Duration Health

Suffering a medical emergency while traveling is a scary experience, especially when far from home and definitive medical care. For those who travel remotely, I recommend taking a wilderness first aid course and bringing an activity-specific first aid kit capable of handling the first 24 hours of accident or illness.

But, what if your travels take you far from medical care, or perhaps through a region that does not have any medical care at all? In these instances, traveling with a medical kit which contains life-saving prescription pharmaceuticals may be the fine line between life and death. Knowing what to include, however, can be confusing and logistically difficult. Unless your family physician has advanced training or experience in travel, wilderness, and emergency medicine, prescribing medications for this type of application may simply be out of his or her wheelhouse. For travelers who desire this level of preparedness, Duration Health may have just what the doctor ordered.

Duration Health

Duration Health is an online company that specializes in customized prescription drug go-bags for travelers and those who take preparedness seriously. The included pharmaceuticals are the same drugs you might receive when discharged from an urgent care or emergency department PLUS prophylactic medications to help you prevent conditions like malaria or altitude illness. These medical go-bags are an excellent adjunct to a well-stocked first aid kit, and I recommend the combination be carried by all who travel remotely.

The Kit

The process of acquiring a kit begins with a visit to Duration Health’s website, durationhealth.com. Here, you purchase the kit for $349 by using a credit card, a Flexible Spending Account, or a Health Savings Account (pre-tax accounts used to pay for healthcare-related expenses). Necessary paperwork will then arrive by email, and you’ll need to sign and return a “consent to treat” form just like you would at a physician’s office. You schedule an online medical interview with a physician (typically an emergency medicine physician with experience in travel medicine), and during this visit, you will discuss your medical history, current medications, allergies, and your specific travel plans. The more detail and honesty you bring to the interview, the more customized your kit will be. For example, the recommendations for malaria prophylaxis vary depending on where in the world you will travel; those with a history of life-threatening allergies might choose to include an Epi-Pen and steroids, and females may want to include Plan B or a pregnancy test. If you and the consulting physician decide to add or remove certain medications, the kit’s price will be adjusted accordingly, and you’ll be asked to pay the difference or receive a refund.

By partnering with a licensed mail order pharmacy certified by the National Association of Boards of Pharmacy, the prescriptions are filled electronically and shipped to your door for no extra charge. Prescriptions can also be sent to your local pharmacy and picked up there if more convenient. Bottles are labeled in accordance with travel recommendations from The Centers for Disease Control and the US State Department, including your name, birthdate, the generic name of the medication, indications, dosage, etc. The published shelf life of most medications is about a year, but studies have shown that some will maintain their efficacy and safety for much longer than this. Duration Health will help you return unused medications by mail if necessary, and they recommend you return the medications once they have expired.

The medications are organized in a bright orange zipper bag which contains a spiral-bound paperback copy of The Duration Health Field Guide, covering all 69 of the potentially included items. Most of the bottles will contain one treatment course of the medication, i.e., one course of antibiotic pills (about a week’s worth), but some medications like malaria prophylaxis would obviously contain an appropriately long course depending on travel plans.

Legal Points

Mail-order pharmaceuticals are perfectly legal, but it’s important to note a few pertinent points. Prescription drugs must be prescribed by a physician licensed in your home state, and Duration Health has physicians licensed in 48 states but not in other countries. The medications themselves must be dispensed by a licensed pharmacy, and any profit from the drugs themselves is passed on to either the mail order pharmacy or your local pharmacy. Controlled substances such as narcotics or benzodiazepines are another issue, and they cannot be included in the kit. Travel with these medications is governed by the International Narcotics Control Board (INCB) (incb.org). A visit to their website can provide country-specific regulations for travelers needing more information on this topic. Prescription drugs are intended for a single individual only, so each person desiring to obtain a kit must have a face-to-face conversation with the prescribing physician. Although medications are not to be shared amongst a group or even between a family or couple traveling together, Duration Health will work with your group to ensure everyone has access to a personalized kit.

All of the included medications are for acute conditions or prophylaxis of travel-related conditions, and they’re intended for healthy adult travelers, not those with multiple chronic conditions. Duration Health does not supply refills of medications prescribed by your regular physician, like those used for high blood pressure or depression. Traveling with an extended supply of your regular medications is recommended by nearly all travel experts, and a routine visit to your regular doctor can accomplish this task and serve as a good time to update vaccinations if needed.

Medication Stewardship

The prophylactic prescription of antibiotics is a serious issue and deserves some attention. When antibiotics are irresponsibly taken for things which do not respond to antibiotics, like coughs, colds, sore throats, etc., we all lose because it contributes to antibiotic resistance in addition to unnecessary side effects like diarrhea, rashes, and allergic reactions. None of the antibiotics prescribed by Duration Health are intended to treat viral upper respiratory conditions like the common cold, bronchitis, flu, sore throats, or even Covid-19. These kits, especially the antibiotics, are intended for use in true emergencies only, in a last resort scenario where there is no access to a doctor or medical care of any kind for a prolonged period of time. In these instances, the benefits of taking an antibiotic may outweigh the risks, and these scenarios should be discussed ahead of time during the medical interview with your Duration Health physician.

Experiencing the unknown is part of the allure of adventure travel, and while it’s simply not practical to carry a tool or medication for every obstacle along the way, preparedness and the ability to improvise a solution should be part of every traveler’s tool kit. Fortunately, accidents happen infrequently, and most illnesses and injuries can be addressed with the knowledge obtained in a wilderness first aid course and the tools available in a quality first aid kit. But, for those who take travel and adventure seriously, and for those who intend to travel to areas where there is no medical care, the addition of a well-thought-out travel pharmacy can definitely be worth the effort, cost, and space.

Special offer for Expedition Portal readers: Use the code OVRLND at checkout and get $50 off your Duration Health Med Kit.

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Jon S. Solberg, MD, FAWM, FACEP, is a military- trained, board certified emergency medicine physician; he is a Fellow in the Academy of Wilderness Medicine with a diploma in mountain medicine. His medical exploits have taken him to a jungle hospital in Cameroon, a combat zone field hospital in southern Afghanistan, and across Greenland as the medical officer for the first longitudinal crossing by motor vehicle, to 82.5°N. Passionate about community involvement and education, he teaches wilderness medicine courses, provides direction for EMS, fire departments, and search and rescue groups, and mentors medical students and resident physicians as the Chairman for the Department of Emergency Medicine at the University of North Dakota. He and his wife, Agnieszka, enjoy exploring the backcountry in their Power Wagon and Maule M-5 bush plane.