Editorial, by Jon L. Jordan, MD, JD
Medications and Flying: Let’s Get the Word Out

Dealing with issues related to use of medications by airmen has often proven to be a complex and, therefore, frustrating experience for both AMEs and those of us in the Federal Aviation Administration (FAA) who must make medical eligibility decisions. The extensive number of medications, including both over-the-counter and prescription medications is mind boggling, to say the least.

From time-to-time we have been urged to create a comprehensive “list” of either disqualifying medications or medications that might be used safely while performing aviation duties. While we have identified categories of medications that we consider either acceptable or unacceptable and have done the same for certain individual medications, we have for a number of reasons resisted the urging for a comprehensive list. These reasons include the formidable and labor-intensive task of developing and keeping current an easy-to-understand source document for medications and the resources such an effort would consume.

There are thousands of prescription and over-the-counter medications currently on the market, and hundreds of new medications approved by the Food and Drug Administration each year. Considering issues related to the underlying conditions for which medications are used, drug interactions, medication dosages, and the shear number of medications, it is unlikely that a source document could be developed and accurately maintained that would be used or clearly understood by airmen.

In spite of the obstacles and reasons for not establishing a source document for medications, I recognize that the absence of clear and comprehensive information on medications is problematic for both aviation medical examiners (AMEs) and airmen. To clarify the acceptability of certain medications, we provide information in the Federal Air Surgeon’s Bulletin and various other publications, at seminars for AMEs and airmen, and in the Guide for AMEs, which, as you know, is available on the FAA Web site.

Recently, the National Transportation Board recommended that FAA develop, then periodically publish, an easy-to-understand source of information for pilots on the hazards of using specific medications when flying. This recommendation was an outgrowth on an observation that in many surface and aviation accidents investigated by the NTSB, the use of a licit medication by a vehicle operator has been causal or contributory to the accident.

FAA’s response to the NTSB recommendation indicated the belief that FAA’s educational programs and regulations currently in place address the safety issue regarding medication use. FAA pointed out the various educational initiatives underway, including the planned development of a new brochure to expand information on over-the-counter and prescription medication and their impact on flying.

This response satisfied the NTSB, contingent on their review of the brochure and acceptability of a distribution plan that would ensure that pilots are provided a copy of the brochure. You will find elsewhere in this issue of the Bulletin a copy of the brochure. We are in the process of developing a distribution plan that will almost certainly require the support of all AMEs to make certain that applicants for medical certification are knowledgeable of the dangers of use of certain medications and have access to the brochure.

I am completely in agreement with the NTSB regarding the safety issue presented by airmen who use over-the-counter or prescription medications that may negatively impact safety. It is important, therefore, that we caution airmen about the use of such medications. I trust that you, as aviation medical examiners, will do your part in raising the visibility of this issue to airmen and assist in this important safety initiative.