Tough Painkiller Rules Push Some Russian Cancer Patients To Suicide : Parallels The rules have been altered following cases where patients killed themselves, saying they couldn't bear the pain and couldn't get painkillers. But advocates say the changes haven't gone far enough.

Tough Painkiller Rules Push Some Russian Cancer Patients To Suicide

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Here in the U.S., a concern about illicit drugs and abuse of painkillers has kept many doctors from delivering high levels of painkillers to those who really need them - patients who are dying. That's also true in Russia, and it's led to a spate of suicides among cancer patients. NPR's Corey Flintoff has that story.


COREY FLINTOFF, BYLINE: This is the call center for Project Co-operate, a support hotline for cancer patients from all over Russia. Eight volunteers - most of them psychologists - sit in narrow booths taking calls from people who are desperate for help. Olga Goldman, the project director, says many callers feel abandoned by government social services.

OLGA GOLDMAN: They are humiliated by the system. Nobody tells you how you do it. You have to figure out yourself. There is no social support for these people.

FLINTOFF: One of the biggest problems, Goldman says, is getting proper treatment for pain when people are in the terminal stages of their illness. That's because Russia's anti-narcotics police, the agency that combats heroin trafficking and other illegal drugs, also takes a very hard line on prescription painkillers.

GOLDMAN: Doctors are very easy targets because everything is documented. If you make one mistake, you - it's so easy to find, and the police also needs to show that they are working, and they need to show number of cases.

FLINTOFF: The result is that many Russian doctors are afraid to write prescriptions for painkillers because they could be prosecuted if anything is out of order. And many patients are unwilling to complain publicly for fear of making their situation worse. A recent high-profile case saw a doctor convicted on drug charges after prescribing pain medication for a dying cancer patient, although that conviction was overturned on appeal. Experts say there's another problem with Russia's medical culture and the way doctors regard pain.

ANNA FEDERMESSER: They think that pain is normal, that suffering from pain is normal when you have cancer, that dying in suffering is normal.

FLINTOFF: This is Anna Federmesser, the director of the Vera Hospice Charity Fund, one of the few hospice services in Russia.

FEDERMESSER: It is quite typical that we hear from doctors when they talk to their patients, yes, you are in pain, but what can you do? This is what cancer is about.

FLINTOFF: Olga Goldman says that's a matter of better educating Russian doctors.

GOLDMAN: How do you understand how painful it is for the patient? You couldn't measure it, and the only gauge is what the person tells you. And it means you have to trust the patient to tell you the truth.

FLINTOFF: The problems with pain relief have led to an upsurge in suicides by people in the last stages of cancer. In February, there were at least 11 such deaths in Moscow alone. Last year, there was an especially high-profile case in which a retired admiral shot himself. He left a note saying that he didn't want to put his family through the ordeal of watching him suffer. That led to revisions in the law in painkilling narcotics that just took effect this month. Among other things, doctors will be able to give patients supplies of drugs for up to 15 days at a time instead of just five. But Federmesser says that what's really needed is to free doctors from the fear of prosecution.

FEDERMESSER: If we trust doctors to work on our open hearts, do brain surgery, organs transplant, we maybe should trust them when we talk about working with pain in a patient.

FLINTOFF: Russian medical officials and lawmakers have promised to keep working on the issue. Corey Flintoff, NPR News, Moscow.

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