Did not know about ADHD restrictions when I got my medical. What do I do?

C

Concerned CFI

Guest
In my early 20s I got diagnosed with ADHD (although I was never tested). Used the medication for about 5 years but then discontinued use in 2018 as the side effects were cumbersome and there was no more benefits. Since then I have no more symptoms and my quality of life has increased.

At the end of 2020 I got my first medical to start flight school and today I'm a CFI. I found out this week that even though I wasn't using/prescribed medication for at least 2 years when i got the medical it should have been reported to my AME.

I have checked the latest FAA guidance but I'm not sure what to do. Should I let the medical expire and then correct it with my AME? Anyone has any idea?
 
Technically it should have been reported even after the 2 years….its a lifetime scarlet letter with the FAA.

“Have you ever been diagnosed with……..”
 
"I got diagnosed with ADHD (although I was never tested)"

What?
 
Daleandee said:
"I got diagnosed with ADHD (although I was never tested)"

What?
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Probably the infamous, "I'm having trouble focusing at [work, school, fill in the blank]" to the GP, who writes a script for ritalin or whatever, codes it as ADHD for insurance purposes, and sends victim on their way.
 
SkyChaser said:
Probably the infamous, "I'm having trouble focusing at [work, school, fill in the blank]" to the GP, who writes a script for ritalin or whatever, codes it as ADHD for insurance purposes, and sends victim on their way.
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Literally that
 
Sierra1 said:
Technically it should have been reported even after the 2 years….its a lifetime scarlet letter with the FAA.

“Have you ever been diagnosed with……..”
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I had no clue at the time since ADHD is not explicitly stated on the 8500-8 and I'm not a doctor who knows the actual terms.
 
You should do what is necessary on the "Fast Track" pathway (4 years no meds). See attachments, and NOT renew your medical until you have this "in the bag (e.g in the eyes of the FAA, "Lie again").

You WILL need a community Phd Psychologist for this pathway, but if you have it ALL you can be issued in the office.
 

Attachments

  • ADHD Document Checklist.pdf
    114.2 KB · Views: 44
  • ADHD Fast Track Evaluation General Information.pdf
    122.2 KB · Views: 48
  • ADHD Fast Track Evaluation Report Requirements.pdf
    102.5 KB · Views: 46
  • ADHD Fast Track Info for Psychologist or Neuropsychologist.pdf
    96.2 KB · Views: 39
  • ADHD Fast Track Summary.pdf
    150.5 KB · Views: 40
  • ADHD Pathway Chart.pdf
    69.1 KB · Views: 39
  • ADHD Personal Statement Guidelines.pdf
    150.7 KB · Views: 42
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Concerned CFI said:
I found out this week that even though I wasn't using/prescribed medication for at least 2 years when i got the medical it should have been reported to my AME.
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Note that it's the diagnosis that you should have reported, not the medication that you were no longer taking.
 
SkyChaser said:
Probably the infamous, "I'm having trouble focusing at [work, school, fill in the blank]" to the GP, who writes a script for ritalin or whatever, codes it as ADHD for insurance purposes, and sends victim on their way.
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Surely you are correct (I know, "I am serious — and don't call me Shirley").

Seems to me that prescribing such powerful drugs for such a condition without any testing borders on malpractice. I get it ... I just don't like it.
 
Daleandee said:
Surely you are correct (I know, "I am serious — and don't call me Shirley").

Seems to me that prescribing such powerful drugs for such a condition without any testing borders on malpractice. I get it ... I just don't like it.
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Lots of docs just want to load people up on what they want, they dont care about downstream issues caused by it because they don’t have to deal with it. Same base reason opiates became an issue, but there were downstream issues and it still continued.
 
Sierra1 said:
Same base reason opiates became an issue, but there were downstream issues and it still continued.
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Don't get me started on that. As a prescribing MD in a pain heavy practice (orthopedic surgery) I've argued against the careless prescribing of narcotics for mild to moderate pain, and you are correct about the downstream issues because they rarely affect the prescriber.
 
dbahn said:
Don't get me started on that. As a prescribing MD in a pain heavy practice (orthopedic surgery) I've argued against the careless prescribing of narcotics for mild to moderate pain, and you are correct about the downstream issues because they rarely affect the prescriber.
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Yeah I've seen multiple issues. Some PMP printouts are shocking as hell. My wife works in a MD office and they even try with them, they just caught a doozy last week. I'm glad you take it seriously, wish others did.
 
The PMP access has been a wonderful BS filter. I find that drug seeking behavior has been greatly reduced in my practice and it has become much easier to confront the small percentage of drug seekers with objective evidence of an issue.
 
@Palmpilot

Prescription Monitoring Program. Database of scheduled drug prescriptions for individuals maintained by the pharmacy boards and shared across many state jurisdictions. It can only be legally accessed by a provider that is treating the patient and can justify the necessity of accessing the data. Some states require a prescriber to obtain the data on a patient if they are prescribing any scheduled drug, some require access only if the prescribed quantity and/or frequency reach a certain threshold.
 
dbahn said:
Don't get me started on that. As a prescribing MD in a pain heavy practice (orthopedic surgery) I've argued against the careless prescribing of narcotics for mild to moderate pain, and you are correct about the downstream issues because they rarely affect the prescriber.
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I may need to PM you.
I have a "pain heavy" procedure in the future - total knee replacement.
Wondering about recovery and time before being cleared to fly. I have been working with my CFI to project a schedule for my return to flight training.
 
Dry Creek said:
I may need to PM you.
I have a "pain heavy" procedure in the future - total knee replacement.
Wondering about recovery and time before being cleared to fly. I have been working with my CFI to project a schedule for my return to flight training.
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I didn't take ANY narcotics after total knee replacement. It was a few days of toughing it out then just ibuprofen for pain. Before the discovery of narcotics humans used endogenous mechanisms to manage their injuries - over many thousands of years, actually.
 
Dry Creek, my stance is to start with the lowest and least dangerous medication and work up. I had a major oral surgery many years ago where I was prescribed the military normal 800mg motrin ALONG WITH Percodan. All of a sudden I was every drug-seeker's best friend in the barracks. Never felt the need to take the narcotic and did just fine. Later in life, got the big snip courtesy of an Air Force clinic. Doc sent me down to the pharmacy to fill a script for pain meds. Pharm tech looks at the paper and says "Oh, you got the GOOD stuff!" Oxycodone. Fortunately, I had asked my wife prior to the procedure to bring a bottle of Motrin. I refused the script, downed 800mg of Motrin and never had to take another dose of pain meds. Everyone's pain tolerance is different so YMMV but in my experience, at least each time I've been offered a narcotic I've not needed it.

As for the OP, I'd have to figure out if "being diagnosed without being tested" really qualifies as "being diagnosed." Given a CFI, I'd say better safe than sorry and follow some of the guidelines above. But it might be more trouble than you're bargaining for. Sounds like a good question to ask an AME other than your own or AOPA's advice line.
 
Sorry - didn't mean to hijack the thread.
After my first joint replacement I learned that opioids are not compatible with my system. Naproxen sodium (Aleve, Anaprox) or plain old aspirin for me.
 
SkyChaser said:
Probably the infamous, "I'm having trouble focusing at [work, school, fill in the blank]" to the GP, who writes a script for ritalin or whatever, codes it as ADHD for insurance purposes, and sends victim on their way.
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Huge problem with kids. Saw it first hand. They put a 30 day starter pack of drugs in our hands at the Doc's office to get our kid hooked, and stood there urging us to "do it now" rather than looking into alternatives. It literally felt like being at a car dealer. Walking away from that was very hard, but in retrospect one of the best decisions we made as parents. Can't imagine how much harder it would be for a young adult facing down authority figures alone.
 
KE5BM said:
As for the OP, I'd have to figure out if "being diagnosed without being tested" really qualifies as "being diagnosed."
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The FAA considers a prescription a diagnosis. I was never officially diagnosed with ADHD either, but (like half the population under 40) was still given medication. I got to go through the joys of the full gamut of FAA neuropsychological testing in order to get my medical.
 
ADD HIMS Success said:
The FAA considers a prescription a diagnosis.
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The FAA considers a diagnosis a diagnosis, no matter how casual it poorly considered. But past prescriptions aren't reportable, so if you really weren't diagnosed, there's nothing to report.
 
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Lindberg said:
The FAA considers a diagnosis a diagnosis, no matter how casual it poorly considered. But pay prescriptions aren't reportable, so if you really weren't diagnosed, there's nothing to report.
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But most prescriptions are a result of a visit to a health care professional, which is a yes/no checkbox if done within the last 3 years, followed by a listing of the reason for the visit below that. So you move up the ladder of "failure to disclose" if don't comply with that. And 17a above that asks you if you currently use any medications (also including non-prescription), which is potentially another rung of "failure to disclose" by missing that as well. One the FAA gets a whiff of a bad smell, they simply ask for all the documentation they want. Of course, in 18m you also have to pass through the "have you ever in your life" clause checkbox to "mental disorder of any sort" listing . . .

Might get away with and might not, but in retrospect it must have been a string of lies rather than a simple ommission.
 
ADHD itself is highly variable, ranging from mild to moderate to severe. Response to medication also varies.

Someone with mild ADHD who is well-medicated is no danger. AFAIK it's also not a condition that would prevent accurate self-assessment just like all of us do each time we fly.

The recent committee report on mental health calls out the FAA on this exact thing.
 
xenadu said:
ADHD itself is highly variable, ranging from mild to moderate to severe. Response to medication also varies.

Someone with mild ADHD who is well-medicated is no danger. AFAIK it's also not a condition that would prevent accurate self-assessment just like all of us do each time we fly.

The recent committee report on mental health calls out the FAA on this exact thing.
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and if that was the standard, then every person who has any level of ADHD would classify themselves as "mild". The reality is that the group/demographic that you are talking about - whether its adhd, or depression, or bpd, or whatever else - will always classify themselves as "fit to fly" where some entity like the FAA and their docs think otherwise. So that is what needs to be administered and adjudicated but not by the afflicted, as that determination (or the determination by their own doc) is often flawed.
 
mryan75 said:
Yes you were.
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Meaning that some individual, to whom the state had granted authority to authorize the sale of controlled substances, wrote down a diagnosis to facilitate said sale, including the partial reimbursement of the costs involved by an insurer, the costs to include their fee.

I have a memory of Bill Maher saying once about prescription drug adds that go "Ask your doctor about ... " -- Maher said "If the only reason you go to a doctor is to get access to a pill, then he's not your doctor, he's your pusher." So it was with Ritalin.
 
Anthem said:
and if that was the standard, then every person who has any level of ADHD would classify themselves as "mild". The reality is that the group/demographic that you are talking about - whether its adhd, or depression, or bpd, or whatever else - will always classify themselves as "fit to fly" where some entity like the FAA and their docs think otherwise. So that is what needs to be administered and adjudicated but not by the afflicted, as that determination (or the determination by their own doc) is often flawed.
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What about when all the specialists, i.e. treating physician, HIMS psychologist, HIMS neuropsychologist say you're okay to fly but the FAA, in its infinite wisdom, say otherwise? Are you telling me that someone in DC who's never interacted with the applicant is correct in concluding the opposite that every Dr. the FAA made you get evaluations from did otherwise?
 
UTLonghorn_1979 said:
What about when all the specialists, i.e. treating physician, HIMS psychologist, HIMS neuropsychologist say you're okay to fly but the FAA, in its infinite wisdom, say otherwise? Are you telling me that someone in DC who's never interacted with the applicant is correct in concluding the opposite that every Dr. the FAA made you get evaluations from did otherwise?
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their sandbox, play within their rules. And I doubt that in your case the HIMS neuropsych and psychologist would clear you based on ALL the facts that are out there. You're trying to twist some things around as it appears that your docs dont have all the information available to them. But nonetheless - it has to be someone they trust (and just not your doc without any sort of real liability if something does happen) to give a clearance for the FAA then make their decision.
 
Anthem said:
their sandbox, play within their rules. And I doubt that in your case the HIMS neuropsych and psychologist would clear you based on ALL the facts that are out there. You're trying to twist some things around as it appears that your docs dont have all the information available to them. But nonetheless - it has to be someone they trust (and just not your doc without any sort of real liability if something does happen) to give a clearance for the FAA then make their decision.
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What exactly do you mean by "your case" and "ALL the facts?" What's being twisted around??
 
DJTorrente said:
Its ALL OUR sandbox. The bureaucrats are the ones who have to justify their existence.
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I agree we should have standards, I'm under a HIMS review/medical deferral, and I want safe pilots in the air too. I also know pilots who breezed through the medical process, got their PPL and there's no way in hell I'd fly with them.

Also, someone please help me understand, and please note I'm thrilled for this person, that Jessica Cox can fly with no arms and be medically safe to fly, but so many pilots are declined for so many other reasons that are, I'd say with little room for argument, far less prone to accidents and far safer in the air. I read she is going for her class 3 medical, does she realize if she's declined she's then no longer able to fly under sports pilot privileges? Or will the FAA make an exception for her? If so, that's completely unfair to the folks out there who inadvertently shot themselves in the foot by trusting the process by reporting conditions which then lead to medical issuance declination and forfeited the sports pilot option.

I'm curious how the FAA will handle this and what can of worms it opens up for existing pilots that have been declined class 3 medicals, and thus can't even operate under sports pilot privileges.
 
FAA just released new guidelines.

Cut and paste from the FAA safety team

There is also a new option for AMEs to issue a medical certificate to pilots who used to be on medication for Attention-Deficit/Hyperactivity Disorder (ADHD) if otherwise qualified. This option requires that pilots be off medication for 4 years, have no symptoms, and not have been diagnosed with any other mental health condition. For more, see the latest Pilot Minute video at bit.ly/PilotMinuteor go to faa.gov/ame_guide/media/ADHD_pathway_chart.pdf.
 
DJTorrente said:
Meaning that some individual, to whom the state had granted authority to authorize the sale of controlled substances, wrote down a diagnosis to facilitate said sale, including the partial reimbursement of the costs involved by an insurer, the costs to include their fee.

I have a memory of Bill Maher saying once about prescription drug adds that go "Ask your doctor about ... " -- Maher said "If the only reason you go to a doctor is to get access to a pill, then he's not your doctor, he's your pusher." So it was with Ritalin.
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And this changes nothing about what I said. But thanks for the reply. This person WAS diagnosed. End of story.
 
mryan75 said:
And this changes nothing about what I said. But thanks for the reply. This person WAS diagnosed. End of story.
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I think DJ's point is we're a prescription and diagnosis happy country, both individuals and doctors are taking the expedient route, treating the symptoms vs. the underlying condition, or just wanting to do what's the most convenient for parents/teachers/etc vs. what's truly best for the individual. It's easier to just put a diagnosis on a 6-15 YO kid and put them on ADD meds vs. find a learning environment or outlet that's conducive to a child that can't sit still. And just because a person has an episode of sadness, doesn't mean they are clinically depressed and doctors should not be so quick to prescribe something that just numbs a person vs. dealing with those feelings. Think Purdue Pharma on the ubiquitous use of opiates for things like headaches (that's crazy!). We're a nation with a pill for everything!

Depression and anxiety disorders are real, as is hard core ADD/ADHD. But I find it hard to believe that there's really a 400% increase in people with ADD/ADHD over a 10-15 year period.

People are misdiagnosed all the time, so saying a diagnosis is final and written in stone is pretty disingenuous, IMO.
 
Maybe you should take your crusade to the doctors, parents, and schools, and stop taking out your frustration about bad medical practices on the FAA. The FAA knows that people with true ADHD, depression, etc. are not safe pilots. The rules, as they say, are written in blood. It isn't the FAA's fault that people are getting their children or getting themselves drugged just because it is easier.
 
UTLonghorn_1979 said:
Depression and anxiety disorders are real, as is hard core ADD/ADHD. But I find it hard to believe that there's really a 400% increase in people with ADD/ADHD over a 10-15 year period.
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[/QUOTE]
It's also quite possible that people were underdiagnosed in the past. That certainly does apply to a lot of the ASD. Johnny was always a weird kid was often a diagnosis in the past without delving into why.
UTLonghorn_1979 said:
People are misdiagnosed all the time, so saying a diagnosis is final and written in stone is pretty disingenuous, IMO.
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And if it were considered written in stone, it would be disingenuous. The answer, however, that there is a procedure to verify that misdiagnosis. It has waffled over the years with the FAA, but we are back in the case where long term success without medication, gets you a pass. Otherwise, there's analysis (perhaps slower and costlier than one might like) to confirm it.

The problem is that you don't "grow out" of ADD/ADHD, so if you actually did have it as a kid, it's a large red flag as an adult.
 
SkyChaser said:
Maybe you should take your crusade to the doctors, parents, and schools, and stop taking out your frustration about bad medical practices on the FAA. The FAA knows that people with true ADHD, depression, etc. are not safe pilots. The rules, as they say, are written in blood. It isn't the FAA's fault that people are getting their children or getting themselves drugged just because it is easier.
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So you do admit that the FAA has bad medical practices? Clearly you didn't really read, or understand the underlying point of my posts.

1. If the FAA's medical practice is so refined, why is the AOPA and other groups constantly working to change the guidelines and processes for special issuance? I guess AOPA should redirect their efforts to the doctors, parents and schools as well?
2. You really think people flying with mild cases of ADD or anxiety are more dangerous than a person with corrective lenses, of older age or with no arms (Jessica Cox)? There are so many things that can go wrong midflight that take something from "safe" to outright dangerous and irresponsible.
3. I'm sure you can chew gum and fly at the same time. Why does just one part of the problem need to be focused on at a time?

And please tell me how flying under LSA with zero medical needed is any different from PPL privileges from a practical safety/medical fitness standpoint? Especially once MOSAIC is enacted...

Looked at some stats, a 2017 study by the National Transportation Safety Board (NTSB) found that 0.08% of fatal aviation accidents in the United States between 2000 and 2015 were possibly associated with ADHD. That's 1 out of every 1,250 accidents. I guess all those folks that crash due to not paying attention to airspeed, aircraft attitude, fuel quantity, poor aircraft (or boat as we've recently seen) avoidance, etc. had ADD/ADHD or should not have been flying?

By the way, I don't have ADD or ADHD. I just know folks who's dreams have been crushed by things like this when I would much rather sit right seat or passenger seat with them vs. many folks with what the FAA would define as good to go.
 
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