Fear of Flying Policy

The doctors and nurses at Pembroke Road Surgery have been asked on occasion to prescribe tablets such as diazepam, temazepam, lorazepam, clonazepam and zopiclone(z-drugs) for fear of flying or to aid sleep on long haul flights.

Having considered local and national guidance we have decided that we will no longer be prescribing these drugs for these requests.

The following reasons have been considered before arriving at this decision:

Safety

The drugs listed above are central nervous system depressants and will slow normal reaction times. Although mid-air emergencies are rare, slower reaction times would place you and others in danger during an emergency situation.

Whilst most people find benzodiazepines like diazepam sedating, a small number have paradoxical agitation and aggression. They can also cause disinhibition and lead you to behave in a way that you would not normally. This could impact on your safety as well as that of other passengers and could also get you into trouble with the law.

Deep venous Thrombosis Risk

The use of CNS depressants may induce non-REM sleep. During this phase of sleep a person is less likely to move. Sitting down not moving for more than 4 hours has been shown to increase the risk of thrombosis whether in an airplane or elsewhere. Deep venous thrombosis is a serious potentially life-threatening condition.

Respiratory depression

The sedating effects of these drugs may slow down normal breathing. At 8000ft oxygen levels drop to 90% and therefore suppression of breathing in some individuals may be harmful.

Legalities and good clinical practice

In some countries these controlled drugs are illegal and therefore may result in confiscation or trouble with local police if caught in possession.

Diazepam stays in your system for quite a while. If your job requires you to submit to random drug testing, you may fail this having taken diazepam.

NICE guidance

NICE guidelines advise that benzodiazepines should not be used for mild anxiety health disorders/phobia and that there is risk of dependency with prolonged use.

Fear of flying in isolation is not a recognised ‘generalised anxiety disorder’.

There is a possible risk of early dementia in users (though it is currently unclear if this risk is in regular users only or includes occasional use).

According to the prescribing guidelines doctors follow (BNF) Benzodiazepines are contraindicated (not allowed) in phobia. Your doctor is taking a significant legal risk by prescribing against these guidelines. They are only licensed short term for a crisis in generalised anxiety. If this is the case, you should be getting proper care and support for your mental health and not going on a flight.

So, we will no longer be providing Diazepam or similar drugs for flight anxiety. In rare circumstances the practice may consider prescribing when the benefits of undertaking the flight clearly outweigh the risks of prescribing, and where the risks can be contained to be as low as reasonably possible, i.e., medication usage in full collaboration with the airline medical department; where the passenger has a medically trained escort; and where there has been sufficient liaison and clearance with relevant customs authorities & medical defence organisations.

Useful Links

Instead, please try one of these aviation industry recommended flight anxiety courses.

Easy Jet - Fearless Flyer

British Airways - Flying with Confidence

Virgin Atlantic - Flying Without Fear