Policy Statement:
As of the 12th October, 2023, Torrington Park Group Practice has implemented a new policy refraining from prescribing benzodiazepines or sedatives, such as diazepam, for fear of flying. This decision is aligned with the understanding that benzodiazepines pose risks to passenger safety, contribute to potential abuse, and are inconsistent with recommended medical practices. Flight anxiety does not fall under the remit of General Medical Services as defined in the GP contract. Consequently, the practice is not obligated to prescribe benzodiazepines for this purpose.
Rationale:
1. Flight Safety Risks: The use of benzodiazepines causes longer reaction times and slowed thinking, posing a significant risk during flights, especially in emergency situations that require swift action.
2. Health Hazards: Sedative effects of benzodiazepines can lead to an increased risk of blood clots, particularly during flights exceeding 4 hours, potentially resulting in serious health consequences, including Deep Vein Thrombosis (DVT) [v].
3. Paradoxical Effects: While most individuals find benzodiazepines sedating, a subset may experience paradoxical agitation and aggression, posing safety risks to themselves and fellow passengers.
4. Combined Risks: Combining benzodiazepines with alcohol intensifies the aforementioned risks, compromising passenger safety.
5. Legal and Guideline Compliance: Prescribing benzodiazepines for fear of flying contradicts British National Formulary guidelines, contraindicating their use for phobic states and emphasizing inappropriate usage for short-term anxiety [i].
6. NICE Guidelines: National Institute for Health and Care Excellence (NICE) guidelines discourage the use of medication for mild mental health disorders and advocate against prescribing benzodiazepines, sedating antihistamines, or antipsychotics for significant anxiety-related states [iii].
7. Legal Implications Abroad: In some countries, importing benzodiazepines is illegal, potentially leading to legal consequences for travellers.
8. Occupational Implications: Benzodiazepines, including diazepam, remain in the system for an extended period, leading to potential issues for individuals subjected to random drug testing.
9. Long-Term Health Concerns: Studies suggest a link between benzodiazepine use and the onset of dementia, as well as evidence indicating a perpetuation of anxiety over time [iv].
Alternative Recommendations:
In lieu of benzodiazepines, individuals seeking assistance for flight anxiety are encouraged to explore aviation industry recommended courses, such as those offered by:
-British Airways: https://flyingwithconfidence.com/courses
-Virgin: https://flywith.virginatlantic.com/gb/en/wellbeing-and-health/flying-without-fear.html
–https://www.flyingwithoutfear.com/
Private Consultation:
Patients seeking benzodiazepines for flight anxiety are advised to consult with a private GP or travel clinic.
Insurance Advisory:
Patients are reminded to declare all medical conditions and medications to their travel insurer to avoid nullifying insurance policies [v].
References:
[i] British National Formulary; Diazepam – https://bnf.nice.org.uk/drug/diazepam.html
[iii] Generalised anxiety disorder and panic disorder in adults: management. NICE Clinical guideline [CG113] Published date: January 2011 Last updated: July 2019 https://www.nice.org.uk/guidance/cg113
[iv] Acute and delayed effects of Alprazolam on flight phobics during exposure. Behav Res Ther. 1997 Sep;35(9):831-41
[v] Travel Health Pro; Medicines and Travel; Carrying medication abroad and advice regarding falsified medication – https://travelhealthpro.org.uk/factsheet/43/medicines-abroad