Opioid Epidemic An Aviation Concern

COVID-19 is storming back with the Delta variant. Yet another deadly epidemic lurks in the background, claiming many lives—opioid abuse.

According to government estimates almost one-third of the population suffers from chronic pain of one source or another. About 25 million people have moderate to severe pain to the point where activity and performance are severely limited.

So it’s not surprising that there is a large demand for the pain relief provided by opioids. In addition to illegally manufactured fentanyl and heroine,

misuse of prescription opioids such as morphine, Demerol, hydrocodone, codeine and fentanyl account for a rising tide of disability and death. In 2019, 49,860 fatalities were attributed to narcotic overdose.

So how does a straight-arrow gal or guy, as most pilots are, get into opioid abuse? Addiction or dependency usually results from long term use of one of these pain killers. The medical community is well aware of this. Alternate pain reduction strategies tend to be favored over narcotics in most instances. Yet there are times where prescriptions appropriately written are misused or overused and abuse or addiction results. The FAA clearly defines a pilot as being dependent if he/she manifests any one of the following:

• Increased tolerance of medication;

• Manifestation of withdrawal symptoms;

• Impaired control of use of medication;

• Continued use despite damage to physical health or impairment of social, personal or occupational functions.

It is a violation of Federal Aviation Regulations (14 CFR 61.53) to operate an aircraft while any opioids are onboard. If you are flying Part 121 or 135 operations you are subject to random drug testing for narcotics among a number of other potentially impairing drugs. Obviously, a positive test is big trouble.

There are a number of common-sense precautions to take to prevent ever getting into a run-in with opioids. First of all if you have a pain problem, discuss alternate therapies with your physician. There are a range of progressive approaches that might include non-drug treatments such as physical therapy, behavioral therapy or complementary medicine approaches. Non-steroidal anti-inflammatory agents can be an effective next step. If you have the tendency to doctor yourself, watch it! Don’t take other person’s medications. What worked wonders for Joe may well be a no-go for you. Don’t take medications for a condition other than that for which it was prescribed.

If you do require an opioid, obviously you’re grounded. You should also ask the question, “does the problem I have for which I’m taking this drug also ground me?” A talk with your AME might be in order.

So how long do you have to wait to fly after taking a disqualifying drug? Let’s say you dropped a sledgehammer on your foot, broke a bone or two, were given OxyContin for a short time. You hobbled around for a while and now feel fit to fly. How long after taking the last dose of a bad drug is it safe to “kick the tires and light the fires”? People are different and the speed with which their body eliminates a drug can vary, but the FAA recommends waiting five drug half-lives or five maximum dosing intervals before hopping back into the cockpit. Let’s say you’re given hydrocodone/acetaminophen tablets to take every 4 to 6 hours as needed for pain. Wait for 30 hours (6 hours x 5) after the last dose before flying. Hopefully that will be long enough, but sometimes not. If you are operating under Part 121 or 135 and

get a positive drug test in spite of waiting the appropriate interval you are in technical violation. Fortunately you will have the opportunity to show a Medical Review Officer (MRO) a valid prescription for the drug detected. No need to bring along the sledge hammer. The MRO is empowered to downgrade the positive laboratory test to a “negative MRO verified test.” Bottom line—err on the side of caution. Fly wisely. See you next month.