Doctor Guzel Abuzarova explained why oncologists are afraid to prescribe strong painkillers

In total, 2 million patients in Russia need pain relief with various drugs

On average, 1.2 million Russians annually need palliative care, of which about 230 thousand are cancer patients. And although palliative care has radically changed since 1994, when the first hospice opened in the country, still about 20% of terminal patients in need of narcotic painkillers have serious problems obtaining them. Palliative care specialists spoke about this during the VI International Forum of Oncology and Radiology “For Life”.

Every year 4 million patients with cancer are registered in Russia; about 300 thousand people with this diagnosis die every year. The five-year survival rate today is almost 57% – that’s 2.5 million patients who reach the stage of long-term remission. 90% of patients who died were palliated, but only 55% received pain management.

As Diana Nevzorova, the chief specialist in palliative care in Russia and chairman of the board of the Association of Professional Participants in Hospice Care, says, palliative care is almost the same age as the new Russia: in the early 90s, the first hospices began to open in the country. Then they were intended exclusively for cancer patients, but over time, they began to accept patients of other nosologies who suffer from incurable diseases in the terminal stage. Medicine cannot help them, but it can improve their quality of life, which in itself prolongs it. Today, palliative care has become a separate type of medical care. Since 2012, it has been included in the program of state guarantees for the provision of free assistance to the population; since 2015, a procedure for providing such assistance to children has appeared (until now they were outside this area, which created serious problems). Since 2016, the list of narcotic drugs approved for use in pain syndrome has been expanded. And since 2019, the concept of “palliative care” has included psychosocial and spiritual support in addition to care and pain relief.

According to plans, in 2024, 1,000 adult mobile teams and 300 children’s teams will provide pain relief and medical supplies to palliative patients at home. Thus, 75% of patients in need will be provided with medical products.

Today, there are 365 thousand cancer patients in the palliative care system, and almost all of them require pain relief with various types of narcotics. According to the leading specialist in the treatment of pain syndrome, head of the palliative care center of the Moscow Research Institute named after P.A. Herzen Guzeli Abuzarova, about 290 thousand out of 300 thousand deceased cancer patients experienced pain at the end of life, and in total 2 million patients in the country need pain relief with various drugs. The incidence of chronic pain in cancer reaches 98%.

However, the issues of pain management to this day remain one of the most pressing in oncology. Diana Nevzorova shared data from a survey among palliative patients: almost 20% have difficulties obtaining painkillers. 15% are not satisfied with the availability of drugs, and 13% with the availability of medical care.

“Why don’t oncologists prescribe narcotic painkillers?” says Guzel Abuzarova. “The main reasons are low awareness of doctors, poor knowledge of clinical recommendations, fear of writing such prescriptions, don’t want to bother, lack of time. Just last week a patient came from the Moscow region with a huge tumor process “She has been given NSAIDs (non-steroidal anti-inflammatory drugs) for six months! Since April she has been experiencing severe pain.”

Dr. Abuzarova believes that oncologists should have the right to prescribe strong painkillers not only to palliative patients, for which it is necessary to adopt new clinical guidelines on pain in oncology. All colleagues agree with this. And Dr. Nevzorova adds that palliative care often needs to begin in parallel with treatment, “so that the patient’s transition into our system is not so traumatic.”

The regions with the lowest provision of narcotic painkillers for cancer patients were St. Petersburg and the Moscow region (here, less than 35% of those in need were provided with such drugs). In Moscow the situation is one of the best. As Tatyana Kravchenko, deputy director for the organization of palliative care at the State Budgetary Healthcare Institution “Center for Palliative Care of the Department of Healthcare of the City of Health”, said, 65% of prescriptions for narcotic drugs in Moscow are written by palliative medicine doctors. They are dispensed by 29 pharmacies, and in each district there is an on-duty pharmacy operating around the clock. Prescriptions are written out at home.

According to Lyudmila Shershakova, a member of the working group of the Russian Ministry of Health on improving the legal regulation of issues of circulation of narcotic and psychotropic drugs, today about 20 INN (in international nonproprietary names, that is, formulas) drugs are used in the world for the treatment of chronic pain syndrome. There are 12 registered INNs for opioid drugs in Russia, including morphine; some products are prohibited, and some have been recalled by Western pharmaceutical companies. “Today we have such drugs in the form of tablets, patches, drops, solutions, films. There were proposals to produce painkillers in the form of lollipops: these are used in the American army (as soon as a soldier is wounded, he has a lollipop to relieve pain). But we abandoned this idea. We have domestic morphine in all forms, we have introduced indications for children – all morphines have indications from the age of three. In 2023-25, we will have 36 Russian medicines in 13 dosage forms (in 2014 there were 16). From 2014 to 2023, the consumption of such narcotic drugs by subjects of the Russian Federation increased 10 times. And if in 2013 Russia was in last place out of 42 countries in terms of consumption of narcotic substances, then by 2021 consumption increased 5 times, and we moved to 36th place,” says Shershakova.

Experts recall the words of the Minister of Health, “The pain of a patient is the pain of the entire healthcare system.” And they urge us to pay more attention to pain management issues.