May 12, 2011

Glossary

Ambulatoria: An outpatient clinic that together with the feldshersko-akusherski punkt (FAP) is often the only source of healthcare available to patients in rural areas.

Analgesic: A medicine that reduces pain.

Central District Hospital: The main health facility and administrative center for the public healthcare system. Each of Ukraine’s 490 districts has one.

Chronic pain: Defined in this report as pain that occurs over weeks, months, or years rather than a few hours or days. Because of its duration, moderate to severe chronic pain should be treated with oral opioids rather than repeated injections, especially for people emaciated by diseases such as cancer and HIV/AIDS.

Controlled medicines: Medicines that contain controlled substances.

Controlled substances: Substances that are listed in one of the three international drug control conventions: the Single Convention on Narcotic Drugs of 1961 as amended by the 1972 Protocol; the Convention on Psychotropic Substances of 1971; and the United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, 1988.

Dependence: Defined by the World Health Organization (WHO) Expert Committee on Drug Dependence as a “cluster of physiological, behavioral and cognitive phenomena of variable intensity, in which the use of a psychoactive drug (or drugs) takes on a high priority. The necessary descriptive characteristics are preoccupation with a desire to obtain and take the drug and persistent drug-seeking behavior. Determinants and problematic consequences of drug dependence may be biological, psychological or social, and usually interact.”[1] Dependence is clearly established to be a disorder. For Dependence syndrome, WHO’s International classification of diseases, 10th Edition (ICD-10), requires that three or more of the following six characteristic features have been experienced or exhibited:

  1. A strong desire or sense of compulsion to take the substance;
  2. Difficulty controlling the onset, termination, and levels of use of substance-taking behavior;
  3. Physiological withdrawal state when substance use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms;
  4. Evidence of tolerance, such that increased doses of the psychoactive substance are required in order to achieve effects originally produced by lower doses;
  5. Progressive neglect of alternative pleasures or interests because of psychoactive substance use, increased amount of time necessary to obtain or take the substance or to recover from its effects;
  6. Persisting with substance use despite clear evidence of overtly harmful consequences, such as harm to the liver through excessive drinking, depressive mood states after periods of heavy substance use, or drug-related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm.

The Expert Committee on Drug Dependence (ECDD) concluded “there were no substantial inconsistencies between the definitions of dependence by the ECDD and the definition of dependence syndrome by the ICD-10.”

Diversion: The movement of controlled drugs from licit to illicit distribution channels or to illicit use.

Essential medicines: Those medicines that are listed on the WHO Model List of Essential Medicines or the WHO Model List of Essential Medicines for Children. Both model lists present a list of minimum medicine needs for a basic healthcare system, listing the most efficacious, safe, and cost-effective medicines for priority conditions.

Feldshersko-akusherski punkt(FAP): A local health clinic that provides basic procedures, including prenatal care and first aid. These health centers are run by feldshers, physician assistants trained in vocational medical schools. They provide routine checkups, immunizations, emergency first-aid, and midwifery services. There are no physicians at these clinics.

Hospice: A specialist palliative care facility. In Ukraine, hospices are exclusively in-patient facilities.

Life-limiting illness: A broad range of conditions including cancer, HIV/AIDS, dementia, heart, renal, and liver disease, and permanent serious injury, in which painful or distressing symptoms occur; although there may also be periods of healthy activity, there is usually at least a possibility of premature death.

Misuse (of a controlled substance): Defined in this report as the non-medical and non-scientific use of substances controlled under the international drug control treaties or national law.

Morphine: A strong opioid medicine that is the cornerstone for treatment of moderate to severe cancer pain. The WHO considers morphine an essential medicine in its injectable, tablet, and oral solution formulations.

Narcotic drugs: A legal term that refers to all those substances listed in the Single Convention.

Opioid: The term means literally “opium-like substance.” It can be used in different contexts with different but overlapping meanings. In pharmacology, it refers to chemical substances that have similar pharmacological activity as morphine and codeine, i.e. analgesic properties. They can stem from the poppy plant, be synthetic, or even made by the body (endorphins).

Over-the-counter pain medicines: Non-opioid pain medicines suitable for mild pain, including paracetamol (also known as acetaminophen), aspirin, and ibuprofen.

Palliative care: Health care that aims to improve the quality of life of people facing life-limiting illness, through pain and symptom relief and psychosocial support for patients and their families. Palliative care can be delivered in parallel with curative treatment but its purpose is to care, not cure.

Psychosocial support: A broad range of services for patients and their families to address the social and psychological issues they face due to life-limiting illness. Psychologists, counselors, and social workers often provide these services.

Strong opioid analgesics: Pain medicines that contain strong opioids, such as morphine, methadone, fentanyl, and oxycodone and are used to treat moderate to severe pain.

Weak opioid analgesics: Pain medicines that are generally used to treat mild to moderate pain, including codeine, dihydrocodeine, and tramadol.

[1] WHO, “Achieving Balance in Opioid Control Policy: Guidelines for Assessment,” 2000, p. 6, http://apps.who.int/medicinedocs/en/d/Jwhozip39e/6.html.