Summer travel and vacation season is coming up. Many of my patients are looking forward to getting away. If you are a chronic pain patient, planning a vacation has an extra level of complexity and potential hassle: managing your medications, particularly your opiates (there is a difference between opioid, opiate and narcotic pain medications. For the purposes of this blog will be referring to all as opiates).
I hear from my patients that they are afraid of scrutiny at airport security. Or having pills enough to last the entire trip. My main concern is that their medications do not get lost or stolen while traveling.
A little extra planning and forethought can help your vacation go smoothly. A few, easy precautions can prevent disaster.
- Take only the medications you will need for your trip. There might be some medications that you use infrequently on an ‘as needed’ basis. It may be easier to just leave those at home.
- Take only the number of pills you need for the trip, plus a few extra for unanticipated emergencies or delays.
- Medications left at home should be secured. Gun safes and safety deposit boxes are my first recommendations. After that, a hidden lock box.
- Take a list of your medical conditions and the medications used to treat each.
- Bring a non-descript, water-proof container for daily use of medications.
Special precautions for opiate medications
Opiate pain medications (oxycodone, hydrocodone, hydromorphone, methadone, morphine, fentanyl and others) are highly sought after as drugs to abuse. Unfortunately, the safest approach is to assume that everyone you come in contact with would, given the opportunity, steal some or all. Think of your pills as 5, 10 or 20 dollar bills (these amounts are actually what each of your pills may fetch on the black market). You would not leave money lying unattended or in easy reach. Do not believe that because you are visiting your best friend, cousin or kids, that your opiates are safe. I have had patients whose medications have been stolen by their best friend, siblings and kids, you name it.
Avoid talking to people about your pain medications. It is none of their business and the less people who are aware of your opiates the better.
Keep only a few pills in the original containers. The rest should be put in a non-descript and non-valuable looking container, like an old Tylenol bottle or a repurposed travel size shampoo bottle. Most of my patients believe that it is best to leave all medications, including the opiates, in the original prescription bottle; and many travel sites tell patients to do just that. However, pain medications in the original containers are just too easy to identify and steal. Your chances of getting into trouble for not having proof of prescription is very small compared to your chances of getting medications stolen.
If available, keep medications in the hotel safe in your room.
Keep medications in your carry-on when flying. Unless you are carrying liquid medications, they can remain in the carry-on and go through the scanner. Generally speaking, TSA is more concerned with things that go boom or weapons than your medications. But sadly, individual TSA agents have reportedly stolen medications. Never put medications in checked baggage.
Sometimes it is hard to tell if it is safer to leave medications in a hotel room, ships cabin, or take them with you while you explore Mayan ruins. If there is a safe, use that and take only the pills you will need for the day (in that non-descript, water-proof container). If there is no safe, this is a judgment call.
Some countries require a letter from your prescriber with the diagnosis and medications listed (best to use generic names). Others allow you to have only a 30 day supply. The CDC says in some countries your pain medication could be illegal. They advise checking with your destination country to verify that you are not unwittingly carrying contraband.
Food and drink
Consuming alcohol with opiates can be extremely dangerous. Alcohol will increase the risk of some of the dangerous side effects of medications (like drowsiness and reduced breathing). Most patients are advised not to use alcohol in combination with pain medications. Vacations are not the time to start imbibing.
Many of us eat richer foods and more of it while on vacation. We may also hydrate a little less. This can increase the chances of opiate induced constipation. Bring your favorite laxative.
Motion sickness, nausea and vomiting are unpleasant experiences during any vacation, but when you are taking opiates, throwing up can be a disaster. You took your pain pill, but did it get dissolved and absorbed before you lost your lunch? Should you take another? If you are prone to getting stomach problems, ask your prescriber for anti-nausea medications before you go.
Diarrhea is generally less of a problem, in terms of getting medications into you system. Most of the time anti-diarrheals are not recommended, and can be dangerous. Expelling bacteria through frequent, watery stools is one of the ways your body is trying to protect you. If you really need to get a respite (like to get on a plane) bismuth subsalicylate (ie Pepto-bismol) or loperamide (Imodium) are usually the safest, and should be used for the shortest length of time possible. They can interact with medications, so discuss your specific medications with your pharmacist before using.
A great resource for travel information is the Centers for Disease Control at http://wwwnc.cdc.gov/travel/
Do you have a tip as a chronic pain patient that has helped you prevent disaster, or just let your trip go more smoothly? Maybe you have a travel horror story concerning your medications? Please share them, I’d like to know.
Editor’s Note: Dr. Richard Radnovich is a contributor to the National Pain Report. He runs the Injury Care Medical Center in Boise, Idaho and is a clinical researcher who has been a principal investigator on numerous research projects.