More than half of all general aviation pilots killed in crashes between 2018 and 2022 tested positive for at least one drug. That’s a record high — and a finding the National Transportation Safety Board published in a landmark safety research report on May 14, 2026, that should put every certificated pilot on notice.
The NTSB’s 2018–2022 Update to Drug Use Trends in Aviation examined toxicology results from 930 of the 984 pilots fatally injured in U.S. civil aviation accidents during that five-year window. The 94.5 percent capture rate gives the dataset unusual statistical weight. The headline number: 52.8 percent tested positive for at least one drug of any type. Nearly 28 percent — 27.7 to be precise — tested positive for two or more drugs simultaneously.
The Substances Involved
The most alarming subcategory is what the NTSB calls “potentially impairing drugs” — a classification covering illicit substances and sedating antihistamines commonly found in allergy and nighttime cold-and-flu products. That figure reached about 29 percent in the new report. It’s the highest level recorded since the NTSB began tracking this data in 1990.
The single most detected potentially impairing drug was diphenhydramine — the active ingredient in Benadryl, Tylenol PM, ZzzQuil, and dozens of other over-the-counter products pilots routinely pick up at any pharmacy without a second thought. The FAA has been explicit about the danger. Performance testing shows that pilots taking diphenhydramine are as cognitively impaired as someone who is legally drunk on alcohol, even when they report feeling fine. The agency’s own guidance requires a 60-hour wait after the last dose before a pilot may legally fly.
Illicit drug detection rose to 7.4 percent of cases, driven primarily by delta-9-tetrahydrocannabinol — the psychoactive compound in marijuana. That figure has climbed steadily across every study period: roughly 3 percent during the most recent five-year sub-window of the 1990–2012 baseline study, approximately 5 percent in the 2013–2017 update, and now 7.4 percent. The trend line tracks the broader state-level legalization wave. But the regulatory reality has not changed. Under federal law — which exclusively governs aviation — marijuana remains a Schedule I controlled substance. Flying after use is prohibited, full stop.
Who Is Most at Risk
The data breaks down sharply by certificate level and operating context. Pilots holding airline transport or commercial certificates showed significantly lower drug prevalence than those holding private, sport, or student certificates. Pilots without a current FAA medical certificate showed higher rates than those with one. Pilots conducting Part 135 operations tested positive at lower rates than those flying general aviation. The pattern is consistent: the further a pilot operates from the formal oversight structure, the worse the numbers get.
Nearly all of the crashes in the dataset — 97 percent — were general aviation accidents, consistent with findings from every prior NTSB study in this series.
A Three-Decade Trend With No Reversal
This report is the third in a series. Each one has shown increases. The 2014 study covering 1990–2012 established the baseline. The 2020 update covering 2013–2017 showed worsening numbers. This latest report continues the trajectory. The NTSB acknowledges that improved test sensitivity may account for some of the increase — but explicitly states that overall drug presence has continued to climb regardless of that caveat.
The NTSB is careful to note that a positive toxicology result does not automatically prove impairment at the time of the accident. Presence is not causation. But the agency is equally clear that pilots should not read that caveat as a green light — some drugs classified outside the “potentially impairing” category may still degrade performance, and many treat underlying conditions that are themselves disqualifying.
What Comes Next
The report is expected to pressure the FAA to revisit its outreach strategy on pilot drug awareness. The NTSB previously closed a safety recommendation on marijuana pilot education as “Unacceptable Action” in July 2018, citing insufficient FAA follow-through — a concern that was still being flagged as recently as the 2020 report. With illicit drug detection now at its highest recorded level, observers expect that conversation may reopen.
Pilots looking for guidance on specific medications can consult AOPA’s Medication Database and the FAA’s Do Not Fly/Do Not Issue list. AOPA’s Basic Medical Education Course — free to all pilots regardless of membership status — covers these issues directly. We’ll continue to monitor for any formal FAA response or new guidance triggered by this report.
Sources
- NTSB Press Release — May 14, 2026: 2018–2022 Update to Drug Use Trends in Aviation
- General Aviation News — NTSB Drug Trends Report Coverage
- AVweb — NTSB Shows Rise in Drug Detection in Fatal Crashes
- Aerotime — 28% of Fatally Injured Pilots Tested Positive for Potentially Impairing Drugs
- Simple Flying — Pilots Killed in Crashes and Impairing Drugs: NTSB Report
- FAA — Pilot Pharmaceuticals and Medications Guidance
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