WASHINGTON (May 14, 2026) — The National Transportation Safety Board published a safety research report that found that 52.8% of fatally injured pilots tested positive for at least one drug of any type, and 27.7% tested positive for two or more drugs, continuing an upward trend.
The study examined drug presence identified through toxicology testing of pilots killed in U.S. civil aviation accidents between 2018 and 2022. The report, 2018–2022 Update to Drug Use Trends in Aviation, updates earlier NTSB studies examining drug presence among fatally injured pilots from 1990–2012 and 2013–2017.
Among drug categories identified, the most commonly detected included cardiovascular medications, sedating antihistamines, nonsedating over-the-counter drugs, cholesterol-lowering medications, prostate or erectile dysfunction drugs and illicit drugs.
Detection of potentially impairing drugs increased slightly to 28.6%, with the sedating antihistamine medication diphenhydramine remaining the most detected potentially impairing drug. Illicit drug detection increased to 7.4%, driven primarily by increases in delta-9-tetrahydrocannabinol (delta-9-THC), the primary psychoactive chemical in marijuana.
Researchers also found that drug prevalence varied by pilot age, certification level and type of operation. Drug presence was lower among pilots conducting Part 135 operations than among those operating in general aviation, lower among pilots with an active medical certificate than pilots without an active medical certificate, and lower among pilots holding airline transport and commercial pilot certificates than among pilots holding private, sport or student certificates, or no certificate.
The report emphasizes that the presence of drugs identified through toxicology testing does not necessarily indicate pilot impairment. Instead, the study documents trends in drug detection and provides context for understanding factors that may affect aviation safety.
The safety research report is available on the NTSB website.
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