STIMULANTS Wired? Are you under the influence? By Captain Karen Speight, Log Board member magine if I told you that the highly regulated trade of an airline pilot is rife with drug addicts, blatantly using stimulants to enhance their performance. Its the type of sensationalist headline designed to lure you into demanding a few more details, so that you, an in-the-know professional, can reject the outlandish claim. Imagine if I told you that the drug of choice is a plant-based stimulant of the methylxanthine class, and is chemically similar to the base of DNA? Derived from xanthine (which, incidentally, is also synthetically manufactured as a pesticide ingredient), the drugs effects include increased heart rate and contraction, better muscle power, airway dilation and improved reaction times. Imagine if I told you that its widespread use is no word of a lie, cross my heart and hope to die true. Surprised? Sceptical? Lets try to understand this: ours is a profession where staying awake at key times is not only important, but often difficult to achieve. Effective performance is essential, sometimes during the Window of Circadian Low (WOCL) and the consequences of not getting it right could be severe. Jet lag, hotels, odd shift times, trying (and failing) to live a normal life (whatever that is) are but a few of the trials of the average crew member. Is it any wonder that so many might turn to a cost-effective stimulant, readily available on the open market? As with most addictions, dependence on this pepper-upper is included in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) DSM-5. Despite the performance-enhancing effects, the sobering news is that its side effects include dehydration, anxiety, insomnia, heart palpitations, headaches and withdrawal symptoms. The physical and psychological addiction is so strong that many people struggle to give the stuff up. Imagine if I told you that the use of this drug is largely uncontrolled by aviation regulating bodies in liquid form although pill form is banned by the CAA. Your Class One is probably quite safe as long as you dont suffer heart-rhythm disturbances, but take heed of EASAs warning of dangerous overconfidence with its use. Its the worlds most widely used, widely available, psycho-active drug. With me yet? Its caffeine. Me? Addict? Much as I would love to claim incorruptible goddess-like status, Ive come to terms with being in no way exempt from caffeines addictive properties. Noticing several years ago that I felt quite tired just after breakfast, I initially put it down to the shifts and (lets face it) being not quite as young as I used to be. Things didnt improve after a few good nights sleep and, as I became more concerned, I spent an exciting time on the internet, self diagnosing with anything from ME to coeliac disease. If you havent tried self-diagnosis on the internet, I can recommend it only if you have a particularly strong sense of cynicism. I eventually realised that the true affliction was far less exciting I was simply an addict in need of a fix. My daily cappuccino was usually around mid-morning and I was at my most irritable, craving-ridden, lowest ebb in those couple of hours between breakfast and my coffee. I also began to notice another curious symptom. As I walked away from a cafe, I felt a peculiar head rush, and not just from the flattering attention of the handsome barista. Caffeine increases blood pressure and is a vasodilator. However, on the blood vessels in the head and neck it acts as a vasoconstrictor. Its hardly surprising that these complex blood-flow dynamics made me feel a tad lightheaded as I supped my skinny extradry one-shot flat white. Determined to regain as much of the incorruptible goddess status as I could reasonably hope for after a few well-lived decades (particularly my stint at university with several now-politicians), I vowed to switch to decaffeinated in an attempt to regain the all-day energy that is the distant dream of most shift workers. Examination licences for Air Trafc Controllers (ATCO s). Weekly House, Padbury Oaks 583 Bath Road, Longford, UB7 OEH our own car-parking facilities. www.heathrowmedical.com Medicals to meet EASA and CAA requirements as well as Initial, Renewal & Revalidation European Class 3 Medical Personal service with a quick turnaround for Initial, Excellent availability of appointments. Adjacent to Heathrow Airport, we have the standards of the major International civil aviation authorities including CASA, Canada, and GACA. Renewal & Revalidation Class 1 and Class 2 applications. Your body is tricked into ignoring signals that you are tired and your already depleted battery is pushed hard for more juice Science-y bit If you fancy cutting down, you may want to silence your inner picket line of resistance with the wot it does to you science-y bit. Its quite an eye-opener. The longer you are awake, the more a neurotransmitter called adenosine builds up. This makes you feel drowsy when it binds to receptors in the brain. You feel tired and, eventually (hopefully not during approach to a major international airport) fall asleep. Caffeine has a sneaky little trick up its sleeve though it blocks the adenosine receptors so they cant send the message about you being tired. This stimulates various other centres in your central nervous system, which affect your heart, breathing and blood flow. Some of the brains own natural stimulants start to work more effectively eg. dopamine (the feelgood neurotransmitter). Adrenaline is also secreted as a result, and your body switches into a wired, ready-for-action state. Sadly, the story doesnt end there on the heady high of chemicals. Your brain is clever it adapts. Cells start growing more adenosine receptors and fewer adrenaline receptors, to maintain the status quo. So now, to get that lovely buzzy alive feeling from your morning espresso, you need two cups. In fact, just to feel normal, you need your standard fix. Then, with further adaptation, you need three cups, then four you get the picture. Despite the fervent prayers of most students, caffeine is not a substitute for sleep. Your body is tricked into ignoring signals that you are tired, and your already depleted battery is pushed hard for more juice. Intoxicated? Moi? Checking the DSM-5 list of symptoms for the diagnosis of caffeine intoxication, I am taken by the idea of periods of inexhaustibility, which sounds like a panacea for the average modern lifestyle. Im less keen on the cardiac arrhythmia (stay off the coffee before the medical), psychomotor agitation (experienced after a well-known cafe accidentally made me a three-shot coffee despite me asking for a decaf), rambling flow of thought and speech (many thanks to the first officer who put up with this after the aforementioned poisoning), flushed face (situation normal?) and nervousness (no comment). In fact, very high caffeine intake can result in mania, depression, delusions, psychosis and death. The tempting allure of inexhaustibility aside, how much is too much? 10g of caffeine is usually fatal, 5g can result in the craziness described above, and yet global consumption is around 120,000 tonnes a year from 10 million tonnes of coffee beans, which is around one beverage a day per person. Luckily, the average cup of coffee has around 80-175mg of caffeine, so youd have to drink about 50 cups to qualify for toxicity. Problem is, its not just the coffee, is it? Tea, cola, energy drinks you probably know about, but it is also hidden in many medicines, such as flu remedies, chocolate, and even a cup of decaf can have around 10mg of caffeine. And I thought I was now clean and sober! Super humans While we mere mortals may choose to use, there is stronger encouragement of peak performance drugs elsewhere. Ever asked yourself how astronauts deal so well with long duty periods punctuated with short sleeps in zero G? The medical kit of the Apollo missions contained Dexedrine, a type of amphetamine, although it seems to have been largely used to treat motion sickness. According to the Canadian Medical Association Journal, modafinil is the vigilance-enhancing drug allowing International Space Station crew members optimal performance. Things get even murkier in the military. In World War 1, the British Army developed a heady concoction of cola and cocaine, known as forced march. In World War 2, the Germans spearheaded with cocaine chewing gum and yummy chocolates with delicious centres full of methamphetamine. The US, Japan and Britain stuck with boring old amphetamine pills and, come the Vietnam war, the US military issued 225 million high-strength pep pills, plus steroid injections for those on special missions. Thats before any self-medication. Coming down Say you are a purist, whod like their brain to have its original number of adenosine receptors to regain access to what your body is telling you and to reclaim your incorruptible god-like status. What can you expect as you detox? Headaches, as the blood vessels in your brain adjust back to normal; difficulty concentrating as your body anticipates its normal dose; and depressed mood, irritability, fatigue and flu-like symptoms. It will take around seven to 10 days for your brain and body to adjust back to normal. What if you dont want to come off completely? Sleep expert Dr Lindsay Browning suggests that smaller amounts of caffeine, but more frequently, will help maintain alertness when necessary. She recommends no caffeine at all within six hours of intended sleep. Watch out for sneaky sources of caffeine you didnt even notice, and aim to become more aware of how and when you ingest it. We are mere mortals in pilots uniforms trying to manage our alertness to do our job. Caffeine in moderation can be a useful and legal tool. However, it has side effects and blocks your ability to respond to tiredness signals from your body. Whats your limit? This article is looking at the extremes of caffeine. The average cup of coffee contains between 90-125mg of caffeine. Health organisations worldwide suggest that up to 300mg of caffeine a day is safe for most people, though pregnant women should not consume more than 200mg per day, according to the NHS. BALPA does not advocate flying with high levels of caffeine or any drug. Caffeine is no substitute for sleep and a proper rest period. Email: medicals@heathrowmedical.com Tel: 020 8528 2633