Benzodiazepines and Fear of Flying

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Robin Lane Health and Wellbeing Centre Policy on benzodiazepines and related medication for fear of flying, dental work, scan or other investigations

Background

People often come to the GP requesting diazepam for fear of flying or to assist with sleep during flights.

As a practice, Robin Lane Health and Wellbeing Centre has taken the decision that we will not prescribe benzodiazepines for this purpose.

Definitions:

Benzodiazepine: class of drugs which are sedating. Can be used in short courses to treat acute anxiety, seizures, insomnia, alcohol withdrawal and muscle spasm. Examples: diazepam, clonazepam, lorazepam, temazepam, chlordiazepoxide

‘Z’ Drugs: A class of drugs which are commonly used as sleep aids. Examples: zopiclone, zolpidem

Reasons for not prescribing

  1. The use of any sedating drug causes longer reaction times and slower thinking which during a flight may put yourself and or other passengers at significant risk of not being able to act in a manner which could save life in the event of an emergency.
  2. The use of any CNS depressant has the potential to increase the risk of Deep Vein Thrombosis (DVT) also known as blood clots.
  3. For some countries it is illegal to import these drugs.
  4. National guidelines advise that medication should not be used for mild and self-limiting mental health disorders and/or phobias.
  1. Use of these medications increases the risks of falls and accidents.
  2. Benzodiazepines can stay in your system for a long time. If your job requires you to submit random drug testing, then you may fail this.
  3. According to the BNF (guidelines GPs follow for prescribing) benzodiazepines are contraindicated (not allowed) in treating phobia. It states, ‘the use of benzodiazepines to treat short-term mild anxiety is inappropriate’. They are only licensed for short term use for a crisis. If this is the case, you should be receiving support for your mental health and consider whether taking a flight is a sensible decision. Your GP would be taking a significant risk in prescribing these medications for you.

What you can do

We appreciate fear of flying is very real and very frightening. The recommended approach to manage this fear is by attending a specific fear of flying course or engaging in psychological therapy such as cognitive behavioural therapy (CBT). For those who still wish to consider benzodiazepines, we would suggest you consult with a private doctor or travel clinic who may be able to offer you a private prescription.

https://www.nhs.uk/mental-health/conditions/phobias/self-help/
https://www.anxietyuk.org.uk/anxiety-type/fear-of-flying/
https://www.fearlessflyer.easyjet.com/
https://www.flyingwithconfidence.com/

Other situations- Prescribing for scans / procedures

We have a duty of care to provide safe, consistent, and appropriate care for our patients. 

We do not provide prescriptions of benzodiazepines for dental procedures, prior to scans or hospital procedures. The responsibility for this lies with the individual carrying out the treatment / procedure. Responsibility to prescribe this does not rest with your GP. If you do require a prescription, we recommend you contact your dentist or the person carrying out the procedure and discuss with them further. They may prescribe it if they feel it is appropriate.

We have outlined our reasons for this below:

  • Small doses of benzodiazepines such at 2mg diazepam are probably sub-therapeutic for most adults for any effective sedation. Conversely anxiolytics can have an idiosyncratic response in patients, and even very small doses can cause increased agitation in some subsets of patients.
  • A patient may take a sedative ‘an hour’ before their assumed procedure, to then attend the hospital to find their procedure has been delayed, therefore the timing of the anxiolytic being sub optimal.
  • GPs are not regularly involved, skilled, trained or appraised in sedation skills.
  • All hospital consultants, both those requesting imaging and those providing it, have access to the same prescribing abilities as GPs. If a patient needs a certain medication to enable an investigation to go ahead, they are just as well positioned to provide a prescription, either through the hospital pharmacy or a hospital FP10.

You may wish to discuss next steps with your radiologist or consultant.