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Boston Globe January 4, 2003

Defense cites stimulants in 'friendly fire' case

Lawyers say pills to stay alert impaired pilots

By Robert Schlesinger, Globe Staff, 1/4/2003

WASHINGTON - The US armed forces have dispensed amphetamines - ''go pills'' in military parlance, ''uppers'' in civilian slang - to pilots for decades, arguing that they are vital for keeping aviators alert on extended missions. But a ''friendly fire'' incident last April in Afghanistan has brought new scrutiny to the practice.

Lawyers for Major Harry Schmidt and Major William Umbach, the two Illinois Air National Guard pilots facing court-martial for the April 17 bombing which left four Canadian soldiers dead, are questioning the safety of giving dextroamphetamine, or Dexedrine, to pilots.

''I don't think we should be putting our pilots in a position where they have to be taking Schedule 2 controlled substances to complete missions,'' said Charles Gittens, Schmidt's lawyer. The Food and Drug Administration classification means that a drug is regulated and available only with a doctor's prescription.

The Federal Aviation Administration does not allow commercial and private pilots to fly while under the influence of the drug, and the manufacturer warns that the drug may impair the ability to ''engage in potentially hazardous activities such as operating machinery or vehicles.''

The United States has increasingly relied on air power to extend its military might across the globe since the end of the Cold War, forcing pilots to fly more and longer missions. And the military argues that the stimulants are necessary for the ''performance maintenance'' of its pilots.

''Keep in mind the last 10 years, in particular, the nature of warfare and the distances that we have to project our air power has changed dramatically,'' said Lieutenant Colonel Christy Nolta, an Air Force spokeswoman. ''So the length of missions has increased.''

The practice of issuing pills to pilots harken back at least to World War II, when the Germans and British gave amphetamines to their aviators. The US Air Force's Strategic Air Command first started dispensing amphetamines in 1960, followed two years later by the Tactical Air Command. NASA uses amphetamines and other drugs to combat space sickness. The Air Force and Navy also sometimes use sedatives to maintain regular sleeping schedules.

In the last 10 years, the United States has relied on air power in the Gulf War, Bosnia, Kosovo, and Afghanistan - all at a time when the number of military forces stationed abroad has decreased. As a result, sortie lengths have increased, Nolta said. The Air Force could not provide specific data about average sortie length. The most extreme examples include B-2 stealth bombers that flew 35 to 40 hours to hit targets in Afghanistan.

The FDA has approved prescriptions for narcolepsy and attention deficit hyperactive disorder, and Dr. David Brendel of McLean Hospital in Belmont, Mass., said that it is also legally prescribed in other situations, including for people who need to stay awake for prolonged periods.

Lawyers for Schmidt and Umbach argue that given the drug's potential side effects - which can include agitation, paranoia, and psychosis - it is dangerous to dispense to fighter pilots, and could have affected their clients' judgment.

But Brendel said that the typical military dosage - 5 mg to 10 mg - ''is an average, modest dose of the medication. If prescribed under controlled circumstances, it's pretty safe,'' he said. ''In rare cases, it can cause side effects that can seriously impair people's judgments, but usually at higher doses and with prolonged use - over many weeks or months.''

Major Cheryl Law, an Air Force spokeswoman, said that there have been ''nearly 100 mishaps where fatigue was cited as a contributing factor,'' but that the go pills have never been cited in an accident.

John Pike, director of GlobalSecurity.org, a defense think tank, said the pills are warranted, but cautioned that attitudes might be too lax regarding their use. ''If you read the flight surgeon's manual, it basically makes it sound like a triple espresso, and it's not,'' Pike said.

''Abuse is possible but felt to be unlikely, given the professional nature of aviators, the limited and well-defined circumstances within which these medications will be used, and by close aeromedical supervision,'' the guide said, adding, ''Aviators, by their nature, are efficient at using tools given to them to achieve specific goals. Antifatigue medications are no exception.''

Betty-Anne Mauger, a spokeswoman in the office of the Air Force Surgeon General, said the pills are dispensed with a specific time in the mission to take them, and any not used by the pilots are returned.

Pilots in both services are tested for adverse reactions and must sign an ''Informed Consent'' form. Failure to sign the form or accept the pills can result in the commander deeming a pilot ''unfit to fly a given mission,'' Mauger said.

''If a pilot chooses not to use this tool on a specific mission, the squadron commander evaluates that factor with all of the others that are pertinent to the mission,'' Mauger said. ''The commander may find that the pilot isn't the right choice for that specific mission, given their personal fatigue state and their choice not to have the Dexedrine available.''

Umbach's lawyer, David Beck, said, however, that the Air Force routinely pressured pilots to take the pills.

Mauger said that the Air Force does not track the amount of pill usage, but that, ''anecdotally, we have estimated that the medications were made available to the pilots in less than 5 percent of the missions.''

An Air Force survey of 464 fighter pilots deployed in the Gulf War found that 57 percent took the pill at least once during the six-week air campaign (with 17 percent using it routinely, 58 percent occasionally, and 25 percent once). Sixty-one percent of those who took the drug responded that they thought it was essential to complete their mission, according to the survey.

Still, the Air Force temporarily banned the use of the drugs for about five years, until 1996, when John P. Jumper, then the director of operations general, reinstated their use, citing the length of ongoing air missions in Eastern Europe. Jumper is currently the Air Force chief of staff.

''We've learned lessons from more recent combat from Bosnia and Kosovo showing that the requirement is acute,'' said Major Cheryl Law, an Air Force spokeswoman. ''Now we're flying combat sorties from the US, and the missions are getting longer and longer, and that's just one more combat tool.''

Alice Dembner of the Globe Staff contributed to this report.Robert Schlesinger can be reached at schlesinger@globe.com.

This story ran on page A3 of the Boston Globe on 1/4/2003.

Copyright 2003 Globe Newspaper Company.