Comparison of Pilot 

Medical History and 

Medications Found In 

Postmortem Specimens

Dennis V. Canfield

Guillermo J. Salazar

Russell J. Lewis

James E. Whinnery

Civil Aerospace Medical Institute

Federal Aviation Administration

Oklahoma City, OK 73125

May 2006

Final Report

DOT/FAA/AM-06/12

Office of Aerospace Medicine

Washington, DC 20591
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.

___________

This publication and all Office of Aerospace Medicine 

technical reports are available in full-text from the Civil 

Aerospace Medical Institute’s publications Web site: 

www.faa.gov/library/reports/medical/oamtechreports/index.cfm
i

Technical Report Documentation Page 

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

DOT/FAA/AM-06/12 

4. Title and Subtitle 5. Report Date 

Comparison of Pilot Medical History and Medications Found In May 2006 

Postmortem Specimens 6. Performing Organization Code 

 

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

Canfield DV, Salazar, GJ, Lewis, RJ, Whinnery, JE 

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

 

11. Contract or Grant No. 

FAA Civil Aerospace Medical Institute 

P.O. Box 25082 

Oklahoma City, OK 73125 

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

 

 

 

Office of Aerospace Medicine 

Federal Aviation Administration 

800 Independence Ave., S.W. 

Washington, DC 20591 14. Sponsoring Agency Code 

15. Supplemental Notes 

Work was accomplished under approved task AM-B-05-TOX-204 

16. Abstract 

Introduction: Pilots are required by Federal Aviation Administration (FAA) regulations to report all medications and 

medical conditions to the FAA Office of Aerospace Medicine for review and consideration as to the overall suitability of 

the pilot for flight activities. Methods: Following a fatal aviation accident, specimens from deceased pilots are collected 

by local pathologists and sent to the Bioaeronautical Sciences Research Laboratory for toxicological analysis. The 

results of such tests are entered into the Bioaeronautical Sciences Research Laboratory, Forensic Case Management 

System (© 1998, DiscoverSoft Development, LLC, Oklahoma City, OK). This database was searched to identify all pilots 

found positive for medications used to treat cardiovascular, psychological, or neurological conditions over the period 

January 1, 1993, through December 31, 2003. These medical conditions were selected because of their potential to 

rapidly incapacitate a pilot in-flight. It is important to note that some of the medications found may have been 

administered by health care workers as a part of emergency medical treatment after the accident. Results: Our

laboratory conducted toxicological evaluations on 4,143 pilots during the study period. Psychotropic drugs were found in 

223 pilots (5%). Cardiovascular medications were found in 149 pilots (4%). Neurological medications were found in 15 

cases (0.4%). Pilots reported psychological conditions in 14 of the 223 pilots found positive for psychotropic drugs. Only 

1 of the 14 pilots reporting a psychological condition on their medical application reported the psychotropic medication 

found after the accident. Cardiovascular disease was reported by 69 of the pilots found to have cardiovascular drugs in 

their system. The cardiovascular medications found in the pilots were reported by 29 of the 69 pilots reporting a 

cardiovascular condition. Additionally, two pilots reported taking cardiovascular medications, but no cardiovascular 

medications were found in the postmortem specimens tested. Only 1 of the 15 pilots reported having a neurological 

condition on their medical application; none of the pilots found with neurological medications had reported the medication 

on their medical application. The medical history of the pilots did not always specify the type of drugs being taken. 

Conclusions: Based on the drugs screened for by the laboratory, we successfully identified 93% of the medications 

reported by the pilots. One must consider the possibility that the remaining 7% of the pilots stopped taking the 

medication prior to the accident. Pilots involved in fatal accidents taking psychotropic or neurological medications rarely 

reported the medication or their underlying medical condition with the FAA Aerospace Medical Certification program, as 

required.

 

17. Key Words 18. Distribution Statement 

 

 

Forensic Science, Toxicology, Medical, Postmortem Document is available to the public through the 

Defense Technical Information Center, Ft. Belvior, VA 

22060; and the National Technical Information 

Service, Springfield, VA 22161 

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

Unclassified Unclassified 7 

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

1

Comparison of Pilot Medical History and Medications

Found in Postmortem Specimens

INTRODUCTION

The Federal Aviation Administration’s (FAA’s) Office 

of Aerospace Medicine (OAM) monitors the medical 

certification of pilots to verify their compliance with 

FAA medical certification aviation safety standards. This 

research compared the medical history reported to OAM 

by pilots on FAA Form 8500-8 (Application for Airman 

Medical Certificate or Airman Medical & Student Pilot 

Certificate) with the medication analytically identified 

by the FAA’s Bioaeronautical Sciences Research Laboratory in postmortem specimens taken from a pilot after 

a fatal aviation accident. The medical history includes 

reporting medical problems and the medications taken. 

Several papers have reported on the incidence of drugs 

and alcohol in victims of fatal aviation accidents.1-6 A 

previous study investigated a small group of pilots, comparing their medical history with the drugs found after 

an accident.7 The current study evaluated the ability of 

the FAA toxicology laboratory to identify drugs reported 

by pilots on their medical applications. In addition, this 

study examined the reliability of the medical information provided by pilots regarding their reported medical 

condition(s). 

Medical conditions and the medications used to treat 

these conditions are both considered by the National 

Transportation Safety Board (NTSB) to be critical factors 

in the thorough evaluation of transportation accidents. 

The NTSB has issued safety recommendations8 based on 

the dangers of pilots using prescription and/or over-thecounter medications while performing safety-sensitive 

aviation activities. McCormick reported “The Safety 

Board’s investigation must determine if a crewmember 

suffered from a preexisting disease, whether the crew had 

ingested drugs contraindicated with their flying duties, 

as well as a description of all injuries and all toxicological 

and histological findings for crew and passengers. During Safety Board investigations conducted in densely 

populated cites, over oceans, and in remote areas, both 

in the United States and overseas, many situations have 

developed which have caused much investigative effort 

due to less than complete postmortem examinations.”9

The Bioaeronautical Sciences Research Laboratory 

utilizes state-of-the-art forensic toxicological analysis on 

all postmortem specimens to fulfill the need to understand 

the relationship of medications in accident causation.

MATERIALS AND METHODS

Biological fluids and tissues were collected by local pathologists from deceased pilots using procedures 

described at the FAA Internet Web site10 following aviation accidents and sent to the CAMI Bioaeronautical 

Sciences Research Laboratory for analysis.11 The results 

of such tests are entered into the laboratory’s database. 

These data are readily organized and analyzed based on 

the class of drug, as defined by the individual researcher, 

using the “Forensic Case Management System” (© 1998, 

DiscoverSoft Development, LLC, Oklahoma City, OK). 

The toxicology database was searched from January 1, 

1993, through December 31, 2003, to define all cases 

containing the major medications used in the treatment of cardiovascular, psychological, and neurological 

conditions. This selection was made since these medical 

conditions posed the greatest potential to incapacitate 

a pilot during flight. It is important to remember that 

some of the drugs found may have had their origin from 

emergency medical treatment administered immediately 

after the accident. The analytical methodology for each 

of the medications has been previously described and is 

well established.

RESULTS

Specimens from 4,143 deceased pilots were rigorously 

analyzed for medications over the duration of this study. 

Only 3 classes of medication were considered in this 

study: psychotropic, cardiovascular, and neurological 

classes. Psychotropic medications were found in 223 pilot 

fatalities (5%). Cardiovascular medications were found 

in 149 pilot fatalities (4%). Neurological medications 

were found in 15 pilot fatalities (0.4%). Psychological 

conditions were reported by 14 (6%) of the 223 pilots 

found to be taking psychotropic drugs. Only 1 pilot with 

a psychotropic medication had reported the medication 

on the medical application. Cardiovascular disease was 

reported by 69 (46%) of the 149 pilots found positive 

for cardiovascular drugs. Of the 149 pilots found to be 

using cardiovascular medications, 29 had reported this 

on their medical application. Cardiovascular medications reported by 2 pilots were not actually found in 

postmortem specimens tested. Only 1 (7%) of the 15 

pilots taking neurological medications had reported a 
2

neurological condition on the medical application. None 

of the pilots found with neurological medications had 

reported the medication. 

The accuracy of required reporting of medication on 

FAA Form 8500-8 by pilots was low. Of the 387 samples 

reviewed, only 30 (8%) had accurately reported medications they were taking. No medications were reported by 

286 (74%) of the pilots found to be positive for drugs 

by post-accident toxicology, and 71 (18%) had reported 

medications different than what was detected by toxicological examination. Table 1 summarizes the findings. 

The pilots’ reported medical history and records did not 

always specify the type of medications being given or 

taken. Table 2 provides a list of the medications found 

in postmortem specimens.

DISCUSSION AND CONCLUSION

The FAA’s Bioaeronautical Sciences Research Laboratory was successful in identifying 93% of the medications that were reported by pilots (93% of the drugs the 

laboratory screens for). One must consider the possibility 

that the remaining 7% of the pilots stopped taking the 

medication previously reported in their medical applications. Not surprisingly, the accuracy of required reporting 

of medication usage by pilots was low, with 92% of pilots 

either failing to report medications they were taking or 

reporting a different medication than what was found 

during toxicological analysis. Pilots taking psychotropic or 

neurological medications rarely reported the medication 

or medical condition on their FAA medical application. 

Compared with cardiovascular disease, proportionately 

fewer Authorizations for Special Issuance (i.e., waivers) 

were granted by OAM for these two conditions; hence, 

one could speculate that pilots choose to not disclose 

such conditions and continue flying. Almost half of the 

pilots found to be taking cardiovascular medications 

reported their condition to the FAA Office of Aerospace 

Medicine (Figure 1).

REFERENCES

1. Soper JW, Chaturvedi AK, Canfield DV. Prevalence 

of chlorpheniramine in aviation accident pilot 

fatalities, 1991-1996. Aviat Space Environ Med

2000;71:1206-9.

2. Canfield DV, Hordinsky J, Millett DP, Endecott B, 

Smith D. Prevalence of drugs and alcohol in fatal 

civil aviation accidents between 1994 and 1998. 

Aviat Space Environ Med 2001;72:120-4.

3. Akin A, Chaturvedi AK. Selective serotonin reuptake inhibitors in pilot fatalities of civil aviation 

accidents, 1990-2001. Aviat Space Environ Med

2003;74:1169-76.

4. Shkrum MJ, Hurlbut DJ, Young JG. Fatal light aircraft 

accidents in Ontario: A five year study. J Forensic 

Sci 1996;41:252-63.

5. Canfield DV, Fleming J, Berky M, Hordinsky J. 

Drugs and alcohol found in fatal aviation accidents 

between 1989 and 1993. (Report No. DOT/FAA/

AM-95/9). Washington, DC: Federal Aviation 

Administration.

6. Kuhlman JJ, Jr., Levine B, Smith ML, Hordinsky JR. 

Toxicological findings in Federal Aviation Administration general aviation accidents. J Forensic Sci

1991;36:1121-8.

7. Canfield DV, Fleming J, Hordinsky J, Veronneau S. 

Unreported medications, used in incapacitating 

medical conditions found in fatal civil aviation accidents. (Report No. DOT/FAA/AM-94/8). Washington, DC: Federal Aviation Administration.

8. National Transportation Safety Board. Establish a 

list of approved medications. Washington, DC: 

NTSB; Safety recommendation I-00-1 through 4. 

January 13, 2000.

9. McCormick MM. Joint Committee on Aviation Pathology: VIII. Medical investigator preparedness for 

aircraft accident investigation. Aviat Space Environ 

Med 1977;48:932-6.

10. Federal Aviation Administration. Collecting and shipping toxicology specimens. Washington, DC: FAA; 

Retrieved May 23, 2006, from the Internet: www.

faa.gov/education_research/research/med_human

facs/aeromedical/forensictoxicology/forms/index.

cfm.

11. Chaturvedi AK, Smith DR, Soper JW, Canfield DV, 

Whinnery JE. Characteristics and toxicological 

processing of postmortem pilot specimens from 

fatal civil aviation accidents. Aviat Space Environ 

Med 2003;74:252-9.
3

Table 1. Type of medications identified in pilot fatalities and pilot disclosures. 

Medical

Condition

Pilots With 

Medications

Medical Conditions 

Reported by Pilots

Medications

Reported by Pilots 

Cardiovascular 149 69 29 

Neurologic 15 1 0 

Psychological 223 14 1 

Total 387 84 30

Note: Table reflects specific medications and conditions of interest from 4143 individual samples.

Table 2. List of psychotropic, cardiovascular, and neurological medications found in 

this study.

Pyschotropic # Cardiovascular # Neurological #

Alprazolam 8 Amlodipine 8 Carbamazepine 3

Amitriptyline 10 Atenolol 33 Phenytoin 11

Bupropion 14 Bisoprolol 4 Selegiline 1

Buspirone 1 Clonidine 1 Total 15

Chlordiazepoxide 5 Diltiazem 23

Citalopram 13 Doxazosin 1

Clomipramine 1 Flecainide 1

Desalkylflurazepam 3 Labetalol 4

Diazepam 29 Metoprolol 24

Doxepin 2 Moricizine 1

Fluoxetine 40 Nadolol 4

Imipramine 10 Procainamide 3

Lorazepam 1 Propranolol 9

Mirtazapine 2 Verapamil 33

Nefazodone 1 Total 149

Nordiazepam 16

Norfluoxetine 1

Oxazepam 2

Paroxetine 21

Sertraline 26

Temazepam 5

Trazodone 4

Venlafaxine 6

Zolpidem 2

Total 223
4

69

14

1

149

223

15

0

50

100

150

200

250

CV PY NR

Path

Total

CV=cardiovascular, PY=psychotropic, NR= neurological 

Figure 1. Comparison of reported medical conditions to medications found postmortem.