Where do ships get medicine for ships medicine chest?

November 8, 2013 11:52 PM

I plan to sail around the world with several people and regulations state that I have to have a stocked medicine chest on the boat. I have a book by the world health organization called "International medical guide for ships" that has a list off the different medications I need to have and when to use them and the dose ect. but it does not say where to get these medications, many of which are normally prescription in the US. What do most small ships do?
posted by john123357 to Sports, Hobbies, & Recreation (20 answers total)

Interesting question. I googled 'Maritime medical supplies' and there seem to be a few suppliers:

http://www.marinemedical.com/

was the top result. They claim to offer a prescription and non-prescription pharmaceutical supplies service as well as general first aid and emergency medical supply products for commercial or recreational sailing.

(I think they spelled 'preventative' incorrectly though...)
posted by evil_esto at 1:05 AM on November 9, 2013 [1 favorite]

Response by poster: That site says "Prepared in cooperation with your physician" I think that implies you need a prescription and I don't have a ships doctor.
posted by john123357 at 1:15 AM on November 9, 2013

If you look around a bit they ask for your family or personal physician's details on the recreational questionnaire. They also offer staff physician consultations by the looks of it to me.

http://www.marinemedical.com/recquestion.html
posted by evil_esto at 1:21 AM on November 9, 2013

Response by poster: I doubt my family doctor would agree to write prescriptions for 20 or 30 medicines I would need for the medicine chest.
posted by john123357 at 1:24 AM on November 9, 2013

Unless you're looking for narcotics or other majorly controlled substances, you can probably buy most of the medications through various "overseas pharmacy" type places. I have, um, friends who've bought [various medications] through [places] when they didn't have insurance, and they always received the appropriate medication in a timely fashion. Obviously this is something that many people are uncomfortable with, as it's technically illegal (though, in my experience, moderately widespread) in the US.
posted by MeghanC at 2:09 AM on November 9, 2013

Response by poster: I'm looking for a legal way to do it. Most are not narcotics but it does say you have to have morphine on the ship.
posted by john123357 at 2:36 AM on November 9, 2013

You're not going to get a prescription for morphine, but travel clinics will prescribe stuff like antibiotics. Call the local one and ask them about it. They should be able to take care of everything but controlled substances. What regulation requires that you have morphine on a sail boat?
posted by empath at 4:08 AM on November 9, 2013

I just wrote a bunch of stuff about the supply of drugs and medical equipment to ships, and the need for people with the appropriate medical training to use them, but on reading your previous questions, I'm not sure it would be appropriate.

I am not a medical professional. I am a professional seafarer, and yesterday I passed my certificate of medical fitness, which included disclosing to the doctor that I had previously been treated for depression and anxiety - I live with these things. I manage them well enough that they aren't affecting my professional life on ships. I am concerned that you wouldn't currently be able to do that, and at sea, that would make you a risk to the safety of the boat and the other people on board.

So maybe the answer is - you can't just buy a book and a random bunch of drugs, someone with the appropriate training needs to do that.
posted by Lebannen at 4:15 AM on November 9, 2013 [9 favorites]

On failure to preview - empath, I don't know what regulations he's looking at but the British commercial ships I work on have to carry morphine, even the tiny ones with a large-yacht-sized crew. On these ships the controlled drugs are kept locked up in the captain's cabin. It would seem sensible to me for an ocean-going yacht to carry the same, so long as there was someone on board who knew how and when to use it. I haven't read MSN 1768 but it may be relevant.
posted by Lebannen at 4:27 AM on November 9, 2013 [2 favorites]

People I've known who have stocked the ship's medicine chest have gone to their local/family MD, and gotten prescriptions written.
Even if it's dozens.
posted by From Bklyn at 5:21 AM on November 9, 2013 [1 favorite]

Persistence?

This question is fascinating.

It omits the "regulations" that state why you need a medicine cabinet. You are going around the world. On a boat. Unless you stay in international waters, you are going to be in 100 jurisdictions before it's over. You're going with several 'people'? Who the hell tasks someone with the 'you get the drugs' task and is serious about going around the entire world? What it in the world are their qualifications and experience? Please don't suggest you are the most experienced person on this team?

Are you near a large body of water, say an ocean? A place where maritime issues come to relevance from time to time? Are the people on boats you could ask? Boat transport companies? Maritime worker unions? You know, folks familiar with the territory?

Is there a schedule constraint that means you need an immediate answer? Because if not, Task1 is not drugs, Task1 is personal education. There are maybe 100,000 things to learn about a project like that. In the distant past, and probably to this date, there are likely HUGE apprenticeship requirements to get qualified to do something like this. I am sure it's different with the "Circumnavigating Alone" crowd, whose fatalities number 1 per trip,but in a crowd, someone is the responsible party for making sure Boat gets from A to B and as few people as possible die in transit.

If I had your question, I'd take from a few days to a few weeks to answer that ONE question.
Every answer would yield 10 more questions, maybe 100?

That's why 'persistence' is the first thing that came to my mind. Wow. Good luck, amigo.
posted by FauxScot at 5:23 AM on November 9, 2013 [3 favorites]

When I went to China back in the nineties, they were recommending that you bring your own syringes in case of hospitalization because the supply was irregular in some parts at that time. (This would almost certainly not have been true where I was going, but I didn't realize that.) I explained this to my doctor and he prescribed me...a bag of syringes! I thought it was going to be all kinds of dodgy, but it wasn't.

Check with your regular doctor or a travel clinic. Bring a document about the regulation and some details about your trip - when you're leaving, where you expect to go, etc, enough so that it seems plausible. I would be very surprised if no one will prescribe this stuff. This sounds like the kind of thing where it sounds like it will be more difficult than it is because it's so out of the ordinary.
posted by Frowner at 5:33 AM on November 9, 2013

The world health organisation can't make you do anything - it's not a regulatory agency for recreational sailors. A sensible medicine cabinet with first aid supplies does not have to include morphine, and if there's no one on the ship that knows how to dose it, you probably shouldn't have it. Things more important than morphine: antiseptic, bandages, aspirin, a thermometer, etc. 90% of what you need is available at the supermarket.

Having morphine on board might get you into trouble in some ports as well, so be very careful about that. Singapore's zero tolerance approach to drug smuggling springs to mind.
posted by chiquitita at 6:31 AM on November 9, 2013 [3 favorites]

If you don't mind paying for shipping, there's plenty of overseas pharmacies that will sell just about everything but narcotics. Alldaychemist, Mesican pharmacies, etc. You can get antibiotics, and the like.
posted by Ideefixe at 7:26 AM on November 9, 2013

A hospital near you probably has a Travellers' Clinic that could provide the prescriptions you need.
posted by Jode at 7:34 AM on November 9, 2013

The "regulation" you're alluding to patently doesn't exist. I have been sailing for years, in several countries, and have interacted with many other people who have been all over the Americas, South Pacific, Europe, and other places. I have never heard of anyone being obligated to carry morphine (or any other medicine). There are rules that the US Coast Guard imposes while sailing in US territorial waters (i.e., you must have a lifejacket for everyone on board). These rules do not extend outside the US. The Coast Guard does not track itineraries or travel plans. If you sail out of San Diego and head south, the Coast Guard does not care or check if you're going out for the day, to Mexico for a week, or around the world for three years. There are no special "around the world" sailing rules. As you sail into and out of different countries (which are often small islands) you check in and then out of these countries with the local authorities but they do not generally track where you are going next. They have no practical ability to do so, even if they wanted. If I sail out of Bora Bora, I can go anywhere in the Pacific, regardless of what I told the authorities when I was leaving.

There are no special rules for what you must carry internationally, as there are no governing bodies of "around the world". Besides, whatever medicines you bring might be illegal without prescription in some places. You may very well be arrested when you pull into Oman with a chest full of morphine and try to check into the country.
posted by tylerkaraszewski at 9:15 AM on November 9, 2013 [2 favorites]

Hmm, I think I'm an outlier on the far extreme in support of non-trained people providing their own healthcare, but I'll say I have some concerns about someone with no medical training carrying a wide array of medications on the ocean. If you don't know how to give them, medications can be more dangerous than helpful. Not sure which WHO list you're looking at (link?) but I would think an ocean-going vessel should have a few medications including:

Broad spectrum oral antibiotics
Topical antibiotics
Anti-emetics maybe (you can die from dehydration so I'd think severe vomiting and nausea could be life threatening on a boat, on the other hand, anti-nausea medicines aren't terribly effective)
Antihistamine (Benedryl seems adequate to me but I guess an epipen)
Some acetaminophen and/or ibuprofen for routine aches and pains and sprains
Aspirin (give if you think someone's having a heart attack or stroke and then get the fuck to help)

You could have morphine but it's not really a necessity and you can absolutely kill someone with a morphine overdose, and morphine might be an attractive nuisance to say the least, depending on the issues of those on board the ship.

Besides these (I'm probably not thinking of a couple key things), I would avoid carrying a bunch of medications which can cause much more harm than help.

Seems much more important to have solid first aid training than a bunch of meds. I wonder if NOLS would be a useful resource?
posted by latkes at 9:43 AM on November 9, 2013

You could certainly ask your doctor about it. The worst she/he will do is refuse. I've had success getting antibiotics and such from my doctor to take with me when I'm going out on fieldwork, in case of things like traveler's diarrhea or giardia. Explain what you're doing, present him/her with a list of medicines that you'd like to carry and your reasons for doing so, and see if she/he will oblige you with at least some of them. It's worked for me in the past.

Also seconding the idea that you should get some training. I'd recommend a Wilderness First Responder course, as taught by NOLS, WMA, or SOLO. And anyone else on the boat should have at least Wilderness First Aid.
posted by Scientist at 10:31 AM on November 9, 2013

And whether or not this regulation is actually a real rule or or law, it's still a good idea to have some good medicines in your kit if you're going to be spending a lot of time in a remote place, as you are.

I am not a doctor but I am a Wilderness EMT and I consulted with some doctors before putting together my own kit. When I do fieldwork the prescription meds I carry mostly involve a selection of different antibiotics for dealing with GI infections, respiratory infections, and infected wounds. I also carry Flagyl for giardia, though that may be less relevant for you, Coartem for malaria, also perhaps less relevant, and ondasterone for nausea which I would highly recommend. Ondasterone is expensive but it works like a sledgehammer against nausea and has few if any side effects.

I also carry prednisone for severe allergic reactions and epi pens for anaphylaxis. I carry a couple of prescription ointments too: Bactroban, which is the only antiobiotic ointment that's worth a damn (the ones you get OTC haven't been shown to be any more effective than plain vasoline, and contain substances which are common allergens) and an azithromycin eye ointment for scratched and infected eyes/conjunctiva. I've carried percocet in the past but don't think it had enough value to be worth the hassle of getting it again. If you happen to have some of it though or something similar, I'd recommend bringing it for management of severe pain resulting from traumatic injuries. Keep it locked up, though.

As far as OTC meds go, ibuprofen is a staple. I will bring acetaminophen too next time, as we had a guy on my crew who was allergic to NSAIDs. Benadryl is also a very important one, not only for allergies but also as a sleep aid and as a followup to the epi pen for anaphylaxis. A non-drowsy antihistamine like Claritin would be good too, because people often aren't very functional when on Benadryl. I'd bring pseudoephedrine also, and possibly Afrin, for stuffy noses. (Not being able to breathe properly is pretty debilitating if you're in a tough envoronment.) An anti-diahrreal like loperamide, as well as a laxative like bisacodyl tablets.

That's just the medicines, of course. Equipment is another issue, and another AskMe.
posted by Scientist at 11:40 AM on November 9, 2013 [6 favorites]

Medaire or Health Force Partners. They offer an on call doctor service that will assist you through a medical emergency. It's not cheap, but it is popular among yachts.
posted by karst at 3:12 AM on November 10, 2013