Olga Usenko is an affiliate of the Central and Eastern Europe Palliative Care Task Force; she is part of a group of committed people whose efforts to improve access to essential medicines in Russia are gradually changing the minds of government and policy-makers.
The suicide of Admiral Vyacheslav Apanasenko on 7 February 2014 touched the hearts of many people in Russia and across the world. The admiral suffered from terminal cancer. His wife could not collect all the necessary signatures to get a prescription for morphine before the local polyclinic closed. In a suicide note, the admiral wrote: “I do not want to blame anyone but the Ministry of Health and the Government.” The admiral’s death triggered widespread media coverage and efforts from palliative care workers and advocates in Russia to change the regulations. On 22 April, their efforts were rewarded when the Russian Government issued orders to the Ministry of Health and other government departments to develop and implement measures ensuring adequate pain control for patients in Russia.
For the first time, Vladimir Putin, President of the Russian Federation, expressed his opinion concerning pain relief to a media forum in St Petersburg on 24 April, 2014. Acknowledging his awareness of the interagency battle between the Ministry of Health and the Federal Drug Control Service for prescription of narcotic drugs, Putin said, “…of course, their dialogue, fighting for their views about what to do and how to do [it] is important, but people should not suffer, especially the seriously ill.”
The Russian Federal Service for Drug Control exerts tight control over the legal manufacture and distribution of narcotic drugs while Ministry of Health regulations concerning prescription, storage and disposal of narcotic analgesics make it very difficult for doctors and their patients to access essential medicines. The main task of ministry officials is to prevent illegal trafficking of narcotic drugs and they are not concerned about the quality of life of patients who are suffering from pain. Insufficient knowledge of pain management, overly restrictive regulations and the fear of criminal liability all result in a reluctance on the part of physicians to prescribe opioids to their patients. Thus, an entire generation of young physicians, indifferent to patients’ pain and suffering, has grown up in Russia. It’s easier for them to ignore tedious, dangerous, and time-consuming procedures to prescribe narcotic drugs rather than risk criminal liability and fulfil their professional duty to their patients.
The Russian Ministry of Health did not take responsibility for its role in the admiral’s death, insisting that regulations for the prescription of narcotic drugs were optimal and that the only problem was the poor work habits of physicians at local polyclinics and hospitals. Nevertheless, Veronika Skvortsova, the Minister of Health, requested a review of provision of narcotic drugs to patients throughout the country.
On 18 February 2014, Mr Nikolay Gerasimenko, Deputy Chairman of the Health Committee in the State Duma, proposed to amend the laws covering narcotic drugs, and argued “… patients who are in need of pain relief need priority access to narcotic drugs.”
On 4 March 2014, during a hearing at the Public Chamber of the Russian Federation, experts in palliative care stated that the problem of inadequate pain management in Russia was systemic. Complex problems in this area actually lead to violations of the constitutional rights of Russian citizens concerning health care and medical assistance (Article 41), on personal dignity, and freedom from torture (Article 21). After the hearings, recommendations were developed to improve pain management and were then submitted to the government.
Are you coming to Lleida?
See you at the 8th EAPC World Research Congress in Lleida, Spain. 5-7 June 2014. Follow us on Twitter @EAPCOnlus – our official congress hashtag is #eapc2014
Vă așteptăm la cel de-al 8-lea Congres Mondial de Cercetare al EAPC în Leida, Spania, 5 – 7 Iunie 2014. Urmăriți-ne pe Twitter @EAPCOnlus – hashtag-ul oficial al congresului este #eapc2014