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Palliative care in Armenia

About 3,600 people in Armenia need palliative care each day, and about 18,000 people need such treatment over the course of a year.   

Many patients who have incurable illnesses do not get the pain relief they need.

Injective morphine is the main medication used to reduce serious pain, as doctors are afraid of prescribing the opioids, and people are left without proper pain management in Armenia. Oral and other forms of morphine which are easier to take are not used in Armenia. Each country annually applies to the International Narcotics Control Board to get morphine. The Health Ministry of Armenia only asks for 4.5 kg morphine, which is enough to treat about 246 patients, with 50mg doze, per day. By comparison, neighboring Georgia asks for 17 kg. 

“The standard amount that Armenian doctors like to prescribe is 50mg per day. This used to be the standard amount of morphine that doctors used during Soviet times as well,” said Hovhannes Madoyan, a representative for the Pain Relief Movement. 

According to Lara Aharonyan, a representative of stopthepain.com, a group that works to improve palliative care in Armenia, doctors are afraid to use both injective and oral opioids, especially oral ones (Armenia doesn’t have any law for legally dispensing oral opioids), because they think they may be arrested by local police. There is no any law in Armenia that protects a doctor’s right to prescribe morphine, which is why many doctors never inform their patients about possibly using morphine. 

The Pain Relief Movement has demanded that the Health Ministry adopt new laws that would protect doctors who want to prescribe morphine. For five years various ministries have considered the issue, but nothing has been decided yet. 

 ''The other main problem is in people’s way of thinking,” says Aharonyan.  “They are sure morphine is a drug that you can addicted to, so in most cases family members won’t give it to a patient, even one who is in horrible pain. We have a big problem informing people in Armenia that pain can be managed.”

There are currently no guidelines created for doctors who are giving palliative care. Hovhannes Madoyan said the Pain Relief Movement lists a hotline on their web page (stopthepain.am) and the phone number is also written on their flyers and posters so that people can call for consultations.

Doctors often recommend the patients take some analgesics or Diklofenak, which are not effective pain relief remedies in the late stage of illnesses. No doctors prescribe morphine first. In Armenia, doctors give patients analgesics and Diklofenak for a month or two and wait to see any change in a patient’s condition, knowing that they may pass away very soon. 

In Armenia only oncologists have the right to give injective morphine to a patient, but there are other patients who don't have cancer, but need serious pain relief as well. 

The Armenian government pays all expenses for patients in the last stage of illnesses, including doctor’s home visits.  

               Another problem is that not all pharmacies have a license to sell injective morphine. People who live in small towns in the regions may have to travel to a city, and since only enough morphine to last three days is sold at one time, that means two trips a week. Injective morphine only reduces pain for about four hours, which means a doctor should inject a patient five or six times a day.

              Because Armenian society doesn't understand enough about palliative care, patients can suffer until death from great pain that could have been reduced.

 

             ''Our results are not good now, but step-by-step we are getting closer to solving the problem,” says Aharonyan.