Diazepam Prescribing Policy

Background

Benzodiazepines (including diazepam, lorazepam, temazepam, clonazepam) are medicines that have been in use since the 1960s for a wide range of conditions, such as alcohol withdrawal, epilepsy, and muscle spasms. They are strongly sedating drugs that have negative effects on memory, coordination, concentration, and reaction times. They are addictive and withdrawal can lead to seizures, hallucinations, agitation, and confusion.

Unfortunately, benzodiazepines have widely become drugs of abuse, and as a result they are controlled in the UK as Class C, Schedule 4 drugs. This means there are restrictions on when and how much can be prescribed under the Controlled Substances Act, and inappropriate use, supply or possession of these medications is illegal in the UK under the Misuse of Drugs Act.

Many people approach their GP practice asking for diazepam to help with fear of flying. There are several good reasons why prescribing diazepam is not recommended, and as a result we will no longer prescribe diazepam for patients who wish to use this for a fear of flying.

Reasons

1. The national prescribing guidelines followed by GPs (the British National Formulary – BNF) states that all benzodiazepines are ‘contraindicated’ (not allowed) in treatment of phobias (fear conditions, such as fear of flying). It also states that the use of benzodiazepines to treat short-term anxiety is ‘inappropriate’. Benzodiazepines are only licensed for short-term use in a generalised anxiety crisis – but if this is the case for you, you should seek proper care and support for your mental health, and it would not be advisable to go on a flight. Your GP would be taking a significant legal risk by prescribing against these national guidelines
2. Diazepam is a sedative and can impair your ability to concentrate. Although emergencies on planes are rare, diazepam could pose a significant risk of not being able to react in a safe manner should an emergency occur.
3. The sedative effect of Diazepam means you may be more immobile on the plane. This can increase the risk of developing a blood clot in the leg (deep vein thrombosis) or even the lung (pulmonary embolism).
4. A small number of people who take diazepam will have paradoxical agitation and aggression. They can also cause disinhibition and lead you to behave in a way you would not normally. This could pose a risk on the plane and impact your safety as well as others.
5. Diazepam and similar controlled drugs are illegal in some countries. They may be confiscated. The passenger would then have to find an alternative strategy for the return flight.
6. Diazepam has a long half-life. This means it stays in your system for a long time. This is relevant for anyone who is required to take a drug test for work as it could be detected in your system for up to 30 days.

 

What can you do?

We appreciate that fear of flying is very real and can be debilitating. However, there are much better and effective ways of tackling the problem. We recommend that you look into a fear of flying course which are offered by many airlines.

Fear of Flying Courses:

Easy Jet

www.fearlessflyer.easyjet.com

British Airways

http://flyingwithconfidence.com/courses

Virgin Atlantic

Tips For Nervous Flyers | Advice For Nervous Flyers | Virgin Atlantic

If you still wish to consider diazepam for fear of flying, we suggest consulting with a private GP or a private travel clinic, who may be able to help.

Other situations – scans, dental appointments etc.

We do not provide sedative medications such as diazepam for use in other situations, such as for dental/hospital procedures or scans. The Royal College of Radiologists sets out clear guidance for sedation in hospital radiology departments which states “Patients requiring sedation should undergo pre-procedure assessment and have a sedation plan”.

Sedation, analgesia and anaesthesia in the radiology department, second edition.

The Intercollegiate Advisory Committee for Sedation in Dentistry has a similar guideline (https://www.saad.org.uk/IACSD%202020.pdf) which states “The monitoring and discharge requirements for oral sedation are the same as for intravenous sedation. Oral sedation must only be administered in the place where the dental treatment is provided and must only be carried out by practitioners who are already competent in intravenous sedation.”

As a result, responsibility for this type of treatment lies with your dentist or hospital staff, and not your GP. If you feel this is required, we suggest consulting with your dentist or the hospital teams in good time before any scans or treatments occur.