PatientsCann UK has raised urgent concerns with both the UK and Republic of Ireland (ROI) governments over the risks faced by patients prescribed medicines that are classified as Schedule 1 Controlled Drugs in one jurisdiction but legally prescribed in the other.
At present, a prescription issued in the UK, ROI or Crown Dependencies cannot be dispensed across the border if the medicine is considered Schedule 1. More critically, patients cannot lawfully carry these prescribed medicines across the border, even if the crossing is unavoidable in order to travel within their own country.
This issue disproportionately affects border communities, where travel across the border is not optional but a daily necessity.
- Drummully, Co. Monaghan (ROI) can practically only be accessed via roads through Northern Ireland. Patients prescribed treatment elsewhere in ROI must cross NI to return home.
- Teer, Co. Fermanagh (NI) is practically accessible only via ROI. Patients collecting prescriptions in NI must cross ROI to get home.
- Roads such as the N54/A3 frequently cross between ROI and NI, making it impractical or impossible for some patients to avoid travelling across the border.
For patients in these communities, this creates an impossible situation: return home with their prescribed treatment and risk criminalisation, or forego essential medication. Couriers and healthcare professionals delivering medicines face the same challenge.
Practical problems and risks
The current situation gives rise to multiple, connected harms:
- Disrupted continuity of care. Patients attending appointments, clinics or pharmacies within their own jurisdiction may be unable to return home with medicines they were lawfully prescribed, or may be forced to leave medication behind. This is particularly harmful for conditions that require uninterrupted dosing (e.g., epilepsy, severe chronic pain, some mental health conditions), where missed doses can lead to medical destabilisation, hospital attendance, or increased symptom burden.
- Risk of criminalisation and policing uncertainty. Patients are left unsure whether they will face enforcement action if stopped while carrying their legally prescribed medicine in a part of the neighbouring jurisdiction. This uncertainty can deter people from collecting or taking medication as prescribed. It also puts police officers and prosecutors in a difficult position where there is little practical guidance on how to treat such cases, increasing the risk of inconsistent enforcement.
- Logistical barriers for deliveries and pharmacies. Community pharmacies and authorised couriers that deliver prescriptions to patients, a vital service for many, especially elderly and disabled residents, may be legally unable to complete a delivery if the quickest or only route crosses the border. This increases delivery times and costs and may leave vulnerable patients without medicines for days, if they can access it at all.
- Increased travel time, cost and hardship. For many residents avoiding cross-border roads is not feasible: alternative routes can add many miles, time and cost, or may not exist. The financial and physical burden falls hardest on people with limited mobility, limited income, or those who rely on public transport with fixed routes that may make border crossings unavoidable.
- Clinical uncertainty for prescribers and health services. GPs, hospital consultants and pharmacists are left without clear operational guidance about how to advise patients or manage prescriptions that will require cross-border travel to return home. This can lead to inconsistent clinical decision-making that may deny patients access to the most appropriate treatments.
- Emergency and ambulance transfers. In emergency scenarios or when ambulance services must transfer patients across borders, there is potential for confusion over whether carrying or administering medication will expose patients or clinicians to legal risk. That uncertainty risks delaying care.
- Driving and fitness-to-drive consequences. Patients driving after receiving treatment risk being found with drug levels that exceed limits in the jurisdiction they briefly pass through. It is unclear whether such patients would have an adequate medical defence, even if they took medication exactly as prescribed by a clinician in their home jurisdiction. Who is most affected?
- Border pene-enclave residents (e.g., Drummully, Teer) for whom border crossing is unavoidable.
- Elderly, disabled and housebound patients who depend on delivered prescriptions or short local journeys.
- Patients with time-critical medication needs where missed or delayed doses cause immediate health deterioration.
- Carers, clinicians, couriers and pharmacists who carry or transport medicines on patients’ behalf.
- Rural communities with fewer services and longer or no alternative routes. System-level consequences
Beyond individual harm, the problem creates wider public-health and administrative issues: increased emergency presentations, greater strain on social care and inequitable access to treatment depending on postcode.
What PatientsCann UK is asking for
PatientsCann UK has written to the governments of the UK and the Republic of Ireland requesting urgent clarification and guidance, including:
- How patients carrying legally prescribed medication should be treated when transiting another jurisdiction.
- Patients, couriers and clinicians transporting legally prescribed medicines on necessary cross-border journeys.
- Guidance on driving law clarifying whether patients who take their medicine as prescribed have a medical defence if found with drug levels above a neighbouring jurisdiction’s limits.
The Northern Ireland Office has confirmed that officials are reviewing our letter. PatientsCann UK welcomes this development and will continue to press for clear, rapid action to protect patients who rely on any prescribed medicine.
Sal Aziz, Director of PatientsCann UK, said:
“Patients should never have to choose between taking their prescribed medicine and risking criminalisation. In practice this is what border communities on the island of Ireland face today. Governments must issue clear operational guidance and protections, urgently, so patients can continue to receive care without fear.”
What happens next
PatientsCann UK will publish updates as official responses are received. In the meantime, anyone affected by this issue is encouraged to contact PatientsCann UK so we can collate evidence and ensure our representations fully reflect the scale and immediacy of the problem. Please email info@patientscann.org.uk or send us a message on socials (Instagram | X).