For fear of flying
We are often asked to prescribe diazepam for the fear of flying or to help assist with sleeping during flights.
The surgery will no longer be able to prescribe Diazepam or such medications for the purpose of flying due to British National Formulary Prescribing Guidelines issuing that Diazepam (a Class C/Schedule IV controlled Drug) is not allowed for treating phobias/fears. It states that ‘the use of benzodiazepines to treat short term ‘mild’ anxiety is inappropriate’. They are only licensed for short term for a crisis in generalised anxiety, if this is the problem you suffer with, you should seek proper care and support for your mental health, and it would not be advised to go on a flight. Fear in flying in isolation is not a generalised anxiety disorder and the Doctors would be faced with significant legal risk by prescribing against these guidelines.
Diazepam is a sedative and could impair your ability to concentrate and/or reduce awareness and reaction times, increasing the risk to yourself or other passengers in an event of an emergency.
Sedative drugs can make you fall asleep, however it is a un-natural non -REM sleep. This results in less movement than when in natural sleep and increases the risk of developing a blood clot (Deep Vein Thrombosis – DVT) in your legs or lungs. Blood clots are very dangerous and can even prove fatal. This risk is proven to be greater if your flight is more than 4 hours.
Although Diazepam is sedating, a small number of people experience paradoxical agitation and aggression. This can lead to you behaving in a manner that you would not normally do so, impacting on yours and others around your safety as well as the potential of getting you in trouble with the law.
Diazepam and similar controlled drugs are illegal in some countries. You may find that some countries confiscate the medication, and you could find yourself in trouble with the police for being in control of an illegal substance. Diazepam will also stay in your system for a significant amount of time, this may cause you to fail random drug testing if subjected to checks. Failure to declare all medical conditions and medications correctly on your travel insurance can also nullify and insurance policy you may have.
Flight anxiety does not come under the remit of General Medical Services contract and we are not obliged to prescribe for this. Patients that wish to take benzodiazepines for flight anxiety are advised to consult with a private GP or tackling your fear of flying through a ‘Fear of Flying Course.
For further information:
Easyjet: Fearless Flyer Tel: 0203 8131644
British Airways: Flying with Confidence Tel: 01252 793 250
Virgin Atlantic: Flying without Fear Tel: 0344 874 7747
Dental Procedures
GPs will not issue prescriptions for sedating medications (such as diazepam) prior to dental procedures.
Dentists should not direct patients to GPs requesting they prescribes sedating medications, such as diazepam.
If a dentist wishes to prescribe sedating medications for anxious patients that dentist should be responsible for issuing the prescription. The dental practitioner’s formulary, which is the list of drugs a dentist can prescribe is found on the BNF dental practitioners formulary, includes Diazepam Tablets and Oral Solution.
If the dentist is treating a patient within their practice NHS contract, then the prescription should be on a FP14D form.
If the dentist is treating a patient privately, they should issue a private prescription. Dentists can access a patient’s summary care record via the DERs/Rego electronic referral system for NHS England Southeast dental referrals.
Dentists may contact a GP for information or advice, if, for example the patient has a complex medical history.
Investigations including claustrophobia e.g. MRI scans
GPs will not issue prescriptions for sedating medications (such as diazepam) prior to MRI scans or other investigations.
It’s estimated that every year, approximately two million MRI scans worldwide are not performed because of patients refusing to be scanned or terminating the scan early due to claustrophobia.
There are many resources online that can help prepare patients on what to expect during a scan including step by step explanations and videos of MRIs being performed. In more severe cases, the NHS website suggests that mild sedatives are an option for people with severe MRI anxiety. However, the Medical Defense Union would recommend members to carefully consider the 2018 Royal College of Radiologists’ guidance, Sedation, analgesia and anesthesia in the radiology department, which states that a ‘trained and credentialed team should administer sedation and analgesia.’
There is also an emphasis on thorough pre-procedure assessment, planning and monitoring.
This means that the GP is not the right person to prescribe these medications. If they are needed, then this needs to be discussed with the radiology team or the specialists planning to undertake your investigations.