A trip could be ruined due to a medical condition not adequately controlled because a patient ran out of medication. Planning is crucial for having a stress-free holiday, and pharmacists are in a unique position to help by providing advice to their patients about how to travel smart with medications.
The Canadian government advises that travellers check with the foreign government office in Canada to ensure that any medications or supplies that they intend to bring abroad are legal in the country of destination. In addition, patients travelling with narcotics or controlled drugs are limited to a 30-day supply. For more information, visit Health Canada.
Remind your patients who are travelling to keep all medications in their original containers with the appropriate labelling, and not to combine medications into one container to save luggage space. They should also be advised to keep a copy of the original prescription and a note from the physician describing why the medication is needed. Remember to advise patients to always pack an extra supply of medication in case they stay longer than anticipated. More information on travelling with medication can be found at this Government of Canada website.
If patients need to confirm if their medication or medical devices can be stored in their carry-on luggage, please consult this Government of Canada link. You can reassure your patients that liquid medications, such as insulin, and the gel or ice packs used to refrigerate them, are exempted from the 100mL limit. However, they must be presented to the screening officer separately from your carry-on luggage. Syringes can be included in the carry-on baggage if the needle guard is in place and the insulin is also stored in the carry-on luggage. For more info, please see this link from the Government of Canada.
For medications that need to be kept cool, such as insulin or injectable biologics, you can recommend an insulated travel cooler with an ice pack to keep these medications at the recommended storage temperature when travelling long distances. You can also contact the drug manufacturer for stability information in case the drug product goes outside of the recommended storage temperature.
Another way you can support your patients who are planning a trip is to advise them on travel-related issues such as adjusting medication administration times when crossing different time zones. There are no hard and fast rules on how to go about doing this, but most medications can be taken at the regular time in the new time zone. For some time-sensitive medications, it may be best to maintain the usual dosage interval while for others, the administration time may need to be adjusted by one- or two-hour increments to ensure compliance (i.e. to avoid dosing in the middle of the night). For the adjustment of insulin doses, more information can be found on the Canadian Diabetes Association website.
As pharmacists, we are a great resource for providing information to patients who are travelling with their medications. In addition, pharmacists can also advise patients on what vaccines they should be getting prior to their trip. For more information on which vaccinations are appropriate for specific countries, you or your patient can visit this CDC website.
This blog only touches on a few issues related to travel; for more complete information on travel and chronic illness, more information can be found on the Center for Disease Control website.
COVID-19 Information for Travellers
During the pandemic, patients turned to their pharmacist for accurate information regarding the COVID-19 pandemic. Patients will continue to see their pharmacist as a trusted resource, and with travel restrictions easing up, pharmacists are well positioned to provide guidance on how COVID-19 impacts their patients’ travel plans.
Most international destinations accept the Canadian COVID-19 proof of vaccination. However, each country will have different entry criteria on vaccine requirements. Patients should be reminded to check the entry and public health requirements for any countries they visit (even if only while in transit). Additionally, ensure patients need to ensure that the information on their proof of vaccination is correct and matches the information on their passport. Patients can review the COVID-19 – Entry, exit and transit restrictions and requirements for each destination through the Government website.
Returning to Canada
Beginning on April 1, 2022, fully vaccinated travelers entering Canada will no longer be required to undergo pre-entry COVID-19 testing. Some fully vaccinated individuals will be subject to random testing upon re-entry to Canada but will not have to quarantine. Partially vaccinated or unvaccinated Canadian travellers will still be subject to testing requirements when they return to Canada and must quarantine for 14 days, regardless of their test result. Full details on COVID-19 related travel requirements can be found on the Government of Canada’s website.
Health Canada defines a fully vaccinated traveller as someone who received at least 2 doses of a COVID-19 vaccine accepted for travel (this includes a mix of two accepted vaccines) or at least one dose of a Johnson & Johnson vaccine. In addition, the second dose of the vaccine must have been received at least 14 days prior to entering the country. For a list of accepted vaccines please refer to the following link.
Pharmacists should remind patients submitting travel plans through the ArriveCAN app will still be mandatory after April 1st, 2022. Advise patients to submit their information within 72 hours of arrival to Canada. Individuals who do not submit their information may have to undergo testing and quarantine for 14 days. More information on ArriveCAN can be found on the Government of Canada’s website.
Although Cannabis is legal for adults in Canada, it is still illegal to transport any cannabis products across the Canadian border– including, cannabidiol (CBD) products, edible cannabis, cannabis extracts and cannabis topicals – across the Canadian border. Transport of Cannabis across the Canadian border remains illegal even if the patient is authorized by a physician to use cannabis for medicinal purposes, or if cannabis is legal in the country or state where they are travelling to or from. For more details readers are encouraged to review the information on the Canada Border Service Agency website.