Prescribing Medication for Fear of Flying and for Medical Procedures

After very careful consideration, Rolle Medical Partnership has reviewed our benzodiazepine prescribing and established a policy not to prescribe benzodiazepines or sedatives (such as diazepam) to patients for medical procedures or fear of flying. Many other GP practices have a similar policy. 

Fear of Flying

Prescribing these drugs is no longer recommended for the following reasons:

Safety in Flight

The use of any sort of CNS depressant causes longer reaction times and slowed thinking, which during a flight can put a passenger at significant risk of not being able to act in a manner which could save their life in the event of a safety critical incident. One cannot assume that the cabin crew are there to guide passengers in such a scenario). Incapacitation from Benzodiazepines can thus potentially be a risk to life of all onboard an aircraft in the event of an emergency requiring evacuation. (See the outcomes of flights BA2276 on 08.09.2015 vs BA28M on 22.08.1985). Furthermore, there may be a paradoxical increase in aggression reported by patients taking benzodiazepines (see BNF) with the potential to put other occupants of the aircraft at risk. Benzodiazepines added to alcohol consumption causes an increase in the risk posed by many of the points above, and many (nervous) flyers will consume alcohol in the terminal before boarding and during their flight, despite medical advice to refrain from doing so. It is also worth noting that the BNF states that Benzodiazepines should be avoided in phobic states.

Risk of Thrombosis

The use of any sort of CNS depressant has the potential to increase the risk of DVT. Such drugs may induce non-REM sleep which tends to be of a type where the person does not move in their sleep, and therefore increases the possibility of sitting without moving for more than four hours at a time (the amount of time which has been shown to increase the risk of developing DVT whether in an aeroplane or elsewhere).

Respiratory Depression

The sedating effects have the potential to cause respiratory depression, resulting in a drop in oxygen saturations. Normal sats for a healthy person at 8000ft are around 90%, so with the effects added together, this may become significant.

Legalities in Foreign Domains

In some countries it is illegal to import such drugs, e.g. in the Middle East, and so passengers will need to use a different strategy for the homeward bound journey and / or any subsequent legs of a journey. 

Standard GP indemnity does not treatments initiated outside the UK, so your GP would only be insured for medicines administered within the UK. 

NICE

Guidelines suggest that medication should not be used for mild/self-limiting mental health disorders, and that there is a risk of addiction from inappropriate use. In more significant anxiety related states, benzodiazepines, sedating antihistamines or antipsychotics should not be prescribed. Benzodiazepines are only advised for short term use for a crisis in generalised anxiety disorder, i.e. acute anxiety emergencies. In such a scenario, an individual would not be fit to fly (due to the potential risk adversely affecting completion of the flight without diversion). Fear of flying in isolation is not generalised anxiety disorder. There is also 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).

Medical Procedures

To maximise the safety of our patients, and reduce unintended harm, our practice policy is that patients who require a prescription for sedation for a medical procedure should discuss this with and have any medication prescribed by the clinician who is responsible for monitoring their health during the procedure. Therefore, our GPs do not prescribe sedation specifically for medical procedures. Sedation can cause side effects which can cause health to deteriorate and the clinical staff monitoring you during your procedure are responsible for treating any side effects which you experience during the procedure.

There are several reasons why we do not prescribe these medicines for procedures:

• GPs are not trained to provide the correct level of sedation for a procedure / scan. Providing too little sedation will not help you, providing too much sedation can make you too sleepy, which could lead to the procedure being cancelled. Too much sedation can dangerously affect your breathing. After taking a sedative for a procedure or scan, you will need to be closely monitored to keep you safe.
• Although Diazepam makes most people who take it sleepy, in some rare situations it can have an opposite effect and make people aggressive or agitated.
• Scans and hospital procedures are often delayed, therefore the team performing the procedure or scan should provide the sedation, to ensure you become sleepy and relaxed at the right time.

The Royal College of Radiologists have strict guidance on the safe sedation of patients during investigations such as CT and MRI scans. It would be unsafe for us to prescribe a sedative that we are unable to monitor. If you were to become unwell during a scan after taking a sedative that the Radiology team did not know about, this could be very dangerous.

Again, if you have concerns about anxiety of claustrophobia with regards to a scan, please contact the Department who requested the scan or the Radiology department, as they are responsible for providing this if they feel it is clinically necessary. It is not the responsibility of the Practice, and we will not prescribe for these reasons.

Finally, for procedures such as cataract operations or dental procedures it is the responsibility of the Surgeon or Dentist to prescribe any sedation, if they feel you require it. Requests to the Practice for such reasons will always be declined.