Analgesia of palliative patients: the right is there, availability is not

The problem of providing terminally ill patients with narcotic painkillers, which ease the suffering at the final stages of life of terminally ill patients, remains the most acute today. This was discussed during the press conference held as part of the World Day of Hospice and Palliative Care.

As Volodymyr Tymoshenko, Deputy Chairman of the "Ukrainian League for the Development of Palliative and Hospice Care" told, in 2013, the Cabinet of Ministers of Ukraine adopted Resolution No. 333, which legally significantly eased the situation with pain relief: it allowed the use of tablet morphine, prescribing drugs for 10 days, receiving them by proxy persons, etc. This should make pain relief more accessible. However, the problem of pain relief is not exclusively in the legal field. The state must ensure the conditions under which a person can exercise his right to pain relief in his life.

In Ukraine, palliative patients have received the right to pain relief, but do not have physical access to it. People continue to suffer because of the lack of painkillers in pharmacies. In many regions of Ukraine, the number of licensed pharmacies that have the right to sell narcotic painkillers ranges from 4 to 10 for the entire region. Very often, people who have a prescription are forced to travel 40-50 km to a pharmacy for painkillers.

The reason for the refusal of pharmacies to sell such drugs is the "draconian" requirements of the Ministry of Internal Affairs regarding licensing requirements. Changes to the order of the Ministry of Internal Affairs, which issues permits for obtaining licenses to pharmacies, should simplify the conditions for storing narcotic drugs. We will remind you that today, in order to sell narcotic painkillers, a pharmacy must have not only armored doors, double locks, bars on the windows and a safe, but also an alarm system. Therefore, small pharmacies in remote settlements refuse the opportunity to sell narcotics. "Unfortunately, medicine today has become a hostage of the fight against such a negative phenomenon called drug addiction. And the state followed the path of maximum prohibitions and restrictions. In fact, all our legislation was written from such an angle that law enforcement officials put doctors and drug users in the same row. So, doctors and pharmacists began to perceive the topic of pain relief as a threat to their freedom and life. And the hostages in this situation were the terminally ill, who are dying in agony. We need changes to the legal framework to help both doctors and patients," Tymoshenko said, adding that changes to the order of the Ministry of Internal Affairs have already been developed, but the public demands that the state respond to this issue sooner.

Unaffordability of pain relief

The pricing policy for painkillers for palliative patients is highly unregulated. The prices of the same drugs differ by 30%, 50%, and sometimes the "cheats" of pharmacies reach up to 500% of the selling price. In this way, pharmacies try to compensate for their expenses, which go to the storage and protection of narcotic drugs. In addition, Ukraine has a very limited list of appropriate drugs on the market. Despite the fact that the specialized ministry allows the use of painkillers in various forms - in tablets, plasters for children - however, many things are not produced in Ukraine and are not imported. Until today, the strict norms of control over narcotic drugs were such that it was extremely difficult to import and sell them. Currently, the Ministry of Health of Ukraine needs to act more actively in attracting such drugs to the market.

Quirky statistics or why are there not enough drugs?

A big problem for the country is   the lack of real statistics on the need for pain relief . Until today, the Ministry of Health collected applications from the regions about the need for narcotic drugs. Accordingly, the pharmaceutical industry, which purchases raw materials abroad, also ordered them in the amount determined by the regions. All information was accumulated by the State Drug Control Service, calculated the total need and submitted for approval by the CMU. After the government decree, the application was sent to the International Narcotics Control Committee, where Ukraine received a quota for the import of narcotic drugs and substances, which cannot be exceeded .

According to experts, the problem lies in the fact that regional health care departments often rely on the so-called "last year's needs". But in Ukraine, there was a stigma towards palliative patients, doctors were reluctant to prescribe narcotic painkillers, as they had to prove their necessity and keep strict reporting. Ukraine occupies the penultimate place in Europe in terms of consumption of painkillers (Macedonia is in last place). Patients still die in agony due to inhumane approaches in the health care system. Therefore, the main task for the state is to move away from unrealistic figures regarding the need for painkillers, to form real quotas so that various drugs are brought to the market in sufficient quantities, and to give people the opportunity to buy painkillers for their relatives at least with their own funds.