How do you get your Meds ? - SailNet Community

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  #1  
Old 10-26-2006
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How do you get your Meds ?

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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Old 10-26-2006
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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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Old 10-26-2006
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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 ****** 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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Old 10-26-2006
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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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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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Old 10-26-2006
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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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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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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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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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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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