Fear of Flying

Benzodiazepines (including diazepam, lorazepam, temazepam, clonazepam) are medicines that have been in use since the 1960s for a wide range of conditions, such as alcohol withdrawal, epilepsy, and muscle spasms. They are strongly sedating drugs that have negative effects on memory, coordination, concentration, and reaction times. They are addictive and withdrawal can lead to seizures, hallucinations, agitation, and confusion. 

Unfortunately, benzodiazepines have widely become drugs of abuse, and as a result they are controlled in the UK as Class C, Schedule 4 drugs. This means there are restrictions on when and how much can be prescribed under the Controlled Substances Act, and inappropriate use, supply or possession of these medications is illegal in the UK under the Misuse of Drugs Act. 

Many people approach their GP practice asking for diazepam to help with fear of flying, or to sleep during a flight. There are several good reasons why prescribing diazepam is not recommended, and as a result we will no longer prescribe diazepam for patients who wish to use this for a fear of flying. 

Reasons 

1. The national prescribing guidelines followed by GPs (the British National Formulary – BNF) states that all benzodiazepines are ‘contraindicated’ (not allowed) in treatment of phobias (fear conditions, such as fear of flying). It also states that the use of benzodiazepines to treat short-term anxiety is ‘inappropriate’. Benzodiazepines are only licensed for short-term use in a generalised anxiety crisis – but if this is the case for you, you should seek proper care and support for your mental health, and it would not be advisable to go on a flight. Your GP would be taking a significant legal risk by prescribing against these national guidelines. 

1. Diazepam is a sedative, so it makes you sleepier. If an emergency occurred during the flight, this could impair your ability to concentrate, follow instructions, or react to the situation. This could seriously affect the safety of you and the people around you. Such incidents are rare but they do occur, and it can be fatal if you are unable to evacuate the plane properly. No-one else on board a plane will evacuate for you – the cabin crew are there to guide an evacuation, but you need to be responsible for yourself. As a result, many airlines consider sedative medications as a reason why someone would not be allowed on a plane, in a similar way that someone who has consumed excessive alcohol may be removed from a plane. 

1. Sedative drugs can make you fall asleep; however, the sleep is an unnatural non-REM sleep. Your movements during this type of sleep are reduced and this can place you at an even higher risk of developing blood clots in the legs (deep vein thrombosis – a DVT) or lungs (pulmonary embolism – a PE). These blood clots are very dangerous and can even be fatal. This risk further increases if your flight is over 4 hours long. 

1. Going on an aeroplane normally involves your blood oxygen levels decreasing from around 98% to as low as 90%, due to the air pressure decrease at cruising altitudes. Normally your body compensates for this by altering the rate and depth of your breathing. However, benzodiazepines work to depress your breathing and this can put you at risk of hypoxia (excessively low blood oxygen), especially if you have lung problems already, which can be very dangerous. 

1. Most people feel sleepy when they take diazepam, but a small proportion of people experience the opposite effect and can become aggressive. This is called a paradoxical effect, and it can be unexpectedly inconsistent, even if diazepam has been used in the past. Alongside aggression and agitation, this response can cause disinhibition and make you behave in ways you normally wouldn’t. This could also impact on your safety and the safety of your fellow passengers or could lead you to get in trouble with the law.  

1. In several countries, diazepam and similar drugs are illegal (Greece, Japan, and many Middle Eastern countries including the UAE are just some examples). They would be confiscated, and you might find yourself in trouble with the police for being in control of an illegal substance, even if it has been prescribed by a doctor in the UK. This has led to people spending time in a jail a foreign country. 

1. Diazepam has a long half-life, which means it stays in your system for a significant time. If your job requires you to submit random drug testing, you may fail these tests. 

What you can do 

A fear of flying is frightening and can be debilitating. However, there are much better and effective ways of tackling the problem. We recommend you tackle your problem with a Fear of Flying Course, which are aviation-industry approved and are run by several airlines. These courses are far more effective than diazepam and have none of the undesirable effects. Also, the positive effects of the courses continue after the courses have been completed. 

Easy Jet :                 www.fearlessflyer.easyjet.com       

British Airways:        https://flyingwithconfidence.com/  

Virgin Atlantic:          https://flywith.virginatlantic.com/gb/en/wellbeing-and-health/flying-without-fear.html                   

Alternatively, you could contact your local psychology therapy provider to consider having Cognitive Behavioural Therapy (CBT). Details of Talkworks can be found at https://www.talkworks.dpt.nhs.uk/locations/talkworks-torquay 

Ultimately, if you still feel unable to fly, then it may be appropriate to consider alternative routes of transport. 

If you still wish to consider diazepam for fear of flying, we suggest consulting with a private GP or a private travel clinic, who may be able to help you further. These services are private and not offered by the NHS.