Advice for patients and GP's for requests to prescribe sedatives prior to dental procedures, anxiety from flying and claustrophobia before an MRI
Going forward, the surgery have taken the decision no longer to prescribe sedative medication for fear of flying , claustrophobia / refusal to have MRI scans and Dentistry due to new prescribing guidance and safety concerns. This policy decision has been made by the GP Partners and is adhered to by all prescribers working in the practice. The reasons for this can be found below:
Flight anxiety and prescribing of medications for flying
Diazepam is a sedative, which means it makes you sleepy and more relaxed. If there is an emergency during the flight it may impair your ability to concentrate, follow instructions and react to the situation. This could have serious safety consequences for you and those around you.
Sedative drugs can make you fall asleep, however when you do sleep it is an unnatural non-REM sleep. This means you will not move around as much as during natural sleep. This can cause you to be at increased risk of developing a blood clot (DVT) in the leg or even the lung. Blood clots are very dangerous and can even prove fatal. This risk is even greater if your flight is greater than four hours.
Whilst most people find Benzodiazepines like Diazepam sedating, a small number suffer paradoxical agitation and aggression. They can also cause disinhibition and lead you to behave in a way that you would not normally. This could impact on your safety as well as that of other passengers and could also get you into trouble with the law.
According to the prescribing guidelines doctors follow (BNF), Benzodiazepines are contraindicated (not allowed) in phobia. Our prescribers 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.
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.
Given the above, we will no longer be prescribing Benzodiazepines for flight anxiety or Zopiclone for flight insomnia.
We appreciate that 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 and we have listed a number of these below.
Easy Jet – www.fearlessflyer.easyjet.com
British Airways – www.flyingwithconfidence.com
Virgin – www.flyingwithoutfear.co.uk
Research shows that Cognitive Behaviour Therapy (CBT) can be helpful for more severe cases. The person identifies what they actually fear and then learns different ways of overcoming it.
Patients who still wish to take Benzodiazepines for flight anxiety are advised to consult with a private GP or travel clinic.
Prescribing sedatives prior to dental procedures
GPs will not issue prescriptions for sedating medications ( sucha as Diazepam) prior to dental procedures.
Dentists should not direct patients to GPs requesting that they prescribe sedating medications.
If a dentist wishes to prescribe sedating medications for anxious patients, that dentist should be responsible for issuing the prescription. The Dental practitioner's formulary, which is a list of drugs a dentist can prescribe can be found on this link Dental Practitioners’ Formulary | BNF | NICE and it includes Diazepam tablets and oral solution.
If the dentist is treating a patient within their practice NHS contract, then the prescription should be on a FP14D form.
If the dentist is treating a patient privately they should issue a private prescription.
Dentists may contact a GP for information or advice, if, for example the patient has a complex medical history.
Claustrophiobia and refusal to have MRI scans
GPs will not issue prescriptions for sedating medications (such as diazepam) prior to MRI scans.
It’s estimated that every year, approximately two million MRI scans worldwide are not performed because of patients refusing to be scanned or terminating the scan early due to claustrophobia.
There are many resources online that can help prepare patients on what to expect during a scan including step by step explanations and videos of MRIs being performed. In more severe cases, the NHS website suggests that mild sedatives are an option for people with severe MRI anxiety. However, the MDU would recommend members to carefully consider the 2018 Royal College of Radiologists’ guidance, Sedation, analgesia and anesthesia in the radiology department, which states that a ‘trained and credentialed team should administer sedation and analgesia.’
There is also an emphasis on thorough pre-procedure assessment, planning and monitoring.
This means that the GP is not the right person to prescribe these medications. If they are needed, then this needs to be discussed with the radiology team.