- Associated Press - Thursday, May 12, 2011

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.”

Story Continues →