Access to Oral Morphine Will Improve End-of-Life Care
February 13, 2013
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.
Diederik Lohman, senior health researcher

(New York) – Ukraine’s recent registration of oral morphine, a strong pain medication used most frequently to treat severe cancer pain, is a major step toward improving end-of-life care, Human Rights Watch said today.

The registration, on February 1, 2013, will allow Interchem, a Ukrainian pharmaceutical company in Odessa, to begin production of 5mg and 10mg morphine tablets. The medications are expected to enter the market by March 2013.

“This is good news for cancer patients in Ukraine,” said Diederik Lohman, senior health researcher at Human Rights Watch. “This change can bring relief to tens of thousands of Ukrainians who live and die in avoidable severe pain.”

The World Health Organization (WHO) has considered oral morphine an essential pain medication since 1977. The medicine is also the cornerstone of its treatment guideline for cancer pain.

Yet, today, only an injectable form of morphine is available in Ukraine’s public healthcare system. The producer of injectable morphine currently holds a monopoly on the medication. Analgesic patches are also available in some pharmacies, but patients must pay for them out-of-pocket and their cost is prohibitive for most.

In a May 2011 report, “Uncontrolled Pain, Ukraine’s Obligation to Ensure Evidence-Based Palliative Care,” Human Rights Watch concluded that tens of thousands of cancer patients in Ukraine die every year in severe pain because they cannot get adequate palliative care services. Human Rights Watch found that some patients contemplated or attempted to commit suicide because their suffering was unbearable.

According to WHO, most, if not all, cancer pain can be relieved with existing medical treatments.

The report identified the lack of oral morphine as a key obstacle to the provision of quality end-of-life care in the country and recommended its introduction throughout the public healthcare system.

“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,” Lohman said.

Ukraine’s drug control regulations and inadequate training of healthcare workers in end-of-life care were on-going obstacles to palliative care, Human Rights Watch found, urging the government to address these issues as a part of a comprehensive palliative care strategy.

A working group convened by the National Drug Control Service has drafted new drug control regulations that would remove many barriers to the use of strong pain medicines, such as morphine. Ukraine’s new government, which was appointed December 24, 2012, is considering the draft regulations.

“The adoption of the new drug control regulations would provide another major step,” Lohman said. “It would signal the government’s commitment to ensuring no patient has to suffer unnecessarily from severe pain.”