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(marijuana); cocaine; heroin; hashish; mescaline; LSD (d-lysergic acid).
Other agents are also used to alter the mental state, and all produce effects absolutely incompatible with
flying. It is not only the drug effects per se that are of concern but also the psychological factors that would
lead an individual to use them. One would have difficulty in having confidence in a pilot who uses such
agents, even if he presumably has completely metabolized a given dosage. In addition, the fear of
“flash-back” is always present in anyone using hallucinogens.
These same considerations apply to the illicit usage of legitimate medicines such as amphetamines,
barbiturates and other stimulants and depressants, intended for use only when prescribed by licensed
physicians. While some argue that marijuana is “no worse than alcohol”, it does not seem justified on the
basis of studies thus far to assume that “use of marijuana is no worse than social drinking”. Further, there
is insufficient information of the subtle effects on operational performance in aviation to confidently
provide guidelines regarding safe use of marijuana. If a pilot is prepared to take recreational drugs in
violation of civil law and, in consequence, imperils his licensure, such behaviour makes him unsuitable for
undertaking safety-critical aviation functions.
ICAO Preliminary Unedited Version — November 2009 III-14-11
MEDICINES USED FOR SCHIZOPHRENIA, SCHIZOTYPAL DELUSIONAL
AND BIPOLAR DISORDERS
Some of the more commonly used psychoactive pharmaca are: chlorpromazine; chlorprothixene;
thioridazine; prochlorperazine and lithium. Such pharmaca normally have unacceptable side effects, are
insufficiently reliable, and the potential consequences from failure to adequately suppress the underlying
illness are unacceptable. At present, such illnesses pose an unacceptable risk to flight safety.
SUMMARY
The flight safety aspects of pharmacotherapy involve an assessment of risk. Some disorders are minor and
treatment may be more detrimental (to flight safety) than the disorder itself. On the other hand, more
serious illnesses might not be acceptable without adequate treatment. Finally, some diseases have such
potentially adverse effects on flight safety that, whether treated or not, the diagnosis per se is disqualifying.
However, diseases in this latter group are becoming less frequent as new treatment modalities are
developed, medicines are improving, and side effects diminish. This will pose an increasingly difficult
challenge to aviation medicine specialists, who must strike a balance between protecting flight safety and
promoting a “reporting culture” that encourages applicants to admit to the medical problems they have, and
to inform about the medicines they are taking. If a medical problem is not disqualifying per se but requires
medication, then it is clear that the possible effects of the medicines themselves are at issue. Any therapeutic
agent that is likely to significantly interfere with mentation, alertness, vision, co-ordination, judgement, etc.
should be prohibited for all safety-critical personnel.
More information on the use of medicines in relation to specific medical conditions and diseases is given in
the previous chapters of this Manual. Additional, detailed information on problematic use of psychoactive
substances in the aviation workplace can be found in ICAO Doc. 9654.
REFERENCES
ICAO Manual on prevention of problematic use of substances in the aviation workplace (Doc 9654), First
Edition, 1995
Rayman, Russell B. et al.: Clinical Aviation Medicine, 4th. edition, 2006.
Virginia Polytechnic Institute and State University. (2007, September 17). In Wikipedia, The Free
Encyclopedia (retrieved from http://en.wikipedia.org/wiki/Blood_alcohol_content)
————————
ICAO Preliminary Unedited Version — October 2008
Part III
Chapter 15. MALIGNANT DISEASE
Page
Introduction............................................................................................... III-15-1
Primary treatment for malignant disease............................................... III-15-1
Surgery .................................................................................................III-15-1
Radiotherapy ........................................................................................III-15-1
Chemotherapy ......................................................................................III-15-2
Stem cell transplantation ...................................................................... III-15-2
Certification after primary treatment..................................................... III-15-2
　
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