Use of Diazepam (and other benzodiazepines) for Fear of Flying
Woodlands Surgery Policy
We are often asked to prescribe sedative drugs, such as diazepam for fear of flying or to assist with sleep during flights. We have agreed a practice policy that we will no longer prescribe these drugs for fear of flying.
There are several good reasons why prescribing drugs such as diazepam for flying is not safe and no longer recommended:
- Diazepam is a sedative, which means it makes you sleepy and more relaxed. If there is an emergency during the flight, it may impair your ability to concentrate, follow instructions and react quickly to the situation. This could have serious safety consequences for yourself and for those around you. Incapacitation from benzodiazepines is a risk to the lives of all on board the aircraft in the event of an emergency requiring evacuation.
- Sedative drugs can make you fall into an unnaturally deep, non-REM sleep. This means you won’t move around as much as during natural sleep, increasing your risk of developing a blood clot (DVT) in the leg or lungs. Blood clots are very dangerous and can be fatal. This risk is even greater if your flight is longer than four hours.
- Whilst most people find benzodiazepines like diazepam sedating, a small number can experience agitation and aggression. Benzodiazepines 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.
- The sedative effects of benzodiazepines can affect breathing and cause low oxygen levels, which could be life threatening, especially with lower circulating oxygen levels on an aeroplane, in people with breathing problems or when combined with alcohol.
- Diazepam and similar drugs are illegal in several countries. They may be confiscated, or you may find yourself in trouble with the police.
- 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.
- According to the prescribing guidelines doctors follow (British National Formulary) diazepam is contraindicated (not allowed) for treating phobias (fears). It also states that “the use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate.” Your doctor would be 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 travelling on a flight. Fear of flying in isolation is not a generalised anxiety disorder.
- NICE guidelines state that medication should not be used for mild and self-limiting mental health disorders. In more significant anxiety related states, benzodiazepines, sedating antihistamines, or antipsychotics should not be prescribed.
- A study published in 1997 from the Stanford University School of Medicine showed that there is evidence use of benzodiazepines stops the normal adjustment response that would gradually lessen anxiety over time and therefore perpetuates (and may increase) anxiety in the long term, especially if used repeatedly.
We recognise that fear of flying is real and frightening and we don’t underestimate the impact it can have. We recommend tackling this by using self-help resources or considering one of the ‘Fear of Flying’ courses run by many airlines. We do not recommend any specific course, but you may find the following links useful:
Self-help options: https://www.nhs.uk/mental-health/conditions/phobias/self-help/
EasyJet: www.fearlessflyer.easyjet.com
British Airways: www.flyingwithconfidence.com
Virgin: https://flywith.virginatlantic.com/gb/en/wellbeing-and-health/flying-without-fear.html
Flight anxiety does not come under the remit of General Medical Services as defined in the GP contract and so we are not obliged to prescribe for this.
It is important to declare all medical conditions and medications you take to your travel insurer. If not, there is a risk of nullifying any insurance policy you may have.