Terminally Ill to Gain Easier Access to Drugs
Published: May 8, 2013 (Issue # 1758)
For cancer patients in Russia, who may be gravely ill or in severe pain, getting medication to relieve the agony often turns into a bureaucratic nightmare.
Gaining access to these drugs involves collecting official stamps and signatures from a number of doctors, which can take several days. And at the end of all this effort, the dosage the patient is allowed may be insufficient to treat the level of pain.
Now, however, the Federal Drug Control Service wants the authorities to have mercy on cancer patients. The director of the agency, Viktor Ivanov, has suggested the government relax the strict regulations, which are intended to thwart drug abuse and trafficking but end up limiting the supply of analgesics for needy patients.
Russian oncologists look back with nostalgia to the Soviet era, when doctors had the same freedom to prescribe strong painkillers, including morphine, to cancer sufferers as they had to prescribe any other medications. But in the last 20 years all that has changed, to the dismay of Alexei Barchuk, St. Petersburg’s chief oncologist.
“Now the drugs officers see us all as potential drug couriers, which is not only absurd and unfair but also damaging for patients, many of whom are deprived of a peaceful farewell,” Barchuk said at a roundtable on the accessibility of palliative care.
In St. Petersburg, drug controls make it impossible for the 20 ambulance crews serving homebound, terminally ill patients to administer morphine or other strong painkillers. Doctors have to make do with whatever is available, including tranquilizers.
Oncologists and doctors who work with ambulance crews agree that the fear of drug addiction results in what Barchuk called “an ugly and cruel approach to the patients.”
In a recent incident, drug control officers forbade a hospital in the far eastern Kamchatka region to store painkillers on the premises because its drug safe was not bolted to the floor. Patients at the hospital were deprived of these medicines for two weeks.
Even when a patient receives a prescription, there is no guarantee that he or she will actually get the medicine. To begin with, security concerns mean that few pharmacies are willing to run the risk of holding these drugs on site. They are worried that if a robbery were to take place, drug-enforcement officers may well give the pharmacists a very hard time. And if the drug enforcement agency rules that security measures are insufficient, the consequences for the business could include fines, dismissals or even prison time for the employees.
As a result, people living in outlying villages may have to travel many miles to find a pharmacy that has the medications prescribed to them. Reports often come in that cancer patients in some parts of Russia are unable to get access to palliative drugs.
Even in the bigger towns and cities there is the problem of insufficient stock. A patient may arrive at a pharmacy — after calling and being told that it has the drug — only to find that it has just run out.
This distorted control system is driving some relatives of terminally ill patients to extreme measures, to the point where even notorious anti-drug crusader Yevgeny Roizman is calling for change.
Roizman, the founder of a drug-abuse center known for its harsh treatment methods, recalled the story of one man whose wife was dying of cancer. She was in “excruciating pain,” he said, and her husband “was even driven to start hunting for heroin, because her dosage was too small, and there was no legal way to increase it.”
Ivanov, for his part, has not said how the restrictions will be eased: There has been no official word, for instance, on whether doctors will be able to prescribe higher doses of painkillers.
“I suggest that Russia employ the same standards and regulations that have already been adopted by the developed countries,” Ivanov told Rossiyskaya Gazeta, a state-sponsored newspaper. “Our people should be able to receive all the necessary painkillers. We need to be reasonable. If medications are not stored in large quantities, then there is no need to introduce harsh control measures.”
That sounds like a significant concession, but considering that his agency has blocked a more lenient regime by working under the shaky assumption that patients want to sell the drugs rather than take them, it will likely take an attitudinal change to achieve real reform.
“According to the worst estimates, no more than five percent of doctors — whatever the circumstances — are likely to abuse the regulations and, say, sell powerful drugs on the black market,” Barchuk said. “Indeed, it’s easier to pressure the doctors than to hunt down the real enemy: those who make dangerous drugs, smuggle them into the country, and build clandestine networks.”
The only reliable way to ease the suffering of cancer patients, especially in the final stages of the illness, is to allow doctors to prescribe painkillers solely on the basis of need.
This column first appeared on Transitions Online, an award-winning analytical online magazine covering Eastern Europe and CIS countries, available at www.tol.org.