Last year, we started to hear disturbing reports from Lyme patients that some Canadian border guards (CBSA) were stating there had been a policy change on the issue of importing a personal supply of medication. Attached is a news clip of one such story: https://www.ctvnews.ca/canada/n-s-man-angry-after-lyme-disease-medications-seized-at-border-1.3472905 Several Lyme patients advised us they had raised this issue with their federal MPs and that these MPs had reached out to the federal Health Minister to seek clarification. LymeHope has also been raising this issue as one of great concern in our discussions with Public Health Agency of Canada (“PHAC”). The good news is – on February 12, 2018, we met with Dr. Siddika Mithani, President of PHAC, and we discussed this issue with her. She assured us that there was no intentional policy change from Health Canada or PHAC on this topic, and this should not be happening as long as the requirements in the relevant Memorandum (set out below) are met. Dr. Mithani suggested that anyone who is faced with a message to the contrary at the border, should ask for the CBSA officer’s name, badge #, and note the date, time and border crossing. Please send this information to LymeHope at info@lymehope.ca and we will forward it to PHAC asking for clarification and possible solutions to enable Lyme patients to bring back properly prescribed and personal medications in accordance with the relevant laws. The background, excerpts of the relevant laws and some suggestions are outlined in detail below. Background: Here is an excerpt from one letter I received: “CBSA agent said that they had recently received notification that the regulations for bringing prescription drugs across the border into Canada had been updated, and Canadian residents can no longer bring ANY prescription drugs into Canada that have not been prescribed by a physician, and filled by a pharmacy inside Canada, and that all CBSA agents have been directed to seize all prescription drugs that have been prescribed by American physicians & filled by American pharmacies.” This is of great concern, as the majority of Lyme patients are unable to access testing, diagnosis, treatment or care in Canada, which requires those who can afford to do so, to travel to specialists in the U.S. and obtain their prescriptions there. Most of the medications prescribed for Lyme and Co-Infections are common antibiotics and other common drugs which are approved for use in Canada. Medications that are restricted (such as narcotics) may be subject to more stringent requirements. Relevant Legislation: Health Canada has responsibility for the importation of prescription drugs, over the counter medication (OTCs) and natural health products (NHPs). Canadian laws generally prohibit the importation of prescription drugs, with exceptions, including a specific exemption found in Memorandum D19-0-1, dated January 2017 (the “Memorandum”) for a personal supply of prescription drugs. The relevant sections of the Memorandum that pertain to personal supply of prescription drugs, NHPs and OTCs are quoted below. The Memorandum was updated in January 2017; however these particular provisions were unchanged from the 2014 version. Memorandum found here: https://www.cbsa-asfc.gc.ca/publications/dm-md/d19/d19-9-1-eng.html. "23. Health Canada may exercise enforcement discretion to permit a Canadian returning from abroad to bring with them, on their person, a single course of treatment or a 90-day supply based on the directions for use, whichever is less, of a prescription drug. This discretion is generally reserved for Canadian residents returning to Canada with prescription drugs which were dispensed for a treatment prior to leaving Canada, or drugs obtained through a filled prescription to treat an illness while abroad. 24. Prescription drugs imported in this fashion must be for the individual's personal use or the use of a person for whom they are responsible and with whom they are travelling. Additionally, all personal importations of prescription drugs must be packaged in the hospital, pharmacy dispensing or retail packaging, or have the original label affixed to it clearly indicating what the product is and what it contains. 25. The CBSA may detain and refer prescription drugs to Health Canada when these conditions are not met. 26. Canadian residents may not import prescription drugs by mail or courier. Personal Importation of Natural Health Products and Non-Prescription Drugs 31. Residents, non-residents and visitors to Canada can import for their own use or for a person under that individual's care a single course of treatment or a 90-day supply of natural health products and non-prescription drugs. The drug must be packaged in the hospital, pharmacy dispensing or retail packaging, or have the original label affixed to it clearly indicating what the product is and what it contains. 32. The CBSA may detain and refer natural health products and non-prescription drugs to Health Canada when these requirements are not met." Please note that s. 23 above contains a general discretion to allow a personal supply of prescription drugs with no conditions, and that s. 31 states you can bring in a personal supply of NHPs and non-prescription drugs (ie. OTCs) and discretion is not needed. Incorrect Information Being Relayed to Patients: We have been advised that some individuals within the Government and CBSA have erroneously relayed some incorrect messages, including the following: 1. that the purpose of the discretion in the Memorandum is to “allow for continued treatment without interruption while arrangement for treatment in Canada can be established as needed.” Note: there is nothing in the Memorandum that requires this as any part of the assessment of importation of personal medication. We also note that as a general principle, the only way for legislation to be “changed” is if it is done via the democratic process of legislative change in Government. Legislation cannot be substantively changed via “memo”, a “letter” or “directive”. 2. that the “discretion” is ONLY “to avoid interrupting a course of treatment that was required while abroad”. Note: please see s. 23 above. The general discretion is laid out in the first sentence with no absolute requirements attached to it. The second sentence indicates the discretion will be “generally reserved for” (but not exclusively for) “Canadian residents returning to Canada with prescription drugs which were dispensed for a treatment prior to leaving Canada, or drugs obtained through a filled prescription to treat an illness while abroad.” In our opinion, the phrase ‘drugs obtained through a filled prescription to treat an illness while abroad’ does not mean the illness must have been acquired abroad. We believe the correct interpretation of this includes a situation where the prescription is filled abroad (for the purpose of treating an illness), and does not require that the illness was acquired abroad. We note that section 7 of the Canadian Charter of Rights and Freedoms states "Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice." Canadian courts have interpreted section 7 to apply to medical / health care rights in certain contexts. You can read more about this on the Canadian Department of Justice website here: http://www.justice.gc.ca/eng/csj-sjc/charter-charte/check/art7.html Suggestions: If you are filling prescription drugs, or purchasing NHPs or OTC drugs while abroad in the U.S. or other country, for Lyme or any other medical condition, we suggest you take the following steps: 1. Print the Memorandum and highlight the relevant sections and bring it with you (https://www.cbsa-asfc.gc.ca/publications/dm-md/d19/d19-9-1-eng.html), 2. Ensure that your medication (or NHP or OTC) meets all the requirements set out in s. 24 & 31 above, i.e. in its original packaging etc. 3. Ask your international physician or health care provider to write a letter that states you are a patient, that he or she has prescribed / recommended the medication as being necessary or recommended for your health (it is not necessary to disclose your particular health issues in this letter), and includes a name and a phone number if the border guards wish more information on the nature of the medication, NHP or OTC. 4. If the border guard indicates they are unwilling to exercise their discretion to allow a personal supply of prescription drugs, or refuses to allow OTC or NHPs, ask them for the reason and record it along with the details of date, time, border crossing, CBSA’s agent’s name and badge number. If they state they have been given a "directive" or there is a "new policy", ask for a copy of such directive or policy (take a picture if you are not allowed to keep it). You could also ask to speak to a supervisor and note the details of that conversation as well. Being polite and respectful is often the most effective approach - the CBSA agents may (erroneously) believe they are required to seize and destroy medication. 5. If you have any issues, please report them to us at info@lymehope.ca so we can continue to track problems and share these incidents with PHAC who has committed to assist in resolving these incidents. We are very appreciative of Dr. Mithani’s engagement on this issue and her assistance in clarifying what seems to be a misunderstanding. Finally, as always, we encourage everyone to contact your current federal MP (regardless of party) and remind them your vote in the next election will depend on their commitment to meaningful change on the subject of Lyme disease in Canada. Find your federal MP here: http://www.ourcommons.ca/parliamentarians/en/constituencies/FindMP You can also do this at the Provincial level by googling “who is my provincial MPP or MLA”. As always, thank you for your continued support, With Hope, Sue Faber, RN & Jennifer Kravis, LL.B Co-Founders LymeHope www.lymehope.ca