Introduction
At The Orchard Partnership, we are committed to patient safety and following the latest national medical guidelines. After a clinical review of current safety advice and legislation, we have implemented a policy that we no longer prescribe sedatives (such as Diazepam/Valium) for fear of flying.
We understand that fear of flying is a genuine and often distressing phobia, and we wish to support our patients in managing it effectively and safely. This policy outlines the medical, legal, and safety reasons for this decision and provides information on safer alternatives, including local therapy services in Wiltshire.
Why we no longer prescribe Diazepam for flying
Our clinical team has made this decision based on the following safety and legal concerns:
1. Reduced Safety During Emergencies The Civil Aviation Authority (CAA) requires all passengers to be alert and capable of following instructions in the event of an emergency. Sedatives can significantly delay reaction times, impair coordination, and reduce awareness. If an evacuation is required, a sedated passenger may be unable to react quickly enough to save their own life or may put others at risk.
2. Increased Risk of Deep Vein Thrombosis (DVT) Sedatives induce an unnatural, non-REM sleep which results in less movement than natural sleep. This immobility, combined with the seated position on an aircraft, significantly increases the risk of developing a Deep Vein Thrombosis (DVT)—a blood clot in the leg—and potentially a Pulmonary Embolism (blood clot in the lung). This risk is present on all flights but is particularly high on flights over four hours.
3. Adverse Effects on Breathing In the pressurised cabin of an aircraft, oxygen saturation levels naturally drop. Sedatives like Diazepam can depress breathing (respiratory depression). For patients with underlying respiratory conditions, or even those without, the combination of lower oxygen and sedation can be medically dangerous.
4. Paradoxical Effects While sedatives are intended to calm patients, they can occasionally have a “paradoxical” effect, causing increased agitation, aggression, or confusion. This disinhibition can lead to behaviour that endangers the flight and can result in passengers being removed from the aircraft or facing legal action.
5. National Clinical Guidelines The British National Formulary (BNF), which provides the prescribing guidelines for all UK doctors, states that benzodiazepines are contraindicated (not allowed) for the treatment of phobias. Furthermore, NICE (National Institute for Health and Care Excellence) guidelines do not recommend medication for mild or self-limiting anxiety. Prescribing Diazepam for this purpose would force our clinicians to act against national safety guidelines and assume significant medico-legal risk.
6. Legal Risks and Travel Restrictions
Diazepam is a controlled drug (Class C) in the UK. Laws regarding these medications vary strictly across the globe. In some countries (for example, the UAE, Japan, and Singapore), arriving with benzodiazepines in your system or luggage without strict prior approval can result in confiscation, heavy fines, or imprisonment.
Alternatives: How to manage fear of flying
We strongly recommend tackling the root cause of the phobia rather than masking the symptoms. Below are local and national resources to help you manage your anxiety.
Local Therapy & Support (Wiltshire & Salisbury)
Fear of flying is a specific phobia that responds very well to Cognitive Behavioural Therapy (CBT). You do not need to see a GP to access these services; you can refer yourself directly.
- NHS Wiltshire Talking Therapies This free NHS service offers support for anxiety and phobias. They can provide CBT and other evidence-based therapies.
- Phone: 01380 731335
- Website: awp.nhs.uk/talkingtherapies (Select ‘Wiltshire’ to self-refer online).
- Note: They have bases across the county, including Fountain Way in Salisbury.
- Wiltshire Mind A local mental health charity that offers counselling services for those looking for support outside of the NHS.
- Website: wiltshiremind.co.uk
Dedicated Fear of Flying Courses
Most major airlines offer dedicated courses that combine technical reassurance from pilots with psychological techniques. These have a very high success rate.
- Virgin Atlantic Flying Without Fear: flywith.virginatlantic.com/bb/en/wellbeing-and-health/flying-without-fear.html
- EasyJet Fearless Flyer: fearlessflyer.easyjet.com
- British Airways Flying with Confidence: flyingwithconfidence.com
Summary
We appreciate that this policy change may be frustrating for patients who have been prescribed these medications in the past. However, medical knowledge evolves, and our priority must always be patient safety and adherence to national regulations.
The Orchard Partnership Clinical Team