Medicines and travel

Carrying medication abroad and advice regarding falsified medication

Image provided by NHS Photo Library

Key messages

• Travellers who take regular medication should allow time to prepare for their trip well in advance of travel. A medical check-up is recommended to discuss fitness to travel, ensure medication is optimised and sufficient supplies are available.

• Travellers should take medication in its original pharmacy packaging, along with a copy of their prescription and letter from the prescriber. Medication should be carried in hand luggage, with some extra in the hold luggage.

• Some countries may not allow the entry of certain types of medicines, and others may have regulations requiring specific permission for a medication to be brought in. These rules can also apply to medicines available over the counter in the UK.

• Certain medicines are ‘controlled’ in the UK and travellers are required to obtain an export licence prior to transporting a certain quantity (usually three months or more supply) of these drugs out of or into the country. A letter from the prescriber detailing the medicines is advised for travelling with smaller supplies.

• Travellers should be aware that the legal status of their medication may be different outside the UK. Rules for the different countries can be checked with the foreign embassy in the UK but can be difficult to obtain for some countries; other useful resources are provided below.

• Falsified (fake) drugs are more common in certain regions and can be a significant health risk. The internet also provides opportunity for the sale of products (sometimes harmful to health) with false claims on ‘miracle cures’ for various illnesses.

Overview

Travellers who need to carry medication should be aware that a medication’s legal status in other countries may be different from in the UK. Legal requirements for carrying personal medicines across international borders are highly variable and often not consistently enforced. This applies to over-the-counter medication as well as prescription drugs. Some countries may not allow the entry of certain types of medicines, and others may have blanket regulations requiring specific permission. The regulations regarding whether a traveller needs to carry a doctor’s letter describing the medication also varies widely.

Before travel

Travellers who take regular medication should allow time to prepare for their trip well in advance of travel. A medical check-up is recommended to discuss fitness to travel, and ensure medication is optimised and sufficient supplies are available, including cover for possible travel delays or lost luggage.

The NHS accepts responsibility for supplying sufficient ongoing medication for temporary periods abroad of up to three months [1]. The prescriber is responsible for the prescriptions they sign and must be prepared to explain any decisions made when prescribing and monitoring medicines [2].

Travellers should check the regulations on importing or transporting medicines to their chosen destination by contacting the relevant embassy or high commission, or by checking the Foreign, Commonwealth & Development Office (FCDO) country advice. Information can be difficult to obtain for some countries and a resource from ISTM Pharmacist Professional Group may be helpful for travellers as a general guide, rather than a definitive statement of country requirements.

Travellers who are taking certain ‘controlled drugs’ may be required to obtain an export licence prior to transporting set quantities (usually three months’ or more supply) into or out of the UK. The application should be made at least 10 days prior to travel. Some examples of controlled drugs include: diamorphine, diazepam, codeine, fentanyl, methadone, morphine, pethidine, Ritalin and temazepam. Further information on the drugs requiring an export license, as well as application forms can be found on the GOV.UK website. Those carrying controlled drugs and other prescription drugs on shorter trips are advised by the Home Office to obtain and carry a letter from the GP or prescriber detailing the medicines.

Wherever possible, travellers should avoid the risk of purchasing falsified medication, by obtaining all the medication required prior to travel.

Travellers should also be advised to:

• Take out an appropriate level of travel health insurance that includes repatriation and specific cover for any pre-existing illnesses.
• Ensure that the amount of medication packed is adequate to last the whole trip as well as possible travel delays or lost luggage.
• Check the medication is permitted in the countries to be visited.
• Carry medicines in hand luggage, including those bought over the counter. Airline regulations should be checked, particularly for liquids as restrictions apply to the quantity that can be carried in hand luggage. See GOV.UK for further information regarding hand luggage restrictions.
• Medication should be correctly labelled and in its original pharmacy packaging.
• Contact the airline in advance to make appropriate arrangements if needing to fly with oxygen, insulin or other injectable medicines.
• Consider packing some extra medication in the hold luggage in case hand luggage is lost or stolen.
• Check storage requirements for medication in advance. Arrangements for control of temperature during transit with certain medications may be needed.
• Obtain a copy of all prescriptions to carry during travel.
• Request a letter/note from the prescriber detailing the medicines with the generic names for the medications; this can be helpful during border control checks, and in case it is necessary to replace medicines or medical help is required.
• Obtain a note from the prescriber on letterhead stationery for controlled substances and injection medications (see also text in main paragraph above).
• Be aware that some medications/products may not be allowed in to some countries. Check the status of the medication or product with the Consulate or Embassy of the country to be visited before travel.

During travel

Travellers should carry a copy of their prescription together with a covering letter from their doctor. If supplies are needed whilst abroad, a pharmacy or health care provider should be consulted for advice. Travellers should be aware that whilst the name and appearance of medication prescribed in the UK may look the same or similar in other countries, the amount and type of active ingredients may differ.

Medications for recognised health conditions may come under intense scrutiny by foreign officials at border controls. This can result in delays, disruption or medicines being confiscated if the correct paperwork and permissions have not been arranged (e.g. where there are specific regulations and/requirements relating to taking a medication abroad such as for medications containing controlled drugs). On rare occasions, travellers who have been found to have drugs that are illegal at the destination or transit country have been imprisoned [3].

The International Association for Medical Assistance to Travellers and the International Society of Travel Medicine global clinic directory can provide contact details of medical practitioners overseas.

Substandard or falsified medical products

Worldwide estimates of falsified drugs range from one percent of sales in industrialised countries to over 30 percent in parts of Africa, Asia and Latin America [4].

Travellers should be aware of the risks of falsified medical products. This term is used to describe deliberate misrepresentation of a drug or medical product (and encompasses the terms 'substandard' or 'counterfeit') [5].

Falsified medications may be produced by unauthorised manufacturers and presented as authorised products. Very often, both packaging and medication appear virtually identical to the authentic medication. Falsified medications may contain inactive substances or toxic ingredients, resulting in treatment failure and/or serious harm.

According to the World Health Organization, falsified medicines are rarely effective [5]. Use of these medicines can prolong treatment time, which may worsen the condition being treated. Falsified malaria prevention drugs are recognised as a contributing factor in malaria treatment failures and drug resistance [6, 7]. Treatment with falsified antibiotics can also lead to the emergence of drug resistance [8, 9], and in extreme cases, may even cause serious harm or death [10].

Other products may be sold online with false claims for effectiveness against a range of different conditions / illness; for example a product containing sodium chlorite called "Miracle Mineral Solution" or MMS, sold over the Internet as a treatment / cure for a number of diseases, including malaria, cancer and autism. The Food Standards Agency state the product can cause severe nausea, vomiting and diarrhoea, potentially leading to dehydration and reduced blood pressure. If the solution is diluted less than instructed, it could cause damage to the gut and red blood cells, potentially resulting in respiratory failure [11].

After travel

Travellers who have required additional supplies of medication or started new medication, prescribed whilst abroad, are advised to see their regular doctor on return.

Travellers who are unwell after travelling should seek advice from their GP or pharmacist.

Resources

• British Thoracic Society: Air Travel Recommendations Guidance Documents
• Civil Aviation Authority: Travelling with medicines, mobility and medical equipment
• Civil Aviation Authority: Using oxygen on your flight
• Diabetes UK: Travel and Diabetes
• European Medicines Agency: Falsified medicines
• GOV.UK: List of foreign embassies in the UK
• Home Office: Travelling with controlled drugs
• International Narcotics Control Board: Country regulations for travellers carrying medicines containing controlled substances
• ISTM Pharmacist Professional Group Database on International Regulations on Importation of Medicines for Personal Use (intended as a guide only - not a definitive statement on individual country requirements which may change between updates of this database)
• NaTHNaC infographic: Travelling with medicines