Getting Prescription Meds in New Zealand, Difficulty Level: Wellbutrin
September 25, 2019 6:48 PM Subscribe
I'm an American preparing to spend ~7 months in New Zealand, and can legally bring only 3 months' worth of generic Wellbutrin XR with me. I'd assumed I'd find a Kiwi doc to write a refill after 3 months -- but it turns out bupropion is only approved in New Zealand for use as an anti-smoking aid (eg Zyban) -- NOT for use as an antidepressant. How do I get meds for the rest of my trip without committing customs fraud or otherwise breaking the law? I'm willing to jump through bureaucratic hoops, I just don't know what they are.
Scenario 1: Somebody mails me the rest of my meds from the US.
- I do in fact have enough meds here in the US to last the duration -- I just don't how to legally import them into NZ.
- It is my [possibly muddled?] understanding that in order to legally send meds to NZ, one must have a prescription from a New Zealand doctor, confirming that the medication in question is a) necessary and b) cannot be obtained domestically.
- I am willing to pay for a visit to a doc in NZ to obtain such a prescription.
- My US doc has provided me with a letter I can bring to any NZ doc, confirming my medical history and providing her own contact info.
- But can a Kiwi doc even write a prescription for a drug that isn't approved in NZ?
Scenario 2: I visit a doc in NZ and obtain a Zyban prescription (same drug), with the doc's full understanding that I will be taking it for off-label purposes, and purchase the meds in NZ
- In this scenario, I would be paying for meds out of pocket, so there would be no issue of insurance fraud.
- I seriously have *no idea* whether prescribing drugs for off-label purposes would be considered reasonable in this scenario, or a gross violation of medical ethics. (You are not my doctor, etc.)
*******
A few people I know have suggested, half-jokingly, that I just tell a doctor I'm trying to quit smoking. I would really prefer to do this in a way that's entirely above board, if at all possible.
******
So:
1. Is one of the above scenarios more viable than the other? What do I need to know in order to execute it?
2. Is there another, better scenario I have not considered?
3. Barring answers to 1) or 2), can you recommend an Auckland-area psychiatrist I might be able to email to ask for advice?
THANK YOU FOR YOUR HELP
Gahhhhhh I just want my antidepressssssants
Scenario 1: Somebody mails me the rest of my meds from the US.
- I do in fact have enough meds here in the US to last the duration -- I just don't how to legally import them into NZ.
- It is my [possibly muddled?] understanding that in order to legally send meds to NZ, one must have a prescription from a New Zealand doctor, confirming that the medication in question is a) necessary and b) cannot be obtained domestically.
- I am willing to pay for a visit to a doc in NZ to obtain such a prescription.
- My US doc has provided me with a letter I can bring to any NZ doc, confirming my medical history and providing her own contact info.
- But can a Kiwi doc even write a prescription for a drug that isn't approved in NZ?
Scenario 2: I visit a doc in NZ and obtain a Zyban prescription (same drug), with the doc's full understanding that I will be taking it for off-label purposes, and purchase the meds in NZ
- In this scenario, I would be paying for meds out of pocket, so there would be no issue of insurance fraud.
- I seriously have *no idea* whether prescribing drugs for off-label purposes would be considered reasonable in this scenario, or a gross violation of medical ethics. (You are not my doctor, etc.)
*******
A few people I know have suggested, half-jokingly, that I just tell a doctor I'm trying to quit smoking. I would really prefer to do this in a way that's entirely above board, if at all possible.
******
So:
1. Is one of the above scenarios more viable than the other? What do I need to know in order to execute it?
2. Is there another, better scenario I have not considered?
3. Barring answers to 1) or 2), can you recommend an Auckland-area psychiatrist I might be able to email to ask for advice?
THANK YOU FOR YOUR HELP
Gahhhhhh I just want my antidepressssssants
Pretty sure with your documentation you could find a doctor who would write you a script off label. Might take a couple of tries. Probably worth looking at the dose differences between the quitting smoking use and what you need.
If you know someone there (employer? Friends?) ask them to call their doctor and ask the question. It’s not like the US where you have to go through 10,000 layers to talk to someone who can help you, and the doctors generally aren’t terrified of malpractice suits (because they’re explicitly disallowed by law!). I’d bet the first doctor you ask would say “yep I can do that, send them round”.
Also try finding an NZ-US ex-pat group on Facebook, someone there will probably have bumped into a similar problem.
posted by Jobst at 7:25 PM on September 25, 2019 [2 favorites]
If you know someone there (employer? Friends?) ask them to call their doctor and ask the question. It’s not like the US where you have to go through 10,000 layers to talk to someone who can help you, and the doctors generally aren’t terrified of malpractice suits (because they’re explicitly disallowed by law!). I’d bet the first doctor you ask would say “yep I can do that, send them round”.
Also try finding an NZ-US ex-pat group on Facebook, someone there will probably have bumped into a similar problem.
posted by Jobst at 7:25 PM on September 25, 2019 [2 favorites]
You're really overthinking this. Bupropion isn't a controlled substance, and nobody really cares all that much about international transit of meds that aren't controlled. Have someone mail you the meds. You can also have them sent to you via various internet pharmacies that operate internationally.
posted by killdevil at 8:58 PM on September 25, 2019 [2 favorites]
posted by killdevil at 8:58 PM on September 25, 2019 [2 favorites]
Reading the NZ customs page, it looks like you could get a prescription from a NZ doctor for off label Bupropion and then get it sent over to you. If you're on the XL or SR version and only the regular version is available locally, you might want to look into that.
posted by Hactar at 9:29 PM on September 25, 2019
posted by Hactar at 9:29 PM on September 25, 2019
A few years ago I had meds shipped to me for the same reason (from the US to Hungary, not to NZ). The shipper (who was doing me a favor) didn’t mention the meds on the customs form. Hungarian customs clearly opened the package, inspected the contents, and ultimately permitted the package to be delivered. Obviously YMMV, but that’s how it worked out for me.
posted by actionstations at 10:36 PM on September 25, 2019
posted by actionstations at 10:36 PM on September 25, 2019
One thing to be aware of: there is currently a world-wide shortage of Wellbutrin, so just because a NZ doctor is happy to prescribe it doesn't mean a NZ pharmacy will be able to sell it to you.
posted by Murderbot at 3:43 AM on September 26, 2019 [1 favorite]
posted by Murderbot at 3:43 AM on September 26, 2019 [1 favorite]
Best answer: The NZ Best Practices medical journal seems to state that it is entirely legal and not uncommon for NZ docs to deal with this exact scenario:
What is an unapproved medicine?
An unapproved medicine is a medicine for which consent, or provisional consent, has not been given by the Minister of Health for sale, distribution or marketing in New Zealand, i.e. it has not been through the Medsafe regulatory process, approval has lapsed, the application was withdrawn or the product available is different in some way to the product that was approved. Unapproved medicines may still be prescribed to patients.
Section 25 of the Medicines Act allows an authorised prescriber to “procure the sale or supply of any medicine” for a patient in their care. This means that prescribers may prescribe any medicine to a patient (within their scope of practice), regardless of whether it is approved or unapproved in New Zealand. However, the prescriber must always provide an adequate professional and ethical standard of care, which includes gaining informed consent from the patient for use of the unapproved medicine.
Section 29 of the Medicines Act allows the sale or supply of unapproved medicines. The person or company who supplies the medicine must notify the Director-General of Health of the supply (via Medsafe), and record the name of the prescribing medical practitioner, the patient for whom the medicine was prescribed and the name and place of supply.
There are many medicines which are commonly used, and approved for use, in other countries, but which are not currently approved in New Zealand. This does not necessarily mean that they are unsafe to use. It is more likely that no application has been made for approval in New Zealand. Medsafe cannot vouch for the quality, safety and efficacy of unapproved medicines and may not be in a position to monitor and advise on their safety. Responsibility lies with the practitioner who prescribes an unapproved medicine. The practitioner must consider the evidence and clinical experience of the use of the unapproved medicine and weigh up the risks and benefits.
N.B. The original source, quality, safety and efficacy of medicines purchased online cannot be verified or guaranteed. When obtaining “unapproved medicines” it is recommended that a New Zealand supply chain be used.
What if the patient asks for a medicine they used overseas?
Patients who have immigrated to New Zealand or have spent time overseas may request that their doctor prescribes them a medicine that they have been using, which is not approved in New Zealand. Such medicines can be imported for use, but it is the obligation of the practitioner to consider approved, and subsidised, alternatives and be adequately informed about the medicine, e.g. researching the literature, consulting with colleagues, before assisting the patient to obtain it. Practitioners should have a plan in place to monitor the effect of the medicine.
posted by basalganglia at 3:58 AM on September 26, 2019 [4 favorites]
What is an unapproved medicine?
An unapproved medicine is a medicine for which consent, or provisional consent, has not been given by the Minister of Health for sale, distribution or marketing in New Zealand, i.e. it has not been through the Medsafe regulatory process, approval has lapsed, the application was withdrawn or the product available is different in some way to the product that was approved. Unapproved medicines may still be prescribed to patients.
Section 25 of the Medicines Act allows an authorised prescriber to “procure the sale or supply of any medicine” for a patient in their care. This means that prescribers may prescribe any medicine to a patient (within their scope of practice), regardless of whether it is approved or unapproved in New Zealand. However, the prescriber must always provide an adequate professional and ethical standard of care, which includes gaining informed consent from the patient for use of the unapproved medicine.
Section 29 of the Medicines Act allows the sale or supply of unapproved medicines. The person or company who supplies the medicine must notify the Director-General of Health of the supply (via Medsafe), and record the name of the prescribing medical practitioner, the patient for whom the medicine was prescribed and the name and place of supply.
There are many medicines which are commonly used, and approved for use, in other countries, but which are not currently approved in New Zealand. This does not necessarily mean that they are unsafe to use. It is more likely that no application has been made for approval in New Zealand. Medsafe cannot vouch for the quality, safety and efficacy of unapproved medicines and may not be in a position to monitor and advise on their safety. Responsibility lies with the practitioner who prescribes an unapproved medicine. The practitioner must consider the evidence and clinical experience of the use of the unapproved medicine and weigh up the risks and benefits.
N.B. The original source, quality, safety and efficacy of medicines purchased online cannot be verified or guaranteed. When obtaining “unapproved medicines” it is recommended that a New Zealand supply chain be used.
What if the patient asks for a medicine they used overseas?
Patients who have immigrated to New Zealand or have spent time overseas may request that their doctor prescribes them a medicine that they have been using, which is not approved in New Zealand. Such medicines can be imported for use, but it is the obligation of the practitioner to consider approved, and subsidised, alternatives and be adequately informed about the medicine, e.g. researching the literature, consulting with colleagues, before assisting the patient to obtain it. Practitioners should have a plan in place to monitor the effect of the medicine.
posted by basalganglia at 3:58 AM on September 26, 2019 [4 favorites]
I feel like basalganglia has it.
I would suggest people without knowledge of a specific country consider refraining from making speculative answers, as the NZ context is quite different from the US one. The government heavily subsidises certain approved medicines, meaning you're almost certainly not going to have to pay out of pocket - prescriptions usually cost $5 (that's not with insurance. That's what you pay. Note that you'd need a GP appointment, at maybe $60-100, to get the prescription).
Zyban is certainly subsidised as a smoking cessation aid. Without digging a bit deeper I'm not entirely clear whether it's also subsidised if used as an AD, but I suspect it would be. The government agency that makes decisions about which medicines to fund, and pays out subsidies, is called Pharmac - you could contact them to confirm what you'd have to pay if prescribed Zyban as an AD.
posted by Pink Frost at 1:28 PM on September 26, 2019 [2 favorites]
I would suggest people without knowledge of a specific country consider refraining from making speculative answers, as the NZ context is quite different from the US one. The government heavily subsidises certain approved medicines, meaning you're almost certainly not going to have to pay out of pocket - prescriptions usually cost $5 (that's not with insurance. That's what you pay. Note that you'd need a GP appointment, at maybe $60-100, to get the prescription).
Zyban is certainly subsidised as a smoking cessation aid. Without digging a bit deeper I'm not entirely clear whether it's also subsidised if used as an AD, but I suspect it would be. The government agency that makes decisions about which medicines to fund, and pays out subsidies, is called Pharmac - you could contact them to confirm what you'd have to pay if prescribed Zyban as an AD.
posted by Pink Frost at 1:28 PM on September 26, 2019 [2 favorites]
Ah, and immediately I have to add that not everyone is eligible for funded health services, and it depends on your visa class. See here and here for more.
posted by Pink Frost at 1:36 PM on September 26, 2019
posted by Pink Frost at 1:36 PM on September 26, 2019
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