Oops!!

[Karateka]

This is not a "reflexive anti-Bush sentiment." I'm openly anti-Bush. It is a view I have come to with a great deal of intellectual reflection..not reflex. And Yes, I sincerely believe he would retaliate against "friends" who were "out of line" by even disagreeing with his view. If you doubt that, then why is congress calling them "freedom fries"? (This last comment is a sarcastic rejoiner if you didn't notice my sarcastic tone in the previous posts, such as the original "bombing of Toronto" comment I made.)

You are not alone here.

[Gene DeMambro]

Rich,

But the fact that the "go pills" were handed out, for an illegitimate medical purpose, makes it illegal.

And again, I'm not trying to tick you off or otherwise get a rise out of you, but no where, anywhere will we find any information that says that using amphetamines to counter the effects of fatigue passes the risk-benefit test. Contradicting information gleefully accepted.

Now, we can talk "national security" and "military importance" or like compelling reasons if we want, which would bring the debate into whether the the 2nd Iraq was necessary, legal, etc.

Were you in hostile airspace? Did you see any tracer rounds?

Would the pilot's judgement under these conditions be different if theyh weren't taking amphetamines? That's the $64,000 question.

Gene

[RACastanet]

Gene said: "Would the pilot's judgement under these conditions be different if they weren't taking amphetamines?"

That I cannot answer. But I will not second guess the military. They need to deal with matters such as this. Having never been in the pilot's situation, I do not believe anyone who has so far commented can make a judgement.

Rich

[Bill Glasheen]

Glad everyone's keeping civil here.

I certainly hope nobody is implying that this incident of "friendly fire" was intentional, or that Bush's delay in apology was somehow an act of retribution. To start with, this was during the Afghanistan conflict. Canada was a willing ally. Canadian troops were on the ground. This happened before Iraq.

Did anyone know that this incident was Canada's first combat death since the Korean war? (Source - Several online periodicals). One of my reasons for posting the review of "friendly fire" during the U.S. Civil War was to put perspective on the phenomenon. According to that source, there was an incident of friendly fire during that conflict about once every ten days. It's worth mentioning that the Canadians have forgotten exactly what war is like, having avoided armed conflict for nearly half a century (not necessarily a bad thing). To think that such incidents wouldn't happen during a war is just plain naive - period.

The major reason why I initiated this post was to help people understand the concept of "the fog of war." This also happens in a simple barroom brawl, and I'm sure there are a few Canadians that know a thing or two about that. Many people have a pretty unrealistic understanding of what a fight involving a crowd of people is like. I've tried to write about it in the past, but most folks are more interested in the simple concept of a duel.

We've even been flamed by a crowd of folks on this webpage before. Until we got oriented, it was difficult to tell who was friend and who was foe. It's a combat lesson we all need to understand. If we understand why mistakes happen in conflict, then we just might avoid them.

Again...you are free to express your political views here. But let's try real hard to stick with the facts (which has mostly been the case) and learn something.

- Bill

[Bill Glasheen]

Rich wrote...

Do we even know what is in a 'go pill'?

This might help...

``go pills'' ... generally a 5 milligram dose of the amphetamine Dexedrine

The pills -- generally a 5 milligram dose of the amphetamine Dexedrine -- have never been used by a Navy pilot operating from an aircraft carrier, the records say. Instead, the jolt provided by caffeinated coffee, tea or cola drinks apparently remains the Navy's stimulant of choice.

The source for these stats is from Pilot Online, an online version of the newspaper The Virginian-Pilot. That newspaper is published in The Hampton Roads area of Virginia, one of the most military dense locations in the country and the location of the largest harbor in the world. There are a few other interesting quotes in the article.

Navy to tighten control of pills

Gene wrote...

the fact that the "go pills" were handed out, for an illegitimate medical purpose, makes it illegal

A physician may prescribe dexedrine. If you obtain dexedrine from a physician and use it as prescribed, then it isn't illegal. "Off label" use of legitimate medications is common in medicine, although not necessarily a good thing.

As for the "letitimacy" of using dexadrine for fatigue, check out the following. Please read this very carefully. Medical language is as exact as a legal contract.

Amphetamines Systemic
...
Amphetamine - Amfetamine
Dextroamphetamine - Dexamfetamine
Methamphetmaine - Metamfetamine

...

Note: Controlled substances in the U.S. and Canda as follows
...
Dextroamphetamine U.S. "II" Canada "C"

...

Commonly used brand name(s): ... Dexedrine ...

...

Category
Central nervous system (CNS) stimulant

Indications
...
Accepted
Attention-deficit hyperactivity disorder (treatment) ...
Narcolepsy (treatment) ...

Unaccepted
Due to the high potential for abuse, amphetamines are not recommended for use as appetite suppressants.
Amphetamines should not be used to combat fatigue or to replace rest in normal subjects.

...

Dextroamphetamine

...

Usual adult dose
Attention-deficit hyperactivity disorder or narcolepsy -
Oral, 5 to 60 mg a day, or in divided doses.

Strengths usually available
U.S.
5 mg (Rx) {Dexedrine Spansule (tartrazine)}
10 mg (Rx) {Dexedrine Spansule (tartrazine)}
15 mg (Rx) {Dexedrine Spansule (tartrazine)}

- Drug Information for the Health Care Professional

- Bill

[RACastanet]

Great input Bill. This, to me, dispenses with the 'illegality' suggested by others (you all need to read the article Bill linked). The use of go pills has been highly researched and regulated by the armed services.

Thanks, Rich

[Gene DeMambro]

Hi Bill, Rich, et. al.

Background:

As Bill noted, Dexedrine (amphetamine) is a Schedule 2 Controlled substance, meaning (according to the Federal Controlled Substances Act):

(a) The drug or other substance has a high potential for abuse.
(b) The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions.
(c) Abuse of the drug or other substances may lead to severe psychological or physical dependence

I read the article, but it didn't really shed any light on the acceptability of using stimulants to keep pilots awake during long missions, as it lists anecdotal experience among pilots whove done it. But I think it's telling that the Navy is curtailing an already rare practice, and the FAA practically bans it for civilian pilots.

The Air Force has considerable experience with Dexedrine, which by some accounts has been in routine use since the Vietnam War.

And these placebo-controlled double-blind studies can be found where?

In one survey of 464 pilots involved in the 1991 Persian Gulf war, 58 percent reported taking stimulants occasionally during the fighting, and 17 percent said they were regular users. - (emphasis added)

What was that about Dexedrine having a high potential for abuse and can lead to severe psychological or physical dependence....

Bill noted that:

A physician may prescribe dexedrine. If you obtain dexedrine from a physician and use it as prescribed, then it isn't illegal. "Off label" use of legitimate medications is common in medicine, although not necessarily a good thing.

Yes and no. Physicians generally have been given free reign to prescribe/dispense medications to their patients as they see fit, whether for labelled or off-label indications. But they are limited with regard to controlled substances. To wit Title 21, Code of Federal Regulations, Section 1306.04 states:

A prescription for a controlled substance to be effective must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice. The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription.

That same section goes to say that both the prescriber who writes and the pharmacist who dispenses a prescription not fitting the bill can be in deep yogurt. DEA licenses have been pulled as a result of violating this section.

Using Dexedrine to combat fatigue or to replace rest in normal subjects is not a legitimate medical purpose. So says the drug's own prescribing information, as well as prescribing handbooks available to doctors, nurses, druggists, etc, as Bill noted.

And again, I'm not trying to raise anyone's hackles, but just to present supporting information for my position.

Now, that being said, the decision to not charge the pilots in question is probably the correct one - the Fog of War and all that. But the use of "go pills" is pretty dubious, and probably illegal, I you ask me.

Gene

[Le Haggard]

Looks like most of the details about dosages etc have been filled in. Great info Y'all!

As far as my experience being invalid..I differ. No one has the specific experience of those pilots other than the pilots. Getting into a suit and sitting in a fighter plane isn't the same as flying one while on drugs at night in an invasion attack. However, whether or not someone pees in a pad has nothing to do with amphetamines. That's a physical environment. What does relate are psychological states, things that impact those, and hyped mental conditions. My experience is with those in ways similar (not the same) to those mentioned. I won't bother to try to prove it since that's impossible to do. I will say that my dosage of meds to bring my ADHD to somewhat "normal" baseline is over 60 mg a day..Remembering that they work in reverse on me..and my norm without them is like people on them.....Think how much fun I am not medicated. I'm very familiar with being hyped up like those pilots..and I don't need "go-pills" to make it happen.

Le'

[Bill Glasheen]

Good discussion, folks. I appreciate both the passion and the civility.

LeAnn

You must be a real hoot to be around when unmedicated. But hey, we all have our deflects. I have a familial tremor (from as far back as I can remember). Half the people around me think I'm on the drugs that you take to stay "normal" (whatever that is...). So you are in good company. Most everyone around has the same; they just project the perfect image for public comsumption.

ADD/ADHD is some pretty fascinating stuff. I'm confident they're going to solve that riddle in our lifetime. I certainly hope so. And while they are at it, maybe they can get the 75% of the population off these meds that really don't belong on them in the first place. These days, every behavior problem in the classroom gets shoved in the ADHD category and medicated. It's very sad. Real ADHD is serious, and needs to be separated from what amounts to bad parenting, bad teaching, or a simple attitude problem.

Gene

As I said, I wanted you to read what I typed very carefully. Let me re-post part of it, with emphasis added.

Amphetamines should not be used to combat fatigue or to replace rest in normal subjects.

As I stated, medical language is like legal language. No words are wasted.

A fighter pilot (NOT a commercial airline pilot) on a 24-hour combat mission is not a normal subject. I am convinced the language I underlined above is intentional.

Nevertheless, your points are well taken. We need to find the studies (preferably peer-reviewed) that looked into this. Trust me - the military (and academicians) have done them. I'll see if some of them have been published, and get back to you.

What people don't realize is that most prescription medication is in the gray zone at best. Antibiotics kill all the good bacteria in your GI tract, and can kill some people. Decongestants can cause heart attacks. You can get addicted to some laxatives. Long term use of NSAIDs (probably the most common medication taken) can cause renal failure (ESRD). Common hypertensive medication can cause impotence.

It's better not to get sick, but when you do, certain meds have a good cost/benefit ratio. It's best not to use addictive pain medication, but cancer ***** and we should allow people to die pain free and with dignity. Screw the addiction! It's better not to go to war but... That's a life-threatening event too, and certain "treatments" that would otherwise be considered ill-advised may save (our boy's) lives. We need to put this in perspective. People expect medicine to be perfect, but it isn't. (Actually, lawyers count on this for their livelihood... )

Nevertheless, your points are well taken, Gene. Need more data! As far as I am concerned, the jury is still out.

LeAnn

You wrote...

whether or not someone pees in a pad has nothing to do with amphetamines

Actually it does, and this is one of the major points. Caffeine, the (legal) drug (yes, drug) of choice for most Navy pilots, causes polyurea. Translated - it makes you pee like crazy, and then you are dehydrated. So you drink more fluid, and then pee more. Dexedrene does not have this side effect to the same degree. The stress of combat can also cause polyurea. Twenty-four hours in a flight suit with no pee hole creates some serious volume issues (using engineering parlance), never mind personal comfort. Plus...these high tech pressure suits are expen$ive and so must be re-sued. Think about it...

Dehydration is a serious problem in long combat flight. The cabin air has a very low dew point. Taking diuretics for any amount of time is bad enough even for passengers on a commercial flight with "ideal" conditions who aren't under stress.

You could always put a foley catheter up their penises and attach a urine bag to the outside of their suits. I just got done weaning my father-in-law off of one of these after prostate surgery. It isn't pleasant for either male or female. Bottom line - there's no perfect solution here. These are unusual conditions that require an unusual solution.

- Bill

[Bill Glasheen]

This also reinforces my point about combat pilots who must sit still in pressure suits for 24-hour flights not being "normal."

Heart defect could add to 'economy class' clot danger

I frankly don't know what the net effect of dexedrine would be on the risk for DVT. Clotting time decreases under stress, but the blood flow also increases.

Stay well hydrated; avoid caffeine and alcoholic beverages.

Dexedrene has a lower likelihood of dehydrating you than caffeine, which would lower the risk for DVT.

Move around periodically; take a walk in the aisle.

We can do that; the combat pilot cannot.

- Bill

[RACastanet]

Bill: Thanks again for the great supportive info.

Another problem with the environment inside a cockpit is the temp and airflow. Above the clouds the sun is bright and hot... think grennhouse effect. There is climate control and air movement but you have multiple layers of restrictive clothing and this all adds to the discomfort. No personal experience at night flying though.

And speaking of bodily functions, if you or the person in the rear seat has a gas buildup that must be reduced, it really has no where to disperse. I have not personally experienced this 'effect' thank goodness.

Some of the older aircraft still being used, such as the CH46 twin rotor helo, require constant attention. The F/A 18 pretty much flies itself, but you have both hands and both feet busy in the CH46. I have been up in the Vietnam era CH46 and it was very unpleasent. Due to its age and old technology, it is like flying around in a very old school bus.

The military avaiation community has a pretty high attrition rate due to accidents. The public generally does not hear much about it unless it kills a lot of people. I do not know what the rate is but it exceeds all deaths due to combat. In fact, the Marine who demoed the Osprey simulator to me was killed three months later in a crash of the Osprey that killed him and the #2 rated Osprey pilot plus the crew.

Part of the accident rate is due to old equipment, such as the CH46. Part of it is just due to the harsh environment and unforgiving nature of flying high performance aircraft. The last fatal Osprey accident was determined to be the result a software flaw! Imagine that... the in flight computer prevented the pilot from correcting for 'vortex swirl', a new phenomena encountered by high performance rotor wing aircraft.

Please, give military pilots a break.

Rich

[Gene DeMambro]

It's not the pilots I have the problem with, Rich. And you'll never see me write otherwise.

Gene

[Le Haggard]

Good info to consider Bill. Thanks.

Please, give military pilots a break.

I don't believe anyone is criticizing the pilots. My criticisms are for those prescribing narcotics to the pilots and those military officials insisting that the pilots must take them. I see this as trying to find better solutions for the pilots rather than being against them. I wouldn't want to be put on dangerous drugs if there was any other option possible. I have yet to see that anything other than caffine (another drug) has been considered as an alternative solution or that the need outweighs the side effects of drugging pilots.

And yes..I'm a riot without meds..Particularly since adrenaline can over come them and I'm back as if I didn't have them. Bouncing off the walls and chattering at mach 3 is an understatement. Needless to say, sparing can get interesting.

Le'

[RACastanet]

I truly take offense to the remark about 'drugging pilots'. We are talking 5mg prescibed by a medical officer and approved by a senior officer on very few flights.

What effect does 5mg have on one of these highly trained and extremely athletic people? (Understand this... military pilots have intelligence, training, and superstar athletic ability, they have the best genetics nature has to offer.) It may be less than the two large and strong cups of coffee I consume every morning, or less than Bill's ever present diet Mountain Dew.

Le: You are using your chemical imbalance as a reference for others. I do not understand your problem any more than you understand the effects of this 5mg dose on a pilot. Perhaps all the Air Force is trying to to is as Bill suggested... keep the pilots alert without dehydrating them and forcing them to use the beloved sponge packs. I carry one in my pocket when up in one of these planes but have never used one as it is pretty tough to do, and I am generally just along for the ride, not flying the plane/copter. Under the best circumstances you will end up damp and sticky 'installing' and removing it.

Also, combatting dehydration at altitude is doubly tough because there is not room in there for a cooler of beverages. Really.

I will modify my prior statement to: Please, give the military a break. They have a very tough, and largely unappreciated job to do. When someone can show me documented proof of rampant drug abuse in the military perhaps I will reconsider my stance. So far, all I hear are the same anecdotal stories being repeated.

Rich

[Bill Glasheen]

Keep the passions in check and the facts flowing!

As requested... All information obtained from PubMed.

Study #1

Aviat Space Environ Med. 1995 Oct;66(10):930-7.

Sustaining helicopter pilot performance with Dexedrine during periods of sleep deprivation.

Caldwell JA, Caldwell JL, Crowley JS, Jones HD.

U.S. Army Aeromedical Research Laboratory, Fort Rucker, AL 36362-0577, USA.

BACKGROUND: Around-the-clock operations often are mandated in combat, but while aircraft can function effectively throughout continuous 24-hour periods, aviators often cannot because of sleep loss. An efficacious countermeasure in sustained operations may be the administration of dextroamphetamine (Dexedrine). HYPOTHESIS: Dexedrine will effectively prevent many of the performance problems associated with sleep deprivation in helicopter pilots. METHODS: A placebo-controlled, double blind study was conducted. Six U.S. Army helicopter pilots completed five flights in a UH-60 simulator while their performance was evaluated. Immediately following each flight, data were collected on electroencephalographic (EEG) activity and subjective mood ratings. Testing sessions occurred at 0100, 0500, 0900, 1300, and 1700. One hour prior to each of the first three flights on drug-administration days, the aviators were given 10 mg of Dexedrine or placebo. RESULTS: Dexedrine, in comparison to placebo, improved aviator simulator control on descents, straight-and-levels, standard-rate turns, and a left-descending turn. Performance was facilitated most noticeably at 0500, 0900, and 1700 (after 22, 26, and 34 hours of continuous wakefulness). EEG and mood data showed that alertness was sustained significantly by Dexedrine--there was reduced slow-wave EEG activity and improved rating of vigor and fatigue. No adverse behavioral or physiological effects were observed. CONCLUSIONS: Dexedrine appears to be effective for sustaining helicopter pilot performance during short periods of sleep loss without producing adverse side effects.

Publication Types:
Clinical Trial
Controlled Clinical Trial

PMID: 8526828 {PubMed - indexed for MEDLINE}

Study #2

Aviat Space Environ Med. 1997 Dec;68(12):1073-80.

An in-flight investigation of the efficacy of dextroamphetamine for sustaining helicopter pilot performance.

Caldwell JA, Caldwell JL.

U.S. Army Aeromedical Research Laboratory, Fort Rucker, AL 36362-0577, USA.

A promising countermeasure for fatigue in sustained aviation operations is stimulant administration. However, well-controlled, aviation-relevant studies of the efficacy of medications such as Dexedrine are virtually nonexistent. In this investigation, flight performance, mood, and alertness were evaluated in 10 UH-60 pilots during sleep deprivation periods under Dexedrine or placebo. Relative to placebo, Dexedrine improved flight performance during straight-and-levels, climbs, descents, right turns, and a left-descending turn, with tendencies toward better performance during the left turns and the instrument landing system approach. Dexedrine markedly reduced subjective feelings of fatigue, confusion, and depression while increasing feelings of vigor. Central nervous system arousal was enhanced by Dexedrine relative to placebo. No significant side effects occurred, although Dexedrine was associated with mild asymptomatic increases in heart rate and BP. Thus, Dexedrine appears effective for the short-term sustainment of aviator performance during sustained operations. However, future work should investigate the efficacy of stimulants for longer-term use (e.g., more than 40 h of continuous wakefulness).

Publication Types:
Clinical Trial
Controlled Clinical Trial

PMID: 9408555 {PubMed - indexed for MEDLINE}

Study #3

Aviat Space Environ Med. 2000 Jan;71(1):7-18.

Efficacy of Dexedrine for maintaining aviator performance during 64 hours of sustained wakefulness: a simulator study.

Caldwell JA, Smythe NK, Leduc PA, Caldwell JL.

Aircrew Health and Performance Division, United States Army Aeromedical Research Laboratory, Fort Rucker, AL 36362-0577, USA.

INTRODUCTION: The efficacy of Dexedrine for sustaining aviator performance despite 64 h of extended wakefulness was investigated. This study was conducted to extend the findings of earlier research that had proven the efficacy of Dexedrine during shorter periods (i.e., 40 h) of sleep deprivation. METHODS: Dexedrine (10 mg) or placebo was given at midnight, 0400, and 0800 hours on two deprivation days in each of two 64-h cycles of continuous wakefulness. Test sessions consisting of simulator flights, electroencephalographic evaluations, mood questionnaires, and cognitive tasks were conducted at 0100, 0500, 0900, 1300, and 1700 hours on both deprivation days. Two nights of recovery sleep separated the first and second 64-h sleep-deprivation cycles. RESULTS: Simulator flight performance was maintained by Dexedrine throughout sleep deprivation. The most benefit occurred at 0500 and 0900 hours (around the circadian trough) on the first deprivation day, but continued throughout 1700 hours (after 58 h awake) on the second day. Dexedrine suppressed slow-wave EEG activity which occurred under placebo after 23 h awake and continued to exert this effect throughout 55 h (and sometimes 59 h) of deprivation. The drug sustained self-perceptions of vigor while reducing fatigue and confusion. Recovery sleep was slightly less restful under Dexedrine. CONCLUSIONS: Dexedrine sustained aviator performance and alertness during periods of extended wakefulness, but its use should be well controlled. Although effective, Dexedrine is no replacement for adequate crew rest management or restful sleep.

Publication Types:
Clinical Trial
Randomized Controlled Trial

PMID: 10632125 {PubMed - indexed for MEDLINE}

- Bill