Dying for Relief: Access to Pain Medication and Suicide in Russia

A recent spate of suicides among cancer patients in Russia due to not being able to access effective pain relief medication shines a light on one of the most glaring problems with the international drug control system.

Human Rights Watch (HRW) reported last month that the Russian government has banned media from reporting on cancer patients taking their own lives due to poor or non-existent palliative care. The government's absurd justification for this move; press coverage of the issue would promote suicide.

According to Meduza, 11 cancer patients in Moscow alone committed suicide in February this year as a result of not being able to access adequate pain relief medication.

Cancer patients in Russia face endless barriers in their quest for effective pain control medicines, with the American Cancer Society estimating that more than 80 percent of these people cannot access proper care. The United Nations (UN) Commission on Narcotic Drugs (CND) stated in 2010 that Russia was 38th out of 42 countries in terms of availability of painkillers in Europe.

This lack of sufficient palliative care is by no means unique to Russia. HRW have highlighted serious issues in Senegal, Mexico, India and Ukraine, among countless other countries. Globally, an estimated 5.5 billion people --  75 percent of the world’s population -- have low or non-existent access to medicines containing internationally scheduled narcotics (primarily opiates), according to the International Narcotics Control Board's (INCB)  2014 annual report.

When it comes to morphine -- listed by the World Health Organization as an essential medicine -- 92 percent of the world's consumption is concentrated among just 17 percent of the global population. Unsurprisingly, this population lives in the developed world with the drug more or less non-existent in more than 150 countries.

Strict licensing and monitoring requirements as a result of the 1961 UN Single Convention on Narcotic Drugs, along with the fear of diversion of legal opiates into the illicit trade, creates a framework with which many poor countries simply can't comply. As a result of this, Diederik Lohman, a senior researcher for HRW, succinctly notes:

" ... the war on drugs has turned millions of cancer patients into collateral damage: Nobody intended to deprive access to pain medicines, but that’s what happened."

While cases of suicides in other countries that are as clearly linked to a lack of pain relief are not necessarily as apparent as in Russia, there remain numerous horror stories of patients in the developing world suffering unnecessary agony, with some having to travel for hours and even to other countries to receive proper care.

In Senegal, for example, morphine is generally not obtainable unless the patient can travel to the capital city of Dakar. There is regularly a nationwide shortage and so even those who can and do make the journey still aren’t guaranteed access to treatment. As with many other countries, the Senegalese government is fearful of opiate misuse and thus restricts its access.

A small number of countries have taken steps in recent years to remove barriers to accessing pain medications, notably Ukraine, Mexico and India, the latter setting up a simple one-license system in 2014 for obtaining morphine.

Despite these positive changes, though, they are isolated. Restricting access to these medicines violates the right to the highest attainable standard of health and more needs to be done by the bodies upholding the international drug control system -- notably the INCB, CND and United Nations Office on Drugs and Crime (UNODC) -- to remove bureaucratic obstacles.

It's all very well the INCB highlighting the gravity of situation, but there are shades of hypocrisy here; the INCB is one of the biggest problems due to its responsibility in propping up a deeply flawed international drug policy framework.

The developments in Russia are a sad example of just what it means to be deprived of pain relief medications. The fact that the vast majority of the world is at risk of suffering such agony and thus going to extreme lengths to alleviate it is a damning indictment of international drug controls. Action must be taken now to increase access for the world's most vulnerable!!