Blog #19 Update on the Thorny Issue of Traveling with Medications: It Will Remain Thorny

meds

I recently had a request from an organization to supply actual prescriptions to all their travelers for each over-the-counter medication they wanted to bring on their trip. Individual travelers had looked at multiple websites, and understandably, became quite confused and concerned regarding the potential risks to travelers bringing unauthorized medications into various countries. The organization reached the conclusion that the most effective way to protect their travelers would be to get an “official prescription” for all drugs- both prescriptive and OTC.

Of course, that would not be an appropriate solution since:

  • in most cases it isn’t necessary
  • it would create liability concerns for the provider
  • the majority of travel clinics do not have the resources to do this for large numbers of travelers

Yet, it is clear that traveling with medication is a difficult problem for travelers and clinicians to manage.

It is extremely unlikely we will ever have a single, reliable, comprehensive and current resource that provides specifics regarding if, or how, one can bring individual drugs across international borders.   Rules and regulations vary from country to country and often these are not consistently enforced.  Available information is often incomplete or conflicting.  Of note is that narcotics and psychotropic drugs are under the purview of international law. The former includes primarily opioid analgesics while the latter consists of medications used to treat anxiety, depression or psychotic conditions.  Check the International Narcotics Control Board website for general guidelines and their list of additional information by country.  Additional, commonly regulated drugs also include medications for seizure disorders or Parkinson’s disease, HIV drugs, medications for ADHD, or even over-the-counter treatments such as decongestants and sedating antihistamines. Travelers and clinicians need to take country rules regarding medications very seriously as violations can result in severe penalties, including detention and arrest. The United Arab Emirates and Japan are two countries known to strictly enforce their guidelines.

A complex issue such as this really underscores the need for the Pre-Travel Consultation with an informed professional to help patients take the appropriate steps to travel safely with their medications.  Unfortunately, the situation is unlikely to improve any time soon. Below are some useful tips:

  • Strongly encourage travelers to prepare 4-6 weeks in advance of their trip as it may take time to complete any appropriate forms to carry medications across borders.
  • Advise travelers to check the embassy or consulate sites of the destination country to determine what medication restrictions apply, although this can be a frustrating and confusing process for patients. These rules usually only apply to prescription drugs but some over-the-counter drugs may be restricted as well.
  • Contacting the US embassy at a destination may also provide further guidance.
  • Be sure and check the CDC and US Department of State websites for updates.
  • For prescriptive medications or any drugs for which there are restrictions, get a letter from the prescribing clinician on letterhead stationary, appropriately signed and dated, stating “medical necessity.” Attach a copy of the original prescription.
  • Keep medications in their original, labeled packaging. (If you wish, you can transfer them to pill boxes after you arrive at your destination.)
  • As a general rule, travelers should carry only enough medication for their own use for the length of the trip. Extra supplies are likely to lead to delay or detention upon arrival.  However, travelers with certain health conditions (such as diabetes) or those with longer stays or the possibility of trip extensions may need to carry a 1-2 week extra supply. Carrying more than a 30 day supply may require additional permission.
  • If a traveler is using injectable medications, such as insulin or heparin, then they should obtain and carry at all times a provider-signed letter explaining the need to carry needles and syringes. Carry only the necessary number of syringes for the trip.
  • For additional information regarding narcotics, the United Nations Office on Drugs and Crime (UNODC) has published the Guidelines for National Regulations Concerning Travellers Under Treatment with Internationally Controlled Drugs.
  • If you are a member of The International Society of Travel Medicine , the pharmacy group has some additional information: the ISTM Pharmacist Professional Group Database on International Regulations.
  • The International Association for Medical Assistance to Travelers (IAMAT) has a very nice patient handout written by Dr. Larry Goodyer, on the subject that you can find here.

Julie Richards, President

American Travel Health Nurses Association