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Military looks to drugs for battle readiness

As combat flights get longer, pilot use of amphetamines grows, as do side effects.

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"Given the extent of recreational drug use within the military, and the use of performance-enhancing drugs among athletes, it is very easy to imagine that warriors would consider using any manner of drug they thought would increase their chance of returning home alive," says John Pike, a defense expert with in Alexandria, Va.

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During the Gulf War, according to one military study, "pilots quickly learned the characteristics of the stimulant [Dexedrine] and used it efficiently." Pilots were issued the pills and took them if and when they felt the need.

Some people have defended that practice. "If you can't trust them with the medication, then you can't trust them with a $50 million airplane to try and kill someone," says one squadron commander whose unit had the fewest pilots but flew more hours and shot down more Iraqi MIGs than any other squadron.

But military officials, as well as medical experts, warn that the use of amphetamines can clearly have its bad side.

The flight surgeon's guide to "Performance Maintenance During Continuous Flight Operations" (written by the Naval Aerospace Medical Research Laboratory in Pensacola, Fla.) mentions such possible side effects as euphoria, depression, hypertension, and addiction. There's also the possibility of "idiosyncratic reactions" (amphetamines can be associated with feelings of aggression and paranoia) as well as getting hooked on the "cyclic use of a stimulant/sedative combination."

"The risk of drug accumulation from repetitive dosing warrants serious consideration," the guide notes. The "informed consent" form that military pilots must sign notes that "the US Food and Drug Administration has not approved the use of Dexedrine to manage fatigue."

Amnesia on the job?

It's not just the "go pills" that can cause problems in certain individuals. "No-go pills," used to induce sleep, can have dangerous side effects as well – including the possibility of what's called "anterograde amnesia ... amnesia of events during the time the medication has an effect."

"For the military aviator, this raises the possibility of taking the medication, going to a brief, taking off, and then not remembering what he was told to do," according to the lab's report.

But researchers say suchsymptoms "are primarily dose related and are not expected with 5-10 mgs of dextro-amphetamine (Dexedrine)" – the amounts given to pilots in the Gulf War and in Afghanistan.

For the most part, the issue of prescribed drug use by US pilots has gone unreported in the United States. But in England and Canada, it has been raised recently – especially in a possible connection with errant bombings.

In April, four Canadian soldiers were killed and another eight injured when an American F-16 pilot on a long-range mission, thinking he was under attack, dropped a 500-pound laser-guided bomb on an allied military exercise.

"The initial version of the Canadian incident portrayed the pilot as behaving with inexplicable aggression tinged with paranoia, and my first thought was that the poor guy had been eating too much speed," says Mr. Pike of Officials are still investigating that accident, and the pilot has been questioned, among other things, about the possibility of drug use.

More recently, concerns have been raised about aggression and violence among soldiers returning from Afghanistan. In three of four cases in which men killed their wives, the accused husbands were in special-forces units based at Fort Bragg, N.C.

"It is quite obvious that someone needs to pose this question in the context of the business at Fort Bragg," says Pike. "This sort of hyper-aggressive behavior is just what one would associate with excessive use of such drugs or from withdrawal from using them."

As the US moves into an era in which national security is likely to mean wars fought from the air – using attack aircraft and small, specially trained units flown long distances to the battlefield – the issue of performance-enhancing drug use by US military personnel is likely to escalate. "The real story here is the ever-extending reach of air power," says Daniel Goure, a military specialist at the Lexington Institute in Arlington, Va. "We were flying F-15s out of Lakeheath [a Royal Air Force base] in the United Kingdom during Kosovo. Why? Because we had used up the available landing space everywhere else."

"As asymmetric threats such as ballistic missiles become more available to our adversaries, we are going to stand even farther back," adds Dr. Goure. "That means that this problem [i.e., the need to combat pilot fatigue] can only grow."