ABSTRACT

Aims To assess the role of drug violations in aviation accidents.

Design Case–control analysis.

Setting Commercial aviation in the United States.

Participants Aviation employees who were tested for drugs during 1995–2005 under
the post‐accident testing program (cases, n = 4977) or under the random testing
program (controls, n = 1 129 922).

Measurements Point prevalence of drug violations, odds ratio of accident

involvement and attributable risk in the population. A drug violation was defined as a
confirmed positive test for marijuana (≥50 ng/ml), cocaine (≥300 ng/ml),
amphetamines (≥1000 ng/ml), opiates (≥2000 ng/ml) or phencyclidine (≥25 ng/ml).

Findings The prevalence of drug violations was 0.64% [95% confidence interval (CI):
0.62–0.65%] in random drug tests and 1.82% (95% CI: 1.47–2.24%) in post‐accident
tests. The odds of accident involvement for employees who tested positive for drugs
was almost three times the odds for those who tested negative (odds ratio 2.90, 95%
CI: 2.35–3.57), with an estimated attributable risk of 1.2%. Marijuana accounted for
67.3% of the illicit drugs detected. The proportion of illicit drugs represented by
amphetamines increased progressively during the study period, from 3.4% in 1995 to
10.3% in 2005 (P < 0.0001).

Conclusions Use of illicit drugs by aviation employees is associated with a

significantly increased risk of accident involvement. Due to the very low prevalence,
drug violations contribute to only a small fraction of aviation accidents.

CITING LITERATURE

Number of times cited according to CrossRef: 9

 Michael G. Fitzsimons, Keith Baker, Rajeev Malhotra, Andrew Gottlieb, Edward Lowenstein
and Warren M. Zapol, Reducing the Incidence of Substance Use Disorders in Anesthesiology
Residents,Anesthesiology, 10.1097/ALN.0000000000002348, 129, 4, (821-828), (2018).

Crossref
 Anna Schuh-Renner, Michelle Canham-Chervak, Darren W. Hearn, P. Ann Loveless and Bruce
H. Jones, Factors Associated With Injury Among Employees at a U.S. Army
Hospital, Workplace Health & Safety, (216507991773606), (2017).

Crossref

 Mary Pat McKay and Loren Groff, 23 years of toxicology testing fatally injured pilots:
Implications for aviation and other modes of transportation, Accident Analysis &
Prevention, 10.1016/j.aap.2016.02.008, 90, (108-117), (2016).

Crossref

 K. Blaho-Owens, Aviation Medicine: Illness and Limitations for Flying, Encyclopedia of

Forensic and Legal Medicine, 10.1016/B978-0-12-800034-2.00051-3, (394-400), (2016).

Crossref

 Anders Helander, Olof Beck and Matilda Bäckberg, Intoxications by the dissociative new
psychoactive substances diphenidine and methoxphenidine, Clinical
Toxicology, 10.3109/15563650.2015.1033630, 53, 5, (446-453), (2015).

Crossref

 T. Lahey and W. A. Nelson, A Proposed Nationwide Reporting System to Satisfy the Ethical
Obligation to Prevent Drug Diversion-Related Transmission of Hepatitis C in Healthcare
Facilities, Clinical Infectious Diseases, 60, 12, (1816), (2015).

Crossref

 Dayong Lee and Marilyn A. Huestis, Current knowledge on cannabinoids in oral fluid, Drug
Testing and Analysis, 6, 1-2, (88-111), (2013).

Wiley Online Library

 Dayong Lee, Ryan Vandrey, Garry Milman, Mateus Bergamaschi, Damodara R. Mendu, Jeannie
A. Murray, Allan J. Barnes and Marilyn A. Huestis, Oral fluid/plasma cannabinoid ratios
following controlled oral THC and smoked cannabis administration, Analytical and
Bioanalytical Chemistry, 405, 23, (7269), (2013).

Crossref

 Christina M. Rudin-Brown, Eve Mitsopoulos-Rubens and Michael G. Lenné, Perceived

Effectiveness of Random Testing for Alcohol and Drugs in the Australian Aviation
Community, Aviation Psychology and Applied Human Factors, 2, 2, (72), (2012).

Crossref

Volume106, Issue7
July 2011
Pages 1287-1292