If you are a healthcare provider treating medical travelers, your goal is to provide patients with the most accurate and timely information possible to ensure a safe and successful treatment outcome and a positive patient experience. Invariably, this will include sending physician profiles, information about treatment options, risks and benefits of the procedure or treatment, a treatment plan, patient financial obligations, and travel and destination information. One important subject that may not be getting the attention it deserves is the topic of medication management in medical travel.
Medications form an important part of patient care around the world. For traveling patients, the medication management issues are both significant and potentially complex. In the next few paragraphs we will take a look at some of these issues and offer recommendations designed to keep medical travelers safe and reduce the potential for a negative patient experience.
Prior to departure to the destination
Prior to the patient traveling for medical care, it is important that the destination healthcare provider gather an accurate list of the patient’s current medications including the names (generic and chemical), dose and frequency to reconcile with the patient’s plan of care. This will help to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions, [1] and it is especially critical when dealing with traveling patients as medication names and dosages may be different depending on the country. [2] Patients should also be given guidance on the number of doses to bring, with an understanding that there may be travel delays and potential delays in treatment and recuperation.[3] Additionally, patients should be informed if certain medications may need to be suspended prior to surgery. This is often the case with blood thinners such as heparin, warfarin or even aspirin.
Restrictions on bringing medications into the destination country
Every country has their own particular regulations regarding which medications (especially controlled substances) can be brought into the country and what, if any, restrictions they may have (a controlled substance is generally a drug or chemical whose manufacture, possession or use is regulated by a government and whose general availability is restricted [4]). A medication that is considered over the counter in the patient’s country of residence could require a prescription in another country or may even be considered a controlled substance. In an extreme case that happened in October of 2017, a British woman was arrested in Egypt and sentenced to 3 years in prison for bringing pain killers (Tramadol) into the country for her husband who suffers from back pain.[5] While Tramadol is widely prescribed in Britain, Egypt, as well as many other countries, has strict rules on any drugs containing opioid analgesics, such as Tramadol and codeine. [6] Even passengers passing in transit through a country that prohibits certain medications or controlled substances could face legal problems or even jail time if the continuing flight is delayed or cancelled and the patient is forced to enter the country.[7]
The International Narcotics Control Board (INCB), an independent monitoring body for the implementation of the United Nations international drug control conventions, provides the following general guidelines for travelers:[8]
- A medical prescription from a licensed doctor is required by most countries.
- The prescription should be translated into the local language. For some countries, a translation in English will suffice.
- Many countries do not permit carrying more than a 30 to 90 day supply of a prescription.
- Requirements for foreigners might differ from requirements for citizens of that country.
- Different requirements might be in place depending on where you are travelling from.
- Countries are permitted to control other substances not under international control; meaning that non-internationally controlled substances not controlled in one country maybe be controlled in another.
Healthcare providers should be aware of the regulations and medication restrictions in their own country and provide patients with guidance or links to embassies or authoritative sources such as the International Narcotics Control Board to ensure traveling patients do not have any problems entering the country.
Transporting medications
Additionally, it is recommended that healthcare providers advise traveling patients to transport medications in carry-on luggage to ensure they are easily accessible and do not get lost, and to make sure the medications are in their original, labeled containers along with documentation of the prescription.
Prior to departure to the home country
A number of similar precautions need to be taken by the destination healthcare provider before the patient returns to his or her own country.
Managing the care continuum
At the time of discharge, the patient should be provided with a list of all the medications they are to continue to take, and should be advised as to the medications and doses to take during the trip home and over the coming days, weeks or months. [9] Additionally, the patient's medical record should list all the medications the patient is taking, and those medications added, deleted or changed as the result of the care provided by the destination healthcare provider. [10]
Restrictions on taking newly prescribed medications back to the home country
Since patients will likely be prescribed medications during the discharge process, the healthcare provider should corroborate if the prescribed medications can pass through customs in the patient’s home country and in what amounts. A good resource to use is the Country Regulations for Travellers Carrying Medicines Containing Controlled Substances provided by the International Narcotics Control Board. However, even INCB recommends checking with the relevant embassies or other competent government authorities to ensure access to the latest information. If a controlled substance is being prescribed, it is advisable for the physician to either give the patient a duplicate of the prescription, or issue a letter indicating that a preparation containing internationally controlled drugs was prescribed for the traveler and specifying the amount prescribed and the duration of treatment.[11]
Are the prescribed medications available or easily accessible?
A medication that is commonly prescribed in one country may not be available or easily accessible in another. Healthcare providers should check with the patient or the patient’s primary care physician (if possible) to verify availability. It is also possible that the medication is available but very expensive or scarce. If so, every effort should be made to offer suitable alternative medications.
Taking action
As we have seen, managing patient medications across the medical travel care continuum is a complex process that must be carefully managed to avoid potential patient safety issues and a negative patient experience. Accurate patient information must be gathered, patients must be educated and engaged, and international regulations for different countries must be monitored. It is recommended that healthcare providers caring for medical travelers review current policies and procedures related to medication management to ensure they align with the realities of the medical travel care continuum and specific traveling patient populations. For example, forms may need to be updated to ensure they capture appropriate clinical and travel information. Training and education may also be required to ensure physicians and designated staff gain a deeper understanding and appreciation of the medication management challenges faced every day by medical travelers and the opportunity on how to better address those challenges.
[1] Weant, K., Bailey, A., Baker, S., Strategies for reducing medication errors in the emergency department. 2014. Retrieved at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753984/ on 5/28/18
[2] Travellers: Many medications have different names in foreign countries. Retrieved at https://www.safemedicationuse.ca/newsletter/downloads/201408NewsletterV5N5-Travelling.pdf on 5/28/18
[3] Global Healthcare Accreditation Standards Manual 4.1
[4] National Alliance for Model State Drug Laws. Retrieved from http://www.namsdl.org/controlled-substances-and-prescription-drugs.cfm on 5/27/18
[5] The Medicines That Could Get You Jailed on Foreign Holidays – And the Countries Where Tourists Should Take Extra Care. https://www.independent.co.uk/travel/news-and-advice/drugs-medicine-egypt-laura-plummer-tramadol-painkillers-illegal-uae-dubai-abu-dhabi-which-countries-a8038286.html
[6] Ibid.
[7] Fordham, J. Dubai: Warning to Travellers over Prescription Medicine. Retrieved from https://www.telegraph.co.uk/travel/travelnews/7801410/Dubai-warning-to-travellers-over-prescription-medicine.html on 5/29/18
[8] General Information for Travellers Carrying Medicines Containing Controlled Substances. Retrieved from https://www.incb.org/incb/en/travellers/general-information.html on 5/29/18
[9] Global Healthcare Accreditation Standards Manual 4.1
[10] Ibid.
[11] United Nations. Guidelines for National Regulations Concerning Travellers Under Treatment with Internationally Controlled Drugs 2003.
*Medical travel is also commonly known as medical tourism or health tourism.
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