An interdepartmental interregional meeting was held on improving the availability of pain relief in the provision of palliative care in the Russian Federation in pursuance of the Action Plan (“road map”) “Improving the quality and availability of palliative care until 2024” approved by the Deputy Prime Minister of the Russian Federation T.A. Golikova dd. July 28, 2020, No. 6551p-P12, at the initiative of the Russian Ministry of Health. The meeting was chaired by Minister of Health Mikhail Murashko.
The meeting was held in a combined format, more than 320 specialists from all regions of the country attended – representatives of the executive authorities of the constituent entities of the Russian Federation in the field of health care, chief external specialists in palliative care for adults and children.
60 regions delegated 140 in-person representatives: the Republics: Adygea, Altai, Bashkortostan, Buryatia, Dagestan, Ingushetia, Kalmykia, Karachay-Cherkess, Karelia, Komi, Mari El, Mordovia, Sakha, North Ossetia-Alania, Tatarstan, Tyva, Udmurt, Chechen, Chuvash; the Krais: Altai, Krasnodar, Perm, Krasnoyarsk, Stavropol; the Regions: Astrakhan, Bryansk, Volgograd, Vologda, Voronezh, Ivanovo, Irkutsk, Kaluga, Kirov, Kostroma, Leningrad, Lipetsk, Murmansk, Nizhny Novgorod, Novgorod, Omsk, Orenburg, Rostov, Ryazan, Saratov, Samara, Sverdlovsk, Smolensk, Tambov, Tomsk, Tyumen, Tula, Ulyanovsk, Chelyabinsk, Yaroslavl; the autonomous districts: Khanty-Mansiysk, Nenets; cities of federal significance: Moscow, St. Petersburg.
Mikhail Murashko noted that special attention is paid to the development of the palliative care system. Starting from 2018, the Government of the Russian Federation has been allocating every year additional federal funding in the amount of RUR3.7 billion for the organization of palliative care in all regions of the country; in particular, these funds are directed towards the purchase of all modern dosage forms of opioid analgesics. Four Decrees of the Government of the Russian Federation, three orders of the Ministry of Health of Russia have been developed and improved, a hotline of the Federal Service for Supervision of Healthcare (Roszdravnadzor) on the provision of palliative care and the availability of pain relief has been organized and functions effectively.
The amendments were made in the regulatory framework in terms of decriminalizing the actions of health workers for unintentional loss of narcotic drugs and psychotropic substances in the course of their professional activities. It made it possible to level the deterrent when prescribing narcotic drugs to those people who need them for medical reasons.
In 2021, comprehensive measures taken resulted in an 11-fold increase in the availability of opioids for chronic pain treatment compared to 2014; the number of patients who received adequate pain relief increased 8 times.
Despite the restrictions caused by the COVID-19 pandemic, the provision of palliative care and the procurement with centrally-acting analgesics have not changed significantly.
In April 2022, medical institutions resumed routine operation, and for the 1st quarter, the disbursement of declared required amount of narcotic drugs increased by 4% compared to the same period in 2021.
Meanwhile, Mikhail Murashko expressed concern about the emerging negative dynamics in the use of short-acting narcotic analgesics in a number of regions of the country.
The Minister directed Roszdravnadzor to strengthen control over monitoring the availability of narcotic and psychotropic drugs, including buccal and rectal dosage forms of benzodiazepines used to treat convulsive attacks in children.
In Russia, about 290 thousand palliative patients every year need anesthesia. According to FSUE Endopharm’s information, in 2021, the constituent entities of the Russian Federation used almost 930 thousand packages of narcotic drugs in various dosage forms.
Development of a methodology for calculating the need for narcotic drugs in terms of increasing the course of pain relief from 30 to 60 days recommended by WHO and the Ministry of Health of Russia is crucial.
Melita Vujnovic, the WHO’s representative in the Russian Federation, presented information on the practice and trends of pain therapy in foreign countries, noting that Russia has done significant work in the field of palliative care and ensuring the availability of pain relief. At the same time, Melita Vujnovic emphasized the importance of preventing the irrational prescription of narcotic drugs and paying great attention to the training of medical professionals who deal with controlled substances.
Practicing medical professional announced issues requiring attention in improving the availability of pain relief for the provision of palliative care in the Russian Federation. Diana Nevzorova, chief external palliative care specialist of the Ministry of Health of Russia, urged her colleagues to see the patient and his pain, form an application for opioid analgesics adequately to his needs, ensuring disbursement of declared need and the availability of the necessary pain relief for each individual patient.
Elena Polevichenko, chief external specialist in palliative care for children of the Ministry of Health of Russia, noted that a number of regions do not use domestic transmucosal forms of medicines available for medical workers to relieve convulsive syndrome in children. Parents often do not know about new medicines, new opportunities to improve the quality of life of their child. The physicians must timely inform them about available medicines and ensure the possibility of its use both in inpatient and outpatient conditions.
Not incidentially, FSUE “Endopharm”, the main manufacturer of domestic centrally-acting analgesics used in all regions of the Russian Federation for medical care of patients with chronic pain syndrome, was chosen as the venue for the meeting.
Since 2016, FSUE “Endopharm” subordinated to the Ministry of Industry and Trade of Russia has developed and introduced into production 11 domestic narcotic and psychotropic drugs in various pharmaceutical forms and dosages, in order to provide primary health care and palliative care on an outpatient basis, as well as specialized, including high-tech, medical care, emergency medical care, palliative care on an inpatient basis and under day hospital conditions.
To date, all dosage forms of Morphine for the "gold standard" pain relief recommended by WHO have been registered in the country.
12 of 16 dosage forms used in world practice are applied in the national healthcare system.
Before the meeting started, the participants visited the manufacturing site where injectable drugs in ampoules, vials and single-dose syringes, transdermal and transmucosal forms are manufactured, and got acquainted with a wide range of capabilities of FSUE “Endopharm” for the manufacture of finished dosage forms.
The range of topics of the meeting was wide, but the emphasis of each speech was laid on a right of every Russian citizen to have timely, affordable and adequate pain relief.
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