The article, Russia’s war on drugs leaves patients without pain relief, by Fiona Clark, acknowledges the recent change in legislation which simplifies the process of obtaining this essential pain relief, but argues that much more needs to be done before Russia’s population has adequate access.
The author points to the series of at least 40 suicides relating to inadequate pain relief, and the risk of audit and criminal prosecution that doctors face upon prescribing opioids for pain relief.
Dr Clark details the process by which terminally ill patients are required to access pain relief in Russia: “Every 5 days, the patient must go to the general practitioner (GP) who will refer them to an oncologist. Since there is a shortage of oncologists, the patient or their representative will then queue with a roomful of people who are terminally ill and if he or she manages to make it in to a consultation before closing time the oncologist will hopefully agree that pain management is required and send them back to the GP with a note of permission for the GP to write a prescription.
“The GP will write the script but must get the head of the clinic to sign off on it as well. If the patient is in a hospital, the oncologist and head of the department must sign the script. It is only valid at one particular pharmacy and if it is out of stock they will miss out. If they fail to return the packaging or used fentanyl patches, the new script will not be dispensed. The script only covers a 5 day supply so every 5 days the process begins again.”
The recent changes to the law have increased the length of the prescription from five to 15 days, and reduced the number of signatures needed to only one. However, argues Dr Clark, this will not make a dramatic difference for patients.
It is also significant that only oncologists can prescribe opioids, meaning that there can be no access for non-cancer patients.
The article concludes by noting that Russia checks all the boxes according to Human Rights Watch’s barriers to accessing pain relief:
- failure of governments to create a functioning drug supply system
- failure to enact policies on pain treatment and palliative care
- poor training of healthcare workers
- the existence of unnecessarily restrictive drug control regulations and practices
- fear among healthcare workers of legal sanctions for legitimate medical practice; and
- the high cost of pain treatment.
Read the full article on The Lancet website.
Access the Human Rights Watch report: ‘Access to pain treatment as a human right’ online.
This article first appeared on the International edition of ehospice and is republished with permission.