The Alresford Surgery Prescribing Agreement: Sedatives For Travel and Medical Investigations

In an effort to provide a safe, consistent, and appropriate care for our patients the prescribing clinicians at this practice have made the decision we will NOT prescribe sedative medication to patients for the purpose of attending medical investigations/appointments or for travel.

Careful consideration has been given to this approach and evidence pulled from a variety of resources. Some of the reasons have been given with explanation below.

Medical investigation:
• Small doses of benzodiazepines such at 2mg diazepam are probably sub-therapeutic for most adults for any effective sedation.
• Anxiolytics can have an idiosyncratic response in patients, and even very small doses can cause increased agitation in some subsets of patients.
• Timing of the medication can be suboptimal. A patient may take a sedative ‘an hour’ before their assumed procedure but suffer an unexpected delay.
• GPs are not regularly involved, skilled, trained, or appraised in sedation skills.
• Clinicians requesting imaging, and those providing it, have access to the same prescribing abilities as GPs. If a certain medication is required for a procedure, they will prescribe it.
• Sedated patients should be monitored. There are reports where a GP prescribed a sedative, the patient was not monitored, the patient had a respiratory arrest in an MRI machine.

Many of the centres that offer imaging will also offer the opportunity for patients to attend the service on a date ahead of a scheduled appointment. Patients can visit the site, see the equipment and become familiar with the requirements to have the imaging. You would need to contact the service directly or the clinician that made that referral for imaging to arrange this.

Flying/Travel:
• If there were an in-flight emergency, a sedative may impair your ability to concentrate, follow instructions and react to the situation. This could have serious safety consequences.
• Sleep through sedative drugs is an unnatural non-REM sleep and you won’t move around as much as during natural sleep. This can increase your risk of a blood clot (DVT) in the leg or lung. Blood clots are dangerous and can prove fatal. This risk is greater on flights >4 hours.
• A small number of patients have paradoxical agitation and increased aggression through sedative medications. You may behave in a way that you would not normally. This could impact on your safety and other passengers and could get you into trouble with the law.
• According to the prescribing guidelines doctors follow (BNF) Benzodiazepines are contraindicated (not allowed) in treating phobia. Your doctor would be taking a significant legal risk by prescribing against these guidelines. They are only licensed short term for a crisis in generalised anxiety. If this is the case, you should be getting proper care and support for your mental health and not going on a flight or for medical investigations.
• Diazepam and similar drugs are illegal in a number of countries. They 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.

The fear of flying is very real and very frightening. A much better approach is to tackle this properly with a Fear of Flying course run by the airlines. Such as:

Easy Jet: http://www.fearlessflyer.easyjet.com
British Airways: https://flyingwithconfidence.com/
Virgin: https://www.flyingwithoutfear.co.uk/fear-of-flying-courses/adult-course/