| Opioid Availability and Consumption in Ukraine |
| 'The main drugs for cancer pain control in Ukraine [are] - injection forms of morphine, omnopon, fentanyl, promedol, dipidolor, buprenorfin, tramal. Injection forms of opioids are available free of charge to patients and there is no strict restriction for their prescribing' . However, codeine and trans-dermal fentanyl are not available. All opioid prescriptions require the 'round' stamp of the oncological dispensary . 7 |
| One oncologist wrote: |
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'The primary care physician prescribes injectable narcotics with the approval of the chief of the physician's department, oncologist/surgeon, chief of the polyclinic, head of the commission on narcotics administration and the vice-chief doctor of the hospital, assured with the official stamp. Narcotics are issued to the senior nurse of the polyclinic. She issues narcotics to the sub-district nurse according to the daily demand signed by the physician (in 2 copies), and this nurse performs injections at home during the day. Returning of empty vials is mandatory'.8 |
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| A family doctor working in a hospice stated: |
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'In order to receive narcotics from the drugstore I must every day submit the invoice on narcotics (in 5 copies) signed by the officials of the hospital and assured with the official stamp, [together with] doctor's prescriptions for every patient (3 copies, valid for 10 days only). According to the new rule, every hospital must have the special licence for narcotic usage in treatment. As there are no [relevant personnel] I must prepare all the necessary documents myself'.9 |
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| A doctor working in 60 bed urological department of a 500 bed general hospital states: |
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'If the patient requires the protracted prescription of narcotics, the special committee must confirm it; every 10 days the prescription must be re-approved. The nurse performs the injection and the doctor on duty must sign the prescription and make a notice in the history of the disease. Empty ampoules with the signed list of the patients who received narcotics must be returned to the hospital officials the next day to prove the medical usage of the narcotics. Oral narcotics are not available … Often the patient's relatives prefer to take him home. In this case the oncologist from the nearest polyclinic prescribes the injectable narcotics (he must have the hospital's confirmation of the oncological disease, preferably with the result of the histological examination) and the primary care nurse makes injections at home (they have the same rules on the narcotic usage as at the hospital). This situation is often very complicated in the rural areas because of the lack of nurses. In practice, patients' relatives often make additional injections (ketamine+dimedrole [is] available freely at the drug stores without prescription) to control the pain better'.10 |
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| INCB data on opioid consumption in the Ukraine between 1995 and 1998 shows some remarkable variations, for example for codeine 415kg (1995); 1 kg (1996); 36 kg (1997); 5 kg (1998) and for morphine 370 kg (1997); 88 kg (1998). The average daily consumption of defined daily doses of these drugs between 1994-98 was 49 (codeine) and 165 (morphine) - in a country with a population of around 50 million11. |
| 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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