title: Drug violations and aviation accidents: findings from the US mandatory drug testing programs.
abstract: OBJECTIVE
  To assess the role of drug violations in aviation accidents.
  
  
  METHODS
  Case-control analysis.
  
  
  METHODS
  Commercial aviation in the United States.
  
  
  METHODS
  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).
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
authors.affiliation: Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. gl2240@columbia.edu
authors.forename: Guohua
authors.initials: G
authors.lastname: Li
authors.forename: Susan P
authors.initials: SP
authors.lastname: Baker
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhao
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Brady
authors.forename: Barbara H
authors.initials: BH
authors.lastname: Lang
authors.forename: George W
authors.initials: GW
authors.lastname: Rebok
authors.forename: Charles
authors.initials: C
authors.lastname: DiMaggio
mesh_terms: D000060:Accidents, Aviation / Q000706:statistics & numerical data*; D000293:Adolescent; D000337:Aerospace Medicine / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D016001:Confidence Intervals; D006801:Humans; D013287:Illicit Drugs / Q000652:urine; D037141:Mandatory Programs; D016017:Odds Ratio; D016134:Organizational Policy; D012449:Safety / Q000331:legislation & jurisprudence; D015813:Substance Abuse Detection / Q000331:legislation & jurisprudence*; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000652:urine; D014481:United States / Q000453:epidemiology; D017132:Workplace / Q000458:organization & administration
chemical_list: D013287:Illicit Drugs