Transitioning off a med to clear up my Class III? What to expect?

[grasshopperfan]

Happy New Year all,

Been lurking on the PoA forums for a while; made an account to ask this.

BLUF: Student Pilot, reported that I took Abilify, no diagnosis, Class III medical got denied, now ready and wanting to transition off the Rx and see about getting an SI and clearing everything up to finish training and get my wings (an intense long-time dream).

More detailed version: Started my PPL instruction back in 2020, and it was during that time that I had started taking a very low dose of generic Abilify (5mg) to deal with moodiness during a very stressful time in my life. Never visited a psych to get a diagnosis, but my PCP wrote a Rx after some discussion between him, me, and my wife. Reported the med on my class III medical paperwork, which (surprise!) eventually came back denied. So I sent my cert back to OKC and grounded myself. By that time, however, I had racked up a number of hours and was just about to solo (actually got the FAA notice the week before my first solo) so I was super bummed out. I mean, I coouldn't even go Sport since there was a record now.

Nowadays, some time has passed, and the dream to get in the air has not left my heart. My wife and I both agree that transitioning off my Rx is a definitely reasonable move now (remember, health first!).
What can expect with the SI process if I transition off the med, do the 60-day minimum for Path I, work with my AME, etc.? How much of a hassle is the FAA gonna make this (I assume a big hassle)? Should I expect to get told to do some tests and/or see a HIMS AME? What are your best guesses at the likelihood of getting a successful SI issued?

PS- to be vulnerable here, I just feel incredibly frustrated with the FAA. Despite being a young and healthy man who is well enough to be an Infantry officer in the National Guard, balance a civilian career, raise a family, and successfully handle aircraft to the point where my CFI is saying I'm good to solo... yet the FAA is like "you are NOT safe to fly!" ugh. I come from an aviation family, grew up a short drive from Oshkosh... this is all so disheartening, but I am willing to put in the time/money/effort to go through every hoop I need to - resilience!

 

[murphey]

Not to answer to your questions but....

I'm convinced that all CFI candidates should be required to review the MedXPress form IN DETAIL with the student and explain to the student if there are any issues with question 18, to schedule a CONSULT with an AME before continuing on with training.

 

[PaulS]

Www.aeromedicaldoc.com.

His website tells you how to make contact. Ask him your question, his fees are very reasonable and he will give you the correct answer.

The drug sounds like an issue, but it was given to you for a reason. That reason will also be vetted by the faa. Just stopping the drug probably doesn't resolve the issue, you need professional guidance on this.

 

[Rushie]

If insurance paid for your Abilify, there was a diagnosis. They just didn’t tell you what it was. It might be helpful to find out exactly what code the PCP used when they filed your insurance. (Or the pharmacy?)

 

[kell490]

As far as the FAA is concerned your PCP diagnosed you I would get all your records from the PCP and find out what he put down as the diagnose have to bring all that to HIMS AME find out what can be done. Maybe if it just says temporary depression won't be so bad like Psychosis where it's a 10 year grounding. Seems like most PCP's prescribe typical Prozac type drugs I don't know if Abilify is worse with FAA. After my father passed years ago I was offered Prozac from my PCP I never even told him I was depressed the stuff was handed out like candy glad turned him down. Good luck let us know how it turned out maybe it will help someone else with the same question.

 

[midcap]

Tell the FAA the real problem pilots hide their medical history like Roy Holliday

 

[flyingron]

You should have known better than to let some internist prescribe psycho-active drugs for an apparently off-label use so casually. This drug is 100% forbidden by the FAA and despite your protestations that there's no "diagnosis" the idiot MD gave you a presumptive one by prescribing that. You're going to have to find a very good (likely HIMS) AME (there are a couple here) and reapply. There will be substantial hoops to jump through (yes as others point out you need to dig up every scrap of documentation you have from the existing PCP, it's not going to be everything you need but it will be part of it). Now you are in the position of disproving that you don't have any of the stuff that you could legally have been prescribe Abilifiy for.

Not withstanding the FAA issues, this is outright malpractice on the part of your PCP. I hope the trinkets he got from Otsuka was worth it.

 

[kell490]

These drugs are quick fixes PCP's are allowed to hand out without much thought in the matter. It's typical of American health care system instead of sending someone to counseling first before drugs are used. Insurance companies rather go the cheapest route instead which is a pill. All about profit over patient care.

 

[midcap]

You should have known better than to let some internist prescribe psycho-active drugs for an apparently off-label use so casually. This drug is 100% forbidden by the FAA and despite your protestations that there's no "diagnosis" the idiot MD gave you a presumptive one by prescribing that. You're going to have to find a very good (likely HIMS) AME (there are a couple here) and reapply. There will be substantial hoops to jump through (yes as others point out you need to dig up every scrap of documentation you have from the existing PCP, it's not going to be everything you need but it will be part of it). Now you are in the position of disproving that you don't have any of the stuff that you could legally have been prescribe Abilifiy for.

Not withstanding the FAA issues, this is outright malpractice on the part of your PCP. I hope the trinkets he got from Otsuka was worth it.

it seems like the FAA should have a quick and easy avenue to resolve these things since it happens often

 

[flyingron]

it seems like the FAA should have a quick and easy avenue to resolve these things since it happens often

Well, they used to. It was giving a battery of psychological tests which ran a few thousand plus enough sessions with a board-certified Psychiatrist in order for him to make a correct diagosis.
Now it's more or less the same but it involves a HIMS doctor instead.

 

[bflynn]

Not to answer to your questions but....

I'm convinced that all CFI candidates should be required to review the MedXPress form IN DETAIL with the student and explain to the student if there are any issues with question 18, to schedule a CONSULT with an AME before continuing on with training.

It would certainly cut down on the traffic in the Medical Forum.

I wonder at doctors handing out drugs that impact psychiatric factors. Are they experts in that? And isn't that also how the opioid crisis started?

 

[bbchien]

i have maintained over 20 years, that family medicine docs should not be prescribing antidepressives. Neither should Adv. Practice nurses.

 

[t3chiman]

...isn't that also how the opioid crisis started?

No that was more of a corporate policy issue. Watch Dopesick, actually pretty true-to-life.

 

[midcap]

i have maintained over 20 years, that family medicine docs should not be prescribing antidepressives. Neither should Adv. Practice nurses.

same could be said for ADHD

 

[mandm]

The dentist hands out oxy like it’s water washing your mouth after a teeth cleaning.

 

[ahmad]

The dentist hands out oxy like it’s water washing your mouth after a teeth cleaning.

I hate to break it to you but the dentists aren't the ones handing out oxies. Maybe oral surgeons (and that's a big maybe) but no GP dentist would give out oxies. Matter of fact most dentists think MDs are over prescribing Norcos AND antibiotics. You go to the ER and you are handed antibiotics and Norco for everything.

 

[mandm]

I hate to break it to you but the dentists aren't the ones handing out oxies. Maybe oral surgeons (and that's a big maybe) but no GP dentist would give out oxies. Matter of fact most dentists think MDs are over prescribing Norcos AND antibiotics. You go to the ER and you are handed antibiotics and Norco for everything.

I’m talking wisdom teeth removal.

 

[kell490]

Never seen a dentist prescribe OxyContin (Oxycodone) generally it's for chronic pain its an extended release form of hydrocodone. My dentist prescribes hydrocodone usually bottle of 8 pills no refill maybe that is what you were thinking of most people just say oxi for everything.

 

[midcap]

So you have to disclose ever taking Oxycodone?

 

[kell490]

I wonder why the FAA doesn't have the AME look up the patient in the state drug prescription database? I had a prescription for some shampoo from my dermatologist my primary care doctors office had it in their computer asked me if I was still using it that would stop someone like Roy Holliday I was surprised he didn't take someone else with him.

 

[midcap]

I wonder why the FAA doesn't have the AME look up the patient in the state drug prescription database? I had a prescription for some shampoo from my dermatologist my primary care doctors office had it in their computer asked me if I was still using it that would stop someone like Roy Holliday I was surprised he didn't take someone else with him.

probably HIPPA rules

but it's really all a moot point with all the rules and regulations the FAA puts forward in an effort to stemy incidents while flying due to a medical condition.

If you are a person of means, you can go to Mexico and get all of your health care done down there and the FAA sure couldn't do jack **** to get those records.

So in other words, all of these hoops they make you jump through are useless in preventing accidents.

 

[kell490]

probably HIPPA rules

but it's really all a moot point with all the rules and regulations the FAA puts forward in an effort to stemy incidents while flying due to a medical condition.

If you are a person of means, you can go to Mexico and get all of your health care done down there and the FAA sure couldn't do jack **** to get those records.

So in other words, all of these hoops they make you jump through are useless in preventing accidents.

I think you sign a waiver to allow them to review your medical records. Maybe the AME was one of these I heard a few talk about who doesn't dig too deep into things on his own does the minimum exam. His father was an airline pilot likely they knew someone.

 

[flyingron]

probably HIPPA rules .

HIPAA and government agencies are not "covered entities" under that law.

 

[midcap]

HIPAA and government agencies are not "covered entities" under that law.

pretty sure the govt can't just peer into your med records with out probable cause

 

[bbchien]

pretty sure the govt can't just peer into your med records with out probable cause

You're not well informed. HIPAA is about who cannot have your record. But what we are dealing with here is the unprotection of the insurance billing codes (Part of the ACA of 2010). They can't see your record but they sure can tell what was billed to your insuror.....

This is part of the horror of Speaker Pelosi syaing on teh ngith of the ACA debate: I don't know what' s in it. Let's pass it and then we'll read it. The negotiation for that "unprotection" occured at 8:00 PM on the night of the debate in the house sponsor's congressional office.

I have airmen who came to me because the FAA QA department wrote (certified mail) "It has come to our attention that....." So they DO, do it......

 

[midcap]

You're not well informed. HIPAA is about who cannot have your record. But what we are dealing with here is the unprotection of the insurance billing codes (Part of the ACA of 2010). They can't see your record but they sure can tell what was billed to your insuror.....

This is part of the horror of Speaker Pelosi syaing on teh ngith of the ACA debate: I don't know what' s in it. Let's pass it and then we'll read it. The negotiation for that "unprotection" occured at 8:00 PM on the night of the debate in the house sponsor's congressional office.

I have airmen who came to me because the FAA QA department wrote (certified mail) "It has come to our attention that....." So they DO, do it......

ahhhhh....that makes total sense. So you better pay for your doc and SSRI in cash

 

[Half Fast]

ahhhhh....that makes total sense. So you better pay for your doc and SSRI in cash. At night. In South America. While disguised.

FIFY

 

[midcap]

FIFY

 

[mryan75]

reported that I took Abilify, no diagnosis

:facepalm:

 

[flyingron]

While ACA may not provide privacy for billing codes, I disagree that the codes (when associated with your identity) are not PHI according to HIPAA. The problem is that the FAA is not a covered entity under HIPAA. Only the government health plans and government providers are subject to HIPAA.

 

[Warmi]

These drugs are quick fixes PCP's are allowed to hand out without much thought in the matter. It's typical of American health care system instead of sending someone to counseling first before drugs are used. Insurance companies rather go the cheapest route instead which is a pill. All about profit over patient care.

Just so we are clear , without profits there would not be any meaningful patient care to begin with - people need to eat you know…

 

[Warmi]

The dentist hands out oxy like it’s water washing your mouth after a teeth cleaning.

Hardly… I had one old mini implant extracted + another tooth in preparation for proper implants - that was some serious digging I can tell you with serious pain afterwards - got Tylenol and nothing else.

 

[Anon]

i have maintained over 20 years, that family medicine docs should not be prescribing antidepressives. Neither should Adv. Practice nurses.

Yet, unfortunately, they do. Dr. Chien, in your opinion, what can/should we (collectively) do to encourage change at the FAA? Talk to congresspeople? Send letters?

I've talked to you before about my situation involving a PCP prescribing an approved SSRI after a quick online message to the Dr about managing stresses of owning a small business. A quick message to the PCP and he/she prescribed an SSRI. I was on it for two years before realizing a couple therapy sessions allowed me to manage the stress and the medication wasn't helping in the slightest.

The kicker is that the PCP also prescribed 60 days of Xanax via that online message and you informed me that's a rule-out and disqualifier for a medical certificate.

I'm not at all blaming the messenger, but I think a lot of us would love to hear from you and others about what we can do to suggest change to the FAA for situations like this?

 

[SkyChaser]

Yet, unfortunately, they do. Dr. Chien, in your opinion, what can/should we (collectively) do to encourage change at the FAA? Talk to congresspeople? Send letters?

I've talked to you before about my situation involving a PCP prescribing an approved SSRI after a quick online message to the Dr about managing stresses of owning a small business. A quick message to the PCP and he/she prescribed an SSRI. I was on it for two years before realizing a couple therapy sessions allowed me to manage the stress and the medication wasn't helping in the slightest.

The kicker is that the PCP also prescribed 60 days of Xanax via that online message and you informed me that's a rule-out and disqualifier for a medical certificate.

I'm not at all blaming the messenger, but I think a lot of us would love to hear from you and others about what we can do to suggest change to the FAA for situations like this?

Why should the FAA change their policy because PCPs are handing out drugs to people who don't need them? I'm a little confused by this line of thought. It seems like a smarter solution is for PCPs to stop prescribing drugs their patients don't need.

 

[bbchien]

This is not about FAA. It is about our demand for and acceptance if, “make it better with a pill. None of this stuff and some of the underlying diseases belong in the sky.

This is about medical professionals “no knowing what the don’t know. A PCP has only 3 weeks of formal training in psychiatry.

The index case is still Andreas Lubitz. But the decrement in flexible cognition is significant in depression-anxiety states and I think that does impact safety- how much, is not provable.

Eleven years ago, I and 3 co-petitioners got the “On SSRI” pathway adopted. It took 4 years + to get there. Change is slow......

 

[Anon]

Why should the FAA change their policy because PCPs are handing out drugs to people who don't need them? I'm a little confused by this line of thought. It seems like a smarter solution is for PCPs to stop prescribing drugs their patients don't need.

This is not about FAA. It is about our demand for and acceptance if, “make it better with a pill.

I think my question came off wrong and I wasn't attempting to "demand change" at the FAA. I can totally appreciate Dr Chien and co's efforts to enact the On SSRI Protocol.

So I suppose I should have asked, how can we get doctors to stop handing out medication. In my case, I was a young business owner dealing with unexpected successes and the stressful challenges that came with it. I don't really know what 25 year old me was requesting from my doctor other than "sometimes it's hard to relax after the stresses of the day and to slow down and catch a breath." The immediate response from the Dr was "here's the SSRI and 60 day supply of Xanax." Not "let's try counseling to allow you to focus on breathing exercises".

Fast forward a couple years and I'm off the SSRI because I realized it wasn't working and I specifically had to request to be referred for a couple counseling sessions.

And I want to obtain a PPL for a hobby -- but cannot because of the whole 60 day supply of Xanax.

So I think it's multiple problems:
1) Obviously it's absurd that primary docs prescribe medications that are fairly serious when they should try other methods of coping first (I wish I was wiser when I was 25 years old)
2) I wish the FAA would continue to evaluate it's practices. For example, it's hard to wrap my head around the whole 60 days use of Xanax is a lifetime disqualifer from flying.

 

[Half Fast]

Why should the FAA change their policy because PCPs are handing out drugs to people who don't need them? I'm a little confused by this line of thought. It seems like a smarter solution is for PCPs to stop prescribing drugs their patients don't need.

Certainly the FAA shouldn't, but I don't think that's quite the issue being raised here.

As an analogy, consider my own situation: I have autoimmune liver disease (my body's immune system is attacking my liver) and I have to take an immunosuppressant. The FAA required me to get an SI, which Bruce helped me get, and then I went to Basic Med.

When I was first diagnosed with the autoimmune issue back in 2010, my physician prescribed azathioprene to suppress the immune system. That med takes several months to begin working effectively, though, so he also put me on a heavy dose of prednisone to knock down my immune system immediately and avoid further damage to my liver while waiting for the azathioprene to take effect. After two or three months he began to s-l-o-w-l-y wean me off the prednisone, as stopping it immediately after months of use can be fatal. Eventually I was only taking azathioprene, which I continue today.

For maybe five or six months, though, I was taking both meds. That wasn't a disqualifier for me.

I suspect it's a similar situation with anti-depressants. Most of them take a few weeks to begin working, and then a few more to reach full effectiveness. In some circumstances, it might make sense for a prescribing physician to give an initial short-term prescription of Xanax, which takes effect immediately but is not desirable long term. As the SSRI begins to work, the Xanax can be tapered and removed.

It looks to me like that was Anon's situation, and why he was given a 60 day script for Xanax. It doesn't appear that he was on both meds for a long period, yet the FAA deems him ineligible for a class 3 medical.

The recommended change is for the FAA to recognize this treatment protocol and not disqualify him for a medical as though he needed Xanax on top of his SSRI for life. The Xanax was short-term.

The FAA uses a wide brush, is sometimes too rigid, and does not always stay up to date with medical practices and with medications. That's why Bruce and others had to fight so hard to get the current SSRI protocol.

 

[SkyChaser]

Certainly the FAA shouldn't, but I don't think that's quite the issue being raised here.

As an analogy, consider my own situation: I have autoimmune liver disease (my body's immune system is attacking my liver) and I have to take an immunosuppressant. The FAA required me to get an SI, which Bruce helped me get, and then I went to Basic Med.

When I was first diagnosed with the autoimmune issue back in 2010, my physician prescribed azathioprene to suppress the immune system. That med takes several months to begin working effectively, though, so he also put me on a heavy dose of prednisone to knock down my immune system immediately and avoid further damage to my liver while waiting for the azathioprene to take effect. After two or three months he began to s-l-o-w-l-y wean me off the prednisone, as stopping it immediately after months of use can be fatal. Eventually I was only taking azathioprene, which I continue today.

For maybe five or six months, though, I was taking both meds. That wasn't a disqualifier for me.

I suspect it's a similar situation with anti-depressants. Most of them take a few weeks to begin working, and then a few more to reach full effectiveness. In some circumstances, it might make sense for a prescribing physician to give an initial short-term prescription of Xanax, which takes effect immediately but is not desirable long term. As the SSRI begins to work, the Xanax can be tapered and removed.

It looks to me like that was Anon's situation, and why he was given a 60 day script for Xanax. It doesn't appear that he was on both meds for a long period, yet the FAA deems him ineligible for a class 3 medical.

The recommended change is for the FAA to recognize this treatment protocol and not disqualify him for a medical as though he needed Xanax on top of his SSRI for life. The Xanax was short-term.

The FAA uses a wide brush, is sometimes too rigid, and does not always stay up to date with medical practices and with medications. That's why Bruce and others had to fight so hard to get the current SSRI protocol.

... I've talked to you before about my situation involving a PCP prescribing an approved SSRI after a quick online message to the Dr about managing stresses of owning a small business. A quick message to the PCP and he/she prescribed an SSRI. I was on it for two years before realizing a couple therapy sessions allowed me to manage the stress and the medication wasn't helping in the slightest.

The kicker is that the PCP also prescribed 60 days of Xanax via that online message and you informed me that's a rule-out and disqualifier for a medical certificate.
...

I was just reacting to the bolded part of the OP's post, I guess. I definitely wish the FAA could be more up-to-date, and use a finer brush/be able to provide a more personalized medical process so they could narrow the line between those thought to be potentially dangerous pilots and those who are deemed unexpected to be a hazard.

 

[Half Fast]

I was just reacting to the bolded part of the OP's post, I guess. I definitely wish the FAA could be more up-to-date, and use a finer brush/be able to provide a more personalized medical process so they could narrow the line between those thought to be potentially dangerous pilots and those who are deemed unexpected to be a hazard.

You quoted the key elements of Anon's post. He was on the SSRI for two years, but only took the Xanax for 60 days. He was denied not because he took an SSRI (there's a protocol for that), but because he took Xanax (briefly) at the same time.

I agree 100% that PCPs are much too quick to hand this stuff out and they don't have adequate training to do so. Had Anon tried the therapy sessions first he could have avoided the whole problem. It's a shame his PCP didn't recommend that before doling out Xanax and an SSRI.

 

[GaryM]

Y
I agree 100% that PCPs are much too quick to hand this stuff out and they don't have adequate training to do so. Had Anon tried the therapy sessions first he could have avoided the whole problem. It's a shame his PCP didn't recommend that before doling out Xanax and an SSRI.

As the old adage goes, 'When the only tool you have is a hammer, every problem looks like a nail'.