How did a 73-year old Russian doctor end up accused of drug trafficking? It started with two prescriptions for standard pain medication the doctor, Alevtina Khorinyak, wrote for a man in the terminal stages of cancer, writes Tanya Cooper.
After a three-year legal battle to clear her name, the Oktyabrski District Court of Krasnoyarsk, a Siberian city 4,000 kilometers east of Moscow, on October 21 dropped charges of illegal drug trafficking and document forgery against Dr. Khorinyak, and a friend of the bed-ridden patient who took the medicine to him.
The drug that got Dr. Khorinyak in trouble is tramadol, an opioid pain reliever effective for moderate pain. Tramadol is frequently prescribed for cancer patients. But Russian regulations for so-called “controlled” substances, even for routine and essential medical use, are far more onerous than required under international drug control conventions or recommended by the World Health Organization and International Narcotics Control Board. These regulations create unnecessary bureaucratic hurdles and disrupt access to pain medication for people with severe long-term or life-threatening illnesses.
It all started when Viktor Sechin, who had a physical disability and was dying from cancer, asked for Dr. Khorinyak’s help. He usually received tramadol free under a state-run program designed to benefit socially vulnerable people. But in April 2009, the city’s pharmacies ran out of their stock of free tramadol and Sechin’s doctor refused to give him a refill prescription to purchase it. The doctor apparently was afraid that she might be targeted by the federal drug authorities who closely monitor the medical use of tramadol and other pain medications.
Sechin had been bed-ridden and moaning from excruciating pain for several days when he begged Dr. Khorinyak, a longtime family friend, to help. She prescribed the tramadol and Lidia Tabarintseva, also a family friend of Sechin’s, bought it for him at a pharmacy for 286 rubles, less than $10.
In 2011, the year Sechin passed away from cancer, the State Drug Control Agency discovered Dr. Khorinyak’s prescriptions during an audit and charged her and Tabarintseva with illegal drug trafficking and forging documents.
In May 2013, the Oktyabrski District Court convicted both women and fined them 15,000 rubles (US$470) each. In September 2013, an appeals court overturned the verdict on a procedural violation, and sent the case for a retrial. After another year of court hearings and testimony, the two women were finally acquitted of all charges on October 21.
The judge found that the women had lacked criminal intent and recognised that “Sechin needed the medication” to control his pain. But considering that there was no evidence in the first place that the drug was used for any other reason than to treat Sechin’s pain, it’s both troubling and preposterous that the women had to spend three years in and out of court to get rid of these charges.
When I saw Dr. Khorinyak in Krasnoyarsk in September, several weeks before her acquittal, she told me that she was exhausted by this absurd legal battle but would not stop until she cleared her name. She felt wronged by the justice system, which targeted her for helping a dying man alleviate unbearable pain.
She said she knew of several other doctors who faced similar criminal prosecutions but that most of them were glad to be fined instead of sent to prison so they did not appeal their guilty verdicts. “These days doctors are presumed guilty,” Khorinyak told me.
She said that the local department of the State Drug Control Agency inundates doctors in Krasnoyarsk with requests to review and audit their prescriptions. Finding themselves under the accusatory eye of the drug authorities, doctors are afraid to do their jobs. That can lead to situations in which patients like Viktor Sechin are condemned to suffer severe — but treatable — pain.
The Russian authorities who bring these cases are not only violating the rights of people in need of high-quality palliative care to control their physical and psychological distress. They are also going after the very doctors who step in to relieve people’s suffering and fulfill their right to health.
Khorinyak had the will to fight injustice. It took her more than three years. The Russian authorities should take a hard look at their policies concerning palliative care drugs and make needed changes so that doctors who are doing their jobs and helping patients won’t end up in court.