A new report, Uncontrolled Pain: Ukraine’s Obligation to Ensure Evidence-Based Palliative Care, from Human Rights Watch found that tens of thousands of patients with advanced cancer in Ukraine unnecessarily suffer from severe pain every year because they cannot get effective, safe, and inexpensive pain medications.

Listen to the accompanying HRW podcast with Diederik Lohman and Dr. Victoria Tymoshevska here:
[mp3 - iTunes]

The report describes Ukrainian government policies that make it impossible for cancer patients living in rural areas to get essential pain medications. While most cancer patients in cities have access to some medications, the treatment they receive is inadequate and provides only limited relief. Download the full report here…

Vlad’s story is shown in this video from the Stop Torture in Health Care campaign:

Fifty Milligrams Is Not Enough

Vlad is suffering from incurable brain cancer. Despite his chronic pain, doctors in Ukraine are only able to prescribe minimal amounts of morphine due to bureaucratic restrictions. He is allowed only 50 mg of pain medicine per day. In another country, doctors would typically prescribe more than 2,000 mg for a patient like Vlad.

We have good news!

The Government of India Department of Revenue has always been proactive in the matter of opioid availability. Initiatives by David Joranson, his team and partnered by Indian palliative care workers (since 1994 and continuing now) were so well-received by the department that the 1998 recommendations for model rules  have now been accepted by 14 states in India.

Additional support came in the last few years from the WHO’s Access to Essential Medicines programme pioneered by Dr Willem Scholten, advocacy by Human Rights Watch, the positive approach from the International Narcotics Control Board (INCB) and from many other sources, not to mention the persistent and continued support from David Joranson and his team.

Recently, Mr Pavel Pachta, who heads INCB, visited India and had meaningful interactions with stakeholders in the field.

On the 1st and 2nd of February 2011, the Department of Revenue conducted a two day conference in Parliament House Annexe. There were about 100 participants – almost every state was represented by their Drug Control and Excise departments. One half day was spent on deliberations about availability of opioids for medical purposes.

The very fact that the meeting dedicated so much time to this subject shows the importance that the department is giving this issue. In general, the meeting agreed on the following matters:

Instead of only “morphine for cancer pain”, the model rules of the Department of Revenue hereafter would recommend the availability of “opioids for pain management”.

• This would mean that in future we should be able to access opioids other than morphine for treatment of severe pain conditions, when the patient does not tolerate morphine.

The Drug Controller General of India would initiate the process for making methadone available in the country.

• At the moment, it is manufactured in India for export, but not sold in the country.

The Department of Revenue will work with State Governments to simplify their narcotic regulations and to put in simple standard operating procedures.

Community health worker examines a child © 2010 Brent Foster

When a child is in agonizing pain, if you have the means at your disposal to relieve that pain safely, yet refuse to use them, is that not tantamount to torture?!

If you think the following story from Kenya is not relevant to India or to the rest of the developing world, sorry, you are mistaken.

Here are a couple of quotes from the British Medical Journal article “Restrictive government policies leave Kenyan children dying in pain” (BMJ 2010; 341:c4864 doi: 10.1136/bmj.c4864, 9/9/10):

One doctor treating children with cancer in Nairobi told researchers, “People have no problems with relieving pain in adults with morphine, but when it comes to children there is always some reservation. Putting a child on morphine is always a big issue.”

and,

A nurse from Bondo district hospital said, “We have no pethidine, no DF118 [dihydrocodeine], and no morphine. We have children here with advanced HIV; some are in severe pain. The pain management for children with advanced HIV is not enough.”

The BMJ article refers to a 78-page report by Human Rights Watch “Needless Pain: Government Failure to Provide Palliative Care for Children in Kenya”.

You can read the complete HRW report online or download a PDF

Accompanying the report, HRW has two powerful videos from Kenya telling the story of Jethro and Sammy, WATCH them here…

The United Nations’ Commission on Narcotic Drugs (CND) met last week in Vienna.

CND Delegates

Thanks to advocacy by several agencies, most noticeably Human Rights Watch, the commission has recognised that its role is not only to control narcotic drugs but also to ensure its availability for medical purposes.

Human Rights Watch conducted a side-event promoting the global need for opioids for pain relief which was attended by several organizations including PPSG and the Access to Control program of WHO and about 70 CND delegates from all over the world. HRW statements: Day 3: statement to the plenary & Day 4: supply reduction plenary

Antonio Maria Costa

At the CND meeting, Mr Costa from UNODC highlighted [PDF] the need for improvement in opioid availability for pain relief.

The week long meeting passed a resolution “Promoting adequate availability of internationally controlled licit drugs for medical and scientific purposes while preventing their diversion and abuse.” [PDF]

We are sure it will be a powerful tool in our advocacy for pain relief.