In the absence of any form of oral morphine, delivery of quality palliative care is close to impossible – this was frequently discussed during trainings for health providers working in hospices and palliative care units across Ukraine. Ukrainian NGOs joined Human Rights Watch in documenting patients’ stories of lack or absence of pain management for terminally ill patients.
Rather early it became clear that there was only injectable form of morphine available in the country. Without hesitation, IRF and activists from human rights organizations approached a pharmaceutical company producing injectable morphine asking if they would consider starting production of oral morphine. While the development of the drug is expensive and lengthy, and licensing of the production line and control procedures are overly strict and commercial interest is rather low, it still seemed logical that the producer of injectable morphine could do it. However, after almost a year of advocacy, this producer said no.
The International Palliative Care Initiative (IPCI) team from the Open Society Foundation linked us with the Pain and Policy Studies Group, the Union for International Cancer Control, the Worldwide Palliative Care Alliance and the European Association for Palliative Care and many other experts to provide us with resources and contacts to build strong arguments for making oral morphine available in the country.
The Stop Pain Campaign was launched in late 2011 to demonstrate the need for adequate pain control, and oral morphine became its centrepiece with a pill-shaped logo. Round-table discussions, petitions and open letters to the President, Prime-Minister, his Cabinet and Ministry of Health, support groups for patients and family members who dealt with pain across the country, famous and ordinary people – all were mobilized to talk about the access to pain management and oral morphine in particular.
Meanwhile, professionals working in palliative care, activists, and religious groups established the League for Palliative and Hospice Care in Ukraine that united to advocate for quality palliative care services for every patient who needs them.
The former Minister of Health, Dr. Vasyl Knjazevych was elected as a Chairman of the Board and shortly after his appointment he joined the active search for an alternative supplier of oral morphine outside and inside the country.
In one of his business trips to Odessa he set up a meeting with local pharmaceutical company “Interchem,” a Ukrainian-Belgian enterprise that specializes in the production of a wide range of controlled medications.
It never takes long to persuade a visionary person, who can see the perspective even on a grey day. On December 2011, at the official meeting at Ministry of Health, the executive director of Interchem announced that they would be willing to initiate drug development process. Shortly after, in late spring 2012, the IRF team joined the League for a second visit to Interchem to discuss the strategy of how to make oral morphine available for the patients in the country.
We visited the production facilities and met key team members at Interchem. Possible ways to collaborate were discussed, and visitors were assertive in asking that locally produced morphine should be of a good quality, effective and reasonably priced to ensure its affordability.
In October 2012, Interchem supported the First National Congress on Palliative Care and announced that documents are almost ready to be submitted to the registration authorities. There were not only supporters to speed up the registration process, there were also people in high cabinets who were suggesting that morphine should only be used in the injectable form, and that making oral morphine available would only be making more accessible to drug users and there would be no benefit to the patients. There were people who were hesitant about the dosages and the prescription mechanisms; there were recommendations that there should be clinical trials.
As the team of supporters of oral morphine was growing, the opposition team was shrinking. Media attention, strong pressure from human rights activists, the professional community and support from key people at the Ministry of Health placed the issue of oral morphine in the frame of human rights and dignity, and there was no return point.
The battle is not over yet – we are very close to seeing new legislation regulating opioid use in medical settings that will enable providers to prescribe reasonable amounts of drugs to patients in their homes. There are immense plans for training of health providers and much more work ahead. But activists and many people are inspired by this small but very critical victory.
Visit the Open Society Institute blog for another excellent analysis of this situation: A New Dawn for Pain Relief in Ukraine: Access to Oral Morphine.
For enquiries about the continued campaign for pain relief in Ukraine, please contact:
Viktoria Tymoshevska, MD, MPH
Public Health Program Director
International Renaissance Foundation