Nut Federmesser in a video message to Russian President Vladimir Putin raised the issue of availability of pediatric forms of pain medications. The last straw on the scales daily choice between pain and fear is the story of Catherine Connoway arrested for selling the remainder of her drugs for the treatment of his son. This criminal case was dismissed – but as for all rid the patients and their relatives the opportunity to be “under the article” illegal drug trafficking? And what doctors do to make life easier for patients when they have no appropriate drugs?
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- Parents have to wait for the ambulance and watch as the child suffers
- Nut Federmesser: to Solve the problem of pain management for terminally ill children is easy and inexpensive
- “Forbid to hurt!” – The address of Nuty Federmesser to Russian President Vladimir Putin
- When the pain is stronger than the law: how to live “under the article” for possession and trafficking of drugs
“The bureaucrats are never in a hurry” 
Michael Gentle
Oncologist, hematologist, head of the Clinic outpatient Oncology and Hematology Michael/silt Gentle
– What do you do when it is necessary to appoint and recommend pain medicine, which in Russia was in one form, and the patient is preferable to the other?
– There is a conflict of conscience and law. If you can do, should do, because, as said Ostap Bender, the criminal code should be honored. But often, when long-term analgesic need without costs is impossible, of course, you have to ensure that patients receive the most proper for them medicines.
– In your practice there were cases when parents or other relatives of the patient who needs pain relief, was threatened with criminal liability?
– With our law enforcement we at any time face criminal liability: patients, doctors and everyone else, too. I can cite the case of his life. In Europe I was prescribed tramadol in the drops, I brought it to Russia, but not used until the end, because the need has disappeared. But, of course, I saved it because I knew that the time would come when I would need it. When my older daughter broke her arm, it was impossible to be numb in any way, except by using this form of tramadol.
The choice between an unanesthetized child and the Investigative Committee at the time was simple. Although I suspect that often it can be quite complicated.
– How pain can be used by addicts? Ekaterina Konnova sold five vials of diazepam. What narcotic effects can be from this dose?
– Yes, no. For drug addicts there is a much cheaper and simple option that everyone knows, and which our respective services either can not or do not want to cope for decades. Drug addiction is growing – that we are entering a leading position.
– What caused the need for the registration of new forms, even already registered in Russia medicines? What does it proceed, and whether there are situations when it is justified?
Is a legal requirement, it is in all countries of the world.
It must be proven that a new form of already known medicines are safe, effective and affordable. But I don’t see the point of conducting long studies, if the drug is already used in another developed country.
One of the reasons for such a long registration procedures – the General slowness of the state machine. The bureaucrats are never in a hurry.
– The state programme on improving the accessibility of narcotic and psychotropic painkillers said that by 2018, the pain relief will be available to all who need it. This goal is achieved?
– Problems with getting anesthesia to stay. We have long passed the order 1175 (approx. edited by the Order of Ministry of health of Russia “On approval of the order of appointment and invoicing of medicines”)which allows any doctor to prescribe pain medication, but in places it does not work; in addition, they are often afraid to do it. Over the last couple of weeks I had two unanesthetized patient from Moscow, where the anesthesia is much better than in Russia in General. To be numb, I had to connect manual.
“If a person is numb even 12 hours a day – even half a day he is suffering”
Arif Ibrahimov
Arif Ibrahimov, the Deputy chief physician at the branches of the Moscow multidisciplinary palliative care center of the Department of health of Moscow, head of branch of “First Moscow hospice im. Vladimir Millionshikova”
– What you need to do in your opinion to patients and their relatives did not go in fear of the article?
– The main problem – the absence of many non-invasive forms of pain. We have quite a wide range of anesthetic drugs in the form of ampoules, is in the form of tablets.
But let us recall the situation faced by the mother of a child, for which she was threatened with punishment under article “possession and trafficking of drugs.” The child could not swallow pills, and do constant injections of the little man, worn out by disease, for my mother was unacceptable, and I understand it, it’s mockery.
At the same time, as the world has long been there are drugs in the form of syrup, rectal suppositories, micro-enemas. I don’t understand what the problem of the Russian pharmaceutical industry to create the same forms of drugs. Diazepam and morphine – these drugs are registered in Russia and is in the form of tablets and solutions for injection. Why not the same in morphine syrup? This is especially true for sick children. Yes, a sick child is very difficult to persuade to swallow a pill. This may be a feature of the disease – it is difficult to swallow solid forms, and the peculiarities of child psychology – children do not always like to drink tablets, syrup, say, morphine, such problems would obviously be less. But this applies not only to children but also to adults.
– When you fall to a patient who can’t swallow pills that you take to numb it?
– I always try to find an alternative route of administration. For example, a patient with very severe pain was once on preformed morphine in large doses, the drug helped him. But there came a time when he physically can’t swallow pills. If you translate take the dosage in the injection, it turns out about six injections a day to only one of morphine.
What about the comfort of life, we can tell if a person fit and every 4 hours both day and night, doing the injection?
If I appointed such a scheme, then yourself would recognize the unqualified practitioner.
My goal as a doctor to help people, and in this case, I, on the one hand, help and other hand – no, because the injections take a new pain patient. What can we in this situation to do? Usually put an intravenous catheter in the subcutaneous space and the catheter six times daily drugs are introduced. That is, a person do not need to Wake up to take a shot in the night. In some other cases, based on location of pain, you can do the patches, somewhere- cheek drugs.
The doctors try to help despite all the vicissitudes, the obstacles that may arise in connection with the unavailability of non-invasive analgesics. Find solutions in the framework of the law. Still, the situation with the availability of painkillers is changing and hopefully will change here – with children forms.
I am sincerely prepared to say that in just ten years has seen changes for the better, there were many new forms. Unfortunately, this process is not always fast, and for children the situation has not changed at all.
Can’t say that Russia, compared to other Western developed countries far behind. There is a huge gap, but the difference is still there and it has to be overcome.
– If this patient was given morphine syrup?
– He would have been much easier and I would feel better. And if it was the same diazepam in the candlelight, then it would be easier for both patient and family and physician.
Is a form of drugs in a nasal spray when you need to make one or two injections in the nose. A very convenient form, it is very much all would make life easier, from patient to health care worker or person caring for the patient, that is a close relative. But this form, as far as I know, in the coming years, Russia will not appear.
– It happens that the doctor does not appoint potent painkillers, assuring that the patient still has no pain…
– Sorry, I can’t say why the doctor does it. Or really, does not see pain syndrome, or tries to move away from the purpose of drugs for fear of liability, just in case. In General, you must do not only to noninvasive medicines appeared on the market, but doctors knew about them, and rightly be assigned.
Non-invasive remedies are more expensive, but if you look at the difference in price, we have a problem here either. For example, relatively speaking, the drug “A” is worth 4 thousand rubles, but this box will last for 15 days and the same drug “B” in ampoules of 2 thousands is enough for two days. That is, if you count the cost of treatment for each day, the difference is not the biggest will be to stop purchasing. Don’t know what is the problem here, from the unwillingness or ignorance. You can never rule out the fact that maybe people just don’t know, you need to teach them, to personally show what works, and they will begin to implement in practice.
– I appeal to you from the regions?
– I suppose I’ve had calls from other areas. The man in despair begins to call all the phones that you see on TV or find on the Internet. Begin to ask people: what and how? It turns out that it is prescribed, roughly speaking, one promedol. To the question “why”, people can not answer, he is not a doctor.
“ …
– Yes, it helps, the shot is effective for three hours.
– Well, how many injections per day were you prescribed?
– Three shots a day”.
By simple mathematics we know that man is numb 9 hours out of 24.
“ You spoke to your doctor?
– Yes, I did.
– He responded to the doctor somehow?
– Well, he is three injections at four translated”.
That is, from the fact that man is numb not 9 hours, and 12 hours a day, it becomes much easier. Still half a day’s man, it turns out, is suffering.
“ Or maybe something stronger?
– Doctor did not offer anything”.
And why the doctor suggested, I don’t know. Whether the doctor himself does not know whether in the region there is nothing else.
– There is an opinion that prevents the emergence in Russia discussed preparations pharmaceutical lobby.
– I think the pharmaceutical lobby here, it must be hard to draw. After all, pharmaceutical companies best to release a new drug to sell it and make a profit they will.
Another thing is that our legislation does not allows you to quickly enter new formulations into the country. The drug must go through research, but any research is always spending and spending considerable.
For real addicts all of these syrups, rectal suppositories actually have some meaning?
At least, according to statistics of Federal service Russian Federation on control over drug trafficking, participation in narcotic drugs, psychotropic substances and other drugs for medical use in the “black scheme” is negligible. Based on statistics I’ve seen, addicts are not interested.