Non-Prescription of Diazepam for Air Travel Anxiety and Diagnostic Investigations

Policy Title:
Non-Prescription of Diazepam for the Purpose of Air Travel (Fear of Flying) and Diagnostic Investigations (e.g., MRI scans)

Effective Date: 1^st July 2025
Next Review Due: 1^st July 2027

Purpose

This policy outlines Forest House Surgery’s position regarding the prescribing of diazepam (or other benzodiazepines) for the management of flight anxiety and for sedation purposes during diagnostic investigations such as MRI scans. It supports safe, evidence-based, and legally compliant prescribing practices.

Policy Statement

Forest House Surgery has decided it will no longer prescribe diazepam or similar sedative medications for the following purposes:

• Fear of flying or air travel anxiety
• Sedation for diagnostic investigations (e.g., MRI scans)

Scope

This policy applies to all patients registered with Forest House Surgery and all healthcare professionals working within the practice.

Rationale for the Policy

1. Guidelines and Licensing Restrictions
   The British National Formulary (BNF) advises that benzodiazepines should not be used to treat short-term or mild anxiety. Diazepam is only licensed for short-term use in cases of severe or disabling anxiety or insomnia.
• Fear of flying is not classified as a generalised anxiety disorder (GAD) and does not meet the criteria for prescribing under these guidelines.
• Sedation for diagnostic procedures is a specialized clinical intervention, usually managed by hospital or specialist services.
• Prescribing diazepam for these indications would be off-label and outside of accepted clinical practice, placing both the doctor and patient at risk.
2. NHS Prescribing Rules
   NHS regulations state that medications should not be prescribed solely for use outside of the UK, unless the patient is undergoing active treatment at the time. Prescribing diazepam in anticipation of a future anxiety episode during a flight is not supported under NHS General Medical Services (GMS) contracts.
   Similarly, sedation for diagnostic investigations should be managed by the relevant diagnostic or specialist teams.
3. Not Covered Under GP Contract
   Management of flight anxiety and sedation for diagnostic investigations is not considered part of the core General Medical Services provided under the NHS GP contract and therefore does not fall within the routine responsibilities of NHS GPs.
4. Safety Concerns
   Diazepam is a central nervous system depressant. It can impair judgment, coordination, and alertness, posing safety risks:
• It may compromise the ability to respond in emergencies.
• It may affect the care of dependents (e.g., children) during travel or after sedation.
• The sedative effects can be unpredictable, especially in combination with other medications or medical conditions.
5. Legal and International Travel Restrictions
• Diazepam is a Class C/Schedule IV controlled drug in the UK.
• Several countries restrict or prohibit the importation of benzodiazepines, and carrying them without appropriate documentation can lead to legal complications abroad.
  For detailed travel advice, see: NaTHNaC – Medicines and Travel

Alternative Options

Patients experiencing flight anxiety are encouraged to explore non-pharmacological approaches such as:

• Psychological therapies (e.g., CBT)
• Fear of flying courses or support programs:
• EasyJet Fearless Flyer
• British Airways Flying with Confidence
• Flying Without Fear
• Patient.info – Fear of Flying

Sedation for diagnostic investigations should be arranged through the relevant hospital or specialist services.

Patients who wish to pursue the option of diazepam for these indications may seek private medical advice, but this will not be provided via the NHS or Forest House Surgery.

Review and Monitoring

This policy will be reviewed 2 yearly or sooner if national guidelines or NHS contractual obligations change.

Approved by: Dr. Rao
Date: 1^st July 2025