Vladimir Krugly, a member of the Federation Council Committee on Social Policy, the representative from the Orlovskiy Region, is a guest of Tribuna. He discussed with Vladimir Nesterov problems of healthcare in Russia.
- You are an Honored Doctor of Russia, of course, you are one of the most competent speakers on the subject. Among the most acute problems, let's highlight the latest issue of prescription of narcotic drugs and psychotropic substances. From July this year, the procedure of issuing these drugs is significantly simplified. Why has this been done?
- This law was passed in late 2014, the law is very resonant, highly anticipated, there is much hope among the population, social organizations, patient organizations due to this law. The law was, unfortunately, initiated after the tragic events, well-known, popularly called the Opanasenko law. It was being developed after suicide of a famous admiral. And then it became obvious that something was wrong with prescribing, with the ordering of drug prescriptions in our country. Not everything is good with palliative care which does not aim to cure a disease, it aims to alleviate the suffering of those who are terminally ill.
By the way, this concerns not only patients with cancer. That is just one third of them. It's many, many different diseases, including neurological ones.
The law was adopted at the end of last year, but came into force only in July, since there was a need to adopt a lot of other interagency regulations. The problem of prescribing is relevant to many departments. First of all, the Ministry of Health had to develop prescribing instructions. Then the Ministry of Industry, since we are talking about a narrow range of drugs in our country.
It concerns derivatives of morphine, and not just morphine vials, but usable forms of it, including forms for children. These forms are plasters, mixtures. Even an injection is painful for a child. And all over the world there are a lot of morphine-containing drugs.
It needed a lot of coordination. All of them passed, and now the law has come into force, and it is very important to see how it will operate. There are a lot of skeptics who believe that the adoption of this law will not work, because among the doctors who are working there is relatively high inertia and a fear of the Federal Drug Control Service, because really, for so many years there has been very hard pressure on doctors, and documentation, and delivery of vials. In a vial, there is usually one or two milliliters. If 0.2 or 0.3 milliliters are taken from a vial, it would be necessary to deliver and seal the vial, especially in pediatric practice.
A criminal case was brought against the doctor in our region a few years ago. There was 0.4 instead of 0.8 milliliters in a vial. Only because he was defended by the public was he released. That is, the shadow of the prosecutor is always looming before the doctors.
- There are certain reasons for that. You know the statistics, don’t you?
- Certainly there is a problem. Although sometimes our bodies of the Federal Drug Control Service do not always look for the problem in right places. In the Caucasus region there were meetings about anti-convulsions drugs which are sold in the Caucasus in a much larger number than is needed for the patients. This drug is addictive, so to speak it is a narcotic substance. That is there is a danger of proliferation of medicines as drugs.
However, this law contains such a provision that the priority in the medical use of drugs should be the interests of the sick people suffering from pain. And all other laws, and all other decisions, should be made after all for the benefit of the sick person.
There are a lot of problems to be solved. As I said, this range of drugs, there is a very important component, educational, that is, each doctor who has a job and can deal with patients suffering from pain, should know modern software applications and narcotic and non-narcotic analgesics. Pain killers are an important part of palliative care, but not only this. Of course, social services should be involved in this type of care.
The Ministry of Healthcare has taken orders for the palliative care for adults and children. And there are a lot of issues that have been written for the first time, which are breaking. For example, those specialties of physicians who are allowed to prescribe narcotic drugs, that is, it involves quite a lot of unnecessary impediments to prescribe drugs. It is very important that for the first time the possibility of acquiring a medical ventilator for use at home was given.
Palliative care in our country is just beginning to develop. The Ministry is communicating with patient organizations, that this dialogue is now very active. There was such a huge problem of prescribing narcotic drugs to patients who do not live in that specific area. For example, a mother with a sick child moves from Crimea to Moscow. They are treated in a day hospital regime. And in general they are consulting. And this child is suffering pain. And it is not possible for the doctor to prescribe medicine. Now this issue is solved thanks to the efforts of the non-governmental organizations.
- According to statistics, 7 million people used to use drugs in the past or use drugs now; 2 million of them are doing it all the time. Due to the fact that prescribing these medicines has been simplified, are the barriers tough enough to cut off the possibility of using these prescribed medicines for totally other purposes?
- Simplification of prescribing medicines for patients suffering from chronic pain is absolutely not changing the situation with drug addiction. That is another matter altogether. There should be clear work of the Federal Service for Control of Narcotic Drugs and nothing more.
- So this law will just simplify life for patients, and the work of doctors, won’t it?
- Sure. It is a very necessary and very important law – only a component of development of palliative care in our country. Work for psychologists is needed. A serious diagnosis is always stressful; and many people think that they will be a burden on their families, a burden on society, and, of course, there are suicidal thoughts. The task of palliative care is to explain sick people that their natural life will not be a burden to any relatives or to society as a whole. One needs psychological support and care, and the ability to stay in a hospice, and the presence of mobile teams and so on. We have a huge country, and everywhere in different regions there are entirely different situations. By the way, there is a completely different attitude to the elderly and children in the Caucasus regions. And many problems that are common to other regions do not exist there.
