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Strict regulations on opioid-based analgesics deny cancer patients access to proper pain relief
His mother, an administrator at a local fertilizer factory, had to fight off accusations her son was a drug addict and she a drug trafficker, while Mr. Zhukovsky’s moans resonated across their apartment building.
After pressure from local lawmakers and activists, Mr. Zhukovsky was prescribed the maximum 50 milligrams per day of Omnopon, an opioid-based painkiller similar to morphine. But that was not enough to relieve his pain.
Willem Scholten, an expert in controlled medicines at WHO, said a patient like Mr. Zhukovsky 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, Mr. Zhukovsky - emaciated and pale, his hair gone after another round of radiation treatment - described his suffering as a “nagging pain as if somebody is sawing through your back.”
“Why do I have to endure pain and torture for years, my entire youth?” he asked in a weak voice from a bed he shared with his mother in their two-bedroom apartment in Cherkasy, 125 miles southeast of the capital, Kiev.
Anzhela Marchenko, a researcher at Health to the People, the producer of morphine in Ukraine, said the company would consider manufacturing the drug in tablets. But she defended the daily dosage restriction, saying patients could become addicted to morphine or develop side effects if they used more.
“There is no maximum dosage,” he said, adding that the issue of addiction is irrelevant for the terminally ill. “You always should try to take care of people in pain. It is a moral obligation that is on all of us.”
Patients living in remote villages often receive even less pain relief than Mr. Zhukovsky did. A nurse usually administers the pain medication only once or twice a day, as opposed to every four hours, as most patients require, because rural clinics are understaffed and underfunded.
Serhiy Psyurnik, who runs a small palliative care group in Cherkasy that supported Mr. Zhukovsky, said he recently cared for a cancer-stricken retired police officer who kept a handgun under his pillow so he could kill himself if the nurse did not arrive on time and his pain became too severe.
Mr. Gubsky of the Health Ministry agreed that the minimum daily dosage for morphine should be abolished but said it was up to the manufacturer to do so. The government is also trying to make injectable morphine available for self-administration by patients and supports manufacturing morphine in tablets, he said.
Some doctors break the law and commit “heroic deeds” to relieve their patients’ pain, giving them stronger doses of the drugs or sending them home with a supply of analgesics to administer themselves without waiting for a nurse to come, Dr. Paramonov said.
One doctor said on the condition of anonymity that some doctors keep a secret, illegal stash of opioid-based painkillers, obtained from the relatives of already deceased patients to help those who can still benefit from the drugs.
The New York-based rights group called on the Ukrainian government to educate doctors and nurses in pain management as they are often unable to recognize and treat pain.
Albina, 31, an emaciated blonde with suspected tumors in her brain and lungs, said she spent five years in severe pain that her doctors treated only with over-the-counter pain pills because they did not realize the severity of her suffering. She declined to give her surname because she didn’t want her condition to be known.
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