Nut Federmesser – head of the palliative care Center of Moscow, has addressed to Vladimir Putin. In his Facebook, she wrote:
“In August 2017, the President has instructed the (Ol-1650) to solve the issue with the availability of children’s lekarstvennyh forms of drugs to ease suffering before death. But the order is not executed. Today, to ease the pain or cramps are incurable sick child, moms and dads are forced to look for illegal drugs. I don’t want someone else faced with this choice: the suffering of child or prison. But another opportunity in Russia today is not, and therefore, each of us runs the risk of breaking the law, because of illness and die, no one is immune. But since we can’t treat, then I suggest #zaprethaet“.
Here is the address of Nuty Federmesser.
Editor-in-chief Pravmir Anna Danilova asked Nutu Federmesser to describe the situation in more detail.
– Nuta, explain what happens to the registration of medicines?
– In our country registration of medicines is a very long procedure. Even if the drug or dosage form already registered in the world, in Europe or anywhere else, the Russian law treats it as if from scratch, and starts from the very beginning – right from pre-clinical trials, then clinical, and then testing, and finally registration. It’s not less than three years if a green light everywhere. And the sad part is, Estonia these rules extends not only to the new formula, on MNN, a molecule, but also for the new dosage form of the same molecule. Conventionally, if we have morphine in solution, the morphine in the tablet is over.
To understand at the household level, see: you have, for example, coffee beans and ground coffee and instant coffee in granules is prohibited by law. And you need to begin to register coffee. The clear analogy? Or you are allowed coffee is granular, coffee capsules for coffee machines illegal is absolutely absurd situation.
– It turns out that almost every family in palliative child?..
– Absolutely every family. But a disaster for children’s forms… It’s especially hard. Because adults, if we are talking about pain relief, we have patches, and as a joke…
Well, as an adult, too, once again the shot is not very desirable, but the child before the injection and the syringe is already fear — and that six times a day an injection for 8 months, 12 months, 24 months… in our country, except medicines have not was such a thing as a syringe pump, a syringe-driver of the so-called is what allows you to enter a thin needle subcutaneously, and get the drug continuously subcutaneously to avoid these endless shots. For children dosage forms. We have such forms in the country, for example, children’s fever medicines or syrups against cough. It can be a syrup, it can be a nasal spray, it can be lollipop, Lollipop.
What does it mean? This means that technically the country has the pipelines in the plant for the production of such dosage forms. And here we encounter another difficulty is the monopoly on drug production. This monopoly — the Moscow endocrine plant. And Moscow endocrine plant this conveyor no. The amount of drug that is necessary for the country, very small, and to organize such production is expensive, it never pays off. In other countries there are government subsidies for the production of life-saving drugs or dosage forms that are needed to improve the quality of life of the patient. These government grants help pharmacists to avoid the incredible loss in the production of such dosage forms. If we talk about the technical side of the question – there are two main obstacles: legislation — 61 Federal law that requires an absolutely complete the procedure, and the monopoly of the state.
– Why it’s especially painful for children?
– They really need for adults. Adults, too, give in the world of midazolam in nazalnam the spray, but we focus on children in this case. It’s like with a puppy – puppy pitiful than the homeless. The majority of people. It turns out that everywhere, but in Russia it is impossible. Look. We’re on the First channel of collecting funds for the treatment of treatment of some rare diseases of the spine, for example. When the parents return with their children after treatment, they bring appointed there drugs. I remember very well the girl Sonya who came with a pink suitcase full of drugs to the hospice, and when Sony did not, her mother similarly gave these drugs to other moms. I remember a boy called Zhenya, I know dozens of parents even now…
They say: “Parents don’t complain”. Yes, parents are not complaining because they know that those drugs that they have at home, is a violation of the law. Yet they do not complain, because often anesthetize their children themselves. And cramps relieve themselves with the drugs which have remain from the others. Someone that spends money, buys, someone not spending money, they just give up. But to condemn a mother who sells willing to return the spent means, because at times families spent all the apartments are sold, the car is sold sold is meaningless, the child is already dying. To condemn her for what she the drug is sold, without benefit to themselves, it is impossible!
More important, similarly, under article 228.1 get the medics, doctors and nurses, because I write in Facebook almost daily: “Nyta, we know who you are helping. We have the drug, dad died, to transfer the medication?” I always write that you have to destroy it. I allow myself to do that now because the legislation has changed, and at home in ambulatory practice to painkillers now quite simple throughout the country. But three years ago I these medications taken.
Only in Moscow this situation now?
Today to get painkillers and anticonvulsants in adult forms can be anywhere in the country. Today, if someone does not receive, it is the ignorance of the doctor, not the absence of the drug.
So. Still a couple of years ago I these medications always took and I passed them, always passing. After all, what else matters? If you’re my mother, for example, remained the drug that we brought from Germany, from the point of view of our legislation, after my mom died I have to bring to the hospital. And the hospital won’t take him, because there are no legal procedures for destruction of narcotic drugs, which through you were not. You see, even this transfer from relatives in hospice can result in punishment under article 228.1. If this drug were not obtained in the same hospice — this is also marketing.
– The medical community why is silent?
– The medical community is silent, because there are two articles of the criminal code 228.1 and 228.2. In relation to the doctor and health worker for these items may be prosecuted. Doctors are people too, they have families. Mother whose child is dying – probably the only kind of citizen who will say: “I will go to jail, for God’s sake, but my child should not be SO painful.” This is the only human situation in which, even if we know the law, we say: “don’t Care”. In other situations, we begin to think, the doctor starts the patient to convince himself to convince his relatives to convince, which is not so sore.
I watched this yesterday in one children’s institution, when the head of this centre convinced the boy’s mother that he is not sick. He was just convinced… forced really to illegal trafficking. And I think you need to say it.
When it comes to the child, the knowledge about criminal punishment mom does not stop.
– What now to do, that something has changed?
– We have a road map to pain management in Russia, and in the framework of the road map is already painted, when in Russia there will be certain medications. By 2023, a large part dosage forms will. About 2.5 thousand children and more in these dosage forms need each year. Accordingly, many children are suffering to go and cheer until 2023?
First, you can change the law only in respect of new dosage forms of the same drugs, the same molecules. The second thing you can do – it can be a separate disposal of the government to bring into the territory of the Russian Federation sufficient amount of the desired dosage forms. So much so that they were spent until 2023, until your own Russian counterparts, and have once and for all for this problem. There are two ways. These paths were discussed at the meeting with the President, these two routes were approved, and an order was given, OL-1650, if I’m not mistaken, which right and sounds right.
“The Commission PR-1650 from 23.08.2017 following the meeting with the representatives of socially-oriented charity organizations and volunteer. 26.07.2017.
Resolution from 31.08.17 OG P-4458-04.
The Ministry of health to take measures for reduction of terms of carrying out examination of medicines for pain relief, as well as to provide children an early age by non-invasive drugs for pain relief.
There was a period 30.10.2017.
Nothing has changed since we pulled Katya Konnova, but how many Cach… her son was the patient “at Home with the lighthouse,” and a resident of Moscow, and man, where Moniava Federmesser and ran to tear the throat. And how many of these Cach Konovich, Arseniev, doctors around the country? Yes, we definitely increase the clearance rate so according to the article “sales” because it’s marketing. The concept of marketing is, including the gratuitous transfer, including, deed of gift, including, possession with intent to transfer. If the purpose of the transfer is to alleviate the suffering, but you are not legally in the relationship doctor-patient, it is marketing. And sales is 4 to 8 years of imprisonment.
The second article, about which we say three years, it is 228.2, where the violation of the procedure of circulation the doctor or nurse can take. If I as a relative brought in a medical organization after the death of his close remnants of diazepam or morphine (any drug account), and the doctor said to me: “of Course, the house is can not be stored illegally. I will take you and then once they try to dispose of”, – it is also a violation of traffic. The doctor can’t take what he never had. Once he wasn’t this drug originally, so he can’t do this drug to make their magazines for destruction.
It really is a provocation, I have already spoken about it, this law is a provocation of the illegal turnover. As the actions of police officers — they, too, were a provocation against Katie Connoway. And our laws and our drug policy is a provocation for each of us. Motivation for sales and participation in the illegal trafficking.
That’s why I say: if you can’t get sick, it is necessary to forbid to hurt. If not treated, it is necessary to forbid to hurt. Let’s do it – got cancer, epilepsy after severe accidents, genetic orphan disease you have, or the consequences of a severe form of cerebral palsy, neurodegenerative disease, muscle atrophy, – please, here’s a white ticket, pains and die in another country, then it is not treated. Once in Russia you can’t treat it – you do get sick. Or let’s make an exception for registration of children’s dosage forms of painkillers and anticonvulsants, or should #zaprethaet.