Diazepam & Medication for Flying

The Practice Of Health has reviewed its prescribing and based on current national guidelines will no longer prescribe Benzodiazepines (such as diazepam) to patients for fear of flying.

Increasing concerns have arisen regarding prescribing benzodiazepines including Diazepam (also known as ‘Valium’). As safety issues have become better understood, it is clear that diazepam has a number of unwanted side effects and risks. This includes short term memory impairment, co-ordination issues and reduced concentration and reaction times. They also have significant risks of addiction. Unfortunately, benzodiazepine use increased over the past couple of decades and it was historically prescribed for fear of flying.

Diazepam is now a Class C/Schedule IV controlled drug in the UK. You can read more about this on the gov.uk website on controlled drugs:

https://www.gov.uk/government/publications/controlled-drugs–7

This policy decision has been made by the GP Partners and will be adhered to by all the prescribing clinicians in the team, as expanded below.

Taking your regular prescription on your flight

If you take regular medication and are planning to go abroad, we recommend following these steps to ensure that you have your prescription for the length of the trip.

Please contact us 2 months before your flight to let us know what medication you may need and how long you are going away for. You may need a letter signed by the GP stating what medication you are on and why you need it. This may come with a charge.

You will also need a copy of your prescription stating the generic name of your medication. This is due to medications having different brand names and therefore you will need to know the name that is carried across all countries. 

Carry your medication in labelled packaging. NHS guidelines advice that you carry the majority in your hand luggage in a seperate easily accessible bag and then some spare in your suitcase luggage in case of loss or damages.

If you are travelling with liquid medicines over 100mls, contact the airline and airports you are travelling through. This also includes medications such as inhalers. You may need a document to prove the liquid form of the medication is necessary. Carrying over 100mls can sometimes mean this medication needs to be screened seperately to your luggage. Inform security before your X-Ray that you have liquid medication with you. 

If you need to travel with needles or syringes you will need to carry the relevant medication alongside the equipment. You will not be able to travel with needles and syringes only.

If you are travelling to a warm country, get advice from the pharmacy on how to store your medication or see the NHS website's advice for storing your medications.

The country you are travelling to may have restrictions on the medications that they allow into the country. You will want to contact the embassy of the country you are travelling to in order to confirm the regulations. If any medications you are taking are controlled drugs then you will need to contact the relevant embassy before you travel.

Use of Benzodiazepines (and related medications) for flying

Diazepam in the UK is a Class C/Schedule IV controlled drug. The following short guide outlines the issues surrounding its use with regards to flying and why the surgery no longer prescribes such medications for this purpose.

People often come to us requesting the doctor or nurse to prescribe diazepam for fear of flying or assist with sleep during flights. Diazepam is a sedative, which means it makes you sleepy and more relaxed. There are a number of very good reasons why prescribing this drug is not recommended.

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 going on a flight. Fear of flying in isolation is not a generalised anxiety disorder.

Considering the information below, there are a number of very good reasons why we don’t prescribe diazepam for fear of flying any longer:

• The use of any sort of benzodiazepine causes longer reaction times & slowed thinking, which during a flight will put the passenger at significant risk of not being able to act in a manner which could save their life, or that of a loved one or co-passenger, in the event of a safety critical incident. Incapacitation from benzodiazepines is a risk to the lives of all on board the aircraft in the event of an emergency requiring evacuation. In fact there is a risk that you may be unarousable in the case of an emergency.
• The use of such sedative drugs can make you fall asleep, however when you do sleep it is an unnatural non-REM sleep. This means you won’t move around as much as during natural sleep. This can cause you to be at an increased risk of developing a blood clot (Deep Vein Thrombosis – DVT) in the leg or even the lungs. Blood clots are very dangerous and can even prove fatal. This risk is even greater if your flight is greater than 4 hours.
• Whilst most people find benzodiazepines like diazepam sedating, a small number have paradoxical agitation and in 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.
• Benzodiazepine use added to alcohol consumption causes an increase in the risk posed by the points above.
• According to the prescribing guidelines doctors follow (British National Formulary) diazepam is contraindicated (not allowed) in treating phobic states. 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.
• In some countries it is illegal to import these drugs, so the passenger will need to use a different strategy for the homeward bound journey and / or any subsequent legs of the journey. There is a risk the medication 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.
• Benzodiazepines have been linked to the onset of dementia.
• 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 do understand, despite flying being very safe, it can be a source of concern for some. The aviation industry recommended flight anxiety courses which are easily accessible for those who wish to fly and conquer their fear of flying. Treating the cause of the fear with one of these courses is much more favourable than simply masking the symptoms with risky medication. We have included a list of resources below:

1. Easy Jet www.fearlessflyer.easyjet.com
2. British Airways www.flyingwithconfidence.com 
3. Virgin https://flywith.virginatlantic.com/gb/en/wellbeing-and-health/flying-without-fear.html
4. Hypnotherapy approach https://www.hypnotherapy-directory.org.uk/articles/fearofflying.html#livingwithafearofflying