Morphine (including slow release) and dihydrocodeine are easily obtainable at the palliative care unit in Riga. Fentanyl patches are sometimes available. Nevertheless: ‘There is a great lack of resources to control pain and miserable resources from the state [for] the use of weak and strong opioids …We have no problems to obtain morphine in the units, however, outside these, family doctors due to their limited budgets do not prescribe morphine in sufficient amounts, [even though] legislation allows this. The reason is a very restricted health budget in Latvia which is a great obstacle to prescribing pain killers in necessary quantities to the patients with advanced diseases. Especially this concerns Fentanyl patches. It is permitted to prescribe 10 patches per prescription but it is too expensive for the hospitals and GPs.’6 Morphine in liquid form is not available in Latvia. Prescriptions for the use of opioids are tightly controlled (eg only 600mg of morphine can be placed on one prescription) and outside the bigger cities many drugs are not available.
INCB data on opioid consumption in Latvia between 1994 and 1998 are available for codeine, dihydrocodeine, morphine, ethyl-morphine and methadone. In that time information on codeine consumption is available for 1998 only (2 kg) and information for dihydrocodeine in 1996 and 1998 (1 kg per annum); along with ethylmorphine only for 1998 (2 kg); morphine consumption fluctuated between 1997-8 (2,7,3 kg in consecutive years). Methadone consumption over these same three years was 1,2 and 2kg per annum. The average daily consumption of defined daily doses of these drugs per million inhabitants between 1994-98 was: codeine (5); dihydrocodeine (3); ethyl-morphine (5); morphine (84); methadone (48).7
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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