Holiday Traveller

Do you take one or more medications regularly? Do you rely on a powered medical device for a heart, lung, or other medical condition?
What if you want to take them overseas? How likely is it that you’d be stopped and your medication or device confiscated? What if you were refused entry – or worse, detained on suspicion of attempting to import drugs that – at least in that country – are banned?
These scenarios are not as rare or far-fetched as you might think, particularly in non-English speaking countries that take a hard line on drug smuggling, according to the authors of a new study.
For most travellers who take a well-recognised, prescribed drug/s for a common condition, it’s enough to carry a signed letter from a GP or travel doctor on his or her letterhead explaining what medication has been prescribed and the condition it’s taken for. The letter should accompany the medication, which should be enough for the duration of the stay only and kept in its original packaging, rather than decanted into daily doses in a Webster pack-type container.
But, some travellers need to travel with restricted drugs, such as psychotropic medications to manage mental health conditions, narcotic drugs for management of chronic pain, or medications containing codeine, which is an ingredient in a number of over-the-counter medications for pain relief, and anabolic steroids. In some countries these may be banned. (For instance, drugs containing codeine are banned in the United Arab Emirates.)


Sources of information in Australia

So, how do you find out whether it’s okay to bring the medication you’re taking into a country you’re visiting? And, how much are you allowed to bring in? What will happen if you were to cross a land border into a neighbouring country, or if you planned an extended stay, living or working overseas?
Doctors experienced in travel medicine are likely to have more knowledge in this area, particularly for the more popular destinations. Understandably, GPs, who generally prepare far fewer travellers, may not be able to provide any country-specific information.
In Australia, three Federal government bodies – the Australian Department of Foreign Affairs through its Smartraveller website, the Therapeutic Goods Administration, and the Pharmaceutical Benefits Scheme (PBS) – provide some useful information for travellers regarding taking medication and devices abroad. The PBS also has a phone service (1800 599 147).
However, there is little in the way of restrictions or requirements that individual countries might impose. Each recommends that travellers contact the local embassy or consulate of the country they’re visiting.
And, therein lies the problem, according to research which examined just how easy – or not, as it turned out – it is to get clear, accurate information on travelling from Australia with medications and medical equipment. Published in 2014 in the Travel Medicine and Infectious Disease journal, the study was compiled by a team of researchers headed by Dr Moses Mutie, of the Faculty of Health at the University of Canberra.

Study reveals poor-quality advice

More often than not, travellers are likely to be sorely disappointed with the quality of the advice embassies or consulates provide.
The researchers targeted 25 countries popular with Australian tourists, including destinations in Africa, the Americas, Europe, Southeast Asia and the Western Pacific, trawling the websites of the countries’ Australian embassies and consulates for a list of medications travellers could carry and quantities allowed, as well as what might be banned.
The team also sought to find what documentation was required, obtain customs information, and any conditions or restrictions on travelling with medical equipment.
As well as searching online, they asked the same questions in a standardised email sent to the embassies and consulates.
The response was underwhelming: 2 weeks later, only 11 embassies had responded. Two forwarded the questions to their country’s national Pharmacy Board, which resulted in no further response.

Arbitrary bans on drugs

Of the 8 that did respond, their recommendations varied widely, and tended to be much stricter than those laid down by the International Narcotics Control Board (INCB). An independent body, the Board implements the United Nations’ drug control conventions and issues international guidelines for countries concerning travellers taking controlled drugs abroad.
The INCB recommends individual travellers carry a copy of their prescription/s, but there are no other certifications or requirements for less than 20 doses of any medication, or less than a 30-day supply of scheduled drugs, such as the narcotic Oxycodone or psychotropic medications, such as Diazepam and Temazepam.
Many of the responding embassies said all drugs required special certification of ownership and personal use beyond a valid prescription (i.e. a doctor’s letter). 
However, in some countries, a prescription for more medication would not be recognised: Instead the traveller would need to consult a local doctor to validate the ongoing need for medication prescribed by their doctor at home.

Officials, websites less than helpful

Some embassies and consulates warned that if Customs officers were in any doubt over medication, entry may be denied or the drugs confiscated.
“For travellers this is a real problem and the scale of it is not really appreciated,” Dr Mutie said in a telephone interview.
“Embassy staff we spoke to were either not aware of the requirements for bringing medication into their country, or the information they had to offer was very unclear. They really had no way of addressing these kinds of enquiries.”
The embassies’ and consulates’ websites were even less helpful.
“Most sites were very hard to navigate and the information (regarding medication) is either not there, or very scant and hard to reach,” Dr Mutie added.
“Finding out anything was very time-consuming. People who may not be confident using the internet would really struggle.”

Key message: Start process early

A key message from the study was: Don’t leave it until the last minute to get information.
Finding out anything is likely to be difficult and could take weeks. 
To avoid a nasty surprise on arrival begin the process early by:
- Visiting the PBS and Smartraveller websites, and calling the PBS phone information service.
- Asking your doctor or pharmacist if he/she knows if travelling to your intended destination with your particular medication/s could be a problem and if special documentation might be required.
- If they don’t know or can’t find out, can they refer you to someone who can, such as a colleague who regularly prepares travellers.
- Check the International Narcotic Control Board lists of psychotic and narcotic medications.
- Visit online travel forums and check publications like The Lonely Planet.

Check with airline on devices

The researchers drew a blank with the embassies and consulates in regard to travelling with a medical device, such as oxygen bottles, neurostimulators, and defibrillators. None responded to the team’s request for details on taking them into their country.
But, it’s your airline rather than the destination country which is more likely to have an issue with your device. 
Fortunately, airlines usually have clear guidelines on flying with a medical device and using them during a flight, although accessing the information on their website or by phone often proved difficult. Passengers should carry documentation on the device, including the operating manual, in their carry-on luggage.
However, the researchers warned: “Even when cleared, aircraft power is not guaranteed and passengers on life support equipment are required to provide their own suitable back-up battery power supply for use in the flight”.
Again, Dr Mutie recommended beginning the process well before departure.

Centralised resource and certificate needed

Dr Mutie said the study found a glaring need for the medical, pharmaceutical and regulatory sectors from each country to collaborate in producing clear guidelines for travellers, clarifying their respective entry requirements for carrying medication or devices for the information of both travellers and the medical professionals preparing them for travel.
“Departments of Health, Pharmacy Boards, Customs… there are people and resources in every country able to draw together that information so people planning to visit can get the information they need in one place well ahead of their trip,” Dr Mutie said.
“Ultimately, I think at least part of the answer is an official, internationally recognised certificate – just like the one for Yellow fever, which is a mandatory requirement for some destinations in Africa and South America.
“An official certificate that is stamped and signed by an authorised medical professional or pharmacist should be enough to allow a traveller to carry legitimate prescription medication or a device they might need into a country.”
He hopes the study might help to convince the World Health Organisation and other national and international bodies to support the idea of a centralised source of information and, ultimately, an internationally recognised certification system for carrying medication and medical devices into foreign countries.

Laurie Sullivan