barbiturates 0 4 5 9

Cocaine 1 3 8 13

Codeine/Morphine 4 5 8 17

Marihuana 4 17 21 43

Methaqualone 0 0 0 0

PCP 0 0 0 0

Synthetic Opiates 0 4 6 10

CIII - CV Benzodiazepines 3 8 18 33

Fenfluramine 0 0 3 5

Pentazocine 0 0 1 1

Phendimetrazine 0 0 0 0

Phentermine 0 0 4 7

Propoxyphene/Norpropoxyphene 1 4 3 10

Rx Amitriptyline/Nortriptyline 0 0 0 1

Atenolol 1 2 9 13

Azacyclonol 0 1 3 5

Brompheniramine 0 2 5 7

Carbamazepine 0 0 1 1

Cimetidine 0 2 3 6

Diltiazem 0 2 6 10

Diphenhydramine 5 17 30 54

Fluoxetine/Norfluoxetine 1 3 12 18

Gemfibrozil 0 0 1 1

Ibuprofen 1 4 3 9

Imipramine/Desipramine 1 0 2 5

Ketamine 0 0 1 1

Lidocaine 4 10 14 32

Metoprolol 0 3 1 5

Minoxidil 0 1 0 1

N-Acetylprocainamide/Procainamide 0 0 1 1

Naproxen 0 1 4 7

Nizatidine 0 1 1 2

Phenytoin 1 3 4 9

Promethazine 1 1 1 3

Propranolol 1 0 2 3

Sertraline/Desmethylsertraline 0 1 4 5

Sildenafil (Viagra)/ Sildenafil Metabolite 0 1 0 1

Theophylline 0 2 2 4

Triamterene 0 3 4 7

Verapamil/Norverapamil 2 5 10 18

OTC Acetaminophen 14 31 35 81

Chlorpheniramine/Norchlorpheniramine 5 15 24 44

Dextromethorphan 2 8 8 18

Dextrorphan/Nordextrorphan 3 1 4 8

Doxylamine 2 6 7 15

Ephedrine 4 21 21 47

Guaiphenesin 0 1 0 1

L-Methamphetamine 0 0 1 1

Meclizine 0 1 0 1

Melatonin 1 0 0 1

Methylephedrine 0 0 1 1

Naphazoline 1 0 0 1

Oxymetazoline 0 1 1 2

Phenylpropanolamine 9 35 37 82

Pseudoephedrine 9 38 35 84

Quinine 3 7 9 19

Salicylates 11 42 61 114

Table 3. All Drugs Identified between 1994 and 1998
5

C1 = Controlled Dangerous Substance Schedules I and II

Marihuana, Cocaine, etc.

C3 = Controlled Dangerous Substance Schedules III-V

Diazepam, Phentermine, etc.

Rx = Prescription Drugs

Amitriptyline, Imipramine, etc.

OT = Over-the Counter Medications

Pseudoephedrine, Acetaminophen, etc.

Al = Alcohol levels equal to or greater than 0.04% (40.0mg/dL)

The values include in this tabulation incorporate cases in which the source of the alcohol is both known

and unknown.

Fatal = Fatal pilots only

Table 5. Fatal Aviation Accidents with Drugs and Alcohol 1994 to 1998

1 1 4CFR C % C 3 1 C % C x 3 R % R T x O % O l T A %A l l Fata

9 6 1 7 0 5 2 . 4 0 3 6 . 2 0 1 1 9 5. 2 0 6 1 7 8. 1 0 1 8 4 . 147

1 40 35 5 10 . 1 50 . 6 80 . 9 40 . 5 7 . 8

1 00000000006 21

1 60 37 1 30 1. 6 60 . 1 2 1. 1 0 2 10 2. 2 4 . 5

1 0000 10 33 1 10 4. 1 007 4.

T 6 otal 8 0 5 6 . 4 0 3 8 . 2 0 2 1 0 4. 2 0 9 1 2 8. 1 0 2 7 8 . 162

C 1 lass C % C 3 1 C % C x 3 R % R T x O % O l T A %A l l Fata

1 90 4 40 . 2 8 . 1 0 7 6 . 3 0 1 1 5. 1 0 5 4 . 24

2 13 0 5 2 . 1 0 2 9 . 6 0 1 8 1. 1 0 1 1 3 9. 4 0 7 0 . 61

3 64 0 6 5 . 2 0 3 6 . 1 0 3 1 4 8. 1 0 4 1 4 9. 6 0 8 2 . 76

T 6 otal 8 0 5 1 . 4 0 3 3 . 2 0 2 1 7 4. 2 0 9 1 . 8. 1 0 18 7 6 . 161

Table 4. Fatal Aviation Accidents with Drugs and Alcohol 1994 to 1998

C1 = Controlled Dangerous Substance Schedules I and II

Marihuana, Cocaine, etc.

C3 = Controlled Dangerous Substance Schedules III-V

Diazepam, Phentermine, etc.

Rx = Prescription Drugs

Amitriptyline, Imipramine, etc.

OT = Over-the Counter Medications

Pseudoephedrine, Acetaminophen, etc.

Al = Alcohol levels equal to or greater than 0.04% (40.0mg/dL)

The values include in this tabulation incorporate cases in which the source of the

alcohol is both known and unknown.

Fatal = Fatal pilots only
6

Amphetamine/methamphetamine was found in 2

Class 2 commercial pilots. One of the cases was a

CFR Part 137 (agricultural) accident with methamphetamine and was also found to contain fluoxetine,

an antidepressant. The drugs found in this case were

judged an impairing factor in this accident by the

NTSB. Methamphetamine and marihuana were found

in another CFR Part 137 accident. The cause of this

accident is still under investigation. The laboratory

has never detected a positive PCP in specimens received from fatal aviation accidents. No pilot in a

CFR Part 121 (Air Carrier) fatal aviation accident

was found to be positive for drugs or alcohol (Table

5). It is difficult to assign any significance to this

finding due to the small number of accidents (6) that

occurred between 1994 and 1998. There were 87

CFR Part 135 accidents and 4 of the pilots from these

accidents were found to have CDS I and II drugs. Of

the 1683 pilots examined 131 pilots (8%) held a

Class 1 medical and were classified as air transport

and 93 (6%) were classified as Class 1 commercial

pilot (Table 6). Only 1 (0.8%) of the 131 Class 1 air

transport pilots was found to have CDS I-II drugs

and this pilot was given morphine after the accident

during emergency medical treatment. This agrees

with the FAA drug testing program’s findings that

less than 1% of those tested under the random drug

testing program are positive for abused drugs. Between 1990 and 1993 there were 4 (2.8%) out of 145

Class 1 air transport pilots found with CDS I-II

drugs. One of these pilots flying Part 91 was using

cocaine, 2 pilots flying CFR Part 91 were using

marihuana, and 1 pilot flying CFR Part 135 was

using morphine. These data indicate a drop in the use

of abused drugs by Class 1 medical air transport fatal

pilots over the past 10 years.

REFERENCES

1. General Operating and Flight Rules, 14CFR91.17,

Alcohol or Drugs; Federal Aviation Regulations

(January 1, 1999).

2. Aviation Safety Research Act of 1988, Public Law

100-591 [H.R. 4686], Civil Aeromedical Research; One Hundredth Congress of the United

States 2nd Session (January 25, 1988).

3. Aircraft Accident and Incident Notification, Investigation, and Reporting, DOT Order 8020.11,

chap 4, sect 7, par 170 c (1), Civil Aeromedical

Institute Shall (December 20, 1985).

4. Canfield D, Flemig J, Hordinsky J, and Birky M

(1995). Drugs and alcohol found in fatal civil

aviation accidents between 1989 and 1993.

Office of Aviation Medicine Report DOT/FAA/

AM-95/28.

5. Canfield D, Kupiec T, and Huffine E (1993).

Postmortem alcohol production in fatal aircraft

accidents. J Forensic Sci 38(4): 914-17.

Table 6. Fatal Aviation Accidents Class 1 Levels A, C, P, S, and Y for 1994 to 1998

Class A AC% % C P %P S %S Y%Y l Tota

1 1 1 9 3 5 3 3. 9 3 3 5 8. 1 2 6 32 . 1 14 . 0 3 . 24

A = Airline Transport Pilot

C = Commercial Pilot

P = Private Pilot

S = Student Pilot

Y = Private Pilot from Foreign Certificate

Fatal = Fatal pilots only