All I Could Do Was Cry HOT!
Interviews were semi-structured and covered a range of topics related to palliative care and pain treatment. Before each interview we informed interviewees of its purpose, informed them of the kinds of issues that would be covered, and asked whether they wanted to participate. We informed them that they could discontinue the interview at any time or decline to answer any specific questions without consequence. Human Rights Watch made no promises of personal service or benefit to those whom we interviewed for this report and told all interviewees that the interviews were completely voluntary and confidential.
All I Could Do Was Cry
Under regulations issued by the Health Ministry in 1994, only oncologists at local polyclinics can prescribe opioid medicines for outpatients with cancer. The directive clearly states that only cancer patients under the supervision of polyclinics could be prescribed opioids and provides detailed instruction on the prescription process.
The 1994 regulations exclude patients with moderate or severe pain due to diseases other than cancer from receiving these medicines. Even the palliative care pilot projects described elsewhere in this report could not prescribe opioids for the 13 participating non-cancer patients who reported moderate to severe pain. As noted above, moderate to severe pain is a common symptom in numerous health conditions other than cancer and the legal ban on prescribing opioid analgesics to outpatients with these conditions condemns thousands of Armenians to needless suffering each year.
The new regulations also reduced the number of people who have to sign off on a prescription for strong pain medicines to two: the treating physician and the management of the hospital or clinic. These prescriptions can now be filled at any licensed pharmacy; previously, they could only be dispensed at one specific pharmacy. Empty ampoules no longer have to be returned to pharmacies or a hospital, as was previously the practice. Ukraine has also integrated palliative care into its national HIV, tuberculosis (TB), and cancer control programs and developed and disseminated a national pain treatment protocol.
We are also greatly indebted to the palliative care advocates, doctors, nurses, pharmacists, social workers and volunteers in Armenia and elsewhere who helped us conduct our research and understand our findings, without which this report could not have been written. Their commitment to serving people at the most vulnerable time of their lives is both humbling and inspiring. 041b061a72