In 1994, oral slow release morphine, tramadol and dihydrocodeine became available free of charge to cancer patients, and transdermal fentanyl is also available without charge in outpatient settings. A wide range of opioids is available, including: morphine – immediate release, controlled release and injectable; methadone, oxycontin, pethidine and fentanyl. All are free to cancer patients except immediate release morphine and oxycontin.²⁶

For the years 2002-2004, the average defined daily dose consumption of morphine for statistical purposes (S-DDD) in Hungary was 87. This compares with other Central and Eastern European countries as follows: Croatia 15, Romania 54, Serbia 19, Slovakia 114, and Slovenia 146 (Table 2).

Table 2 Average daily consumption of defined daily doses (for statistical purposes) of morphine per million inhabitants, 2002-2004 Central and Eastern Europe/Commonwealth of Independent States (plus Mongolia)

Source: International Narcotics Control Board Narcotic Drugs: Estimated World Requirements for 2006. Statistics for 2002-2004. New York: United Nations, 2006.

The International Narcotics Control Board²⁸ has published the following figures for the consumption of narcotic drugs in Hungary (2004): codeine 2907 kg (up from 2363 kg in 2003); dihydrocodeine 367 kg (down from 460kg in 2003); methadone 7kg (up from 5kg in 2003); morphine 26 kg (down from 31 kg in 2003); pethidine 11 kg (down from 12 kg in 2003).

There has been a lack of adequate knowledge and experience amongst many physicians in relation to the prescribing of strong opioids. This has resulted in a number of lectures that were given to attempt to improve the knowledge of physicians and nurses on the appropriate use of strong opioids and to reduce patients’ fear of opioids.²⁹

Regional and nationwide campaigns against pain were organized by the Cancer League and Hungarian Hospice Palliative Association in 2000.³⁰ Yet Csaba Simko suggests that:

‘There were regional and nationwide campaigns against pain organized by the Cancer League and the Hungarian Hospice Palliative Association. The Cancer League delivered a survey amongst cancer patients in 2000, which gave a disappointing result about painkilling.’³¹

However, Agnes Ruzsa suggests that the attitude of oncologists to palliative care and opiods may be changing:

‘I think, erm, we have a lot of opportunity to use the new drugs in oncology and there [are] a lot of oncologists that were interested in the new protocols, the new chemotherapeutic agents, new chemotherapeutic drugs, but not in palliative care, but two years ago, or five years ago something changed and the oncologists are more interested in my work and in palliative care now, I think it’s very important.’³²

In September 2005, the Hungarian Government announced the National Cancer Control Program (NCCP) as part of the National Development Plan. Quality of life improvement and social and professional collaboration for fighting cancer were indicated as the main aims. A further aim was to 'accomplish a complex oncological approach and to form and operate an effective care system providing balanced patient care’. With this purpose, the NCCP followed the guidelines and recommendations of the World Health Organization's (WHO) National Cancer Control Program. In order to develop the program which was prepared by the Ministry of Health, the Hungarian Hospice-Palliative Association (HHPA) offered to construct the chapter of hospice/palliative care and recommendations/aims, since these were not present in the first plan of NCCP. Very useful relationships were formed between the Association and the Ministry's Department of Health Policy during the years while constructing the Palliative Professional Guidelines (2002) and the Palliative Minimum Conditions (2004) and while organizing joint conferences (2001; 2005). The fist version was submitted for social-professional debate in November 2005. Katalin Muszbek recalls the haste with which the proposal was submitted:

‘We did not have more than two weeks because the Hungarian National Cancer Control Program was in process and the deadline was maybe two weeks and the members of the association immediately came together and we wrote it and we sent it, he sent it back, we re-wrote it etc and there was a one week conference organised for about 250 – 300 doctors, policy members, decision members, pharmacists and other researchers and other groups to have an open discussion on the development of the National Cancer Control Programme. There I had the opportunity to make a presentation about palliative care in the National Cancer Control Programme.’³³

From 2006, palliative care was included in the National Cancer Control Program in Hungary.³⁴ The HHPA represented itself at debates within the professional colleges and via the member organizations it collected further additions and proposals. The final National Cancer Control Program was introduced on the 3rd February 2006, in the National Institute of Oncology in the presence of the Prime Minister and the WHO representative Cecilia Sepulveda. Unfortunately a somewhat less detailed section was included in the final NCCP about palliative care than was in the first version.³⁵ Hospice provision was included in the NCCP with the explicit aim of creating a countrywide hospice network to improve the quality of life of cancer patients. Stage one of the program relates to the coverage of hospice and palliative care in Hungary to be achieved by the scheduled deadline of 31st December 2007. Yet Katalin Muszbek suggests that the target of meeting 70% of palliative care coverage is unlikely to be achieved: currently only approximately 50% of those requiring palliative care are actually receiving it.³⁶