Initial use of benzodiazepines, including the well-known Diazepam also known as ‘Valium’, was enthusiastic and they were hailed as a wonder drug.

 However, it became increasingly clear that, as well as having short term deleterious effects on memory, co-ordination, concentration and reaction times, they were also addictive if used for a long time, with withdrawal leading to fits, hallucinations, agitation and confusion, and further had long-term effects on cognition and balance.

Unfortunately, benzodiazepines have also become a widely used drug of abuse since they first came on the market. Because of these reasons the use of benzodiazepines has been a lot more controlled around the world since the 1980-90s, especially in the UK. 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) 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. 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. NICE guidelines suggest that medication should not be used for mild and self-limiting mental health disorders. In more significant anxiety related states, benzodiazepines, sedating antihistamines or antipsychotics should not be prescribed. Benzodiazepines are only advised for the short-term use for a crisis in generalised anxiety disorder in which case they are not fit to fly. Fear of flying in isolation is not a generalised anxiety disorder.

• Although plane emergencies are a rare occurrence there are concerns about reduced awareness and reaction times for patients taking Diazepam which could pose a significant risk of not being able to react in a manner which could save their life in the event of an emergency on board necessitating evacuation.

• 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, the amount of time which has been shown to increase the risk of developing DVT whether in an aeroplane or elsewhere.

• Whilst most people find Diazepam sedating, a small number have paradoxical agitation and aggression. They can also cause disinhibition and lead you to behave in a way that you would not normally which can pose a risk on the plane. This could impact on your safety as well as that of other passengers and could also get you into trouble with the law. A similar effect can be seen with alcohol, which has led to people being removed from flights.

• 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.

• Diazepam and similar controlled drugs are illegal in a number of countries. They may be confiscated or you may find yourself in trouble with the police. The passenger may also need to use a different strategy for the homeward bound journey and/or other legs of the journey.

• 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.

• It is important to declare all medical conditions and medications you take to your travel insurer. If not, there is a risk of nullifying any insurance policy you may have.

Below are some sites you may wish to visit if you suffer from Flying Anxiety.

https://www.fearlessflyer.easyjet.com/

https://www.britishairways.com/en-gb/information/travel-assistance/flying-with-confidence

https://www.flyingwithoutfear.com/

NHS Policy

By law, the NHS ceases to have responsibility for the medical care of patients when they leave the UK.  In addition GPs are not required by their terms of service to provide prescriptions for the treatment of a condition that is not present and may arise while the patient is abroad.

The NHS does accept responsibility for supplying ongoing medication for temporary periods abroad of up to 3 months. However, if a person is going to be abroad for more than 3 months, then they are only entitled (at NHS expense) to a sufficient supply of regular medication in order to get to their destination, where they should the find an alternative supply of that medication.

Buckland Medical Centre Policy

Travelling out of the country for less  than 3 months
For patients who inform us they will be out of the country for less than 3 months, we will provide sufficient medicines for an existing condition (e.g. asthma, diabetes…) for the period while the patient is away where it is safe to do so.  Drugs that require frequent monitoring may not be prescribed where there are safety concerns.  1 months supply only will be issued for drugs normally available over the counter, such as paracetamol.

Travelling out of the country for more than 3 months
Patients who inform us they will be leaving the country for more than 3 months will be prescribed sufficient medication to enable them to make alternative arrangements at their destination (up to 3 months supply where safe to do so).

Patients and relatives should not seek medication for themselves while they are abroad as this constitutes NHS fraud.

Prescriptions for medicines in case of illness while abroad.

GPs will only prescribe NHS prescriptions in this case for exacerbations of pre-existing illnesses; E.g. antibiotics for patients who have frequent infections secondary to an underlying lung condition.

GPs may provide private prescriptions if it is clinically appropriate and they can be self-administered safely without medical assessment while abroad. These prescriptions are not free.

Patients should be aware that some drugs commonly prescribed in the UK may be illegal in certain countries and you should check with that countries embassy before you travel.

See NHS facts of travel abroad

http://www.nhs.uk/chq/Pages/1755.aspx?CategoryID=73&SubCategoryID=105

https://www.gov.uk/travelling-controlled-drugs

Fitness to Fly During Pregnancy

The LMC has received several queries about patient requests for fitness-to-fly certificates during pregnancy. Please see information below, which can be shared on practice websites and will be available on Kent LMC website.

We are also sharing this information with midwifery and obstetric teams.

Issuing fitness-to-fly certificates during pregnancy is not provided by the NHS, including services from midwives, consultant obstetricians, and GPs.

If you require a fitness-to-fly certificate, you will need to contact a registered private health provider. You can find one by searching for ‘fitness to fly certificate in pregnancy’ online.

For further information on air travel during pregnancy, please look at the Royal College of Obstetricians and Gynaecologists (RCOG) leaflet: RCOG Air Travel During Pregnancy Guide