According to a report by Lilit Arakelyan for the Institute of War and Peace reporting, there are tight controls around access to essential pain medication, with only liquid injectable morphine available. Methadone and oral morphine are not available at all.
Hrant Karapetyan, head of the Armenian Pain Control and Palliative Care Association, said that the regulation dose of morphine is enough to provide only eight hours of pain relief per day, leaving a high burden on the caregiver in the form of multiple visits to the dispensary.
Stephen Connor, palliative care consultant to the Open Society Foundations, notes that this over emphasis on control of medications to prevent their diversion for illicit use comes at a huge cost to the patients who need them for pain relief.
Speaking at a press conference earlier this year, he said: “It’s a question of balance. We need to have access for medical use and also to control the diversion of medications for illicit use,” pointing out that this diversion was highly unlikely to happen in the context of palliative care pain relief.
Dr Connor went on to explain that palliative care is not just about pain relief, but about social, psychological and spiritual issues as well.
A pilot project organised by the Global Fund to Fight AIDS, Tuberculosis and Malaria, together with the Open Society Institute and the Armenian Health Ministry, has been launched. Under this project patients receive methadone pills free of charge.
The pilot project was established two years ago to bring palliative care to three Armenian towns. Two schemes are running in Yerevan, and two more in Ararat and Vanadzor.
A few dozen patients are receiving treatment under the project, but experts say more than 3000 people need daily treatment, so Armenia would need 90 schemes of this kind rather than four, as well as new legislation allowing doctors to prescribe a greater range of medication, according to the report.
Anahit Papikyan, coordinator of the public health programme at the Open Society Foundation, said that Armenia has called for standards and laws that protect the rights of patients, doctors, and nurses, and provide guidance regarding dosage.
Dr Connor pointed to the importance of a multiple focus in implementing palliative care in Armenia. He said: “First, a policy of introducing palliative care to the healthcare sector is needed. Second, there is a lack of the principal medicines, specifically of morphine tablets. Third, specialists need to be trained.”
The Open Society Foundation has collaborated with the Armenian Ministry of Health to draw up a bill to present to the government this month. If the bill is approved, it will go before parliament in September.
Arakelyan reported that part of the plan would include the introduction of painkillers in tablet form. Suren Krmoyan, a senior official at the Ministry of Health, was reported as saying: “When we bring in this programme – which has already been introduced in many countries in the world – the first thing we must do is train the oncologists. We expect this training to include social and psychological elements, and we’re trialling it in our four pilot projects.”
Violeta Zopunyan, a lawyer involved in the draft of the legislation, was quoted, pointing to the difficulty in simplifying mechanisms for prescribing opiates, so that less supervision by the police would be required. She was reported as saying: “At the moment, there seems to be a belief that doctors or patients might sell these narcotics on the black market… Another major problem is that only oncologists can prescribe these drugs. However, other doctors also need to have these powers, including those working in mobile palliative care groups and family doctors.”
Reference:
Arakelyan, Lilit. (2013). Palliative Care Falls Short in Armenia. Institute for War and Peace Reporting. Issue 695 22 July 2013. Accessed online at http://iwpr.net/report-news/palliative-care-falls-short-armenia on 23 July 2013.
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