At the beginning of this month, Ukraine registered oral morphine, a strong pain medication used most frequently to treat severe cancer pain, and Human Rights Watch say this is a major step toward improving end-of-life care. The 5mg and 10mg morphine tablets that Odessa-based Ukrainian pharmaceutical company, Interchem, will be allowed to produce are expected to enter the market by March 2013.
According to Diederik Lohman, senior health researcher at Human Rights Watch, ‘This is good news for cancer patients in Ukraine. This change can bring relief to tens of thousands of Ukrainians who live and die in avoidable severe pain.’ Oral morphine has been considered an essential pain medication by The World Health Organization (WHO) since 1977, and it is the cornerstone of WHO’s treatment guideline for cancer pain.
WHO says that existing medical treatments can relieve most, if not all, cancer pain, but until now, morphine has only been available in Ukraine’s public healthcare system in the form of an injection, the producer of which currently holding a monopoly on the medication. Some pharmacies also stock expensive analgesic patches, but as patients must pay for them out-of-pocket, most are prohibited by the cost.
In May 2011, Human Rights Watch concluded in their report, Uncontrolled Pain, Ukraine’s Obligation to Ensure Evidence-Based Palliative Care, that due to inadequate palliative care services, tens of thousands of cancer patients in Ukraine die every year in severe pain, and some even contemplated or attempted to commit suicide because their suffering was so unbearable. The lack of oral morphine was identified in the report as a key obstacle to the provision of quality end-of-life care in Ukraine.
However, Lohman warned, ‘Now that oral morphine will become available, the government will need to make sure that doctors are trained in its use, and that public clinics have budget allocations to procure the medication.’ Human Rights Watch have urged the government to address Ukraine’s ongoing issues with drug control regulations and inadequate training of healthcare workers in end-of-life care.
Ukraine’s new government was appointed on Christmas Eve last year, and is currently considering drug control regulations drafted by a working group convened by the National Drug Control Service. These regulations would remove many barriers to the use of strong pain medicines, such as morphine, which, according to Lohman, ‘would provide another major step’ because ‘it would signal the government’s commitment to ensuring no patient has to suffer unnecessarily from severe pain.’
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