Benzodiazepines for Fear of Flying

Introduction

Waterloo Health Centre Approach to prescribing benzodiazepines (and related medications) for fear of flying

Waterloo Health Centre will no longer routinely be prescribing benzodiazepines (and related medications) for the treatment of fear of flying. The following information explains the reason for this, and also what steps you can take if you feel that you need support overcoming your fear of flying.

What are benzodiazepines?

Benzodiazepines are a class of medication which are “controlled drugs”.  More specifically, they are Class C/Schedule IV controlled drugs and include medications such as diazepam (Valium®) or alprazolam (Xanax®).  They have a sedative and anti-anxiety effect and are known to be addictive – particularly with long term use.  Because of their effects, some people find them helpful to overcome their fear of flying.

Why will the practice no longer be prescribing benzodiazepines for fear of flying?

Benzodiazepines are licensed for the treatment of anxiety.  However, they are not licensed for the treatment of phobias.  Fear of flying is usually classified as a phobia, therefore the prescribing of benzodiazepines for this purpose is controversial.  In addition, as of April 2019 under the terms of the clinical negligence scheme NHS GPs are not legally covered to prescribe for medications taken outside the UK especially if they have not had aviation medicine training (this would not necessarily apply to GPs prescribing in the private sector).

For you as a patient, there are some important risks associated with prescribing these medications for flights:

• Reduced responsiveness in an emergency.  As these medications have a sedative effect, in the event of a plane emergency you might not be able to respond appropriately to safety/evacuation instructions.
• Increased risk of clots. Benzodiazepines can make you fall into an unnatural (non-REM) sleep.  This means you won’t be moving around as much during sleep.  Reduced movement during flights (particularly long flights) is a known risk factor for developing Deep Vein Thrombosis – a potentially fatal condition.
• Increased aggression. For a minority of patients, benzodiazepines can actually result in increased aggression and behaving in a way you would not normally.  If this occurs on a flight it might put you or other passengers at risk.
• Risk of jail abroad. In some countries these medications are illegal.  If you are found in possession of these medications in countries where it is illegal then you might risk jail, expulsion, or disruption to your travel plans.
• Risk of low oxygen levels in the body.  Oxygen levels in the body are lower at high altitude even for healthy people (e.g. at the cruising altitude for international flights).  Benzodiazepines can reduce your respiratory drive thereby lowering your oxygen levels further.  For some people this combined effect could be very dangerous.
• Risk of addiction. These medications are known to be addictive when used inappropriately.

I have a fear of flying and feel that I need something to help me cope with a future flight. What help is available?

We recognise that our updated approach might be a source of frustration or distress for some patients.  Although we will not be routinely prescribing benzodiazepines for your flight you do have a few options if you feel you need further support:

• You can try to obtain a prescription from a private GP or doctor.  You would be doing this at your own risk, and we would not recommend this approach for the reasons outlined above. But it does remain an option for you if you feel it is the only thing that will work for you.
• You can attend a fear of flying course.  

We have provided some links to these below:

• Easyjet
• British Airways
• Flying Without Fear
• Fear of Flying

If you have further concerns then you may get in touch to discuss this with a clinician.