2018-2022 Update to Drug Use Trends in Aviation

​​​​​​​​This safety research report provides an update concerning drug presence identified by toxicology testing of flying pilots who were fatally injured in United States civil aviation accidents during the years 2018–2022.

This research update showed a continued increase in overall drug presence among fatally injured pilots when compared with the results of previous National Transportation Safety Board (NTSB) reports that examined the periods 2013–2017 and 1990–2012.[1] More than half (52.8%) of fatally injured pilots tested positive for at least one drug, and more than a quarter (27.7%) tested positive for two or more drugs. This report, like the previous two, did not attempt to use information about drug presence to infer whether a pilot was impaired. Rather, we are reporting on the presence of drugs, some of which have the potential to cause impairment or are used to treat potentially impairing conditions.

Among the four drug types analyzed in this research update, two increased and two decreased compared with the NTSB’s 2020 report. The largest increase was in illicit drugs, which were detected in 7.4% of fatally injured pilots for the 5-year period examined, a 2.4 percentage point increase over the previous 5-year period. This increase was primarily due to an increased prevalence in delta-9-tetrahydrocannabinol, the primary psychoactive chemical in marijuana. Potentially impairing drugs, a broader category that included illicit drugs as well as prescription and over-the-counter drugs that could diminish a pilot’s cognitive or psychomotor performance, increased 0.6 percentage points to 28.6%. Drugs used to treat potentially impairing conditions decreased 1.6 percentage points to 13.5%, and controlled substances decreased 3.2 percentage points to 6.9%.

With regard to categories of drugs, the most commonly found were cardiovascular drugs, sedating antihistamines, nonsedating over-the-counter drugs, cholesterol-lowering drugs, prostate/erectile dysfunction drugs, and illicit drugs. A new drug category was introduced in this research update: US Food and Drug Administration unapproved drugs, which was present in 0.8% of fatally injured pilots.

Drug prevalence was related to several factors, including age, flight operations, and certification. The prevalence of potentially impairing drugs and drugs indicating potentially impairing conditions were more common in older pilots. Drug prevalence of all types was lower among pilots conducting Title 14 Code of Federal Regulations Part 135 operations compared with those conducting general aviation operations. With respect to certification, drug prevalence was lowest among pilots holding airline transport pilot or commercial pilot certificates compared with those holding private, sport, or student pilot certificates, or those with no pilot certificate. Similarly, drug prevalence was lower among pilots whose medical certificate was still within the duration limits of a third-class certificate compared with those with expired or no medical certificates.