Ukrainian cancer patients denied pain
relief
May 12, 2011 - Associated Press

CHERKASY, Ukraine (AP) - When his brain cancer pain became unbearable,
Vlad Zhukovsky pleaded for a stronger dose of painkiller, but the
doctors refused, citing Ukrainian health regulations. Unable to
withstand the agony, he tried to jump out of a hospital window, but a
fellow patient held him back.
"He wanted to fall head down to be killed right away to stop the
torture, that's how much his head hurt," his 50-year-old mother
Nadezhda said sobbing. "He howled like a wolf."
Hundreds of thousands of Ukrainians who suffer from terminal illnesses
are denied proper pain relief, Human Rights Watch said in a report
Thursday, urging Ukrainian authorities to adopt international
guidelines for pain management.
"These people are crossed out from life even before death," said Viktor
Paramonov, head doctor at the Cherkasy Regional Oncology Center in
central Ukraine.
Rooted in archaic Soviet-era restrictions and a government campaign to
fight illegal drug use, Ukrainian regulations for the use of
opioid-based analgesics are among the strictest in the world. Unlike
most countries, where patients receive morphine in tablets, the drug is
administered in Ukraine only in injectable form and only by a
professional nurse. Prescribing morphine requires a team of doctors
with hard-to-get licenses.
World Health Organization guidelines dictate that patients must receive
as much pain medication as they need. But most Ukrainian doctors cap
the daily morphine dose at 50 milligrams - far less than patients in
severe pain need - based on the instructions of a local pharmaceutical
company.
With patients often suicidal from pain, some doctors break the law to
alleviate their suffering, risking a prison sentence for illegal
possession and distribution of drugs.
A report published last year by the International Narcotics Control
Board, a U.N. body that monitors drug issues, said the availability of
opioid pain medication in Ukraine was "very inadequate."
Experts say the restrictions have done little to stem the growing use
of illicit drugs here and instead have deprived already dying or
severely suffering patients of a peaceful, dignified death.
"Medicine is not a hotbed for drugs, but medicine finds itself under
greater control than all those drug cartels and that violates a
person's right to medical help," said Paramonov.
Yuri Gubsky, a palliative care official with the Health Ministry,
agreed that the "problem is colossal," but said the government has
already begun reforms to make pain treatment more available.
Vlad's 10-year battle with cancer crushed his dreams of becoming a
computer scientist. He died last year at age 27 after being bounced
from one hospital to another until he was finally discharged to die at
home. He spent three years in excruciating pain, while his mother
begged health officials for a higher dose of opiate-based analgesics.
Nadezhda, an administrator at a local fertilizer factory, had to fight
off accusations her son was a drug addict and she a drug trafficker,
while Vlad's moans resonated across their apartment building.
After pressure from local lawmakers and activists, Vlad was prescribed
the maximum 50 milligrams per day of Omnopon, an opioid-based pain
killer similar to morphine. But that wasn't enough to relieve his pain.
Willem Scholten, an expert in controlled medicines at WHO, said a
patient like Vlad may require at least 75 milligrams daily and up to
4,000 milligrams per day in the final three months of life.
In a video shot by Human Rights Watch months before his death, an
emaciated, pale-faced Vlad, his hair gone after another round of
radiation treatment, described his suffering as a "nagging pain as if
somebody is sawing through your back."
"Why do I have to endure pain and torture for years, my entire youth?"
he asked in a weak voice from a bed he shared with his mother in their
two-bedroom apartment in Cherkasy, 200 kilometers (125 miles) southeast
of the capital, Kiev.
Anzhela Marchenko, a researcher at Health to the People, the producer
of morphine in Ukraine, said the company would consider manufacturing
the drug in tablets. But she defended the daily dosage restriction,
saying patients could become addicted to morphine or develop side
effects if they used more.
WHO's Scholten said that isn't true.
"These is no maximum dosage," he said, adding that the issue of
addiction is irrelevant for the terminally ill. "You always should try
to take care of people in pain. It is a moral obligation that is on all
of us."
Patients living in remote villages often receive even less pain relief
than Vlad did. A nurse usually administers the pain medication only
once or twice a day, as opposed to every four hours, as most patients
require, because rural clinics are understaffed and underfunded.
Serhiy Psyurnik, who runs a small palliative care group in Cherkasy
that supported Vlad, said he recently cared for a cancer-stricken
retired police officer who kept a handgun under his pillow so he could
kill himself if the nurse did not arrive on time and his pain became
too severe.
Gubsky of the Health Ministry agreed that the minimum daily dosage for
morphine should be abolished, but said it was up to the manufacturer to
do so. The government is also trying to make injectable morphine
available for self-administration by patients and supports
manufacturing morphine in tablets, he said.
Some doctors break the law and commit "heroic deeds" to relieve their
patients' pain, giving them stronger doses of the drugs or sending them
home with a supply of analgesics to administer themselves without
waiting for a nurse to come, Paramonov said.
One doctor interviewed by The Associated Press said on condition of
anonymity that some doctors keep a secret, illegal stash of
opioid-based painkillers, obtained from the relatives of already
deceased patients to help those who can still benefit from the drugs.
The New York-based rights group called on the Ukrainian government to
educate doctors and nurses in pain management as they are often unable
to recognize and treat pain.
Albina, 31, an emaciated blonde with suspected tumors in her brain and
lungs, said she spent five years in severe pain that her doctors
treated only with over-the-counter pain pills because they did not
realize the severity of her suffering. She declined to give her surname
because she didn't want her condition to be known.
"It was a sharp pain in all your body that started in the bones and
ended in the skin - it was like an exposed nerve," said Albina, a
mother of two, whose pain was finally relieved by opioid-based
analgesics at Paramonov's hospital.
"When I was alone I was simply howling. It was frightening, I wouldn't
wish that for my enemy."
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That is downright horrible, but opioidphobia is very common among doctors. I had to beg for pain medication every day of the half year I spent in hospital (motorbike accident with following amputations). But the reported circumstances in Ukraine are at the level of severing Human Rights, IMO
For sure it is a problem that young patients might become addicted, but when I think back, I believe that much of the psychological damage the hospital did to me, could have been avoided by proper pain relief. That would have been worth any addiction to me. My family would give me some tramadol on visits. That's why I think that the family of the ukraninan patient failed horribly. If addiction doesn't matter because your going to die anyway, its your duty as a family member to get pain medication no matter how. Heroin is cheap and available everywhere, he shouldn't have suffered.
If I get diagnosed with a terminal illness, I'd say fuck doctors and get a stash of diacetylmorphine, as big as I could afford.
Sad story, Ukrainians are idiots. Someone better invade them for grossly disregarding human rights
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