The short version
- 46 USC 11102 requires a medicine chest. It sits in the US Code, not in 46 CFR, which is why operators cannot find it.
- There is no tonnage threshold on the foreign voyage limb. The 75 gross ton floor applies only to Atlantic to Pacific voyages.
- The penalty runs against the owner and the master. 33 CFR 27.3 puts the 2025 adjusted maximum at $1,562, not the $500 in the statute.
- No CFR contents list exists for the fleet the statute covers.
- Once anything in the chest is scheduled, 21 CFR 1301.25 attaches and that regime is written in full detail.
The medicine chest mandate is not in 46 CFR. It is in the US Code
Operators search Title 46 of the CFR for the rule that makes a medicine chest compulsory and come back convinced there is not one. They are looking in the wrong book.
46 U.S.C. 11102(a), Medicine chests, complete text
“A vessel of the United States on a voyage from a port in the United States to a foreign port (except to a Canadian port), and a vessel of the United States of at least 75 gross tons as measured under section 14502 of this title, or an alternate tonnage measured under section 14302 of this title as prescribed by the Secretary under section 14104 of this title on a voyage between a port of the United States on the Atlantic Ocean and Pacific Ocean, shall be provided with a medicine chest.”[1]
Read the two limbs separately, because the difference decides whether the statute reaches you.
There is no tonnage floor on the foreign voyage limb
The 75 gross ton threshold attaches only to the second limb, the Atlantic to Pacific intercoastal voyage. The first limb, a US vessel sailing from a US port to a foreign port other than Canada, carries no size qualifier at all.[1][2]
| Voyage | Tonnage threshold | Medicine chest required? |
|---|---|---|
| US port to a foreign port, other than Canada | None stated[1] | Yes, on any US vessel |
| US Atlantic port to US Pacific port | At least 75 gross tons[1] | Yes, above the threshold |
| US port to a Canadian port | Expressly excepted[1] | Not under this section |
| Domestic coastwise, same coast | Out of scope | Not under this section. Class rules may still apply |
A small US flag vessel clearing for a foreign port is inside the statute. A much larger vessel running Seattle to Alaska is not, which is why the Alaska fleet and the wider fishing fleet answer to 46 CFR 28.210 instead.
The penalty is not $500, and it lands on the master personally
Subsection (b) reads: the owner and master of a vessel not equipped as required by subsection (a) or a regulation prescribed under subsection (a) are liable to the United States Government for a civil penalty of $500. If the offense was due to the fault of the owner, a master penalized under this section has the right to recover the penalty and costs from the owner.[1]
The $500 in the statute is the 1983 figure. Under the Federal Civil Penalties Inflation Adjustment Act, the Coast Guard publishes the live number in 33 CFR 27.3.
The number that actually applies
Table 1 to 33 CFR 27.3 lists 46 U.S.C. 11102(b), Medicine Chests on Vessels, at a 2025 adjusted maximum penalty of $1,562, applicable to assessments issued after 29 December 2025 for violations occurring after 2 November 2015.[3]
Nothing similar attaches to an uninspected vessel trading domestically, which is the comparison most operators need and never get.
Two details operators miss. The penalty runs against the owner and the master, not the company alone, and the master’s only relief is a statutory right of recovery against the owner after the fact.[1] Second, the neighbouring row for 46 U.S.C. 11101(f), accommodations for seamen, carries the identical $1,562.[3][4]
A duty with a penalty and no contents list
Subsection (b) penalises failure to comply with subsection (a) or a regulation prescribed under subsection (a).[1] So what is the regulation, and what is in the chest?
There is no contents list in the CFR that answers the question for the fleet the statute covers.
- 46 CFR subpart 160.041, the old approved first aid kit standard, was removed and reserved in 2022.[5] It is empty.
- 46 CFR 28.210 names a first aid kit and a medicine chest, but only for commercial fishing industry vessels, and it publishes no contents list either.[6]
- 46 CFR 199.175(b)(10) specifies a kit, but it is the survival craft kit, limited to over-the-counter actives, and it is not the ship’s chest.[7]
The result is a federal duty, backed by a civil penalty against a named individual, with no federal answer to the only question that matters: what goes in it.
What actually fills the gap, in order of authority
Where the CFR is silent, the defensible position is built from documents that exist rather than a document that does not. This is the order our ship medical chest management service works in.
| Source | Status for a US vessel | What it gives you |
|---|---|---|
| 46 U.S.C. 11102 | Binding statute, $1,562 penalty[1][3] | The duty. Nothing about contents |
| MLC 2006, Standard A4.1 | Binding through the flag on internationally trading ships[8] | A chest, medical equipment and a guide, plus inspection intervals |
| WHO International Medical Guide for Ships, 3rd edition | Guidance, not law[9] | The working contents list the industry actually uses |
| FDA CPG 460.500 | Agency compliance policy[10] | The US drug-law overlay on shipboard chests |
| 21 CFR 1301.25 | Binding once anything is scheduled[11] | Who may hold controlled drugs aboard |
The flag layer is the one that moves. Flag state chest rules sets out how far apart the registers are, and fleets that change flag inherit a new contents standard while 46 U.S.C. 11102 stays attached to the US registry.
The moment the chest stops being a stores question
A chest built to the WHO guide will contain prescription medicines, and it may contain scheduled ones. At that point a second federal regime attaches to the same box.
21 CFR 1301.25 requires either a DEA registered medical officer employed by the owner or operator, or the master requisition route, and it brings recordkeeping, inspection readiness, annual reporting and disposal with it.[11] Our controlled substances service exists because that regime, unlike 46 U.S.C. 11102, is written in detail and enforced.
The asymmetry is the point. The statute that requires the chest says nothing about its contents. The statute that governs a subset of the contents is exhaustive. Programmes fail in the space between them, which is what programme setup is for.
Six checks against 46 U.S.C. 11102
- Decide which limb reaches each vessel. Foreign voyage other than Canada, no tonnage floor. Atlantic to Pacific, 75 gross tons.[1]
- Name the master in the compliance record. The penalty runs against owner and master jointly.[1]
- Write your own contents standard and cite what it is built from, because the CFR will not supply one.[9]
- Separate the survival craft kits from the chest. Different rule, different clock, over-the-counter actives only.[7]
- Screen the list for scheduled drugs before purchase and route those through 21 CFR 1301.25.[11]
- Decide who owns the duty ashore. The owner and DPA split decides who answers for the chest when the master changes.
- Diary the inspection. The MLC interval is the practical one, and it is what an audit will look for.[8]
Discovery Health MD is led by Ann Jarris MD, MBA, FACEP, a board certified emergency physician. Programme frame in planning by time to definitive care. Writing a contents standard a US operator can defend when the federal rulebook supplies none is exactly the work. Speak to the team.
Common questions
Is a medicine chest legally required on a US vessel?
Yes, by statute rather than by regulation. 46 U.S.C. 11102(a) provides that a vessel of the United States on a voyage from a port in the United States to a foreign port, except to a Canadian port, and a vessel of the United States of at least 75 gross tons on a voyage between a US Atlantic port and a US Pacific port, shall be provided with a medicine chest[1]. Operators searching 46 CFR for the mandate do not find it because it sits in the US Code, not the Code of Federal Regulations.
Does the 75 gross ton threshold apply to foreign voyages?
No. The tonnage qualifier in 46 U.S.C. 11102(a) attaches only to the intercoastal limb, a voyage between a US port on the Atlantic Ocean and a US port on the Pacific Ocean[1][2]. The foreign voyage limb states no size threshold, so a small US flag vessel clearing for a foreign port other than Canada is inside the statute while a larger vessel trading domestically on one coast is not.
What is the penalty for not carrying a medicine chest?
The statute says $500, but the enforceable figure is higher. 46 U.S.C. 11102(b) makes the owner and master liable for a civil penalty of $500, and gives a penalised master the right to recover the penalty and costs from the owner where the offense was the owner’s fault[1]. Table 1 to 33 CFR 27.3 lists the inflation-adjusted amount for 46 U.S.C. 11102(b), Medicine Chests on Vessels, at a 2025 adjusted maximum of $1,562 for assessments issued after 29 December 2025[3].
Does the master face the penalty personally?
Yes. 46 U.S.C. 11102(b) names the owner and master together as liable to the United States Government[1]. The master’s protection is not a defence but a right of recovery after payment, available only where the offense was due to the fault of the owner. Naming the master in the compliance record, and dating it, is the practical response.
What has to be inside the medicine chest under US law?
No federal contents list exists for the fleet the statute covers. 46 CFR subpart 160.041 was removed and reserved in 2022[5], 46 CFR 28.210 applies only to commercial fishing industry vessels and publishes no contents list[6], and 46 CFR 199.175(b)(10) governs the survival craft kit and limits it to over-the-counter actives[7]. The working standard is the WHO International Medical Guide for Ships, third edition[9], with MLC 2006 Standard A4.1 binding through the flag[8] and FDA CPG 460.500 supplying the US drug-law overlay[10].
Is the medicine chest the same as the lifeboat first aid kit?
No, and conflating them causes real failures. The survival craft kit is specified by 46 CFR 199.175(b)(10), which limits medicinal active ingredients to those conforming to the over-the-counter drug regulations in 21 CFR part 330[7]. The ship’s medicine chest under 46 U.S.C. 11102 has no such limit and routinely contains prescription medicines. They expire on separate clocks and are inspected by different people.
When does DEA registration become part of the chest question?
As soon as anything in the chest is a controlled substance. 21 CFR 1301.25 requires either a DEA registered medical officer employed by the owner or operator of the vessel, or the master requisition route, and it carries recordkeeping, annual reporting and disposal duties with it[11]. Unlike 46 U.S.C. 11102, that regime is written in detail. Screen the contents list for scheduled drugs before purchase, not after delivery.
