Drug violations and aviation accidents: findings from the US mandatory drug testing programs
Version of Record online: 7 APR 2011
© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction
Volume 106, Issue 7, pages 1287–1292, July 2011
How to Cite
Li, G., Baker, S. P., Zhao, Q., Brady, J. E., Lang, B. H., Rebok, G. W. and DiMaggio, C. (2011), Drug violations and aviation accidents: findings from the US mandatory drug testing programs. Addiction, 106: 1287–1292. doi: 10.1111/j.1360-0443.2011.03388.x
- Issue online: 3 JUN 2011
- Version of Record online: 7 APR 2011
- Accepted manuscript online: 10 FEB 2011 07:12AM EST
- Submitted 15 July 2010; initial review completed 15 October 2010; final version accepted 28 January 2011
- drug testing;
- substance abuse
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.