On 21 October, a Siberian District Court acquitted Dr Alevtina Khorinyak of criminal charges over prescribing pain medication to a dying family friend who was not her patient. The ruling came after the Russian Court of Appeals had overturned the conviction of Dr Khorinyak in September 2013 and ordered a re-trial with a new panel of judges. Adri Nieuwhof, Human Rights Advocate, The Netherlands, reports.
Dr Khorinyak wrote two tramadol prescriptions after she saw Victor Sechin suffering from unbearable pain in 2009. Sechin was denied adequate pain treatment for 11 days because the free, state-subsidised tramadol he needed was out of stock at his pharmacy. In order to buy the tramadol tablets in another pharmacy he needed a prescription. Sechin’s general practitioner refused to write the prescription.
The Russian Federal Drug Control Service noticed Dr Khorinyak’s prescriptions during a 2011 audit in the local pharmacy. For obscure reasons, the case was referred to the state prosecutor who brought the case to court. Dr Khorinyak was found guilty of “forgery of documents in order to facilitate the commission of another crime” and “trafficking potent substances in large quantities by prior agreement with the intent to sell as an organized group” in May 2013.
Dr Khorinyak did not expect to be treated like a “drugs baron”, she told the Siberian Times.
“To look at a human suffering, knowing that you can help and not do anything, is just wrong. I am a doctor. I swore to help people.”
Dr Khorinyak’s conviction received international attention and Russian journalists started to report about her case. “It created a debate around the issue,” says Olga Usenko, a Russian doctor specialising in palliative care and activist for patients’ rights. Dr Khorinyak’s acquittal is “absolutely unusual”, she adds. In Russia, people who are charged are seldom acquitted by the Courts.
The World Health Organization does not recommend controlling tramadol as a drug, and neither is it included in the international drug control conventions. But the Russian Federal Drug Control Service added tramadol to a list of potent drugs. Until 2008, the medicine was available to anyone in Russia over the counter without a prescription. Regulations on medical use of controlled substances in Russia are “overly bureaucratic and excessively onerous”, according to Human Rights Watch. They interfere with proper prescribing and with the ability of patients to access these medicines.
It is difficult to reconcile the Russian drug watchdog’s decisions with its legal obligations. For example, the Russian constitution explicitly mentions that “everyone shall have the right to health care and medical assistance. Medical assistance shall be made available by state and municipal health care institutions to citizens free of charge.” As a government body, the drug control authorities are subject to the Constitution. To control tramadol as a drug and to inform the state prosecutor about Dr Khorinyak’s case to write two tramadol prescriptions to a patient with unbearable pain is conflicting with this constitutional right.
Russia has signed and ratified the UN Convention against torture. Victor Sechin’s suffering due to state obstacles in providing adequate pain treatment amounts at least to ill-treatment. States have the obligation to regulate, control and supervise healthcare practices in order to prevent denial of pain treatment, according to the UN Special Rapporteur on torture.
Dr Khorinyak’s case does not stand on its own. After her sentencing, colleagues and patients from all over Russia called her and spoke about similar situations in other regions. For example, Admiral Vyacheslav Apanasenko who, denied adequate pain relief, shot himself because he could not stand the suffering of his family. 1
Discussing efforts to improve palliative care in Russia in a recent interview, Olga Usenko said that adequate pain management is an essential human right and controlled drugs are absolutely necessary for medical and research purposes. Changes to the law on narcotic drugs therefore are badly needed. 2
- Olga Usenko, Russian Tragedy: To the blessed memory of Admiral Vyacheslav Apanasenko.
- EJPC Palliative Care Policy Development Award: An interview with the 2014 winner, Olga Usenko. European Journal of Palliative Care 2014; (vol. 21.5): (225-227).
- In its Prague Charter, the EAPC advocates for the right to palliative care. Palliative care includes access to pain medication. Please sign the charter now!
- You can read other posts on this subject by Adri Nieuwhof and Dr Olga Usenko on the EAPC blog
- Read more about Dr Khorinyak’s trial and acquittal on ehospice.