The Millwood Partnership has reviewed its benzodiazepine prescribing and based on current national guidelines will no longer prescribe benzodiazepines or sedatives (such as diazepam) to patients for fear of flying.
Increasing concerns have arisen regarding prescribing benzodiazepines including Diazepam (also known as ‘Valium’). As safety issues have become better understood, it is clear that diazepam has a number of unwanted side effects and risks. This includes short term memory impairment, co-ordination issues and reduced concentration and reaction times. They also have significant risks of addiction. Unfortunately, benzodiazepine use increased over the past couple of decades and it was historically prescribed for fear of flying.
Diazepam is now a Class C/Schedule IV controlled drug in the UK. You can read more about this on the gov.uk website on controlled drugs:
https://www.gov.uk/government/publications/controlled-drugs–7
Considering the information above, there are a number of very good reasons why we don’t prescribe diazepam for fear of flying any longer:
- The use of any sort of benzodiazepine causes longer reaction times & slowed thinking, which during a flight will put the passenger at significant risk of not being able to act in a manner which could save their life, or that of a loved one or co-passenger, in the event of a safety critical incident. Incapacitation from benzodiazepines is a risk to the lives of all on board the aircraft in the event of an emergency requiring evacuation. In fact there is a risk that you may be unarousable in the case of an emergency.
- 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.
- Whilst most people find benzodiazepines like diazepam sedating, a small number have paradoxical agitation and in aggression. They can also cause disinhibition and lead you to behave in a way that you would not normally. This could impact on your safety as well as that of other passengers and could also get you into trouble with the law.
- Benzodiazepine use added to alcohol consumption causes an increase in the risk posed by the points above.
- 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.
- In some countries it is illegal to import these drugs, so the passenger will need to use a different strategy for the homeward bound journey and / or any subsequent legs of the journey. There is a risk the medication may be confiscated or you may find yourself in trouble with the police.
- 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.
- Benzodiazepines have been linked to the onset of dementia.
- 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.
We do understand, despite flying being very safe, it can be a source of concern for some. The aviation industry recommended flight anxiety courses which are easily accessible for those who wish to fly and conquer their fear of flying. Treating the cause of the fear with one of these courses is much more favourable than simply masking the symptoms with risky medication. We have included a list of resources below: