The Air Force calls them "go pills," and that is what they do: keep pilots going in the air long after their tired minds and bodies would have preferred to fall asleep.
The stimulants have been used by fliers since World War II, and were doled out by the hundreds during the Persian Gulf War and in Afghanistan. But the practice is coming under new scrutiny in the investigation of two F-16 pilots who were taking Air Force-provided amphetamines when they mistook a midnight training exercise for hostile fire and bombed a gathering of Canadian soldiers.
Four Canadians were killed in the April incident, and eight others were wounded. The Air Force has taken the unprecedented step of pursuing criminal charges against the pilots, Maj. Harry Schmidt and Maj. William Umbach; each faces as long as 64 years in prison.
But if the case proceeds beyond a scheduled Jan. 13 preliminary hearing, the Air Force could find many of its own practices also on trial, including its distribution of drugs that are banned in commercial aviation.
A lawyer for one of the pilots said this week that he intends to argue that the airmen's judgments were impaired by repeated use of amphetamines prescribed by Air Force doctors in Afghanistan -- drugs, he said, that would cost the pilots their jobs if they were caught using them behind the wheel of a car instead of in an F-16.
"Were these pilots' perceptions affected by their use of dextroamphetamine? I don't know," said Charles Gittins, a Virginia attorney and former naval flight officer representing one of the pilots who bombed the Canadians. "But we're going to present it and let the [court] decide."
A Pentagon investigation of the bombing ruled out the use of stimulants as a factor, concluding instead that the pilots were guilty of "reckless" behavior and violated rules of engagement.
Experts say Gittins could have a hard time connecting the pilots' fateful mistake to the influence of a relatively small dose of dextroamphetamine. Even he acknowledges that the drugs aren't at the heart of his case.
Instead, he said, the accidental bombing was the result of a series of breakdowns, including the failure of the Air Force to notify the two pilots, both members of the Illinois National Guard, that there were training exercises in the area.
But the level of attention surrounding the case is calling attention to the Air Force's little-known drug policies. Some say that if the Air Force were forced to change those policies, it also would change the nature of its pilots' missions.
Many in the service see the use of stimulants as a prerequisite for nightlong fighter patrols and transoceanic bombing runs that are mainstays of the modern aerial campaign.
"They're used because pilots are sometimes required to fly missions that exceed 10 to 12 hours," said Col. Alvina Mitchell, an Air Force spokeswoman.
"Or they're [used for] missions that are scheduled during time when pilots would ordinarily be sleeping."
Mitchell stressed that use of the pills is voluntary, safe and monitored closely by Air Force surgeons, who prescribe them only after testing pilots' reactions to them on the ground.
The Air Force has never attributed a crash or other accident to the use of stimulants, she said. But, she said, "fatigue has been cited as a contributing cause in nearly 100 mishaps."
The military has a long and uneasy history of experimenting with stimulants as a means of enhancing the performance or endurance of its fighters. Histories of World War II indicate widespread use by German and U.S. troops. But pilots' use of amphetamines expanded dramatically during the 1991 Persian Gulf War, when pilots struggled to adapt to that conflict's largely nocturnal schedule.
Fliers were given "go" pills to keep them awake for night missions, and "no-go" pills, or sedatives, to help them sleep through the din and desert sun on base during the day.
Surveys show that roughly half of U.S. fighter pilots took amphetamines during the Desert Storm campaign. Some commanders were so alarmed by many pilots' growing addiction to the pills that they ordered subordinates not to use them.
Because of such concerns, the Air Force banned the use of the pills that year. But the decision was reversed in 1996, Mitchell said, because officials thought the pills could help pilots during lengthy missions in Bosnia-Herzegovina and in the Serb province of Kosovo in Yugoslavia.
The Navy also forbade the use of stimulants during the 1990s, but lifted the ban in 1999. The policy now leaves the decision to unit commanders. But Navy officials said only a tiny fraction of Navy pilots use the pills, partly because their missions tend to be shorter than those of Air Force pilots.
"A long flight for us is six to eight hours," said one Navy officer, who asked not to be identified. Besides, he said, "Do you want to land on an aircraft carrier at night on amphetamines?"
The drug distributed by the Air Force is commonly known by its brand name Dexedrine. It is primarily used to treat hyperactivity in children and narcolepsy, a disorder in which patients fall asleep suddenly. The drug is produced by United Kingdom-based GlaxoSmithKline.
The company's literature warns that the drug has a "high potential for abuse" and "may impair the ability of the patient to engage in potentially hazardous activities such as operating machinery or vehicles."
But experts concerning the use of amphetamines say the drugs are effective and generally safe when administered carefully. One likened the small doses distributed by the Air Force to cups of coffee.
"Amphetamines can show the same effects as low doses of caffeine," said Mark Rosekind, former director of fatigue studies at NASA's Ames Research facility in Mountain View, Calif. "When you use it right, it's helpful. When you take it too much, you get jittery."
The individual doses taken by the two Air Force pilots involved in the "friendly fire" incident -- between 5 milligrams and 10 milligrams -- are relatively small, he said. But the effect of the drug on the pilots would depend on how many doses they had taken in preceding weeks.
The pilots each had been in Afghanistan for more than a month before the strike, according to an investigation of the incident by U.S. Central Command.
Both "had complained about the 24-hour nature of the operations," the Central Command report said. "Both ... had been prescribed go and no-go pills for use in combating fatigue and in adjusting to the new time zones in the deployed region."
Each had taken a dose during the flight, which was shaping up as a relatively uneventful night in the skies over Afghanistan until Schmidt saw what he described as "fireworks" as they passed south of Kandahar.
The flashes were from Canadian troops engaged in a live-fire exercise at a former Al Qaeda training camp. But Schmidt and his superior, Umbach, believed they were under attack.
Schmidt, who taught at the Navy's elite "Top Gun" fighter pilot school, asked permission to strafe the ground with his cannon. He was told to hold fire and stand by, but instead he moved lower. After further flashes, he said he was "rolling in in self-defense" and, with a call of "bombs away," released a 500-pound, laser-guided munition.
A moment later, a ground commander warned that "Kandahar has friendlies" and to get the F-16s "out of there." By then it was too late.
Schmidt and Umbach both have been charged with four counts of manslaughter and eight counts of assault -- the first time such charges have been leveled against pilots for actions in wartime. The upcoming hearing at Barksdale Air Force Base in Louisiana is to determine whether they will face courts-martial.
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To stay alert, some pilots take stimulants called dextroamphetamines referred to as
How the pill works
Stimulates the central nervous system (nerves and brain) by increasing the amount of certain chemicals in your body. This causes increased heart rate and blood pressure and a decreased appetite.
Restlessness or tremor
Headache or dizziness
Dry mouth or unpleasant taste in mouth
Diarrhea or constipation
Impotence or changes in sex drive
Serious side effects
Irregular heartbeat or very high blood pressure (severe headache, blurred vision)
Hallucinations, abnormal behavior, confusion
Difficulty breathing, closing of throat, swelling of lips, tongue or face
Source: Web MD - Researched by Times graphics reporter Joel Greenberg