# How do you get your Meds ?



## kirstindally (Apr 21, 2006)

Hi guys, 
Another question!!

We are in the process of breaking our ties with land(we are leaving from New Zealand in search of our boat in the USA) and one of the many jobs we have is to source and stock our first aid kit for off shore sailing.
Where to find medical supplies once we get to the states ?
Is it hard to get medications for our trip , ie morphine sulphate, doxyclyclene etc in the states?
Not being residents how would we go about purchasing heavy duty drugs??
I have a marine medic certificate, so am able to purchase and carry all the goodies here in NZ with out problem.
Once we leave the states are there good places to go if a first aid kit needs to be restocked?
Also any tips on health care much appriciated!
Thanks again Kirstin


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## sailingdog (Mar 19, 2006)

Mail order via the internet is part of the solution. If you look in the most recent issue of Latts & Atts, it has an article on medical supplies.


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## Cruisingdad (Jul 21, 2006)

Well, I think you may be in for a little more trouble trying to stock narcotics in the states... especially morphine.

When we stocked up for offshore we took the "reccommended list" from our offshore first aid kit to our Primary Care Physician. Luckily, she was a sailor and knew the issues we would face. She scripted everything except the narcotics. Heaviest thing we got were 7.5 mg Vicodin (Codine & Tylenol). Her attitude was that if anyone was in that much pain, they could take 2 Vicodin to smooth out the pain and would probably pass out anyway. Pretty much agree with her, in my experience. I did work in an emergency room for a while and found that most people passed out (then went into shock, but that is another story). I have found that most of the other meds (Epi Pen, Phenylprop, etc) are a little easier to get a script for. However, we are US Citizens and have long relationships with our family physicians... and we alerted them ahead of time on what we were going to do and demonstrated our knowledge in their use. As far as the morphine, that requires a triplicate (I believe) and is pretty heavy guarded and oversought by the DEA. Not sure I can help you on that one. 

Anyway, to sum up, you can probably get most of what you want with the exception of the morphine... though you may be able to talk them into Vicodin (maybe) or Oxycont (if you are really believable). Take your credentials, look under physician under the yellow pages when you get here, and track down an Internal Medicine Physician (in my opinion). Call around and see if you can speak to their nurse and explain the situation. 

Just another thought too, assuming you are going back to NZ. Just get the minimum in the US, then go to Canada or Mexico to stock. It is my strong understanding that they are a lot more liberal with the meds and it is a WHOLE lot less expensive. If you have not bought drugs in the US, let me warn you, it is probably the most expensive in the world here. Since most of them are manufactured here and in Puerto Rico, I have never totally understood why... but, I think it is just the drug companies screwing over Americans.

Hope that helps. Good luck.

- CD


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## Zanshin (Aug 27, 2006)

Just remember to be aware when buying pharmaceuticals in Mexico and some SE countries that they may or may not contain the listed active ingredients and filler; this can be a crap shoot and many people have died or suffered harm when using under-the-counter drugs for critical medication. Even if it means paying a bit more in Mexico, go to a real pharmacy. I think the Phillipines or Malaysia recently had a serious issue with knockoffs of asthma inhalators which, while not resulting in deaths, almost did.


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## sailingdog (Mar 19, 2006)

Unfortunately, medication, both non-prescription and prescription drugs, have become a huge financial windfall for counterfeiting. Even going to a pharmacy is not guarantee of getting legitmate goods. Having a good reference, like the PDR, helps a lot with making sure that the goods you get are what you actually paid for. Most of the counterfeits are not all that accurate in terms of their physical details, since most people don't even know what the pills they're supposed to take are supposed to look like.


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## TSOJOURNER (Dec 16, 1999)

*US physician's perspective*

As a cruiser and a physician, I have several bits of advice:
First of all, keep in mind that anyone who walks into my office asking by name for a narcotic will immediately have any good doctor suspicious that you are trying to obtain narcotics for illicit purposes. So any documentation of evidence that you could provide to show that you are legitimate will help. Get a letter of introduction from your doctor in your home country describing your training and the medications you left New Zeland with. If they are past their expiration date, or nearly so...bring them in to show the US physician and be prepared to have the "old" meds taken and destroyed when a new prescription is given.

If there is any way to not show up as a total stranger to a US physician, figure out how. Ask around a yacht club to see if there are any physican members. A doctor who is a sailor himself may be more sympathetic to your needs, and if he has heard of you through mutual friends down at the dock, it will go a long way in proving that you are not just some drug addict.

Finally, keep in mind that there is a reason why morphine has such restrictive laws. Not only is it addicting, but when not used correctly, it can be lethal. If your crew stops breathing offshore due to the morphine you gave them, he or she will be in far worse shape than if they had to suffer terrible pain. So be honest about the skills and equipment you have and whether you are prepared to deal with the potential side effects. Any good physician will want to know also that you have these abilities before providing you with such meds.


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## Cruisingdad (Jul 21, 2006)

Haukebo,

Found your perspective interesting. I guess a lot of it mirrors the physician friend I have too.

So, what do you take offshore? WHat is in your bag Med bag? How do you feel about Morphine versus Vicodin or Oxy and what would you suggest? I have to restock again in the next several months and would love to hear some of your reccomendations, as well as would many other offshore sailors in this forum.

Thanks.

Brian


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## FrankLanger (Dec 27, 2005)

And similarly, for those of us who do coastal cruising, but could be several hours from shore, what would you recommend be in our medicine kit? Clearly we wouldn't have to have as much "stuff", nor be as concerned about problems that might take a while to develop yet need to be addressed offshore; but nevertheless a boom strike to the head or ribs, a bad cut, a heart attack, broken bones, etc. can all happen within a few hours of shore, yet can't be left unattended.
Any advice or guidance would be appreciated.
Frank.


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## TSOJOURNER (Dec 16, 1999)

*physician opinion 2*

As a general guide, only carry the meds you'll need until you can get proper medical attention. Consider your medical kit a means to take care of minor problems, and major problems only until you get to port. It's just too expensive to try to keep a full 10 day course of antibiotics, pain pills, or what not if you're never more than a day's sail from help. If you're heading across the pacific, your needs are much greater.

For pain I bring good old tylenol (also good for fever), aspirin (also important shoud someone have a heart attack), Tramadol, (pretty strong, but not a narcotic), and maybe 10 or so vicodin tablets. This for a month long cruise.

I also bring a variety of over the counter meds for colds, constipation, heartburn, allergies, and such.

I bring several different oral antibiotics for urine, skin, ear, respiratory infections. If I were not a physician, I'd probably only bring one broad spectrum antibiotic that would cover most things (Levofloxacin comes to mind) until I could get to a clinic somewhere and have the lab tests done to make a proper diagnosis.

The only injectable meds I brought on my last cruise was epinepherine for severe allergic reactions and Phenergan for severe nausea & vomiting. If making a major crossing, I'd add a few more things.

More important than a list of meds to go buy is the knowledge to use them properly. So first get the training and read the books that have been written for cruisers on offshore medicine, then decide what you need based upon your trip, the people on your boat, and your ability to use the medication correctly.


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## Cruisingdad (Jul 21, 2006)

Haukebo (I appreciate your thoughts here),

Why the injectable phen? Is it because you don't have to refridgerate? I ended up taking suppositories. And for anyone reading and going offshore, this should be mandatory... especially if you are taking anyone without a lot of experience at sea. Once someone gets sea sick (which usually happens in bad storms it seems) they become a seious liability (at least in my opinion). But again, is the injectable better than the supposit?

On the anitbiotics, we have kids and took the powder form. I think you can get that for adults too. Then, all you have to do is add water if needed. It stays better on the boat that way. Your thoughts?

I assume the epi you took was not from a vial but an Epi Pen? Do you carry a Jr Epi also?

We have been carrying amoxicillin for a broad anitbiotic. It is cheap and works pretty well. What do you think about vancomycin or azithromycin (Pfizers little Z-Pack)? Is there a better anitbiotic? What do you carry for urinary tract infections? Not amox, I assume?

We have carried nitro pills, but they do not seem to keep well. Any thoughts?

Is Vicodin still the best pain med... or would you consider going with Oxy (which is addictive, incidentally... but we are talking about emergencies)?

Boy, I bet you feel like you are back at work!!! Still, I know myself and many other cruisers really appreciate your feedback. Meds change so quickly and some things are a pain to keep on a boat.


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## TSOJOURNER (Dec 16, 1999)

*to Cruisingdad*

Phenergan suppositories will melt in the tropical heat, and my wife hates having to look at a suppository sitting next to her food...so I carry a couple single dose vials of injectable Phenergan. It also works well for migraines which my wife is prone to, but it is VERY sedating for some people.

I like powdered liquid forms of antibiotics for several reasons: With a 6 year old boy aboard, I can adjust the correct dose easier for a child than if I had to try to break a tablet. Also, tablets can often start to fall apart in the humidity. If you bring tablets, have them in "blister packs" or in the factory sealed container. Once you open it, the tablets may degrade rather quickly so you're better off having several smaller quantities than one big stock bottle of 100 tablets.

Amoxicillin is cheap and pretty safe, but because it is so popular, there is alot of resistance to it. At home I prescribe it all the time, knowing that maybe 10 or 15 percent of the time a sinus infection or ear infection might be resistant to it. 
Vancomycin is not absorbed orally, so cannot be used in tablet form except for a few types of bowel infections. As an injectable, the dosing is tricky and can cause kidney damage, so it is not appropriate for use on a sailboat where you cant do lab tests.
Azithromycin is a great choice for most respiratory infections: ear infections, bronchitis, or even pneumonia. It is sometimes OK for skin infections, but probably not urinary infections.
The reason I suggested levofloxacin is that it generally covers all of the above common infections. Only problem is that it's not recommended in children, so for my son, I bring along alternatives. It is also fairly expensive compared to the generic antibiotics, but I think worth the cost to be able to carry only one medication that treats so many infections effectively.

If you are under 45 or so and not otherwise at high risk for heart disease, I'd probably skip the Nitroglycerine for exactly the reason you describe: it loses effectiveness rapidly. If you need to carry it, ask about Nitrospray. You can get it in a little spray bottle that you just squirt under your patient's tongue and it has a little better shelf life, I think.

Vicodin (hydrocodone) and Percocet (oxycodone) are pretty equal in my mind in terms of pain relief and addictive potential. I got very nauseated once from oxycodone when I had a cervical strain so that's the only reason I choose Vicodin. But Percocet is ranked slightly higher in addictive potential by the DEA, so prescribing laws are slightly tighter (you can't phone in a refill to a pharmacy, for example, while you can for Vicodin) So that might be another plus for Vicodin.

Whew, this is starting to feel like I'm taking a board exam again. Hope that helps and may you never need to use any of this stuff.


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## Cruisingdad (Jul 21, 2006)

*Thank you*

Thank you for your time. Enjoyed the conversation. You are right about the supposit - we kept them in the fridge. Very nice of you to share your thoughts.

Fair winds.

- CD


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## chris_gee (May 31, 2006)

The outfit where you did your marine medic course has a good kit, and can forward it to you when you actually have a boat, as supplies for a yacht in transit. This has the advantage of the drugs being what you were trained on. If you have a separate minor kit, you may never open the major one. If you did have a major incident at some point, I have no doubt you could worry about replenishment then, quite probably using your own kit supplier. At this point that is a distant concern.


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## TSOJOURNER (Dec 16, 1999)

*phenergan*

Another good reason for using injectable Phenergan (or Compazine) is that suppositories aren't much use when your nausea is accompanied by diarrhea. Gastroenteritis is not that uncommon, especially when traveling outside the U.S. (Mexico, Central America, etc.) With the nasty noro-viruses ("Norwalk virus" that has been a problem on cruise ships) showing up more frequently, suppositories are useless. We had a run of it through several wards at the VA Medical Center I work at in Oregon, and I can promise you that retention of a suppository can be impossible when you are battling a noro-virus.


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## Kuhntar (Jan 7, 2007)

Is it possible to get other prescription meds in the Caribbean. In my case I have to take sotalol. I had thought that I could just buy enough for 6 months and take as usual. I never thought that the pills would disintegrate. Would someone still have problems if the kept the pills in the fridge?


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## chuck711 (Dec 25, 2002)

*We've found Meds in the Caribbean a fraction of the USA Cost*



Kuhntar said:


> Is it possible to get other prescription meds in the Caribbean. In my case I have to take sotalol. I had thought that I could just buy enough for 6 months and take as usual. I never thought that the pills would disintegrate. Would someone still have problems if the kept the pills in the fridge?


We've found Meds in the Caribbean a fraction of the USA Cost.
This also includes dentist and doctors fees. The care is first rate!


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## TSOJOURNER (Dec 16, 1999)

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## TSOJOURNER (Dec 16, 1999)

The one thing which I would definately take in your medical kit, is something to plug the hole if you have old fillings. I was given a small pot of something called "Cavitt G" (I think, it was a while ago now) by my Dentist before leaving the UK. Having taken a beating in mid Adlantic a couple of years later by a the tail end of a kindly hurricane, one of my teeth cracked and most of one of my old fillings fell out. Painfull is one word (others were used at the time though). I used the Cavitt G to pack into the offending hole and with the help of some Asprin, all was well after a few hours.
Once back in the UK, my dentist was pretty impressed with the job I'd done. Although I think he was more impressed by what he charged me.

But whatever you take in your kit.....don't forget those teeth. 
Although it'd probably have been cheaper to have them all removed and dentures made! THINK about it!


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## donradclife (May 19, 2007)

Getting back to the topic, it would probably be easist and cheapest to bring a few essentials with you like antibiotics and painkillers, then wait till you leave the US before you stock your first aid kit. The US medical and pharmeceutical systems have been twisted and broken by greedy people,and you should avoid them like the plague. 

A few examples:

We get our Lipitor from NZ at less than half of the cost in the US.

A US doctor will charge you a minimum of $250 to see you for 15 minutes and write prescriptions for many drugs which you can get outside the US without prescriptions. 

Pharmeceuticals in some lower income contries are subsidized and the price is controlled by the government. 

The other issue you will end up dealing with is when to replace expired medicines. The written rules are usually every three years, but most things (with the exception of the tetracycline family) will last a lot longer.


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## TSOJOURNER (Dec 16, 1999)

Also wanted to point out that meds usually are good for much longer than 1 year. You don't need to throw out and buy new meds just because they say they expire after one year. They may slowly loose efficiency over time but don't "go bad" or anything.

Keep in mind that phenergen is very likely to cause at least some degree of somnolence. It pretty much knocks me out good for about 12 hours....


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## TSOJOURNER (Dec 16, 1999)

> then go to Canada or Mexico to stock. It is my strong understanding that they are a lot more liberal with the meds and it is a WHOLE lot less expensive.


I can't speak for Mexico, but it will not be any easier to get narcotics in Canada. Even things like Oxycondone (generic Oxycontin) are highly controlled here.

Our drug prices are controlled by the government, as they are in much of the world, but the maximum quantity of a controlled or prescription drug that you are allowed to purchase or have in your possession is a three month supply, and if you are attempting to bring those items into the country, then you may be required to produce a _current_ prescription, or surrender them to customs. i.e.: if your prescription was written 45 days prior to the date you are presenting it, then you would be expected to have already consumed 45 days worth of the medication.

If there is any doubt on the part of Customs that your prescription is genuine, your boat may be impounded, you may be arrested and you can be held in a detention centre until you provide proof that you are not attempting to smuggle controlled goods into the country. You will not be compensated for whatever expenses you incur during this process.

It may be possible to obtain a prescription in the country, however pharmacies are required to report on their disposition of controlled substances, hence doctors are reluctant to prescribe the goods unless it is medically necessary. As a visitor to the country, you will be required to pay for the prescribing physician's time. I am not sure what that charge would be.

Me - I would not risk it as the consequences may be exhausting and expensive, not to mention that if you do get detained or arrested, and end up on a "denied entry list" that information may be shared freely amongst all INTERPOL customs and police forces. Trying to land in a lot of countries, particularly the US but also Canada or Britain, when your name has been put on one of those lists, for whatever reason, would be pretty well impossible.

For further information regarding which drugs and substances are considered controlled see:

Controlled Drugs and Substances Act


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