Can I bring my medications on vacation?

A patient emailed me recently: he was going to a few countries in Europe. Could he take his medications with him? He was on a schedule II stimulant.

I think it’s a good idea, before visiting a new country, to check out a few websites:

The first is the US State Department’s Alerts and Warnings Page to see if anything really dangerous is happening where you’re going. http://travel.state.gov/content/passports/english/alertswarnings.html

Then, on the same page, check out the information for the individual country you’re going to: http://travel.state.gov/content/passports/english/country.html

Finally, check out the Center for Disease Control Website to see if there are any medical concerns where you’re going.

http://wwwnc.cdc.gov/travel/destinations/list

It turns out that taking a prescribed stimulant to Europe is legal (keep the medication in the original  prescription bottle).

But every country is different, and the laws in the United States are very different from those of other countries, in some surprising ways.

For example, taking a schedule II stimulant into Japan is illegal, with the exception of Concerta (the only schedule II stimulant allowed in Japan for the treatment of ADHD). Adderall, Vyvanse, dextroamphetamine, etc are illegal, even in the original bottle, with a copy of the prescription and a note from the prescribing physician. So are over the counter inhalers containing pseudoephedrine.

“However, it is illegal to bring into Japan some over-the-counter medicines commonly used in the United States, including inhalers and some allergy and sinus medications. Specifically, products that contain stimulants (medicines that contain pseudoephedrine, such as Actifed, Sudafed, and Vicks inhalers) or codeine are prohibited. You can generally bring up to one month’s supply of allowable prescription medicine into Japan. You must bring a copy of your doctor’s prescription as well as a letter stating the purpose of the drug. However, some U.S. prescription medications, such as Adderall, cannot be imported into Japan, even when accompanied by a customs declaration and a copy of the prescription.”  (my emphasis)

http://travel.state.gov/content/passports/english/country/japan.html  (under the heading: Local Laws and Special Circumstances, and sub-heading: Confiscation of Prescription Drugs and Other Medication

This is not a misprint. From another source:

Prescription Medications

“Heroin, cocaine, MDMA, opium, cannabis, stimulant drugs including some  prescription medications such as Adderall, and including some medications available over-the-counter in the U.S. are prohibited in Japan.  There are no exceptions in bringing these prohibited medications into Japan, even if the medication is legally obtained outside of Japan.  The import of stimulant drugs such as methamphetamines and amphetamines in particular are strictly prohibited, even when accompanied by a customs declaration and a copy of the prescription. Japanese customs officials or police can detain travelers importing prohibited items. Japanese customs officials do not make on-the-spot “humanitarian” exceptions for medicines that are prohibited in Japan.”

http://japan.usembassy.gov/e/acs/tacs-medimport.html

And another:

“When bringing prescription medications to Japan you may have items inspected and cleared upon arrival by the Customs Agency, and avoid further processing if the following conditions apply:…

Items are not prohibited drugs in Japan such as stimulants (i.e. Adderall)

There are no exceptions in the case of (stimulants), even if the medication is legally obtained outside of Japan. The import of stimulants such as methamphetamines or amphetamines, as well as precursors such as ephedrine or pseudoephedrine exceeding a certain concentration level, is prohibited by the Stimulants Control Law.

http://www.seattle.us.emb-japan.go.jp/about/import_restrictions.html

Even more curiously, if one had the illusion that the world is rational, while one cannot bring legally prescribed Adderall or Vyvanse into Japan, one can bring in the following with no problem

“If you intend to import / export the psychotropics equal to or less than theamount indicated in the Table (excluding injection form), you don’t need a certificate written by your doctor nor the permission by authorities under the “Narcotics and Psychotropics Control Law”.

http://www.nco.go.jp/dl_data/keitai/keitai_guideh26.pdf

 

1. Secobarbital, up to 6 grams (a barbiturate, rarely used now due to narrow therapeutic index (too easy to overdose on)

2. Mecloqualone, up to 9 grams: per Wikipedia, “Mecloqualone is faster-acting but shorter-lasting than methaqualone and so was used only as a sleeping pill, in contrast to methaqualone, which was used as a general-purpose anxiolytic as well. Mecloqualone was never as widely used as methaqualone and is no longer prescribed because of concerns about its potential for abuse and overdose. In the United States it is a Schedule I non-narcotic (depressant) controlled substance with an ACSCN of 2572 and zero annual aggregate manufacturing quota. It is most often seen these days as a component in purported Quāāludes (resulting from incomplete synthesis of methaqualone) from underground labs.”

3. glutethimide, up to 15 grams: glutethimide is Doriden. Per Wikipedia, “Glutethimide is a hypnotic sedative that was introduced by Ciba in 1954 as a safe alternative to barbiturates to treat insomnia. Before long, however, it had become clear that glutethimide was just as likely to cause addiction and caused similarly severe withdrawal symptoms… Current production levels in the United States (the annual quota for manufacturing imposed by the DEA has been three grams, enough for six Doriden tablets, for a number of years) point to it only being used in small scale research.

So you’re allowed to bring 15 mg of this into Japan, with no problem: this is equivalent to 5 times the annual quota for the entire United States.

In overview, one is allowed to bring in a month of benzodiazepines (diazepam: 1200 mg (Valium), zolpidem (Ambien) 300 mg, and a variety of amphetamine like appetite suppressants (phendimetrazine 3.15 g, phentermine 1.125 g, benzfetamine 1.5 g)

Finally, meprobamate 18 grams: continuing our tour of pharmaceuticals popular in the Mad Men era, meprobamate (Miltown) was  “launched in 1955 and  rapidly became the first blockbuster psychotropic drug in American history, becoming popular in Hollywood and gaining notoriety for its seemingly miraculous effects” (Wikipedia) in relieving anxiety. Like glutethimide, it soon became apparent that it was as dangerous as the barbiturates. “By 1957, over 36 million prescriptions had been filled for meprobamate in the US alone, a billion pills had been manufactured, and it accounted for fully a third of all prescriptions written” (Wikipedia). In 1965, the Medical Letter reported meprobamate was addictive; in 1970, it became a controlled substance; in 2012, the European Union withdrew its marketing authorization; in 2013, Canada did the same.

But I digress. Back to Japan and Adderall, with an example of what happens when one brings prescribed stimulants into Japan:

Carrie Russell was a 26 year old college graduate,  diagnosed with ADHD at the age of 7, whose mother, a physician, shipped her a 90 day supply of Adderall (prescribed by Carrie’s family practitioner), in a “care package”,  when she was in  South Korea. (Her mother removed her  Adderall from the prescription bottle and put them in a Tylenol bottle, because she was worried they might be stolen if properly labeled). Carrie mailed the box to Nagoya, Japan, where she planned to teach English. “At 11 p.m. on Feb. 20, according to Russell’s Portland-area family, five plain-clothed police officers in black suits burst into a Tokyo restaurant where the 26-year-old American was dining with friends. They took her into custody. She was taken 275 miles west to Nagoya, where she was incarcerated in a women’s detention center outside the city.” She was released after 18 days in custody after the Caroline Kennedy, the Ambassador to Japan, intervened.  She gave her Japanese prison experience a good review:

“Russell said that although her arrest was shocking, the detention center “was not anything terrifying,” Russell said. “The facility was clean. We had daily chores.”  Inmates were served bento meals, Russell said, each with rice as a staple and small portions of noodles, potatoes, vegetables and other food. She said she learned some more Japanese language, such as, “How to say, ‘open,’ how to say, ‘refill my water,’” and, ‘I’m finished with my meal.’”

http://www.oregonlive.com/pacific-northwest-news/index.ssf/2015/03/released_oregon_woman_says_in.html

Interestingly, amphetamine abuse in Japan is quite common: “According to police officials, 2.6 million Japanese had used between 15 and 18 tons of amphetamines in the late 1990′s. This is more than the use of all other illegal drugs combined. Officials state that amphetamines are their biggest challenge. The drugs are popular amongst truck drivers, gang members, partiers, housewives, salary men, people wanting to lose weight, and the rich of Japan. Amphetamines are 10 times the cost in Japan than the United States, but still remain the most favorable drug of choice.” http://www.thecabinchiangmai.com/archive/statistics_of_japan___s_rising_drug_use#.VZbl3vlVikp

Apparently, the illegal amphetamine trade is controlled by criminal organizations, such as the Yakuza, whose profits might suffer if these medications could be legally prescribed by physicians, as is the case  in the United States and the European Union. Thus economics helps us understand what appears irrational at first glance. Why would Japan allow in dangerous sedatives without restriction and forbid a medication commonly and safely  used for ADHD in other countries? Apparently because it would interfere with the profits of the criminal elements who control the amphetamine market. Another factor is that mental illness is stigmatized in Japan.

 

 

 

 

 

 

 

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