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Ukraine: Harm Reduction Association Defends the Rights of People Living with Drug Addiction

Ukrainian activists of harm reduction programs discuss on the web the issues which are vital for people living with a drug addiction.  One of these issues is the necessity for special opiate painkillers when a drug addict is taken to a hospital.

An activist of the Association of Substitution Treatment Advocates of Ukraine reports on the web-site of the association a number of stories where people living with drug addiction had to leave a hospital in severe medical conditions as they were not given painkillers which would help to remove an abstinent syndrome. Sometimes such people are even denied a medical assistance.

Sergey wrote:

Ира приехала в родильный дом счастливая, потому что малыша своего любит и ждёт его появления на свет. Роды были тяжёлые: кесарево сечение, потеря крови, слабость. Утром Ира просила вызвать нарколога, чтобы могли назначить обезболивающее. Нарколог приехал, написал в карточке диагноз и уехал. Врачи сказали, что потакать наркоманке никто не собирается. Хочет, пусть уходит, только напишет отказную на малыша…

Иру мы нашли в заброшенном доме, на 3-й день после родов. Она почти не вставала, плакала. Единственное, о чём Ира просила, чтобы мы не рассказали врачам, где она. Ира больше смерти боялась вернуться опять в больницу».

Ira arrived to a maternity hospital being happy, as she already loved her baby and was waiting for his birth. The delivery went very hard: cesarean section, loss of blood, she was very week. In the morning Ira asked for a narcologist so he would prescribe some painkillers. The doctor arrived, wrote down her diagnosis in some forms and left. The other doctors said that they were not going to indulge a drug addict. She might have left a hospital any time if she wanted but first she should have signed papers resigning her parent’s rights.

We have found Ira in a derelict house on the third day after the delivery. She was not able to stand up and cried all the time. The only thing she asked for was not to say the doctors where she was. Ira was afraid of returning to the hospital more than a death.  

Sergey believes that Ira’s story is fairly typical. Ukrainian doctors in general do not prescribe painkillers for people who need them, not only to people living with a drug addiction but also to other patients and even to cancer patients. He wrote:

Таких случаев тысячи. Врачи не считают боль абстиненции медицинской болью. Люди страдают, а наша страна отчитывается об уменьшении объемов потребления опиоидных анальгетиков и ограничении их доступности для пациентов. По оценкам экспертов, в Украине соответствующее медикаментозное обезболивание получают лишь только около 20% онкобольных… тогда как по данным ВОЗ, 60% онкобольных страдают от хронической сильной боли.

There are thousands stories like this one. The doctors do not consider the abstinent syndrome to be a medical condition. People suffer but our country reports the reduction of the level of consumption of opiate painkillers and a restriction of their availability. According to experts’ assessment in Ukraine proper pain relief is received only by 20% of cancer patients… but according to WHO estimations about 60% of cancer patients suffer chronically from severe pain.

Pain killers. Image from Flickr by Amit Patel. CC BY-NC-ND 2.0.

Sergey thinks that while developing the policy on the medical use of the opiate pain killers, the Ukrainian policy makers should follow the international agreement in public health such as Single Convention on Narcotic Drugs from 1961, which confirms that the use of painkillers in a medical treatment ‘is still necessary to relief pain and suffering’, and mandated the governments to ensure their availability for medical use. Sergey thinks that absence of necessary medications when the patients need them is intolerable. He posted:

Нехватку обезволивающих средств нельзя ни объяснить, ни оправдать.
Я не могу оправдать поступки врачей. Даже когда они объясняют, что боятся милиции. Что всё по розовым бланкам, и они не хотят садиться в тюрьму.
Гадать, причина – страх, следствие – жестокость или наоборот, бесперспективно. […]

Чтобы выйти из тупика, надо чиновников Государственной службы по контролю над наркотиками и врач, который отказал выписать обезболивающее, привести и оставить на одну ночь в палате или квартире, где кричит человек от боли. Потом ещё на одну ночь.

Может тогда позиция нашего государства по наркотикам, которую принято называть – наркополитика, изменится в сторону решения реальных проблем.

I cannot explain or justify the absence of painkillers. I cannot justify such actions of doctors.  Even when they explain that they are afraid of police. Everything which should be prescribed on the ‘pink’ forms is under police control and they do not want to go to a prison. There is no sense to make guesses what resulted in what. Either fear leads to cruelty or vice versa.   

To find out the solution it would be good to make an official from the State Service of Narcotic Drugs Control and a doctor who refused to prescribe a painkiller to spend a night in a same room with a person crying from a pain and then to make them to spend one more night over there.
It might be that after this the position of our government on drugs which is often called a Narcopolicy will change aiming to solve the real problems.

Sergey is positive that forcing Ukrainian government to follow the international conventions which it signed is one of the main goals of the work of the Association of Substitution Therapy Advocates and the Association has already made some steps in this direction via reminding the government about its international obligations, collecting the stories and forming a list of violations to be used for advocacy purposes. Sergey concluded:  

Два из 14 неотъемлемых прав пациента – это:

¨ право на доступность медицинских услуг, которые он/она требует по состоянию здоровья. Медицинские службы должны гарантировать равный доступ для всех без дискриминации по признакам финансовых ресурсов, места проживания, вида заболевания или времени обращения за помощью;

¨ право избегать страдания и боли на каждом этапе заболевания.

Теперь мы не только об этом знаем, но и успешно пользуемся своими правами. Только мы в самом начале пути.

Two out of 14 essential rights of patients are:

A right of access to medical services required by health conditions. Medical establishments should provide an equal access without a discrimination based on financial state, place of residence, type of disease and time of requested services.

A right to avoid suffer and pain during each stage of a disease.

Now we not only know about this but are able to successfully implement our rights. But we still have a lot of thing to do in the future.

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