In Albania, people with cancer are entitled to 20 ampoules of morphine, 10mg per week, free of charge; amounts above this must be paid for direct and there is no such provision for those with non-malignant disease.4 Morphine can only be prescribed by physicians authorised by the Ministry of Health or from authorised pharmacies, of which there are 2-3 in each city. There is a need to see a wider range of medications recognised for reimbursement, for example NSAIDs. In some areas, special capsules (formerly twists of old newspaper) are made up with morphine powder, phenol-barbiturate and an anti-inflammatory drug and other constituents; nurses find these ineffective for pain relief and inclined to make patients drowsy and unresponsive.
INCB data on opioid consumption in Albania between 1994 and 1998 are available for codeine, morphine and pethidine. Codeine consumption increased eight fold from 5 kg in 1994, to 40 kg in 1998. Over the same period morphine consumption remained low and dropped from 2 kg in 1994 to 1 kg in 1998 and pethidine consumption also fell during these years, from 7 kg to 4 kg. The average daily consumption of defined daily doses of these drugs per million inhabitants between 1994-98 was: codeine (231); ethyl morphine (3); morphine (44); pethidine (6).5
Average defined daily doses of morphine, Central and Eastern Europe (1994-1998)
Source:Clark D, Wright M (2002)Transitions in End of Life Care: Hospice and Related Developments in Eastern Europe and Central Asia.Buckingham: Open University Press
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