The first shipment of the medication is being stored at the importer’s warehouse in Bishkek awaiting testing, which normally takes three weeks.
Once the testing is completed, the tablets will be available to those pharmacies, clinics, and hospitals qualified and wishing to purchase it.
If there are no problems with the testing, this essential pain relieving medication could become available to doctors to prescribe and for patients to use in a month’s time.
In Kyrgyzstan, pharmacies need to have a contract with the mandatory health insurance plan to be able to purchase morphine and to dispense it. They also need a license to dispense morphine from the Ministry of Health. For patients with stage IV cancer morphine is covered by the health insurance plan with only a very small co-pay.
Bureaucracy surrounding stocking, prescribing and dispensing opioid medications make it difficult for pharmacies to renew their licences to provide morphine. However, it is hoped that these barriers will be addressed in the near future.
A government decree on opioid prescribing is being developed that will address changes including:
- treating, duty and emergency doctors will be included in those allowed to prescribe morphine and other opioid medications
- allowing nurses as well as doctors to give injections and to administer oral morphine
- allowing unused tablets or liquid to be returned to pharmacy to be either reused or destroyed
- allowing hospital doctors to prescribe sufficient morphine for patients going home until they can be registered at their local Family Medicine Center
- allowing patients with pain of 4-10 on the visual analogue scale or numeric rating scale to receive a prescription for morphine
- eliminating the requirement that prescriptions for morphine must be signed and stamped by the head of the health organization
- changing the limit on amount of morphine per prescription from 20 ampoules to 60 vials.
Stephen Connor, Open Societies Foundation consultant and Senior Fellow to the Worldwide Hospice Palliative Care Alliance, met with the State Agency on Drug Control to discuss plans for roll out of oral morphine tablets and the prevention of misuse.
Going forward, work needs to be done to facilitate the distribution of oral morphine tablets, including training prescribers, amending national drug policy and strengthening the distribution network.
However, the registering of oral morphine tablets is a great step forward for pain relief in Kyrgyzstan.