The use of opioid analgesics in palliative care in Ukraine: Changes in legislation and availability

Abstract

Introduction: The main task of palliative care is to improve the quality of life of a patient, and the therapy of chronic pain with opioids is a significant problem for palliative care patients in Ukraine. Therefore, this study aimed to assess the opioid availability for palliative care patients in Ukraine. Methods: Analysis of the list and consumption of opioids according to the scientific publications and legal documents. Results: It was found that in Ukraine as of June 2021, 12 international non-proprietary names of opioids were registered, most of which are represented by several dosage forms, which makes it possible for patients to receive adequate pain relief through non–invasive therapy with oral forms. It was shown that two thirds (63.2%) of trade names of opioids registered in Ukraine were of domestic origin. Based on a comparative analysis of the range of opioids, available in current regulatory documents, it was established that in the State Register of Medicines of Ukraine and the Unified clinical protocol there is an almost identical list of opioids (12 drugs). However, in the State Drug Formulary and the National List of Essential Medicines, this list is much smaller (8 and 5 drugs, respectively). Since 2013 changes in the regulatory documents on the medical use of opioids in Ukraine have occurred, and oral morphine was registered for the first time, allowing access to adequate pain relief. Analysis of the morphine con sumption level by dosage forms has shown that before 2013, the pharmacies sold only morphine in injections, and since 2013, the consumption of oral morphine increased. Conclusions. Changes in regulatory documents partially simplified the complicated process of obtaining opioids by patients. However, more than 80% of patients still do not receive adequate pain therapy due to the hesitancy of doctors to prescribe opioids and an extremely insufficient number of pharmacies (1.8%) that sell opioids for the population.