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Aeromedical Advisory: Marijuana and Derivatives What are the Aeromedical Implications?

--by Dr. Michael Berry, FAA Federal Air Surgeon

The Federal Air Surgeon’s office has received a number of inquiries about marijuana, due to the recent increase in the number of states around the country that have approved its use for medical and recreational purposes. Specifically, airmen are concerned about the safety of cannabidiol (CBD) oil use and how such use impacts an airman’s medical certificate. Be aware that federal law — not state law — governs FAA medical and pilot certification.

First, we should note that commonly used terms within the context of marijuana can be confusing. The marijuana or cannabis plant contains more than 400 different chemicals and 60 cannabinoid compounds, all of which are absorbed when the whole leaf is smoked or ingested. The compound responsible for the euphoric, mind-altering effect is tetrahydrocannabinol (THC). Although the use of cannabis is legal for medical and/or recreational use in many states, the United States Drug Enforcement Agency (DEA) continues to classify the whole cannabis plant as a Schedule I controlled substance, which is defined as “drugs with no currently accepted medical use and a high potential for abuse.” The U.S. Department of Transportation (DOT) drug test includes THC, and its presence at defined levels constitutes a positive drug test.

More recently, interest has grown in other compounds derived from the cannabis plant that may have positive health benefits, but without the mind-altering features of THC. One such compound being widely marketed is CBD oil. In 2018, the FDA announced the approval of Epidiolex (cannabidiol), purified pharmaceutical grade CBD extract from the cannabis plant, for the treatment of seizures associated with two rare and severe forms of epilepsy. As a FDA approved medication, it is subject to strict quality control. In other words, you know what you are getting. Commercially available CBD, by contrast, is not regulated and may be contaminated with a variety of substances, most significantly, THC. Product labels are often inaccurate. Although most CBD products claim to have under 0.3-percent THC, they could contain high enough levels of THC to make a drug test positive. Use of CBD oil is not accepted as an affirmative defense against a positive drug test.

Furthermore, despite legalization in some states, it remains uncertain whether marijuana has therapeutic benefits that outweigh its health risks. There is evidence that marijuana adversely affects brain function both acutely and chronically, especially in younger individuals. It is generally agreed that currently available marijuana products are more potent than those used in older research, which casts doubt on the reliability of that research. We need to understand much more before considering the use of marijuana and its derivatives for airman certificate holders. Please also be aware that no special issuances have been granted for conditions treated with medical marijuana.

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Dr. Michael Berry received an M.D. from the University of Texas Southwestern Medical School, and an M.S. in Preventive Medicine from Ohio State University. He is certified by the American Board of Preventive Medicine in Aerospace Medicine. He served as an FAA Senior Aviation Medical Examiner and Vice-President of Preventive and Aerospace Medicine Consultants for 25 years before joining the FAA. He also served as both a U.S. Air Force and NASA flight surgeon.

This article was originally published in the May/June 2019 issue of FAA Safety Briefing magazine.
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