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Stimulant is pilots' last tool

AFPN

1/14/2003

by Master Sgt. Scott Elliott Air Force Print News

01/14/03 - WASHINGTON -- When fatigue closes in and all other tools in the fatigue management program have been exhausted, many pilots reach for the "go pill" to help them get home safely.

"Fatigue is a known killer," said Maj. Gen. Daniel P. Leaf, director of Air Force operational capability requirements at the Pentagon. "We've got to fight it."

According to Air Force safety officials, fatigue was a contributing factor in 391 Air Force aircraft accidents from 1991 to 2002.

To fight the problem, the service uses a comprehensive fatigue-management program, featuring scheduled rest periods before flight operations, proper nutrition and exercise. When all else fails, a pilot may turn to prescribed medication to remain alert for the duration of the flight.

"('Go pills') are used in an environment where you can't simply pull over to a rest area and take a nap," Leaf said.

Formally known as the amphetamine Dexedrine, "go pills" are prescribed to pilots in very low doses to take the edge off fatigue. But, Leaf said, pilots must complete a rigorous ground-testing protocol to determine how the drug will affect them individually.

According to Col. (Dr.) Peter Demitry, the Air Force Surgeon General's chief of science and technology, the stimulant has been safely used for 60 years to combat fatigue on extremely long missions.

"We've never found anyone to have suffered any kind of adverse effect from it," he said. "('Go pills') have saved lives. Fatigue is the hazard here, not this medication.

"Fatigue kills, this medicine saves lives."

Dexedrine was first developed in the 1930s and is routinely prescribed by physicians to treat children diagnosed with attention deficit disorder.

"We use a far lower dosage than you give elementary school children who have trouble staying awake in class," Demitry said. "In the miniscule doses we prescribe it, it has never caused an aviator any complications."

But even if a pilot is prescribed "go pills' for an extremely long mission, it is up to the pilot whether or not to use them.

"They are not mandatory," Leaf said. "It says in six places (on the voluntary consent form) that use is voluntary.

"We trust our aviators with high-risk missions, high-value equipment, and life or death decisions," he said. "We provide this as a tool, with medical advice and under the prescription from a physician. Then we trust their judgement."

"Go pills" are only authorized for single-seat aircraft missions of more than eight hours, and dual-place aircraft missions of more than 12 hours.

Demitry said the 10-milligram "go pill" has the stimulating effect of three or four cups of coffee.

"It serves its purpose," said Leaf, who has taken the medication on long flights. "It gets you through that valley of fatigue and keeps your performance to an acceptable standard. It simply allows you to fight through the fatigue and fly normally."

While the Food and Drug Administration approved Dexedrine in the treatment of narcolepsy, Demitry said the Air Force is correct to prescribe the stimulant in an off-label format.

"The Air Force is completely in compliance with all federal laws, regulations and policy for the dispensing of medications," he said. "Physicians routinely prescribe safe and effective medications beyond the original FDA certification."

For example, Demitry said, the FDA did not approve aspirin for use in the prevention of heart attacks until 1998. For 20 years before that, 75 percent of physicians at the premier medical institutions in the country were prescribing aspirin off-label.

"Once (a medication) is safe, once it's effective, physicians are legally allowed to prescribe it," he said. "We know it's safe because we've never had an attributable, causal occurrence related to the stimulant."

The Air Force briefly halted the "go pill" program in the mid-1990s, but reinstated it in 1996.

"I understand, very much, why we went back to including it in the fatigue-management tool kit -- it's because an important part was missing," Leaf said. "We found that (the 'go pill') is the best, most effective way to protect our people and our resources.

"It's been part of a program that has allowed us to fly very long, very demanding combat missions safely and effectively," he said. "The 'go pill' is the tool of last resort when all other means to combat fatigue have been exhausted. Frankly, I'm glad we brought back that tool."